X 
 
 LIBRARY 
 
 I uNivwsmr 
 VCAUTORMIA 
 
 BIOLOGY LIBRARY 
 
THE 
 
 HUMAN BRAIN: 
 
 ITS 
 
 STRUCTURE, PHYSIOLOGY AND DISEASES. 
 
 WITH A 
 
 DESCRIPTION OF THE TYPICAL FORMS OF BRAIN 
 IN THE ANIMAL KINGDOM. 
 
 ' r A*;V 
 
 t 
 
 BY SAMUEL SOLLY, F.E.S., 
 
 SENIOR ASSISTANT-SURGEON TO ST. THOMAS'S HOSPITAL, AND LECTURER ON CLINICAL SURGERY, 
 
 ETC. ETC. 
 
 FROM THE SECOND LONDON EDITION. 
 
 V7ITH ONE. HUNDRED AND EIGHTEEN WOOD-ENGRAVINGS. 
 
 PHILADELPHIA: 
 
 LEA AND BLANCHARD. 
 
 1848. 
 
BIOLOGY LIBRARY 
 
 PHILADELPHIA ! 
 T. K. AND F. G. COLLINS, PRINTERS. 
 

 TO 
 
 BENJAMIN TRAVEBS, ESQ., F.E.S., 
 
 PRESIDENT OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, 
 
 IN REMEMBRANCE OF MANY KINDNESSES, 
 
 AND AS A TRIBUTE OF RESPECT 
 FOR HIS DISTINGUISHED TALENTS, 
 
 THIS WORK 
 
 IS INSCRIBED BY HIS OBLIGED PUPIL, 
 AND SINCERE FRIEND, 
 
 SAMUEL SOLLY. 
 
 059 
 

PREFACE. 
 
 IN the first edition of this work, in 1836, 1 remarked that the structure 
 and functions of the human brain are objects of comparatively slight in- 
 terest to the medical student. I fear that this is still too much the case 
 in 1847. 
 
 According to the plan generally pursued in describing the brain, in 
 systematic works of anatomy, the information conveyed amounts to little 
 more than a vain catalogue of names applied to parts, without reference 
 to their structure, their functions, or even their analogies in the nervous 
 system of the lower orders of animals. Such a barren prospect as a list 
 of names holds out but little to attract the most zealous among students, 
 while the dryness of unconnected detail, and the obstacles to clear con- 
 ceptions engendered by the absence of everything like arrangement, al- 
 most certainly deter him from attempting to learn more than is required 
 to prepare him for examination for the diploma. It is unfortunate, in- 
 deed, that candidates for this honorable certificate are still very generally 
 required to describe the appearances presented by the brain dissected, 
 or rather destroyed, by the old method of slicing ; a method most un- 
 philosophical in its conception, and totally inadequate to impart any 
 real information in regard to the structure of the organ. And I do not 
 hesitate to affirm that this mode of examination has contributed essen- 
 tially to retard the diffusion of sound knowledge in regard to the anatomy 
 and physiology of the most important system in the body. 
 
 It is sad to reflect that medical students, on whom the duty devolves 
 of tracing the relations which exist between the structure of organs and 
 their functional manifestations, with a view to the successful treatment 
 of disease, should thus neglect the most important part of the whole 
 
vi PREFACE. 
 
 organism. No labor should be thought too great which can assist- us in 
 understanding the nature of that instrument which the mind employs in 
 its communications with this world. Every day shows us that conscious- 
 ness and volition maybe disturbed by the slightest accident to the head, 
 and that disease seldom invades the brain without dethroning the mental 
 powers. 
 
 When I published the first edition of this work, I was not aware that 
 so high an authority as Dr. Craigie had exposed, in the following forcible 
 language, the evils I then, and have since, deplored. I gladly avail my- 
 self of his authority to assist in subduing this evil : 
 
 " To the mind, however, which is unfettered by prejudices in favor 
 of ancient opinions, it appears singular that the enlightened physiologists 
 of the eighteenth century should talk of the medullary and cortical mat- 
 ter of an organ in which nothing like marrow or bark can be seen; and 
 it is more extraordinary still, that the accurate distinctions which ana- 
 tomy has introduced since the commencement of the nineteenth century, 
 have not demonstrated the evil of retaining terms which are improper, 
 as mere nominal distinctions; but which are doubly erroneous as the 
 relics of an unfounded and exploded theory. Is the error of likening 
 the brain to marrow, obviated by shrouding it under the learned deno- 
 mination of medulla and medullary? Or is the absurdity of supposing 
 the gray matter of the convoluted surface, a bark, or envelope to the 
 white pith, diminished in the slightest degree by calling that gray mat- 
 ter cortical? The common sense of the present day will not hesitate to 
 answer these questions in the negative. 
 
 " Should it be said by the ambiguists, that now, when the absurdity 
 of these names is known, it can do no harm to retain them as mere 
 names, we answer, it may do no harm ; but as it can communicate no 
 information and explain no difficulties, it is, at least, a superfluous labor 
 to augment the confusion of a department of anatomy not very easy, by 
 useless and antiquated names, which live only to proclaim their absurd- 
 ity, and the impropriety of finding them there. Knowledge, in the pre- 
 sent day, to be worth the labor of acquisition, ought to be accurate ; the 
 books which are to be, the means of conveying this knowledge ought to 
 contain no superfluous or erroneous information." 
 
 Foville, who has devoted so much attention to the structure of the 
 
PREFACE. vii 
 
 brain, though he has paid too little attention to the labor of others, thus 
 expresses himself in regard to the difficulties which attend its study :* 
 " If we confine ourselves to the examination of its exterior, we know no 
 more of its organization than we could know of the human body if we 
 merely looked at the surface of the carcass: even sections of the brain 
 teach little more than sections of the body would." 
 
 Foville gives to Gall the credit of teaching us how to separate the 
 fibres of the brain without cutting them. 
 
 1 have been much disappointed with Foville's work. The anatomical 
 descriptions are most tediously minute, without any reference to physio- 
 logical inferences. For instance, the shape and outline of a part will 
 be given most accurately, but not one word regarding the course and 
 direction and termination of its component fibres; and still less is any 
 attempt made to classify the component parts of the brain under the 
 heads of ganglia, commissures and nerves. So that, after having waded 
 through a long description, the pons-Varolii, for instance, we are left quite 
 in the dark as to whether this part is a commissure or a ganglion, or both 
 combined. 
 
 Is it not strange that any man who has devoted his attention to the 
 anatomy of the brain, as Foville has done, should gravely assert that we 
 might as well describe the optic nerve as an optic bulb, as the olfactory? 
 No student who has traced the varied forms and position of the olfactory 
 ganglion in the various classes of animals up to man, will make such a 
 mistake. His words are, p. 508 : " And if we ought, in speaking of the 
 word olfactory lobe, to separate its description from that of the nervous 
 cords, we ought with equal reason to separate the optic nerve, and pre- 
 sent it also as a particular lobe." 
 
 Cuvier, in the report which he made to the Academic Royale des 
 Sciences de Paris, upon M. Serres' work, " De 1'Anatomie Comparee du 
 Cerveau," remarked very forcibly on the inconvenience of dissecting the 
 brain from above downwards in the manner generally pursued, and he 
 showed that, in consequence of comparative anatomists adopting this 
 
 mode of dissection, their researches into the constitution of the nervous 
 
 * 
 
 * Traite Complet de 1'Anatomie, de la Physiologic et de la Pathologic du Systeme Ner- 
 veau Cerebro-spinal, par M. Foville, p. 41. 
 
PREFACE. 
 
 system of the lower orders were productive of very imperfect results, in- 
 asmuch as the chain of resemblance between the lower and the higher 
 orders of animals was soon lost sight of; whilst M. Serres, by com- 
 mencing with the dissection of the spinal cord, and tracing it upwards, 
 was enabled to throw great light on this interesting branch of physiology, 
 and to prove that there is a regular gradation in these parts, that the 
 chain is perfect, and that such differences as do occur simply consist in 
 the abstraction of parts, and the loss of those powers which have been 
 proved to be dependent on them. 
 
 With regard to the nomenclature which I adopted in the first edition, 
 I shall continue to adhere to it in most instances, as I believe it to be 
 simple and correct. I still think it is an error not to distinguish the 
 ganglionic portion of the hemispheres from the rest of the mass, as the 
 hemispherical ganglion, but I would willingly have adopted a different 
 title if a better one had been proposed. 
 
 I have endeavored, without presuming to arrogate to myself the credit 
 of discovering any new system, to lay down a plan for the study of the 
 anatomy of the cerebro-spinal axis, founded upon the rational basis of 
 investigating its structure in man by the light of comparative anatomy. 
 
 The only philosophical method of simplifying and giving a character 
 of general interest to the anatomy of the human brain, is by commenc- 
 ing with the structure and functions of a nervous system in the lowest 
 and simplest forms of animal existence, rising by degrees to the highest, 
 carefully observing each addition of parts, and the relationship borne by 
 these to an addition of function. By pursuing this course we shall be 
 rewarded by finding that the encephalon, this apparently most compli- 
 cated organ in the human being, is but a gradual development from an 
 extremely simple fundamental type on one uniform and harmonious plan, 
 and that the seeming complexity of the cerebro-spinal axis in man really 
 arises from the great concentration, as opposed to the extreme diffusion, 
 of its component parts in the lower order of animals ; for in no particu- 
 lar are the higher orders more strikingly distinguished from the lower 
 than in the concentration of function within circumscribed spaces. In 
 following out the plan I have adopted in this work, I shall strive to 
 avoid, on the one hand, falling into the error of attempting too minute a 
 detail of all the various discoveries which have been made, and giving 
 
PREFACE. ix 
 
 an account of all the various opinions which have been broached ; and, 
 on the other, of basing ray descriptions or confining my views to the 
 circle of ray own individual researches and speculations. My constant 
 object will be to clear the path of all unnecessary incumbrances ; and, 
 carefully arranging whatever is known upon the anatomy and physiology 
 of the human brain, to keep in view the principle which Herschel has 
 so concisely stated, that " Science is the knowledge of many, orderly 
 and methodically arranged and digested, so as to be attainable by one." 
 Every honest and erudite anatomist must acknowledge that we are 
 indebted mainly to Gall and Spurzheim for the improvements which 
 have been made in our mode of studying the brain. For my own part, 
 I most cheerfully acknowledge, that the interest which I derived from 
 the lectures of Dr. Spurzheim at St. Thomas's Hospital, about the years 
 1822 and 1823, has been the inciting cause of all the labor which for 
 above twenty years I have at intervals devoted to this subject. I believe 
 that to Mr. Green, in his Dissector's Manual, is due the honor of having 
 first given to the English student an abstract of Gall and Spurzheim's 
 method of dissecting the brain. Mr. South, in his edition, enlarged it 
 considerably. Believing that, in the first edition of this work, I had 
 unintentionally neglected to do Gall and Spurzheim full justice, I got my 
 friend Mr. Streeter, of Harpur-street, who is well acquainted with this 
 subject, to give me a short historical account of the order in which their 
 labors appeared before the world. 
 
 20, Harpur street, April 1847. 
 
 MY DEAR SIR, As you manifested, in the Preface to the first edition of your work 
 on the Anatomy of the Brain, what Gall, in one of the latest of his written paragraphs, 
 termed "une tendance singuliere que manifestent beaucoup de personnes, d'attribuer 
 notres decouvertes & d'autres, par exemple a Reil,' 7 &c., I venture to direct your at- 
 tention to this error, into which you have fallen, in common with most of the English 
 writers on the anatomy and physiology of this most curious and difficult paft of the 
 human frame. I am the more induced to do so, because Dr. Spurzheim himself 
 directed my attention to this error when Mr. Herbert Mayo was engaged in his courses 
 of Lectures on the Nervous System, at the Royal College of Surgeons, nearly twenty 
 years ago, and fell into the same mistake. What Gall has written in its refutation, 
 may be found in the 8vo. edition of his work " Sur les Fonctions du Cerveau," vol. 
 vi. p. 490. What Spurzheim, in a pamphlet, entitled " Examination of the Objections 
 made in Britain against the Doctrines of Gall and Spurzheim," Edinburgh, 1817, p. 
 50-54; in the Preface to his "Anatomy of the Brain," 1826; and in his reprint of 
 Chenevix's article on Phrenology, from the Foreign Quarterly Review, 1830, Ap- 
 pendix. I would, however, direct your attention to the earliest notices of the dis- 
 
X PREFACE. 
 
 coveries and proceedings of these illustrious men in the English medical periodi- 
 cals publications which, as they were not so numerous as in our day, may be fairly 
 imagined not to have been entirely overlooked by the co-existing generation of men. 
 
 The earliest notice that I am aware of, that appeared in this country, was that in 
 the Medical and Physical Journal, for 1800 (vol. iv. p. 50). It refers, however, ex- 
 clusively to craniological ideas : 
 
 " Mr. F. J. Gall, at Vienna, has finished a most elaborate work on the Exercise of 
 the Brain, and on the possibility of recognizing the several Faculties and Propensities 
 from the Construction and Form of the Head and Skull. Mr. Geisweiler, of Parlia- 
 ment-street, has in his possession a part of the manuscript and several drawings, fin- 
 ished in the most curious and elegant style, deserving the attention of the curious. 
 The author intends to publish the work at the same time, both in England and Ger- 
 many." 
 
 This, you will observe, is before Dr. Spurzheim was associated with him. The 
 next medical notice appears in the October number of that Journal for 1805 (vol. xiv. 
 p. 327). The contributor, Dr. Arneman, one of their editors, speaks of Dr. Gall as 
 one " that may justly be ranked amongst the most extraordinary men of the present 
 age." He states that their Prussian Majesties, the physicians of the court, all the 
 medical professors, and among them the Nestor of the present anatomists, Dr. Walter, 
 and almost everybody who makes a claim to a liberal education, attended Dr. Gall's 
 Lectures. He divides the doctrine into two parts 1st, The Doctrine of the Brain : 
 2dly, The Doctrine of the Skull and gives an abstract of both. In the March num- 
 ber for 1806 (vol. xv. p. 201), there is another notice, which states that the craniology 
 of Dr. Gall was the favorite topic of the German literati, during the summer of 1805, 
 at almost every university and capital of the Northern provinces of Germany* that 
 Gall employed himself in researches on the conformation and anatomy of the human 
 brain. The government of Vienna, however, forbade his lectures. "But this did 
 not stop his inquiries' students in physic and men of research came from every part 
 to procure information, which he never refused, and his doctrine was soon spread all 
 over Germany by the writings of some of his pupils. The Doctor himself prepared a 
 work, illustrated with copper-plates, in which all his striking observations on com- 
 parative anatomy and the dissection of the brain were to be laid before the public. 
 Subscriptions for it were opened, and completed in a short time. But previous to its 
 publication, the Doctor resolved to make a circuit of all the Northern universities and 
 capitals of Germany, in order that the literati and professors might hear and scruti- 
 nize the lectures which he intended to deliver in every place wherein he should 
 make any residence." 
 
 In the July number of the Edinburgh Medical and Surgical Journal for 1806, will 
 be found a very careful but concise abstract of Gall's Examination of the Brain, 
 abstracted from all the psychical view r s of its author, from the pen of Professor 
 Rosenmuller of Leipsic. In the same number, there is also a review of Professor 
 Bischoff and Hufeland's Account of Dr. Gall's Cranioscopy, which was looked upon 
 as a correct epitome of Gall's Lectures, and of the objections raised against his de- 
 monstrations of the brain, and opinions, by Professor Walter and others. Copies of 
 the abstract by Rosenmuller, and of the review of Bischoff, I enclose, but shall be 
 glad to have them returned at your convenience. Other notices exist in the general 
 periodicals of the day, but these are sufficient to show that Gall and Spurzheinr's 
 public dissections and demonstrations of the brain preceded those of Reil in Germany ; 
 and it is curious to observe the influence they exerted in leading Reil to publish on 
 this subject in 1807; Baron Cuvier, in France, in 1809; and Sir Charles Bell, whose 
 
PREFACE. XI 
 
 first pamphlet was circulated only among private friends, and entitled, "Idea of a 
 New Anatomy of the Brain." The labors of these eminent men, and their successors, 
 have indeed only been successful in carrying out the details of Gall and Spurzheirrrs 
 general principle, that the nervous system was not a unit, but an aggregation of sys- 
 tems, as numerous as the functions, intellectual, emotional or physical, of which it is 
 the organized instrument. 
 
 Believe me to remain, yours, very truly, 
 S. Solly, Esq. J. S. STREETER. 
 
 There is one point regarding the physiology of the brain to which I 
 must here advert. It is Dr. Wigan's theory of the duality of the mind. 
 The facts and reasoning he has brought to bear on the subject are most 
 interesting, and his arguments are well worthy of attention. But to do 
 it justice, and at the same time to criticise it judiciously, would have 
 occupied more space than I could allot to the subject. 
 
 I have but few words to say regarding the pathological section. I 
 added it, because I believed it would render the work more useful, and 
 I hope it may prove so, notwithstanding the narrow limits to which I 
 have been obliged to confine it. 
 
 With regard to the Wood-cuts, I can vouch for their general accuracy: 
 they are all, unless stated to the contrary, from drawings of my own, or 
 made under my immediate inspection. Some of them I drew on the wood. 
 To Mr. Kearney the artist, and Mr. Branston the engraver, my thanks 
 are due for the trouble they have taken to execute them in accordance 
 with my wishes. 
 
 1, St. Helen's Place, 
 Aug. 25th, 1847. 
 

 CONTENTS. 
 
 PART I. STRUCTURAL ANATOMY. 
 Neurine, 33 37 
 
 1. Gray, vesicular, pulpy, 42 48 
 
 a. Source of power 
 
 b. Its vascularity 
 
 c. Its phosphatic quality 
 
 d. Its intelligential agency 
 
 2. White, tubular, fibrous, 37 42 
 
 a. Conductor of power 
 i. Nerves of sensation 
 
 ii. volition 
 
 iii. Excito-motory nerves 
 iv. Commissures 
 
 b. Its chemical composition 
 
 c. Its fibrous character 
 
 3. Sympathetic, gelatinous neurine, 34,42-46 
 
 a. Its minuteness 
 
 b. Its ganglionic character 
 
 c. Its sources in the brain and cord 
 
 d. Its universality 
 
 e. Its mode of distribution 
 Investing membrane of nerves, 48 
 Structure of nervous centres and ganglia 
 
 PART II. COMPARATIVE ANATOMY. 
 
 1. Its object, the elucidation of the several 
 
 functions, 50, 51 
 Comparative anatomy of brain 
 Nervous system, the medium of connec- 
 tion with external world 
 Volition and involition proper to nerves 
 Consciousness not necessarily proper to 
 
 nerves 
 Nerves, re-agents from within and from 
 
 without 
 
 The simplest animal implies the existence 
 of a proper nervous system 
 
 2. The animal kingdom, 61, 52 
 
 Five divisions 
 1st. Cryptoneura 
 
 Nervous system indiscernible 
 2d. Nematoneura 
 
 Nervous system a mere thread 
 i. Ganglia ) 
 
 ii. Commissures > rudimenlal 
 iii. Nerves ) 
 
 3d. Homo-gangliata 
 
 All the ganglia of one size 
 4th. Hetero-gangliata 
 
 Ganglia dispersed and separate 
 5th. Myelencephala 
 Perfect brain and cord 
 
 1. Ascaris or intestinal worm 
 
 a. Its limited existence, 52, 53 
 
 b. Microscopic thread of nerves 
 i. Law of development 
 
 ii. Egg, at the twenty-fourth hour, incu- 
 bation 
 
 2. Asterias, or star-fish 
 
 a. Locomotion for seeking food 
 
 b. Nervous cords emanating from nervous 
 
 nodules 
 
 i. A low type of the highest organizations 
 ii. Human brain studied in its lowest ele- 
 mentary forms 
 iii. Rudimental development of ganglia, 
 
 commissures, and nerves 
 Term ganglion, not physiologically cor- 
 rect 
 
 Human brain, a series of ganglia 
 Nature of a ganglion 
 Similarity between ganglion of the fifth 
 
 and posterior roots of spinal cord 
 Cineritious neurine is a ganglion 
 " Cortical substance" a misnomer 
 Peculiarity of organism implies pecu- 
 liarity of junction 
 
 Gray neurine a ganglion white neu- 
 rine a nerve 
 
 Gray generates, white conducts, power : 
 e. g. nerves and commissures are con- 
 ductors to and fro ; the commissures 
 are organs of comparison gray neu- 
 rine the seat of judgment, &c. 
 Diagram of the Phenomena of Life-: 
 Vital Phenomena 
 
 Sympathetic, Spinal, Cerebral, 
 
 or or or 
 
 Cyclo-ganglionic. Excito-motory. Brain system. 
 
 Sensation. 
 
 Locomotion. Consciousness. 
 i v. i 
 
 Percepuveness. Intelligence. 
 
 Mind. 
 
 Will. 
 
 Memory. Understanding. 
 
 Man. 
 
 History of ganglionic nerves, 58 
 3. Articulata 
 a. Spinal cord, 60 62 
 
 Not the seat of sensation, nor of vo- 
 luntary or instinctive motion 
 Analogy between arliculata and verte- 
 
 brata 
 
 Symmetrical nerves of Sir C. Bell, the 
 analogue of the spinal cord of the 
 vertebrata 
 
 Nervous thread of the lower is rudi- 
 mental of the spinal cord of the 
 higher 
 
 Whenever the rudimental thread of the 
 lower terminates in, or is joined to 
 
XIV 
 
 CONTENTS. 
 
 a gray ganglionic centre or brain, 
 then there is volition 
 Comparative anatomy works out the 
 analysis of the functions in man 
 
 4. Tunicata, 62, 63 
 
 Simply vegetative life 
 
 Elastic coating, the analogue of the 
 
 valvular conchifera 
 In structure a mere sac, with oral and 
 
 anal openings, guarded by sphincters 
 Rudimental lungs or aerating surfaces 
 Self-procreation by germs 
 Elastic coating, contractile 
 The ganglion with nerves radiating to 
 
 the sac and its sphincters 
 Tentacular filaments fringing the 
 
 branchial orifices nerves of sensa- 
 tion 
 The sphincters act from consent or 
 
 sympathy, analogous to the sphincters 
 
 in man 
 
 5. Conchifera, 64, 65 
 
 1. The oyster 
 
 a. No locomotive power 
 
 b. A particular muscle for closing its 
 shell 
 
 c. Rudimental organs of vision 
 
 d. One ganglion or nervous centre, the 
 analogue of the medulla oblongata, 
 governing its respiratory and oral 
 apertures 
 
 e. The smaller ganglia, analogues of 
 the cerebral ganglia in man or- 
 gans of sense 
 
 2. Shell-bearing molluscae 
 
 a. Locomotion 
 
 b. Rudimental foot implies additional 
 
 vesicular neurine the pedal gan- 
 glion. 
 i. Brain consciousness "*| *i 
 
 ii. Medul. oblong, excilo- ! .| 
 motory and respiratory ["lag, 
 functions J I J^js 
 
 iii. Spinal or pedal ganglia [2~> 
 Locomotion j- 
 
 6. Gasteropoda, 65 
 
 1. Snail, slug, limpet, &c. 
 
 a. Sense of sight and"^ 
 
 smell ' Additional 
 
 b. Copulation neces- f ganglia 
 sary for procreationj 
 
 Individuality of ganglia not decided by 
 
 anatomical lines of demarkation 
 i. (Esophageal ganglia 
 ii. Optic and olfactory 
 
 v. Cephalic 
 c. Gustatory and manducatory organs 
 i. Pharyngeal ganglia 
 7. Myriapoda, 67 74 
 1. Sandhopper 
 
 a. Ganglia all one size and at equal 
 distances 
 
 i. Cephalic ) Ana- (Brain ) i*o a 
 
 ii. Respiratory [ logues I Medull. obi | 
 iii. Pedal ) of (Spinal cord) s o -3 ^ 
 
 b. Commissural connections / .2 | 
 i. Cerebral com-) . TCorp. call. 1 | g a 3 
 
 missures i ,f " ' J transverse I | 6-3.2 M 
 ii. Spinal com- f lo ^ ies j fibres of 
 missures J cord 
 
 7. Cymothea 
 
 a. Nerves of instinct a distinct set 
 
 b. Brain of Myriapoda and higher articu- 
 
 lata composed of four ganglia 
 
 i. Olfactory ganglia 
 
 ii. Hemispherical and optic ganglia 
 iii. Manducatory ganglia 
 iv. Excito-motory or instinctive nerves 
 
 c. Sympathetic, or ganglion of vegetative 
 
 life, large, and chiefly distributed to 
 the salivary glands 
 Visceral ganglia relatively large 
 Brain and nerves of sense relatively 
 
 small, e. g. lulides 
 In insects this is the reverse 
 Visceral nerves diminish in exact pro- 
 portion to the increased activity of 
 sense and motion 
 
 d. Structure of cord double, or composed 
 
 of two lateral columns with transverse 
 fibres ; butterfly 
 
 a. Reflex phenomenon 
 
 b. Fibres of reinforcement 
 
 c. Sensation and voluntary motion 
 
 d. Pedal or tarsal nerves 
 
 e. Commissural connections 
 . f. Ganglionic enlargements 
 
 i. Upper fibres ) Joined to cephalic 
 ii. Under fibres J ganglia 
 iii. Transverse fibres (Commissural 
 iv. Lateral (connections 
 
 g. Lateral fibres reflex only 
 
 8. Crustacea, 74 
 
 Three divisions of nervous system 
 a. Supra-cesophageal sensation 
 i. Dorsal or spinal ) Reflex 
 ii. Stomato-gastric $ functions. 
 Exterior configuration no guide to identity 
 
 of function 
 1. Crab 
 
 a. Ganglia collected into masses 
 i. Cephalic ganglia, small 
 ii. Thoracic ganglia, large ; muscular 
 system, large 
 
 9. Insecta, 7578 
 
 Nerves decidedly concentrated 
 i. (Esophageal ring, a mass ) . ,. , 
 ii. Sensory ganglia, large ( Primordial 
 iii. Pulpy or gray neurine ) 
 Volition and consciousness, e. g. moth 
 
 10. Cephalopoda, 79 82 
 
 1. Pearly nautilus 
 
 Organs or ganglia of sensation enlarged 
 
 2. Cuttle fish 
 
 a. First analogue of a skeleton for the 
 support and protection of the nervous 
 
 r centres 
 
 b. Corpus geniculatum analogized 
 
 c. Cardiac and solar plexuses analogized 
 Imperfect development of the nervous 
 
 masses harmonizes with the low or 
 imperfect habitudes of animals 
 Sensible mantilla, the first sign of the 
 excito-motory system 
 
 11. Vertebra ta, 82 
 
 Central masses exalted above the periphe- 
 ral nerves 
 
 Supra-o3sophageal ganglia become a brain 
 in a brain-case 
 
 Ganglia joined in a bony canal form a spin- 
 al cord 
 
CONTENTS. 
 
 XV 
 
 Brain and cord connected 
 
 Nerves or ganglia reside in appropriate 
 
 cavities 
 
 Gray neurine enlarged 
 A. Pisces or Fishes, 8392 
 
 i. Brain ) True cerebro-spinal 
 
 ii. Spinal cord J axis 
 
 Weight of brain 
 
 Cord resembles human 
 
 Analogous to foetal spinal cord 
 
 Length different in different fishes 
 
 Sensory ganglia, united in man, are se- 
 parate in fishes 
 
 " Origin of Nerves" a misnomer 
 
 Increased size of hemispheres argues 
 increased intelligence 
 
 Eight cerebral ganglia enclosed in a 
 capacious skull 
 
 Whiting, Cod, 89 
 
 Hemispherical ganglia the analogues of 
 the foetal hemispheres 
 
 Motor and sensory nerves more deve- 
 loped 
 
 Carp, Pike, Skate, 8992 
 
 Sensory and hemispherical ganglia still 
 more demonstrable 
 
 Branchiogastric nerves analogues of the 
 pneumogastric. Electric ray 
 
 The brain more concentrated in carti- 
 laginous fishes 
 
 Cerebellum large in skate, shark, &c. 
 The locomotive powers of these fishes 
 great, and they have no air-bag 
 
 Fifth pair of nerves visible 
 
 B. Amphibia, 93 
 
 Hemispheres, sensory and motor nerves, 
 and cerebellum, more developed 
 
 C. Reptilia, 9395 
 
 1. Turtle 
 Striking exemplification of the functions 
 
 of the pneumogastric 
 Office of the gray neurine negatively 
 proved 
 
 D. Aves, or birds, 9597 
 
 Cerebro-spinal axis more decidedly figured 
 Intelligence and hemispherical ganglia in- 
 crease pari passu 
 Convolutions begin to be seen 
 Why the brain is convoluted 
 Cerebellum large, and the reason why 
 Vermiform process 
 
 {Implacentalia (Monotremata 
 (Marsupiata 
 f~Rodentia 
 I Edentata 
 I Ruminantia 
 Placentalia ^ Pachydermata 
 
 Cetacea 
 I Carnivora 
 ^Insectivora 
 
 1. Implacentalia, 97 
 Monotremata 
 Cloaca of birds 
 Bird-like brain 
 Relative weight of brain 
 Convolutions almost absent 
 Marsupiata, 99 
 
 Brain relatively small 
 Absence of placenta! fcetation typifies low 
 intelligence and small brai'n 
 
 2. Placentalia, 101 
 t 
 
 Rodentia rabbit 
 
 All the parts of the human brain here de- 
 veloped 
 
 Convolutions manifest 
 Pons Varolii and medulla oblongata 
 Edentata, 104 
 Brain, simple 
 Ruminantia sheep, 104 
 
 A more highly organized brain 
 Brain more oval in figure 
 Convolutions distinct 
 Cerebellum, commissures, thalami large 
 Olfactory nerve ; a nerve and ganglion 
 
 not identical 
 Decussation of fibres 
 Cerebral nerves of the base 
 Human brain now no longer rudimental, 
 
 but complete 
 
 Pachydermata horse, 109 
 Brain of a high class 
 Gray and white neurine same as in man 
 Medulla oblongata bold and decided 
 Commissures and cerebellum large 
 
 Note: Ganglia of lingual nerves. The 
 motor tract (elephant) : hemispherical 
 ganglia absolutely larger in man 
 The intelligence of the highly organized 
 
 brain of the elephant 
 Cetacea porpoise, 112 
 
 As it nurses its young, it so requires 
 intelligence. Its highly organized 
 brain 
 
 Plexus choroides peculiar 
 Nerves of sense large 
 Anterior and posterior columns 
 The whale 
 
 Fibrous neurine distinct 
 Its relative weight 
 Carnivora 
 
 The brain similar 
 Insectivora, 116 
 
 Olfactory nerve large 
 No convolutions 
 The chimpanzee 
 
 The figure of the brain in the mammalia 
 
 varies 
 Comparative anatomy of particular parts 
 
 of the brain 
 
 Tubercles of third pair, 116118 
 Optic thalami 
 Corpora striata 
 Corpus callosum, &c. 
 Ventricles 
 
 Convolutions, 118126 
 The intelligential ganglia 
 Mammalia classified according to convo- 
 lutions 
 This classification associates animals of 
 
 corresponding faculties 
 The reason of the brain being convo- 
 luted 
 
 Four kinds of foldings in the convolu- 
 tions 
 
 Brain folded in the progress of develop- 
 ment according to a determinate law 
 Foldings more or less according to in- 
 telligence 
 An attempt at a classification of animals in 
 
 groups of similar convolutions 
 Cerebral vessels, 126129 
 
XVI 
 
 CONTENTS. 
 
 Below man, the brain not supplied by the 
 
 same set of vessels 
 In man four arteries 
 
 Contrivance for averting the heart's force 
 The rete mirabile 
 
 Below man, varieties in the sets of vessels 
 supplying the brain instances 
 
 PART III. 130144. 
 Protective apparatus of the human brain 
 1. Osseous, 2. Membranous, 3. Aqueous 
 Bony or osseous 
 
 i. Dermal skeleton external deciduous 
 ii. Ligamento-bony internal permanent 
 Its progressive development from a cartila- 
 ginous tube up to a jointed bony canal 
 The skull modelled by the brain 
 Phrenology 
 
 Mode of opening the skull 
 Membranes of the brain 
 Dura mater and its processes 
 Its arteries and nerves 
 Reflections of the arachnoid 
 
 Foetal membranes 
 Pia mater its vascularity 
 
 Placental tufts 
 
 Physiology of the membranes 
 Pulsatory movements of the brain their 
 
 cause 
 
 Cerebro-spinal fluid 
 Spinal canal larger than its contents 
 Its sheath kept tense by the fluid 
 
 Senile dementia and atrophy of the brain 
 Localities of this fluid 
 Nerves bathed in it 
 Its four confluences 
 Changes its position 
 
 Spina bin* da 
 
 Its quantity in healthy adult and old age 
 Its rapid restoration 
 Its use 
 
 Its chemical analysis 
 Best manner of removing the brain 
 
 Base of brain nerves, &c. 
 Best manner of removing spinal cord 
 The spinal canal 
 Its membranes 
 Its plexus of veins 
 The spinal nerves 
 The cauda equina 
 In what the spinal veins differ from the 
 
 sinuses of the brain 
 Ligamentum denticulatum 
 Neurilemma of nerves 
 Filiform process 
 
 PART IV. 145155. 
 
 Weight of human brain 
 
 Horses', elephants' and whales' brain 
 
 Metaphysical and physiological remarks on 
 the properties of gray and medullary 
 neurine 
 Average weight of human brain 
 
 Its increase, decrease, and final decay 
 Men of talent weight of their brains 
 Idiots weight of theirs 
 Female brain 
 
 The age at which the brain is fully deve- 
 loped 
 
 Tables showing the weight of the brain 
 Phrenological and physiological remarks 
 
 PART V. 156170. 
 Configuration of encephalon 
 Two surfaces 
 
 i. Convoluted or external 
 ii. Figurate or internal 
 Perpendicular section of skull 
 An outline of the entire brain and spinal cord, 
 
 with directions for dissecting them 
 Convolutions 
 
 A particular description of their depth, order, 
 
 direction and foldings 
 Figurate surface 
 
 Dissection of hemispheres 
 Centrum ovale 
 
 Important post-mortem appearances of 
 
 this part in insanity 
 Lateral ventricles 
 
 Propriety of the term " Cavity" 
 Meaning of the term "Figurate surface" 
 Anterior cerebral ganglia or motor columns 
 Descriptions of the various parts brought into 
 view 
 
 PART VI. 171228. 
 
 Dissection of the human brain and spinal cord 
 Mode of hardening the brain for dissection 
 Spinal cord 
 
 Two halves, with anterior and posterior fis- 
 sure 
 Thirty-two nerves 
 
 i. Smaller anterior or motor 
 ii. Larger posterior or sensatory 
 Each posterior root furnished with a ganglion 
 Continuity of nerves with the gray neurine of 
 
 cord 
 
 Transverse section 
 An internal canal 
 Gray neurine within, a series of ganglia with 
 
 commissural connections 
 Fibres of the cord 
 Motory and sensory fibres 
 
 Opinions of the older physicians, 180 
 Comparative anatomy of cord 
 Cranial division of the cerebro-spinal axis, 
 
 181 
 Medulla oblongata 
 
 Gray neurine, how disposed 
 Six ganglia 
 
 i. Two anterior motor root of the fifth 
 ii. Two lateral pneumogastric 
 iii. Two posterior auditory 
 
 Comparative anatomy 
 Decussation of pyramidal bodies 
 Its pathological importance 
 Opinions of the older physicians and of 
 
 modern pathologists 
 The mode of decussation 
 Line of demarkation between the tracts of sen- 
 sation and motion, 1S7 
 The distinct offices of the two spinal columns, 
 
 not an anatomical distinction 
 Pons Varolii distribution of the decussating 
 
 fibres 
 Mode of dissecting medulla oblongata, 192 
 
 196 
 
 Dissection of the fibres of the motor columns 
 Cerebral fibres of the sensory columns 
 Decussation behind the pons Varolii 
 Mode of demonstrating it 
 Mode in which nervous matter is finally appro- 
 priated to sensation and motion, 200 
 
CONTENTS. 
 
 XV11 
 
 Diagram of Reflex Functions. 
 Brain. 
 
 Gray neurine 
 
 Medullary neurine. 
 
 Volition. Motion. Sensation. 
 
 Spinal Cord. 
 
 ^ (2 
 
 Anterior . Posterior 
 Column. >,S Column. 
 
 _ cs __ 
 
 Motor O S Sensory 
 Nerves. G Nerves. 
 
 Peripheral 
 surface. 
 
 The perpendicular arrows may represent the fibres 
 of reinforcement. The horizontal arrow may repre- 
 sent the transverse commissural fibres of the cord. 
 
 Dissection of the fibres of the sensory tract 
 The structure of the hemispherical ganglia, 204 
 
 Section of the cerebrum 
 
 Distribution of gray neurine 
 
 Medullary fibres pass into and through gray 
 matter 
 
 Externaf layer of the gray matter is white 
 
 Comparative anatomy 
 Commissures 
 
 Definition of the word 
 
 Note : Commissure of the star-fish 
 
 Transverse commissure 
 
 Lateral ventricles 
 
 Note: The ventricles are not cells 
 The other commissures 
 
 Longitudinal 
 
 Commlssura mollis 
 Pons Varolii, fornix, &c. 
 Inter-cerebral commissure 
 
 Arrangement of its fibres 
 
 Arbor vita? 
 The cerebellum, 217 
 
 Its situation, shape, and relations 
 
 Mode of preparing it for dissection 
 
 The vermiform process 
 Comparative anatomy 
 
 Connection with the pons Varolii 
 
 The course of its fibres 
 Comparative anatomy 
 Tuber cinereum, &c. 
 Recapitulation 
 
 PART VII. 229240. 
 Cerebral nerves 
 
 Opinions respecting their precise numbers 
 Eleven pairs described 
 
 Decussation or semi-decussation of optic nerves 
 Theory of vision 
 
 PART VIII. 241243. 
 Cerebral circulation 
 
 PART IX. 244256. 
 Development of the brain 
 Facts prove the law of progressive develop- 
 
 ment 
 A brief outline of the passing comparative ana- 
 
 tomy of the fetal existence 
 
 2 
 
 PART X. 257268. 
 Physiology of the cerebro-spinal axis 
 Phrenological observations 
 
 PART XL 269 484. 
 Diseases of the brain 
 Arrangement 
 
 A. Anaemic affections 
 
 B. Hyperaemic affections 
 
 C. Convulsive affections 
 
 D. Organic affections 
 
 History, diagnosis and treatment not strictly 
 
 divided 
 Variableness in the amount of blood within the 
 
 calvarium 
 Authorities maintaining that the amount of 
 
 blood never varies 
 Authorities maintaining the reverse 
 
 Experiments proving the ebb and flow of 
 
 blood within the skull 
 
 A. Anaemic affections 
 Diminished flow of blood 
 
 Instances of cutting off the arterial supply 
 Effect on cerebrum from obliterating one 
 
 of the carotids 
 
 Effect of tying carotid in epilepsy 
 Effect of ingurgitation 
 
 1. Delirium tremens 
 
 Its seat hemispherical ganglion (?) 
 
 a. Venous canals charged 
 
 b. Opacity of arachnoid 
 
 c. Effusion 
 
 Effect of light in delirium tremens and in 
 
 mania, compared 
 Two kinds 
 i. Proximate 
 ii. Consecutive 
 
 Hysteria, is it anaemia of the brain ? 
 The nature of delirium tremens sometimes in- 
 flammatory 
 
 Treatment : use of opium, stimulants, bleed- 
 ing, &c. 
 Diagnosis the pulse r- J>:, 
 
 2. Anaemic coma, 281288 
 
 i. Coma. ii. Hydrocephalus. iii. Ratnollisse- 
 
 ment 
 
 i. Coma from exhaustion infants 
 Nature, signs, and treatment 
 
 from erysipelas capites 
 
 Proper treatment 
 ii. Cerebral anaemia, 289 
 Effect of mental exertion 
 Nature, signs, and treatment 
 iii. Ramollissement, 291 
 
 Cause and period of accession 
 Its nature hypersthenic, or asthenic? 
 Remarks on the condition of the blood- 
 corpuscles 
 Two kinds of ramollissement 
 
 i. Inflammatory ) Pathology 
 
 ii. Non-inflammatory 5 of each 
 
 3. Atrophy of brain, 302 
 Arrest of development (?) 
 Gives rise to effusion in children 
 
 Hydrocephalus 
 
 The result of chronic inflammation 
 i. Fatuity 
 ii. Mania 
 iii. Old Age 
 
 B. Hyperaemic affections, 303, 304 
 
XV111 
 
 CONTENTS. 
 
 i. Inflammation of brain, from within 
 
 ii. , from without 
 
 Internal inflammation of brain 
 
 1. Inflammation of cortical substance 
 
 2. medullary matter 
 
 3. ^ base 
 
 4. cerebellum 
 
 Caution as to the report of post-mortem ex- 
 aminations 
 
 Morbid signs of inflammation of the several 
 
 membranes and the neurine , 
 
 1. Inflammation of hemispherical ganglia 
 
 Its effects and symptoms, 307 
 
 Intelligence excited or deranged 
 
 Volition impaired or exaggerated 
 
 Meningitis ) 
 
 Arachnitis > meaning of these terms 
 
 Phrenitis ) 
 
 Symptoms, 313 
 
 Mania its probable organic lesions 
 
 An account of the mental and bodily dis- 
 turbances 
 
 The great importance of attending to the 
 particular kind of effusion, mania, de- 
 lirium, or headache 
 
 The intellectual faculties to be well observed 
 
 and considered 
 Concussion, 316 
 
 Intellect deranged or abolished 
 
 Meningitis its effects often insidious 
 
 A remote cause of insanity 
 
 Treatment 
 
 Antiphlogistic to what extent 
 Fractures of the skull 
 
 Inflamed dura mater 
 
 Otitis or earache its importance 
 
 Syphilitic taints 
 
 Ossifications 
 
 Causing mental irritability or insanity 
 Skull often thick or hypertrophied in 
 
 mania 
 Treatment 
 
 Strictly antiphlogistic 
 
 Scarlatina its sequel, meningitis 
 
 Treatment of inflammation of brain 
 
 a. Value and extent of bleeding 
 Pathology of insanity 
 
 b. Purgatives 
 
 c. Cold 
 
 d. Various other remedies 
 
 Treatment of insanity 
 
 e. Proper use of mercury, opium, &c. 
 
 f. Erect or recumbent position 
 
 g. Darkness, silence, &c. 
 Apoplexy, 363 
 
 An indefinite term 
 Pressure on the brain 
 Symptoms 
 
 Its real and aberrant forms 
 It may resemble sleep, syncope, or epilepsy 
 Three forms 
 
 i. Apoplexy with coma 
 
 ii. headaches 
 
 Hi. palsy or 
 
 paralysis 
 
 or 
 
 i. Sanguineous apoplexy 
 ii. Serous apoplexy 
 iii. Simple apoplexy 
 
 Another form may be added 
 iv. Congestive 
 
 Predisposing causes specified 
 
 Cardiac disease 
 Premonitory symptoms 
 Effects of apoplexy 
 
 Its most fatal form 
 
 Its least fatal form 
 Lesions of corp. striat., 375 
 
 thalam. nerv. opt., 376 
 
 medullary substance 
 
 Meningeal apoplexy, 378 
 Its localities 
 Its consequences 
 Its intellectual injuries 
 Its acute pain 
 Apoplexy of cerebellum 
 
 Effusion, affecting the limbs of the same side 
 Observations on sanguineous apoplexy, and 
 
 its resemblance to epilepsy 
 Serous apoplexy 
 
 Arrest of respiration 
 Passive congestion 
 Determination of blood to the head 
 Apoplectic fever at Madras 
 Treatment, 392 
 
 Of premonitory symptoms 
 Treatment of apoplexy itself 
 Sthenic or asthenic 
 The promptitude and decision requisite for 
 
 success 
 
 The symptoms indicating or contra-indicat- 
 ing the loss of blood 
 Rules for the extent of bleeding 
 Danger of bleeding without absolute neces- 
 sity 
 
 Danger of calomel in apoplexy 
 Cold, croton oil, &c. &c. 
 The after treatment 
 C. Convulsive affections, 405 421 
 Their seat in tubular neurine 
 Convulsions on one side indicate disease on 
 
 the other 
 
 The result of pressure 
 
 Injuries to the head give rise to convulsions 
 Fractures of the skull 
 Trephining 
 
 Opening the dura mater 
 Pulsatory movements of dura mater 
 Epilepsy, 423463 
 
 Opinions of the older physicians 
 Its outward signs 
 Associated with mania 
 Frequency of the fits 
 The mild or half attacks 
 Disturbance of intellect 
 Forewarnings 
 Their varieties 
 Aura epileptica 
 
 Portion of radial nerve removed for it 
 Its probable nature 
 Fits from dentition 
 Brutes subject to epilepsy 
 Post-mortem examinations 
 Bony deposits 
 Morbid growths 
 
 [rritation of the excito-motory system 
 Two kinds of epilepsy 
 
 Centric and centripetal^ 
 Causes of epilepsy 
 Cerebral disease 
 Gastro-hepatic irritation 
 Generative disorders 
 
CONTENTS. 
 
 XIX 
 
 Determinations of blood to the head the cho- 
 
 roid plexus 
 Headaches in epilepsy 
 
 Theory of the pathology of epilepsy 
 Various opinions respecting the seat of the 
 
 disease 
 Hyperaemia of the brain during the epileptic 
 
 paroxysm 
 
 The use of digitalis 
 GEnanthe crocata 
 Effects of tying the carotid 
 Th-robbings of the carotids 
 Mental excitement 
 Cold, a cause of epilepsy 
 Remote causes of epilepsy 
 Venereal poison 
 Inflammation of dura mater 
 Prognosis in epilepsy 
 
 The various causes and kinds of epilepsy 
 
 seen in practice 
 
 Determinations of blood to the head 
 The pulse in epilepsy 
 Treatment 
 
 Local and therapeutic 
 Aperients 
 Bleeding 
 
 Oxyde of silver, zinc, &c. 
 Digitalis 
 
 Its modus operandi 
 Shower bath 
 
 D. Organic diseases of the brain, 463 484. 
 Morbid growths from neurine, or the mem- 
 branes not the result of simple hyperaemia 
 Tumors within the skull, 463 
 
 Mercury and its iodurets 
 
 The ordinary reports of these cases almost 
 valueless 
 
 Dura mater 
 
 Tumors outside of the membrane absorbing 
 
 the bone and protruding outwards 
 Malignant or cancerous growths 
 
 Diagnosis difficult 
 
 Pulsatory movements of the brain 
 
 Ulceration of the integuments 
 Apoplectic terminations 
 Inflammatory tendencies 
 Non-malignant growths 
 
 Their various characters 
 
 Hydatids of plexus choroides 
 Haematoma of the brain 
 The best pathognomonic signs 
 
 Headaches their character 
 
 Vomitings their kind 
 
 Organs of sense disturbed 
 
 Convulsions and their form 
 
 Paralysis 
 
 Gastro-hepatic disorders 
 
 Giddiness of what sort 
 Hypertrophy of the brain, 477484 
 
 Brain hypertrophied like the heart 
 
 A result of fatal precocity 
 
 Its post-mortem character 
 
 Induration of the brain 
 
 The kinds of hypertrophy 
 
 Simulates hydrocephalus 
 
 Its causes obscure 
 Relative weight of brain in disease 
 
 The co-existence of enlarged thymus gland 
 The aspect of passive hypertrophy 
 Constitutional symptoms 
 Distinction between hypertrophy and hydro- 
 cephalus 
 The treatment 
 

*T 
 
 
 THE 
 
 HUMAN BRAIN. 
 
 PART I. 
 
 STRUCTURAL ANATOMY. 
 
 BEFORE we commence our study of the configuration and anatomical 
 arrangement of the human brain, we must investigate the physical, che- 
 mical, and microscopical character of its component matter. The name 
 of this matter is NEURINE. Neurine is the substance in which the pecu- 
 liar powers of the brain and nerves reside. It is never found by itself, 
 for it is too delicate in texture to retain its properties if it were unsup- 
 ported. It is always supported and protected by the membranous fibre 
 arranged in various ways. 
 
 In the construction of the nervous system, the plan is the same as that 
 which prevails in all the other systems of an organized being. Mem- 
 branous matter forms the basis of each organ, in the interstices of which 
 the peculiar material of the organ is deposited. The bones consist of a 
 membranous network, in the interstices of which the earthy matter is 
 deposited, giving them the solidity required for the performance of their 
 office. 
 
 Muscles consist of a membranous network, in the tubular meshes of 
 which fibrinous matter is placed, which is endowed with the power of 
 contraction, on the application of its appropriate stimulus. Glands 
 consist of a membranous network, on which blood-vessels ramify, en- 
 dowed with the power of separating or secreting from the blood a pecu- 
 liar fluid; the liver forming bile, the salivary glands saliva, the kidneys 
 urine, &c. 
 
 The glands consist of two portions, the secreting portion and the con- 
 ducting portion. In the one portion, in addition to the membrane, there 
 are nucleated cells; in the other there are tubes. By the one portion, 
 the fluid is formed ; by the other, it is conducted to the place where it 
 is required. 
 
 The essential material of the nervous system is denominated Neurine. 
 Some anatomists still persist in calling it nervous matter, but it appears 
 to me wrong to use two words where one expresses the thing to be de- 
 scribed much better. 
 3 
 
34 STRUCTURAL ANATOMY. 
 
 There are two kinds of neurine, differing in color, consistence, and 
 microscopic character. They are easily recognized, and soon known to 
 the anatomist. They are well seen in the brain of Man, and in the 
 Mammalia generally. The one is of a gray or ash color, and pulpy 
 texture, as seen by the naked eye, and roughly examined ; and hence 
 its title cineritious, or pulpy neurine. With the microscope it has been 
 discovered to consist of nucleated cells or vesicles, and therefore more 
 justly denominated vesicular neurine. The other is of a pearly white 
 color and fibrous texture: this is medullary or fibrous neurine. The 
 difference in texture depends, in all probability, more on the arrangement 
 of the supporting membrane than upon any physical difference between 
 their elementary particles. 
 
 Under the microscope, the fibrous neurine is found distinctly to con- 
 sist of tubes, and hence its present title, tubular neurine. A third kind 
 has been described to exist in those nerves which have been long known 
 to the anatomist as the sympathetic. To the naked eye, this appears 
 almost identical with the cineritious neurine of the brain, and has been 
 generally classed as cineritious neurine; but it has been lately denomi- 
 nated, from its microscopic character, filamentous or gelatinous neurine. 
 Its filaments are about half the diameter of those of the tubular, and 
 without any distinct cavities. This neurine, as will be shown hereafter, 
 is merely the tubular neurine without an investing layer. 
 
 The revelations of the microscope regarding the ultimate texture of 
 these different kinds of neurine, are most deeply interesting, and quite 
 determine the correctness of the view advocated in the first edition of 
 this work, of their relative function. This view of the subject is now 
 almost universally admitted; but in the year 1836, it was by no means an 
 established point in physiology. The view to which I refer is this: that 
 the cineritious neurine is the source of power, and the medullary neurine 
 merely the conductor of it. The importance of establishing this position 
 will be best understood when we come to the dissection of the human 
 brain and spinal cord, and endeavor to discover the office of its compo- 
 nent parts. Until this point was established, (and even now it is not 
 considered to be so by all,) the study of the anatomy of the brain was 
 barren and fruitless. Our predecessors had some glimmering of light 
 on the subject, but their opinions were various and unsettled. 
 
 Lauth considered the gray substance as only a preparing organ. 
 Treviranus says that it prepares the blood for particular processes which 
 go on in the medullary substance. Vieussens, that it prepared and 
 purified lymph as nourishment for the medullary substance. According 
 to Berenger, it is said to assimilate the living spirits of the blood, and 
 to metamorphose it into animal spirits. Sylvius imagines it evaporates 
 the water from the spirits, as by distillation, and purifies them. Diemer- 
 broeck, Ruysch, Haller, and others, entertained the same opinion. 
 
 Meckel says* that " the most probable hypothesis is that which repre- 
 sents the gray and medullary substances as two masses, the opposition 
 or contrast of which results from the difference which exists in their 
 structure and chemical composition, and is necessary to the accomplish- 
 
 Vol. i. p. 256. 
 
 e 
 
OPINIONS. 35 
 
 ment of the functions of the nervous system; and that, however incon- 
 testable the importance of the gray matter, it does not authorize us to 
 believe that it is more noble than the medullary: that is to say, that in 
 this portion the spiritual changes corresponding to the material pass into 
 one another, as Wenzel appeared to believe when he says, * Cinerea 
 singularum cerebri partium substantia videtur prrecipue id esse, quo 
 propriae cuivis istarum partium sensationes efficerentur;'* and that the 
 office of the medullary is not simply that of a conductor." 
 
 Not, however, agreeing with Meckel, but rejoicing to derive support 
 to my opinions from such accurate observers as the Wenzels, I shall 
 quote the whole passage : " Verisimiliter itaque diversor singularum 
 cerebri partium functiones maxima saltern ex parte a cinerea, mutua 
 autum singularum cerebri partium conjunctio, totiusque nervus a medul- 
 lari substantia dependet ; sive quod idem est : cinerea singularum 
 cerebri partium substantia videter prascipue id esse, quo propriaB cuivis 
 istarum partium sensationes efficerentur, et substantia medullaris eadem 
 modo pro reliquo cerebri ductor impressionum sive sensationum singu- 
 larum cerebri partium esse videtur, rion secus nervus sensoriusid ipsuni 
 suo organo prsestat." 
 
 Willis (Anatomy of the Brain, translated by S. Pordage, 1679, p. 59), 
 says, " And what is chief of all, the universal cortical, or shelly sub- 
 stance of the brain, (to wit) in which the animal spirits are procreated." 
 A little further on, he says, " The callous body is rather designed for the 
 circulation than the generation of spirits." He considered that the 
 animal spirits which the gray substance secretes, are circulated by the 
 medullary. Reil, (Mayo, Physiological Commentaries, Part II. p. 117,) 
 speaking of the fornix, says, " Like these, the corpus callosum involves 
 no gray matter, and with them perhaps forms an apparatus for transmis- 
 'sion only." 
 
 Even Gall and Sptirzhetm, who have done so much for the anatomy 
 and physiology of the brain, did not see clearly the relation of the cine- 
 ritious neurine and the medullary. They considered the former as the 
 womb or generator of the medullary substance. 
 
 Tiedemann, as will be seen from the following passage, does not con- 
 sider it as the sole agent in the production of power, but merely as an 
 instrument to exalt and increase that which is already generated by the 
 nerves. 
 
 " The quantity of gray substance," says Tiedemann, " in those parts 
 of the spinal marrow from whence issue the large nervous trunks, and 
 which receives so many vessels that Ruysch imagined it entirely vascular, 
 contributes certainly, during life, to increase and exalt the nervous action, 
 according to this general law, that an organ possesses more force and 
 energy as it receives more arterial blood. M. Gall is deceived in saying 
 that the gray substance, which he terms the womb of the nerves, is the 
 first formed, being the producer and nourisher of all the nerves. I allow, 
 with him, that it strengthens and fortifies the action of those parts of the 
 brain and nerves which emanate from it, in as much as this effect is pro- 
 duced by the arterial blood which it contains, and by the greater rapidity 
 
 * De Penitiori Cerebri Structur4, cap. vi. p. 69. 
 
36 STRUCTURAL ANATOMY. 
 
 with "which it repairs the loss which the exercise of the vital action pro- 
 duces. I admit, then, an intimate relation between the volume of the 
 spinal nerves and the enlargements of the spinal marrow in those points 
 from whence these nerves issue. It is very easy to be convinced of this 
 in fishes, where the origins of the nerves produce particular ganglia, 
 always when the nerves and the organs to which they are distributed 
 have acquired a greater development, or when there are particular organs 
 not found in other fishes. The remarkable and regularly disposed 
 enlargements observed immediately behind the cerebellum in the flying- 
 fish (Triglavolitans*)) are the origins of the nerves destined to the digi- 
 tiform prolongations peculiar to these fishes, observed in front of the 
 ventral fins, and provided with numerous muscles, serving at the same 
 time as organs of touch and progression ;f of this I have been convinced 
 for some years. We find also in the torpedo (Raia Torpedo) two large 
 ganglia, situated also behind the cerebellum, the size of which they 
 much surpass, and from whence issue the nerves analogous to the eighth 
 pair, which furnish a great number of branches to the electrical organs 
 of these fishes. The Raia clavata, Raia Batis, Raia Pastinaca, and 
 other species of the skate properly called, present but a very small 
 swelling, giving origin to the eighth pair, which in these animals are 
 only distributed to the gills. In the sheaf-fish (Silurus) the origin of the 
 fifth pair of nerves forms a very voluminous mass, because this pair 
 sends large branches to the long barbules which cover the superior 
 maxilla, and to the muscles of these appendages. We find similar 
 enlargements along the spinal marrow of most fishes. i Thus, for ex- 
 ample, in the carp, there are behind the cerebellum two swellings, united 
 together by a middle tubercle, and representing in some degree a second 
 cerebellum. We cannot then doubt that the local augmentation of the 
 mass of the spinal marrow, by the addition of a greater quantity of this' 
 substance, is to exalt the action or activity of the nerves which emanate 
 from these ganglia. " 
 
 One of the first physiologists who decidedly advanced the opinion 
 that the gray neurine is positively a source of power, was Dr. Fletcher, || 
 of Edinburgh. In his Lectures, when speaking of the distinction be- 
 tween a plexus and a ganglion, he says, u The abundance of gray mat- 
 ter which they contain, and which there is good reason to believe is always 
 a primary source of some distinct faculty or power, &c."1F And again, 
 in another part of the same course of lectures, he says: 
 
 41 It is probable that no impediment whatever is offered to the function 
 of a ganglionic nerve by such a division as entirely paralyzes the cere- 
 bro-spinal. Such is the case with the latter only ; because the white 
 
 * Samuel Collins has described and represented them, System of Anatomy, vol. ii. tab. 
 70, fig. 3. 
 
 + This I have demonstrated in a Memoir addressed to the Academy of Sciences at Berlin. 
 
 I Arsakay, foe. cit. p. 16. De posteriore Gangliorum Encephalum constituentum Parte. 
 
 Tiedemann on the Foetal Brain, translated by Bennet. 
 
 || It is with great pleasure that I embrace this opportunity of expressing the high opinion 
 I entertain of the late lamented Dr. Fletchers talents and philosophical mind. Dr. Fletcher 
 had the honor of being among the first, if not the very first lecturer in the kingdom who 
 taught human physiology on the wide and scientific basis of comparative anatomy. 
 
 \ Ryan's Journal, April 18, 1835, page 961, note. 
 
OPINIONS. 37 
 
 matter of the nerve, being dependent for its energy upon the gray mat- 
 ter of the central parts of this system, becomes, of course, inert when 
 separated from it: but no such line of demarkation exists in the gan- 
 glionic system, every point of every nerve of which contains white and 
 gray matter intimately interwoven together, and may be considered, 
 therefore, as a centre of nervous energy to itself; and it is in this way 
 only that we can explain how the total removal of a muscle from the 
 rest of the body, which implies a division as well of its blood-vessels as 
 its nerves, is not for some time effectual in destroying its irritability." 
 
 As the student advances in the study of the structure and physiology 
 of the brain, he will see many reasons for assenting to this view of the 
 office of the cineritious neurine, which cannot be fully appreciated with- 
 out a further knowledge of the subject than he is supposed to possess at 
 present. We believe then that the peculiar power of the nervous sys- 
 tem resides in the cineritious portion. In short, that the cineritiolis 
 portion of the nervous system stands in the same relation to the rest of 
 that system as the secreting portion of a gland does to the rest of that 
 organ, though one portion would be useless without the other. The 
 medullary or tubular neurine appears to act simply as a passive con- 
 ductor of the power generated by the vesicular neurine, not possessing 
 any control over that power, not capable of acting upon it or changing it. 
 
 Thus we find tubular neurine performing various offices: 
 
 1st. As a conductor of an impression from the surface of the body to 
 the brain a nerve of sensation. 
 
 2dly. As a conductor of an order to act, from the brain, to the volun- 
 tary muscles nerve of volition. 
 
 3dly and 4thly. As a conductor of an impression from the surface 
 of the body to the spinal cord, which is reflected thence down another 
 set of conductors to the muscles whereby they are called into action, 
 independently of volition the exdto-motory nerves of Dr. M. Hall. 
 
 5thly. As a conducting medium between the centres of power the 
 commissures. 
 
 Further explanation will be given hereafter of the function of the 
 nerves of sensation, the nerves of motion, the excito-motory nerves, and 
 the commissures. One simple pathological fact will now be sufficient 
 to illustrate the distinction between the power of the nervous centres 
 and their conducting instruments, and show that the central portion pos- 
 sesses its power independent of the peripheral. A patient may be para- 
 lytic from disease affecting the motor tract ; the individual as perfectly 
 retains the power of willing the motion of his limbs as previous to the 
 occurrence of the disease, though his will is no longer conducted to the 
 point where it would be executed. But this illustration does not, of 
 course, afford the slightest explanation of the mode of action of these 
 two parts, nor need it imply a belief in the necessity of a physical 
 change for the production of nervous action. 
 
 Tubular or medullary neurine, though firmer than the cineritious neu- 
 rine, nevertheless, in comparison with the other tissues of the body, is 
 soft and yielding. 
 
 This want of tenacity is principally owing to the large quantity of 
 water which enters into its composition; water actually constituting 
 
38 STRUCTURAL ANATOMY. 
 
 from three-fourths up to seven-eighths of its weight. Vauquelin, whose 
 analysis, though made as long ago as 1812, is still referred to by all 
 our best authorities as most deserving of credit, states that the brain 
 consists of 
 
 Albumen .... 
 
 r^. 1,^1 fof Stearine 4-53 
 
 Cerebral fat . 
 
 Phosphorus . 
 
 Osmazome ..... 
 Acids, salts, Sulphur ..... 
 Water 
 
 100-00 
 
 M. John* is the only chemist who, in his analysis of the brain, has 
 hitherto separately examined the gray and white matter. He has stated 
 that the white matter contains more fat than the gray, and that its albu- 
 men is more firm. The following comparative analysis was made of 
 the brain of one of the insane patients who died at Salpetriere. 
 
 Entire brain (density = 1048). 
 
 Water . . . . . . 77-0 
 
 Albumen ..... 9-6 
 
 White fatty matter .... 7-2 
 
 Red fatty matter . , . . . 3-1 
 
 Osmazome, lactic acid, and salts . . . 2-0 
 
 Earthy phosphates . * . . 1-1 
 
 White Substance. Gray Substance. 
 
 Water . . . 73-0 . 85-0 
 
 Albumen ... 9-9 . 7-5 
 
 White fatty matter . . 13-9 . 1-0 
 
 Red fatty matter . V- 0'9 . 3-7 
 
 Osmazome, &c. . { ^ I'O . 1-4 
 
 Earthy phosphates . 1-3 1-2 
 
 Foville states that the brain of a fat man contains a much larger 
 quantity of fatty matter than that of a thin man; also that the brain of 
 the Cetacea contains a large quantity of oil : that the brain wastes with 
 the rest of the body ; but the fat of the brain is combined in so intimate 
 a manner with its substance, that it never forms solid and visible isolated 
 masses external to the nervous matter. 
 
 " The presence of fat," says this author, " in proportion to its amount, 
 gives a more rich form and more rounded contour to all the surfaces of 
 the nervous centres. Its absence alters these forms, rendering them 
 poor and sharp. With its absence coincides the increase of free serosity 
 in the internal cavities, and those which separate the convolutions."! 
 
 He also in some cases attributes to emaciation the peculiar appearance 
 
 * Journal de Chimie Medicale, August, 1835. 
 
 j- Trait6 complet de I'anat 6 de la phys e et de la path* du systeme nerveux Qe.reb. 8vo, 
 1844, par Foville, p. 122. 
 
TUBULAR NEURINE. 
 
 Fig. 1. 
 
 of the brain of old people, though at the same time warning us from 
 confounding this appearance with true senile or morbid atrophy. 
 
 It has been stated that the relative quantity of phosphorus varies at 
 different periods of life, also in healthy and diseased brains; that it is 
 small in the infant and the idiot; but I do not feel satisfied that this 
 assertion is established. 
 
 Professor Ehrenberg has shown that the medullary neurine actually 
 consists of very minute fibres; and he informs us that these fibres can 
 only be discovered by the aid of a magnifying power of 300 diameters, 
 and that he was sometimes obliged to have recourse to a much greater 
 magnifying power, as 800 diameters, in order to bring them into view. 
 He examined thin slices of the recent brain, and states that the fibrous 
 structure was in general most obvious at the margins of the slices. 
 These fibres in the cineritious portion are interspersed with globules 
 and plates ; the greater number of 
 these fibres, instead of having a 
 regular cylindrical form, are knotted 
 like a string of beads, the swelled 
 portions being situated at some dis- 
 tance from one another, and united 
 by narrower parts which are con- 
 tinuous with them, and are formed 
 apparently of the same material. 
 
 It is now believed that this vari- 
 cose appearance depends simply on 
 pressure or other force used in pre- 
 paring the objects. Still in some 
 portions of the nervous system this 
 beaded appearance is much more 
 easily produced than in others, show- 
 ing that it depends on some peculi- 
 arity of structure. It is most easily 
 seen in those fibres which are most 
 centrally situated, and in all proba- 
 bility depends on the greater deli- 
 cacy of the protecting portion of the 
 fibre, and also of the investing mem- 
 brane. If the fibres which compose 
 the fibrous neurine are examined 
 
 With a good micrOSCOpe, they will 
 
 be found to have a peculiar and com- 
 
 plicated Structure. TheV are not Tubula r membrane. B. Tubular fibres, e. In a 
 
 1 TJ /., mi natural state, showing the parts, as in A. /.The 
 
 Simply SOlld nbrCS. 1 hey are per- white substance and axis cylinder interrupted by 
 
 fpff pvlin<-lprc xrari/i'^nf i rli'orvmfo,. P ressure ; while the tubular membrane remains, g. 
 Cylinders, Varying in diameter 
 
 --*-th to ___ ? __ th nf nr. innVi 
 (nn^n 1 looooin 01 an men. 
 
 average Width IS from ranrtb 
 , _ i xi f i m, n 
 
 10 T"0~0"0 in * <*n inch. A "ey are all 
 
 invested and supported by a distinct 
 elastic homogeneous membrane, 
 similar to the sarcolemma of the 
 
 A. Diagram of tubular fibre of a spinal nerve 
 
 The same, with varicosities. h. Various appear- 
 ances of the white substance and axis cylinder 
 forced out of the tubular membrane by pressure. 
 
 * Broken end of a tubular fibre, with the white 
 substance closed over it. k. Lateral bulging of 
 white substance and axis cylinder from pressure. 
 
STRUCTURAL ANATOMY. 
 
 Fig. 2. 
 
 fibres of the voluntary muscles. The neurine which is contained within 
 this membrane consists of two portions, a central, which is probably the 
 active portion of tubular neurine, and an outer or investing portion, 
 which possibly acts merely as an isolater of the conducting central axis. 
 The central portion is called by Rosenthal and Purkinge, the axis cylinder. 
 The outer portion is the white substance of Schwann. (See fig. 1.) 
 
 The tubular membrane presents the same characters wherever it is 
 met with. But the white substance of Schwann exhibits much variety 
 as regards its thickness in different parts of the nervous system. In the 
 nerves it is more developed than in the centres; but even in the former 
 it differs a good deal as to thickness. We find it most developed in 
 the ordinary spinal nerves ; in those of pure sense it exists in small 
 quantity. The chemical composition of the white substance, being 
 obviously different from that of the axis, sufficiently denotes a difference 
 of function in these two portions of the nerve-tube. 
 
 Stadelmann describes the axis-cy- 
 linder of the nerve-fibres as very dis- 
 tinctly visible in transverse sections of 
 them. Its outline has commonly the 
 same form, and is nearly half as large 
 as that of the nerve-fibre itself; but 
 sometimes it looks as a mere chink 
 or a central point. It has been sug- 
 gested, that the distinction of these 
 two substances is merely the result of 
 coagulation or chemical agents, and 
 that it does not exist in the living 
 organization ; but Dr. Todd and Mr. 
 Bowman, who have paid great atten- 
 tion to the microscopic anatomy of 
 these parts, and from whom this ac- 
 count is derived, give the above as 
 their deliberate opinion.* 
 
 There are certain little bodies, called 
 Pacinian corpuscles, which in the hu- 
 man subject are found in great num- 
 bers in connection with' the nerves of 
 the hand and foot. In the mesentery 
 of the cat, they may be seen with the 
 naked eye, and under the microscope 
 it exhibits the appearance of fig. 2, 
 taken from the above work. (Fig. 75, 
 p. 397, Todd and Bowman.) 
 
 The discoverer of the Pacinian cor- 
 puscles states that the nerve filament 
 has a single contour, like the sympa- 
 thetic filaments: up to the base of the 
 corpuscle, the contour is double ; at 
 its termination it presents a granular 
 
 Pacinian corpuscle, from the mesentery of a 
 cat. intended to show the structure of these bo- 
 dies. The stalk and body, the outer and inner 
 system of capsules, with the central cavity, are 
 seen at a. Arterial twig, ending in capillaries, 
 which form loops in some of the intercapsular 
 spaces, arid one penetrates the central capsule. 
 b. The fibrous tissue of the stalk, prolonged 
 from the rieurilemma. n. Nerve-tube, advanc- 
 ing to the central capsule, there losing its white 
 substance, and stretching along the axis to the 
 opposite end, where it is fixed by a tubercular 
 enlargement. 
 
 Physiological Anatomy of Man, 1845. 
 
TUBULAR NEURINE. 
 
 41 
 
 Fig. 3. 
 
 Ideal representation of the nerve- 
 tube entering a Pacinian corpuscle, to 
 represent more clearly the distinction 
 between the central axis and the en- 
 velope, s s. White substance of 
 Schwann. 
 
 swelling, like the common ganglion corpuscle. Thus it will be seen 
 that the central axis alone enters the central capsule. The envelope 
 having, as it were, conducted the central 
 portion to the door, leaves it, and stops out- 
 side. Thus we have, as Dr. Todd says, a 
 natural dissection made for us. This fact 
 renders his view of the office of the white 
 matter still more likely to be correct. 
 
 Nerve-tubes never branch like blood- 
 vessels, and never inosculate with one ano- 
 ther ; though they form loops at their origin 
 in the nervous centres, and at their termi- 
 nations. 
 
 Often as I have traced these nerve-tubes 
 under the microscope, I have never seen 
 them join or anastomose, as we do the blood- 
 vessels. 
 
 A nerve-tube always performs one and 
 the same office ; it always conducts in the 
 same direction, and the same kind of nervous 
 power : not at one time carrying impressions 
 which, on reaching the brain, become sensations, and at another time 
 conveying orders to a muscle to contract. 
 
 This last position is thus decidedly asserted, because I feel not the 
 shadow of a doubt of its correctness ; and to me it appears that all the 
 important discoveries of Bell must be abandoned, if this be not true, and 
 that we should then be more in the dark than ever regarding the physio- 
 logy of the brain. Nevertheless, this position is actually disputed by 
 some anatomists in the present day. 
 
 In an admirable article in the Medico-Chirurgical Review for July, 
 1845, page 1, the writer of it thus forcibly combats such opinions: 
 
 "We certainly did not anticipate, and least of all in England, that a 
 time would arrive when it would be necessary to vindicate the great 
 principle announced by Bell, that principle upon which all accurate 
 knowledge of the nervous system must ever repose, the individuality, 
 namely, and uninterrupted continuity of the primary nervous filaments. 
 Doubts have, however, been thrown upon this fundamental truth, and 
 principally, as it would appear, on the faith of certain dissections and 
 experiments of Stilling, from which it is inferred that the elementary 
 fibres interlace one with another in the spinal cord, in the several nervous 
 plexuses, and in other parts of the system ; that, in fact, the disposition, 
 of the nervous system is precisely analogous to what is seen in the venous 
 and lymphatic systems. We believe this to be an entire fallacy, and 
 unhesitatingly express our conviction, resting on repeated and careful 
 examination, that no anatomist has ever seen in any of the parts just 
 mentioned, a true anastomosis in the sense of that existing in the vascular 
 system. The only places where the primary nervous tubules do actually 
 communicate is in their peripheral extremities, where, both in the muscles 
 and in the tactile papilla? of the skin, they unite and form Iqops. It has 
 also been asserted by Valentin, that a similar disposition prevails in the 
 
42 STRUCTURAL ANATOMY. 
 
 central ends implanted in the gray matter of the brain, but, as we shall 
 subsequently state, this must at present be held to be doubtful 
 
 " The functions of the blood-channels and nerves are so totally dif- 
 ferent, that it is surprising any comparison between them should have 
 been attempted. It is the office of the blood-vessels, not merely to carry 
 the nutritive fluids to all parts of the body, but specially, by overcoming 
 the repeated obstacles which impede the circulation, to secure in the 
 extreme divisions or capillaries that uniform current which alone is com- 
 patible with healthy nutrition. Now, how is this to be accomplished ? 
 Clearly by providing free intercommunications between all the parts of 
 the vascular system, and more particularly between its smaller divisions. 
 Thus, as to the function of the blood-vessels, it matters not how the 
 blood reaches its destination, provided it does but get there. But in the 
 case of the nervous system, all is reversed ; here the whole action of in- 
 nervation requires in theory what is shown by observation, a disposition 
 of the nervous threads, which will make them to act as isolated conduct- 
 ors, so as to transmit unmingled the mandates of the will centrifugally 
 to special muscles, and centripetally the impressions made on the organs 
 of sense to the brain. In consequence of the unsatisfactory results of 
 many of Stilling's researches, we have again cautiously examined the 
 disposition of the primitive tubes in the spinal cord, with the express 
 object of ascertaining if, in any part of the white matter of the white 
 substance, anastomosis could be detected. All our examinations have 
 shown that the fibres invariably observe an isolated course. When 
 viewed with a sufficiently high power, an objective of one-sixth of an 
 inch focus for example, the beaded particles are beautifully and distinctly 
 seen in a perfectly recent specimen, and mixed with their branches of 
 minute blood-vessels and capillaries; these latter canals, it is necessary 
 to state, present appearances so deceptive, that to an unpractised eye, 
 and especially when low powers are used, as was done by Stilling, they 
 may very readily be mistaken for nervous tubes, and herein, we believe, 
 will be found the source of the errors above noticed. The capillary 
 vessels are seen branching and uniting, but they present physical marks, 
 and especially nuclei in their walls, which are quite distinctive : indeed, 
 we were never more impressed with the certainty and elucidation which 
 microscopic examination confers on the great questions of physiology, 
 than by thus seeing under the eye the true characteristics of the vascular 
 and nervous systems. 
 
 u The conclusion at which we have ourselves arrived, as the result 
 of direct inspection, is confirmed by the best observers. Thus, Valentin, 
 in his Physiology, just completed, after pointing out and demonstrating 
 the physiological necessity of isolated conductors in the peripheral portion 
 of the nervous system, both as relates to sensation and motion, says, we 
 conclude, as a general anatomical proposition, that all ramifications, 
 anastomoses, and interlacements of the nerves, are in reality only appa- 
 rent, and therefore that no true divisions nor communications similar to 
 those in blood-vessels exist, but merely a corresponding entrance or exit 
 of unbranched, uninterrupted primitive fibrils; a disposition which enables 
 us easily to comprehend the laws of nervous conditions." 
 
 Vesicular or pulpy neurine is much more vascular than tubular. Where 
 
VESICULAR OR PULPY NEURINE. 
 
 43 
 
 Fig. 4. 
 
 A. Vesicle from the cineritious neu- 
 rine of the brain of a frog. B. Blood 
 corpuscle of the same animal, to show 
 their relative size. 
 
 Fig. 5. 
 
 its capillaries are well filled with injection, it appears under the micro- 
 scope like a minute network of countless blood-vessels. 
 
 Theneurine, which is deposited between 
 the meshes of this intricate mass of blood- 
 vessels, consists almost entirely of cells, 
 with nuclei and nucleoli, (see fig. 4, A,) 
 in various stages of development. The 
 wall of every vesicle consists of an ex- 
 ceedingly delicate membrane, containing a 
 soft but tenacious, finely granular mass. 
 They are mostly globular, but not uniform- 
 ly so. Some are caudate, and the tail pro- 
 longations are frequently long. In point 
 of structure, say Messrs. Todd and Bow- 
 man, the caudate processes are exceedingly delicate, and finely granular, 
 like the interior of the vesicle, with which they distinctly seem to be 
 continuous. Such is the delicacy 
 of these processes, that they readily 
 break off'; in general, very close to 
 the vesicle. Sometimes, however, 
 one or more of them may be traced 
 to a considerable distance, and will 
 be found to divide into two or into 
 three branches, which undergo a fur- 
 ther subdivision, and give off some 
 extremely fine transparent fibres (fig. 
 5), the connection of which with 
 the other elements of the nervous 
 tissue has yet to be ascertained. It 
 is most probable, however, that 
 they serve either to connect distant 
 vesicles, or else that they become 
 continuous with the axis cylinders 
 'of the tubular fibres. In the cere- 
 bro-spinal centres, we have found 
 
 the tissue in the vicinity of the caudate vesicles freely traversed in all 
 directions by numerous very delicate filaments, which seem to be the 
 ramifications of the caudate processes. These often exhibit consider- 
 able tenacity and elasticity. The situations from which we may obtain 
 such caudate vesicles as are best suited for examination, are the " locus 
 niger" in the crus cerebri, and the gray matter of the cerebellum and 
 spinal cord. 
 
 Many of these cells are evidently of quite recent formation ; so much 
 so, that we cannot help observing the analogy in the microscopical struc- 
 ture of this portion of the nervous system and the secreting portion of 
 the glandular system. 
 
 John Goodsir* has thrown great light on the part which the nucleated 
 
 * Anatomical and Pathological Observations, by John Goodsir and Harry Goodsir, 1845, 
 .page 7. 
 
 (Todd and Bowman, p. 212.) Nerve vesicles 
 from the Gasserian ganglion of the human sub- 
 ject, a. Globular one with a defined border, b. 
 Its nucleus, c. Its nucleolus. d. Caudate vesicle. 
 e. Elongated vesicle, with two groups of pigment 
 particles, f. Vesicles surrounded by its sheath, 
 
 or capsule, of nucleated particles, 
 the thread only being in focus, 
 diameters. 
 
 ;The same, 
 agnified 300 
 
44 STRUCTURAL ANATOMY. 
 
 cell plays in the secreting process. It has been already stated, upon 
 other grounds than those now to be advanced, that the cineritious sub- 
 stance of the brain stands in the same relation to the nerves that the se- 
 creting portion of a gland does to its duct. This theory appears to me 
 now most curiously confirmed by the structure and functions of the in- 
 testinal villi. 
 
 To understand the part which the vesicles of the villus play in diges- 
 tion, it is necessary to be aware of certain of the functions of the cell 
 with which physiologists are yet unacquainted. 
 
 Not only are these bodies the germs of all tissues, as determined by 
 the labors of Schleiden and Schwann, but they are also the immediate 
 agents of secretion. A primitive cell absorbs from the blood in the 
 capillaries, the matters necessary to form, in one set of instances, nerve, 
 muscle, bone, if nutrition be its functions ; milk, bile, urine, in another 
 set of instances, if secretion be the duty assigned to it. The only dif- 
 ference between the two functions being, that in the first, the cell dis- 
 solves and disappears among the textures, after having performed its 
 part ; in the other it dissolves, disappears, and throws out its contents 
 on a free surface. 
 
 In another place, he says,* "The ultimate secreting structure, then, is 
 the primitive cell endowed with a peculiar organic agency, according to 
 the secretion it is destined to produce." 
 
 The observations of Henle, quoted by that admirable physiologist, Dr. 
 Carpenter, regarding the difference in the structure of the cortical sub- 
 stance of the brain, (the hemispherical ganglion,} all support this view. 
 On the surface of the brain, that is, the portion of the ganglion which is 
 nearest to the vascular network, the ganglion vesicles seem to be imper- 
 fectly formed. There is a finely granular substance containing spherical 
 or oval vesicles, with one or two dark granules in them. In a rather 
 deeper layer these vesicles, instead of being irregularly scattered through 
 the granular substance, seem to have appropriated each to itself a portion 
 of the latter for an independent covering; and from this condition there 
 seems to be a regular gradation, till, in the yet deeper layers of the cor- 
 tical substance, the vesicles, with their granular coverings, are replaced 
 by perfect ganglion-like globules with their filamentous sheaths. 
 
 It is, then, most probable that the nucleated cells of vesicular neurine 
 are the active agents in the production of nervous power; that they are 
 developed, and perform their office, in the same way as the nucleated 
 cells. 
 
 The enormous quantity of blood which the vesicular neurine receives, 
 affords strong evidence that this structure, like the acknowledged secret- 
 ing organs, employs that blood in the preparation of a something. In- 
 deed, the effect of arresting the cerebral circulation shows most clearly 
 that all the mental operations are dependent on the flow of blood through 
 the brain, for their production. The experiments of Sir Astley Cooper 
 on the rabbit are most interesting and satisfactory. 
 
 We have seen that neurine contains about one per cent, of phosphorus. 
 The excessive excretion of phosphorus with the urine, after severe mental 
 
 * P. 25, kc. dt. 
 
VESICULAR NEURINE. 45 
 
 exertion a fact first pointed out by Dr. Prout may be cited as support- 
 ing this view of the analogy between the production of nervous power 
 and ordinary secretion. 
 
 Dr. Golding Bird, in his excellent little work on urinary deposits, gives 
 a very striking case, illustrative of this connection.* 
 
 " Where the presence of the triple phosphate is only occasional, its 
 connection may be traced with some cause which has rendered the system 
 morbidly irritable, at the same time that its tone or vigor has become 
 depressed. The simplest examples of this kind that have occurred to 
 me, have been in cases of individuals of nervous temperament, who 
 have periodical duties to perform, requiring so much mental tension and 
 bodily exertion. I have witnessed this state of things several times in 
 clergymen, especially in those who, from the nature of their secular 
 engagements, have been compelled to lead sedentary lives- during the 
 week, and to perform full duties on Sundays; the best illustration of this 
 I ever met with, was in the person of a well-known and deservedly 
 popular clergyman, who, from his connection with a public school, 
 scarcely used any exercise during the week, whilst on Sunday he per- 
 formed duty thrice in church. This gentleman was a tall thin person, 
 of dark complexion, lustrous eyes, and almost phthisical aspect. He 
 was the subject of constant dyspepsia. The urine passed on Saturday 
 evening, as well as on Sunday morning, though repeatedly examined, 
 was healthy, except in depositing urate of ammonia, and being of high 
 specific gravity. Before his Sunday duties were completed, he almost 
 invariably became the subject of complete fatigue, with a painful aching 
 sensation across the loins, in addition to the flatulence and epigastric 
 uneasiness under which he always labored. The urine voided before 
 retiring to rest after the severe exertions of the day, was almost con- 
 stantly of a deep amber hue, high specific gravity, and deposited the 
 triple phosphate in abundance. The urine of Monday would contain 
 less of this salt, which generally disappeared on the following day, and 
 once more reappeared on the Sunday evening. I had an opportunity of 
 observing this state of things for several weeks, and it ultimately disap- 
 peared by the patient relaxing from his duties and enjoying the amuse- 
 ment of traveling for a few weeks." 
 
 I have been frequently consulted by a gentleman in business, of a 
 highly nervous temperament and excitable brain, on account of a depo- 
 sit of phosphorus in his urine. In the morning this excretion is per- 
 fectly clear and healthy, but after he has been harassed by business, it 
 then becomes cloudy. If, however, he is in the country, and free from 
 anxiety of any kind, the water is then bright and natural. " Many cir- 
 cumstances," says Dr. Carpenter, u lead to the belief, that the nervous 
 tissue, when in a state of functional activity, undergoes a rapid waste or 
 disintegration, and a corresponding renewal." 
 
 My readers must not conclude from the above observations, that I 
 consider mind to be dependent on matter. I believe that matter is 
 merely the instrument which the mind employs, and I quite agree with 
 my friend from whom I have last quoted, where he says, p. 83, "When 
 
 Urinary Deposits, &c., by Golding Bird, M. D. 1844. 
 
46 STRUCTURAL ANATOMY. 
 
 we speak of sensation, thought, emotion, or volition, therefore, as func- 
 tions of the nervous system, we mean only that this system furnishes the 
 conditions under which they take place in the living body." 
 
 The gelatinous nerve fibre was first described by Henle : it is flattened, 
 soft, and homogeneous in appearance; containing numerous cell-nuclei, 
 some of which are round, others oval ; some situated in the centre of 
 the fibre, others adhering to either edge, their longest diameter being 
 generally parallel to the longitudinal axis of the nerve. These nuclei 
 are arranged at nearly equal distances, and frequently exhibit distinct 
 nucleoli. Sometimes these fibres show a disposition to split into very 
 delicate fibrillaB. Acetic acid dissolves the fibre, leaving the nuclei un- 
 changed. These fibres, containing nothing analogous to the white sub- 
 stance of Schwann, are devoid of that whiteness which characterizes 
 the tubular fibre ; and it would seem that the gray color of certain 
 nerves depends chiefly upon the presence of a large proportion of the 
 gelatinous fibres; hence they are sometimes called " gray fibres." 
 
 The mode of connection of the gelatinous fibres with the elements of 
 the nervous centres is, as yet, quite unknown. They are found in con- 
 siderable numbers, in what are called the roots of the sympathetic, or 
 the communications of that nerve with the spinal nerves ; it has been 
 supposed by Valentin that they are continuous with certain elements of 
 the vesicular nervous matter. 
 
 These fibres are smaller in general than the tubular fibres ; their 
 diameter ranges between the eoV^th and the ^oWth of an inch. They 
 resemble very much the fibre of unstriped muscle. 
 
 When I first read the description of this fibre, I confess I thought it 
 improbable. We can understand the existence of one kind of neurine, 
 for the production of power, and another for the conduction of it. But 
 I could never quite understand why there should be a different kind for 
 the sympathetic nerve, and cerebro-spinal system, when it is clear that 
 the same kind of vesicular or cineritious neurine performs twenty offices 
 in different situations for instance, in the spinal cord and in the brain ; 
 yet the microscope detects no difference of structure. It did, therefore, 
 appear to me contrary to that beautiful simplicity which reigns through- 
 out the animal organism. 
 
 Mr. Paget, in those admirable reports on physiology which are pub- 
 lished in the British and Foreign Quarterly Medical Review, gives an 
 excellent summary of the state of the discussion at present (July, 1846). 
 
 "Bidder and Volkmann, on the one hand, have maintained that 
 there exists in the sympathetic nerve a set of nerve-fibres, characterized 
 by their fineness, (they being only about half or one-third as large as 
 the cerebro-spinal fibres,) their paleness, the absence of a double contour, 
 their nearly uniform contents, and their yellowish gray color when in 
 bundles ; Valentin holding that the sympathetic fibres are neither in 
 structure nor in relations peculiar." 
 
 "The most important contribution," says Mr. Paget, "to the phy- 
 siology of the nervous system this year (1846), is from Kolliker.* 
 
 * Die Selbstiindigkeit und Abkangigkeit des sympathischen Nerven-system. Zurich, 
 1844, 4to. 
 
VESICULAR NEURINE. 47 
 
 u ln the discussion of the question, Kolliker states, 1st, that the fibres 
 described by Remak as peculiar to the sympathetic nerve, and which 
 are commonly called Remak fibres, are, as Valentin has always held, 
 not nerve fibres at all, but Neurilemma, consisting of imperfectly deve- 
 loped fibro-cellular bundles; 2d, he determines that Bidder and Volk- 
 mann are right in their description of the structure of fine nerve-fibres, 
 or at least of the well-marked examples of them, and that these are not 
 (as Valentin maintained that they were) Remak fibres. But he denies 
 that these fine nerve-fibres are peculiar to the sympathetic system, or 
 even so different from the common larger cerebro-spinal nerve-fibres, 
 that they ought to be regarded as of a kind distinct from them. To 
 justify this denial, he shows that the characters assigned to these fine 
 nerve-fibres, as distinctive by Bidder and Volkmann, are neither defi- 
 nitely marked, nor constant, nor essential; that there is no real differ- 
 ence between these fine fibres and those of the brain, spinal cord, and 
 nerves of special sense; that commonly the larger fibres assume near 
 their peripheral end the size and other characters of the smaller ones ; 
 and that many fine fibres are found in all nerves, though it is generally 
 true that there is a smaller proportion of them in the cerebro-spinal than 
 in the sympathetic nerves. 
 
 " But, although it thus appears to be an error to speak of sympathetic 
 and cerebro-spinal nerve-fibres as if they were two different kinds of 
 fibres, yet the differences which do exist between them, and the various 
 proportions in which the fine fibres occur, in different nerves, make it 
 important to discern their origin and course. On these points, Kolliker 
 first proves that these fine fibres have their origin, not only in ganglionic 
 or nerve corpuscles of the sympathetic ganglia, but in those, also, of the 
 ganglia on the cerebral and spinal nerves, and in the corpuscles of the 
 brain and spinal cord. In this, his observations fully confirm those of 
 Helmhotz, Will, and Hannover,* who, like him, have seen this mode 
 of origin ; and from Bidder and Volkmann, who, from another mode of 
 investigation, concluded that fine fibres must thus arise. Kolliker has 
 seen this mode of origin of nerve-fibres in the spinal cord, and in the 
 spinal and sympathetic ganglia of the frog, in the spinal ganglia of the 
 tortoise and cat, and in the Gasserian ganglion of the cat and guinea- 
 pig. Hannover has found it in all classes of Vertebrata, and in many 
 Invertebrata, in the brain and spinal cord, and in all kinds of ganglia ; 
 neither has he observed any^ other mode of origin besides this. The 
 description given by Kolliker, of the spinal ganglia of the frog, is, that 
 they contain one form of ganglion or nerve corpuscles, which are of 
 simple shape, and give off no processes, and many other corpuscles, more 
 or less pyriform, which,, at their smaller end, are drawn out into a pro- 
 cess. This process, like the corpuscles, is pale, and finely granular; it 
 is from fo^Wh to Tffo^h of an inch in diameter, and, after proceeding 
 about j-^th of an inch, it rather suddenly acquires a dark contour and 
 slightly granular contents: it is, in short, becoming a fine nerve-fibre. 
 And in regard to those cases in which he has not seen this mode of origin 
 of the fine fibres, Kolliker so far confirms or admits the truth of Bidder 
 
 * Recherches Microse sur le systeme Nerveux ; Copenhague, 1844, 4to. 
 
48 STRUCTURAL ANATOMY. 
 
 and Volkraann, respecting the relative number of fine fibres, which enter 
 and leave the ganglia, that he considers it proved that a great number of 
 these fibres have their origin in the ophthalmic ganglion, and in the gan- 
 glion of the vagus of fish, and considers it as highly probable that the 
 ganglia of the cerebral and spinal nerves of all the higher animals are 
 also sources for similar fibres.* 
 
 " As to the relative proportions of large and fine fibres in the nerves, 
 distributed to various parts, Kolliker concludes, from his own and other 
 observations, that 1st, The nerves of voluntary muscles contain in their 
 trunks a majority of large fibres, but in their peripheral distribution either 
 only, or a majority of, fine fibres. 2d. The nerves of the skin contain 
 (for the most part) equal numbers of both; but, in some of them, one or 
 other size of fibres greatly preponderates, and, in all of them, the fine 
 fibres greatly preponderate in their peripheral distribution. 3d. The 
 nerves of sensitive mucous membrane are, in this respect, like those of 
 the skin, except that in the nerves of the teeth, pulps, and the gums, 
 there is a great majority of large fibres. 4th. In the nerves of involun- 
 tary muscles, and of the less sensitive or insensible mucous membranes, 
 there is a great preponderance of fine fibres. "f 
 
 From the above facts, it may be concluded that nerve-fibres of the 
 sympathetic nerve differ from those of cerebro-spinal, in the absence of 
 the white substance of Schwann ; and this substance is found where the 
 nerve is more exposed to pressure, or any kind of injury, from external 
 causes. When the filaments of the cerebro-spinal have nearly reached 
 their destination, then they cease to require the protecting material which 
 was necessary in their course down a limb, and between the bodies of 
 the muscles. The sympathetic nerve is generally deep-seated and well 
 protected, and hence the absence of this protecting matter. We can 
 easily understand what contrivance must be necessary to protect the deli- 
 cate neurine when it has to travel, like the sciatic nerve, for instance, 
 from the pelvis to the toes. Physically, it appears almost as strong as a 
 tendon, and it had need to be so, exposed, as it is, in all the movements 
 of the limb. 
 
 Its physical strength, then, and its power of resisting injury, are due to 
 its investing membrane, and the presence of the matter of Schwann; 
 while the essential portion of the nerve, that in which its vital powers 
 reside, is the axis cylinder. 
 
 We all know, that even with all this bountiful provision, the nerves 
 may be easily compressed so as temporarily to suspend their function. If 
 we only fall asleep with one leg crossed over the knee of the other, so 
 as to compress the popliteal nerve, when we awake we find our leg numb 
 and powerless, until we have suffered all the pain of the feeling com- 
 monly called pins and needles, or live blood, as the nerve-fibres recover 
 their power, and the nervous current is re-established. 
 
 * The most striking instance in which more fibres leave than enter the ganglia, is seen 
 in the septum of the auricles of a frog's heart, which is so transparent that the ganglia and 
 nerve-fibres may be counted in it. Here Bidder has often seen more fibres in one than in 
 the other two branches from a ganglion ; e. g. five in one, seven in the other. Volkmann, 
 in Art. Nerven Physiologic, /. c. 
 
 f British and Foreign Quarterly Medical Review, p. 273. 
 
GELATINOUS FIBRE. 
 
 49 
 
 Sometimes when you are examining the nerve-tubes under the micro- 
 scope, from the spinal 
 
 cord of the frog, you will Fi e- 6 - Fi s- 7 - 
 
 see the two kinds of 
 tubes most distinct. The 
 accompanying figure re- 
 presents two of the gela- 
 tinous fibres, one twisted 
 round the other. They 
 were exactly the size of 
 the axis cylinder of the 
 ordinary fibres, as seen 
 in the same field. This 
 sketch was taken with 
 Dr. Carpenter, through 
 whose glass I observed 
 them. (Fig. 6.) 
 
 The nervous centres, 
 or ganglion, consist of 
 the vesicular neurine 
 traversed by the tubular neurine. (See Fig. 7.) This represents very 
 well the appearance exhibited by a ganglion or nervous centre. Let it 
 then be remembered that vesicular neurine does not exist in the nerves, 
 and that, when these cords present a grayish appearance, as in the sym- 
 pathetic, it is owing to the deficiency of the white substance of Schwann. 
 
 Gelatinous nerve- 
 fibres in the frog. 
 
 (Todd and Bowman, after Valentin.) A 
 small piece of the otic ganglion of the sheep, 
 slightly compressed ; showing the interlace- 
 ment of the internal fibres and the vesicular 
 matter. 
 
50 
 
 PART II. 
 
 COMPARATIVE ANATOMY. 
 
 THE naturalist who devotes his time to observing the habits and 
 instincts of animals, their external form and general appearance, pursues 
 a branch of science which has unfolded a multitude of facts highly inte- 
 resting and amusing to him who delights in the works of nature. But 
 the physiologist follows in his pursuit of knowledge a more arduous and 
 elevated path; for, not satisfied with observing the manners, actions and 
 outward appearance of animals, he carries forward his researches to 
 their internal organism, with the view of ascertaining the relation which 
 structure bears to function. 
 
 Researches of this kind afford us the most important and valuable 
 proofs which we possess, of the office of a nervous system in the execu- 
 tion of those acts which are exhibited to us by living beings. By such 
 investigations the physiologist, discovering that the development of their 
 internal organs corresponds with an increased capacity of enjoyment, the 
 existence of which is demonstrated by their habits and instincts, obtains 
 the only evidence which a science of observation like physiology is capa- 
 ble of affording, that they stand in the relation of cause and effect. 
 
 On this principle, I consider that the study of the anatomy and phy- 
 siology of the human brain could not be introduced to the student in a 
 more philosophical manner, or with a prospect of greater advantage to 
 himself, than by taking an extended but general view of the nervous 
 system of the lower orders of animals. I shall not enter with much 
 detail into the immense variety of forms which the study of the nervous 
 system of the whole animal kingdom presents to us, because I merely 
 wish to use comparative anatomy as an ally in my attempt to simplify 
 the study of the human brain, without regarding it, as it really is, as an 
 object of extreme interest, independent of the service which it thus is 
 capable of rendering to the student in medicine. 
 
 The celebrated Haller, who thoroughly felt the value of comparative 
 anatomy in the study of human physiology, and the importance of taking 
 this course, when reasoning on the functions of a nervous system, after 
 observing that a brain and medulla spinalis are met with in animals 
 with a head and with eyes, says, " Neque credo aut oculos absque cere- 
 bro, aut absque oculis cerebrum in ullo animale reperiri. Sunt ergo sua 
 cerebra vermibus, mytulis," &c. 
 
 All physiologists of the present day agree in considering the nervous 
 system as the medium by which animals are connected with the external 
 world. Apd when, in our dissection of some of the inferior orders of 
 
DIVISIONS OF THE ANIMAL KINGDOM. 51 
 
 animals in whom there is an evident susceptibility to receive impres- 
 sions from external nature, and to react upon those impressions, we are 
 unable to demonstrate the existence of a nervous system, we come to 
 the conclusion that the sentient matter which we call neurine is not ab- 
 sent, but developed in such minute quantity and so transparent that it 
 escapes our observation. 
 
 The presence of a nervous system is not necessarily a proof of con- 
 sciousness on the part of the animal in whom it is found. The invaluable 
 and philosophic researches of Dr. Marshall Hall have quite established 
 this most important fact, that all the actions which take place in man 
 and animals in general, independent of volition, are as much excited 
 and guided by the nervous power as those which are directed by the 
 will. For instance, all the complicated acts of swallowing are as much 
 dependent on the nervous system as the act of raising the food to our 
 mouths. These important discoveries of Dr. Hall will of course be more 
 fully considered in relation to the^cerebro-spinal system of man ; but I 
 cannot mention his name without expressing the regret I feel, that the 
 most important contribution to physical science, since the discovery of 
 Bell, should have been passed by unnoticed and unknown by that scien- 
 tific society, whose object is to promote science and reward real merit. 
 These researches of Dr. Hall have been rendered still more valuable by 
 those of Mr. Grainger, Dr. Carpenter, Mr. Newport, and others, who 
 have shown that one of the most important functions of a nervous sys- 
 tem, as regards the vital existence of an animal, is to receive impres- 
 sions, and to react on such impressions, independent of the consciousness 
 or the will of the individual. This fact will be found universal in its 
 application. Wherever the wants of an animal require a consent in the 
 action of its organs, such actions are called into play, and superintended 
 and controlled by a nervous system. If we examine the organization of 
 the simplest animals, we find that it consists of little more than a sto- 
 mach for digesting food, and arms for the collection of it. There must, 
 however, be a consent between these organs of digestion and collection, 
 and we find in them a nervous system to effect it. As we ascend in the 
 animal kingdom, we find other organs added to those of mere digestion 
 and collection, or prehension, and with them a more complicated nerv- 
 ous system ; so that, in fact, the size and complexity of the nervous sys- 
 tem are a good criterion of the endowments of the animal, and its relative 
 position in the scale of animated existence. And the nervous system is 
 now universally allowed to afford the best principle for the classification 
 of animals. The animal kingdom has been divided into five grand di- 
 visions, or sub-kingdoms, and named in accordance with the form arid 
 arrangement of the nervous system. 
 
 1st. The Cryptoneura of Rudolphi, or the Acrita of MacLeay. 
 
 2d. The Nematorieura of Owen, Cycloneurose of Grant, Radiata 
 of Cuvier. 
 
 3d. Homo-Gangliata of Owen, Diploneurose of Grant, Articulata of 
 Cuvier. 
 
 4th. Hetero-Gangliata of Owen, Cyclo-Gangliata of Grant, Mollusca 
 of Cuvier. 
 
 5th. Myelencephala of Owen, Spini-cerebrata of Grant, Vertebra t'a 
 of Cuvier. >**' 
 
52 
 
 COMPARATIVE ANATOMY. 
 
 Fig. 8. 
 
 In the first of these divisions the nervous system is indiscernible, and 
 neurine, if existing at all, is so minute in quantity, and so transparent, 
 that it cannot be demonstrated as forming a separate system. In the 
 second, the Nematoneura, the ganglia are so extremely minute that the 
 whole presents a mere thread-like appearance. But the term is applica- 
 ble only as designating the appearance, and not the actual structure ; for 
 in these animals, Ganglia, Commissures, and Nerves, the three element- 
 ary portions of every nervous system, though scarcely visible, exist as 
 perfectly formed as in the highest animals. Thirdly. In the Homo- 
 Gangliata the ganglia are generally of nearly equal 
 size; none decidedly exceeding any of the rest. 
 Fourthly. The Hetero-Gangliata are so named 
 from the singular manner in which the ganglia 
 are scattered through the body. Fifthly. The 
 Myelencephala include all animals with a perfect 
 brain and spinal cord. 
 
 It will generally be found that the Nematoneura 
 are the most simple ; the Homo-Gangliata the next, 
 and so on. But this is not uniformly the case; 
 for the nervous system, to which, as being the 
 most simple, it will be desirable first to direct our 
 attention, is taken from the Homo-Gangliate divi- 
 sion. But it is not improbable that the simplicity 
 in this instance arises solely from its being imper- 
 fectly developed or in a rudimentary state, and 
 may perhaps, therefore, be considered as affording 
 an imperfect type of a nervous system. 
 
 As my present object, in alluding to the nerv- 
 ous organization of the lower orders, is not, as I 
 have said, to carry my readers minutely into the 
 subject, but solely to make the study of the human 
 brain more simple and interesting, I shall confine 
 myself to the description of the most prominent 
 features in each division. 
 
 The most simple form in which we find the nerv- 
 ous matter arranged so completely as to constitute 
 a distinct nervous system is in the Ascaris, a spe- 
 cies of intestinal worm ; we can scarcely conceive 
 an animal having its relations to the external world 
 more limited than this; it has not even to seek its 
 food beyond the narrow spot to which its existence 
 is confined, and can therefore have little necessity 
 Mouth surrounded by three f Qr a nervous system, and we find it accordingly 
 
 tubercles, b. The anus. r. t J ' CT J 
 
 Contracted portion found at but imperfectly developed. Jules Cloquet has 
 
 the union of* the anterior . , * /. . 
 
 third of the body, with the given us the best account of the nervous system 
 two posterior thirds %T i.Ab- animals: it is from a work published by 
 
 1* Female Ascaris seen on 
 its abdominal surface 
 
 dominal nerve. 2. Vulva. 
 
 2* An enlarged view of him on this subject, in 1824, that the following 
 
 Two white 
 
 a transverse section of the - . 
 
 game worm. A. The skin, account and drawing were derived. 
 
 '"Dorsal nerve, 
 nal nerve. 
 
 2. Abdomi- 
 
 i. cords, rather thicker in the middle of the body 
 t ^ e ex t re mities, composed of a series of 
 
ASCARIS. ASTERIAS, 
 
 Fig. 9. 
 
 small lines united at angles, or, as it were, broken and slightly swollen 
 at each angle, sending to the right and left filaments so thin that they 
 escape the eye, except when seen through a magnifying lens, constitute 
 their nervous system. These cords are situated within the plane of the 
 muscular fibres, and descend, the one on the abdominal, the other on 
 the dorsal, surface of the alimentary canal. The abdominal nerve forms 
 a circle around the vulva of the female, as will be seen by reference to 
 the diagram ; the slight enlargements Cloquet regards as ganglionic. 
 
 Laennec, Otto, Lamarck and Cuvier all agree with Cloquet in con- 
 sidering the lines above described as the nervous system. Nevertheless 
 it appears to me extremely probable that these cords do not represent a 
 perfect type of a nervous system, even in its most simple form, but that 
 in this individual it has been arrested in its development 
 at a period corresponding to one of the regular stages 
 through which the nervous system passes in the higher or- 
 ders, in whom we know that the nerves are developed first, 
 and the centres or ganglia afterwards ; and in this animal, 
 where the ganglia scarcely exist, is it not possible that the 
 organization is incomplete; that the animal, in fact, is not 
 perfect; that the conducting portion of the nervous appara- 
 tus has been formed, but not the point from which the 
 power emanates, requiring to be conducted ? 
 
 The above simple arrangement perfectly corresponds with 
 the first appearance of the cerebro-spinal axis during deve- 
 lopment of the vertebrated class of animals, and affords a 
 beautiful illustration of the law, that the higher classes of 
 animals, during their development, go through some of those forms which 
 are permanently retained by the lower 
 orders. About the twenty-fourth hour 
 after incubation has commenced in 
 the egg of the common fowl, the ru- 
 diment of the spinal cord may be 
 seen in the form of two white lines 
 (see fig. 9), perfectly similar in ap- 
 pearance to the nervous cord in the 
 Ascaris. 
 
 Let us next direct our attention to 
 the nervous system of one of the 
 Asterias ; it is beautifully simple, and 
 not the less instructive ; for whether 
 we regard the motions of this animal 
 as the result of volition or not, they 
 are evidently regulated, and not ac- 
 cidental. It has the power of loco- 
 motion, and will adapt the position 
 of its rays, one after the other, to the 
 crevices of the rocks, where it seeks 
 
 and obtains its food; and When in Nervous system of the star-fish, drawn from a 
 nftnn^An nn ' 4.U *i_ ' r preparation in King's College Museum. 1,2,3. 
 
 accordance With thlS power Of appa- Nerves distributed to .three of the rays. 4. One 
 
 rently commanding the execution of u f re h s ? twelve gailglia - 5 * " e of the commi8 
 
 Ovum of the 
 chick, 24th hour. 
 (After Dr. Allen 
 Thomson.) The 
 white line repre- 
 sents the rudi- 
 ment of the ner- 
 vous system. 
 
 Fig. 10. 
 
54 COMPARATIVE ANATOMY. 
 
 i 
 
 certain offices in different portions of its frame, we detect nervous cords 
 emanating from nervous nodules, we are induced to regard them as in- 
 struments employed in the production of these phenomena. Tiedemann 
 was the first to prove decidedly the existence of a nervous system in the 
 star-fish. His account was published in 1816,* accompanied with a 
 beautiful drawing of it, representing a ring surrounding the oesophagus, 
 giving off a filament to each ray, besides ten smaller ones, which he be- 
 lieves to descend to the stomach ; at the same time he observes that he 
 could not discover anything like ganglia. Their existence has, how- 
 ever, been since distinctly proved ; and in an excellent preparation of 
 the twelve-rayed star-fish in the Museum of King's College, twelve little 
 nodules of neurine or ganglia, one opposite each ray, may be distinctly 
 seen, from which fig. 10 is taken. 
 
 This nervous system, simple as it is, forms an accurate type of the 
 most complicated in the highest species of animated beings, containing, 
 if I mistake not, exactly the same number of elements; and the distinct 
 portions to which we must now attach different names, should peculiarly 
 engage the student's attention when thus presented to his observation 
 under this the most simple form. When called upon to trace the same 
 arrangement in the human being, he will be in danger, from the greater 
 number of similar parts closely connected together appearing to do away 
 with this fundamental simplicity, of being lost in the labyrinth of per- 
 plexing obscurity, which seldom fails to disgust those who attempt to 
 learn the structure of the brain in the ordinary method. 
 
 The three portions may be designated, ganglia or nervous centres, 
 commissures, and nerves. 
 
 The small swellings or nodules of neurine, are the ganglia. 
 
 The cords which pass between the different ganglia, and thus connect 
 them together, are the commissures, or apparatuses of union. 
 
 The cords which are connected to the ganglia by one extremity, and 
 the textures of the different organs by the other, are the nerves. 
 
 The term ganglion is not the best that might be devised for the de- 
 signation of this portion of the nervous system, as merely signifying a 
 knot : it only characterizes its external appearance, without in the 
 slightest degree implying its function as distinguished from the nerves 
 and commissures. 
 
 But as it seldom answers to attempt a decided change in the nomen- 
 clature of a science like anatomy, which has existed for so many years, 
 it will perhaps be better to employ the same term in the comprehensive 
 meaning which comparative anatomy justifies us in adopting. 
 
 Human anatomists have been too much in the habit of considering a 
 peculiar rounded form essential to the constitution of a true ganglion, 
 not usually, therefore, applying the term ganglion to a collection of cine- 
 ritious matter, unless moulded into a knotted form and supported by a 
 dense membrane: thus the medical student has been led to imagine that 
 the neurine which is contained within the human skull, is altogether 
 different from the ganglia of the lower orders of animals, merely because 
 it differs from them so much in its outward appearance. 
 
 * Anatomie der Rohren-Holothurie des Pomeranzfarbigen Seesterns und Stein. 
 
GANGLIA. 55 
 
 But the fact really is, that if the terra ganglion be correct as applied 
 to the nodules of neurine or centres of power in the lowest animals, it is 
 equally correct to apply it to those of the highest ; and it therefore follows 
 that the human brain is but a series of large ganglia. Their close con- 
 nection, and the great size of the commissures, give to it a degree of 
 complication which we can only unravel, by seizing the thread at this 
 simple though perfect type of a nervous system, and never dropping it 
 till it has conducted us through all the various additions made to its 
 fundamental simplicity, up to the perfect but complex organization in 
 the human being. 
 
 That a peculiar form is not indispensable to the constitution of a gan- 
 glion, even according to the confined sense in which that term is used in 
 the descriptive anatomy of the human body, is proved by the fact, that 
 a simple layer of cineritious neurine of a sernilunar form, lying between 
 the dura mater and skull in the temporo-sphenoidal fossa, through which 
 the posterior root of the fifth pair of nerves passes, is described as being 
 perfectly analogous to the rounded firm knots which are attached to the 
 posterior roots of all the spinal nerves; and the analogy is perfect : but 
 it ought to teach us this lesson that a particular form is not essential to 
 the constitution of a ganglion. I think, therefore, that we are justified 
 in extending the term ganglion ; and I am quite sure that it would enable 
 us very considerably to simplify the anatomy of the human brain, if we 
 were to apply it thus to any collection of cineritious neurine into a cir- 
 cumscribed mass, whatever form or arrangement it may assume: for in- 
 stance, the cineritious neurine which forms the convoluted surface of the 
 hemispheres of the human brain, I should denominate the Hemispherical 
 Ganglia; for the convoluted appearance arises solely from the circum- 
 stance, that it was necessary a contrivance should be adopted to pack a 
 very extensive surface into a small space, on the same principle, (and I 
 trust that the homeliness of my simile will be excused for its simplicity,) 
 that when we put a handkerchief into our pocket, we fold it up instead 
 of attempting to carry it about us spread out to its whole extent. Now 
 there would be just as much reason to deprive the semilunar ganglion 
 of its generic title, and give it a name merely in accordance with its 
 appearance, as there is in separating the hemispherical ganglia of the 
 human brain from their analogous ganglia in the lower animals, and 
 designating them by a term which gives a mystery to their character 
 they do not deserve. 
 
 It is a great pity that anatomists cannot agree upon some generic title 
 for the cortical substance of the human brain, so as to distinguish it from, 
 the tubular neurine which, with it, forms the hemispheres of the brain. 
 It is a distinct ganglion, and as such ought to have a name ; I gave it 
 that of hemispherical, because it appeared to me the best that could be 
 adopted : and I think so still ; but if any other anatomist had re-named 
 it well, I would have followed him in this edition, sooner than leave it 
 without a name. There would be just as much sense in calling the 
 occipito frontalis muscle the cortical substance of the cranium, as there 
 is in calling the hemispherical ganglion the cortical substance of the brain. 
 
 When the physiologist is engaged in the difficult task of discovering 
 the office of any particular apparatus in the organism of an animal, there 
 
5# COMPARATIVE ANATOMY. 
 
 are few proofs which are so clear and satisfactory as those derived from 
 some decided peculiarity of structure : as a simple instance, we may cite 
 the tubular form of arteries and veins, convincing us that they are in- 
 tended to carry fluids, and the valves in the interior, proving to us that 
 those fluids could only flow in one direction. Now in our investigations 
 into the functions of a ganglion as distinguished from the other portions 
 of the nervous system, it is true that we shall not be able to derive, from 
 the study of its structure, proofs of its function so clear and decided as 
 those just cited in reference to the circulating system. The gray or 
 pulpy neurine is always met with in a ganglion, and the fibrous alone 
 enters into the composition of a nerve, while the commissures are occa- 
 sionally compounded of the two. This circumstance, independent of all 
 that has been already advanced, to prove that the nervous power is 
 generated by the vesicular neurine, would be almost conclusive. 
 
 If it be true, that -the cineritious matter alone is endowed with the 
 faculty of generating or producing power, while the medullary is simply 
 capable of conducting it, we must conclude that the nerves are not only 
 the instruments of conduction, but that those portions of the human brain 
 which are formed of medullary neurine must perform exactly the same 
 function, and that the great transverse commissure or corpus callosum, 
 the longitudinal commissure or fornix, and in fact all those commissures 
 into whose texture the medullary neurine alone enters, must necessarily 
 be conductors and not originators of the peculiar powers by which the 
 nervous system is distinguished from every other. Is it not then ex- 
 tremely probable that the office of the commissures is to enable the 
 individual to compare those impressions which are conducted by the 
 nerves of sensation, from the especial organs of sense in which they 
 originate, as the eye and the ear, to the hemispherical ganglia, the seat 
 of judgment, memory, &c. ? 
 
 The vital phenomena which living beings present to our observation 
 are of two kinds : the one comprehends all those functions which tend 
 to the maintenance and preservation of their individual existence, and 
 the reproduction of their species ; while the other class of phenomena 
 bring them into relation with the external world, informs them of the 
 existence of surrounding objects, and, manifested in the activity of the 
 intellectual faculties, teaches man in particular the properties of bodies 
 and the laws which regulate them. Those functions by which the nutri- 
 tion and growth of individuals and the reproduction of species are 
 effected, are common to all living beings, vegetables as well as animals, 
 and there can be no life without them ; but the second order of functions, 
 the manifestation of which proves to us that the individual is capable of 
 receiving impressions from external nature, and of reacting upon these 
 impressions, showing thereby a consciousness of their existence, is pecu- 
 liar to animals. 
 
 All true physiologists, even from the time of Aristotle, have observed 
 more or less accurately the distinction between these two classes of phe- 
 nomena; arid arranged them accordingly. Aristotle conceived that they 
 might be classified under three heads vital, natural, and animal ; the 
 first two comprehending those which we now combine under the head 
 of vegetable life. 
 
CYCLO-GANGLIONIC SYSTEM. 57 
 
 Galen adopted the same arrangement, but added the hypothesis that 
 these functions were superintended or controlled in their operation by 
 presiding spirits; something in the same way that some physiologists of 
 the present day believe in the existence of a single vital principle, whose 
 office it is to effect all the various vital phenomena which are presented 
 to our observation by living beings. 
 
 Bichat arranged the functions, like many of his predecessors, under 
 two heads; but instead of referring the power, which appears to regulate 
 and preside over these phenomena, to some mysterious spirit, he con- 
 sidered it to be dependent for its very existence on the nervous system; 
 and this led him to divide the nervous material into two systems, the 
 one of which he called the nervous system of organic, perhaps better 
 called vegetative life, and the other of animal life. 
 
 The first of these systems in man was formerly designated the sym- 
 pathetic nerve, from a belief that it arose from the brain in a similar 
 manner to the cerebral nerves in general. Its title of sympathetic was 
 owing to the idea that the sympathy which exists between all the vital 
 organs was dependent for its existence on this nerve. The idea that it 
 arises from the brain is erroneous; for it differs from the cerebral nerves 
 as completely as the brain and spinal cord themselves do from the nerves 
 which arise from them. And the notion being rejected, it has since been 
 called the ganglionic system a name which I think objectionable, in as 
 much as it might lead the student to imagine that those nodules of neu- 
 rine called ganglia were peculiar to this system, which, as he advances 
 in his studies, he would find to be erroneous. 
 
 It has appeared to me that, in describing this portion of the nervous 
 system in man, it would be better to designate it the Cy 'do- ganglionic or 
 hetero-ganglionic system, as corresponding in its mere anatomical ar- 
 rangement with the nervous system of the cyclo-gangliated or molluscous 
 division of the animal kingdom. 
 
 Physiologists were divided in opinion as to which of the two systems, 
 the sympathetic or the cerebro-spinal, the nervous apparatuses of the 
 lower orders ought to be referred. Before the sympathetic system had 
 been acknowledged in man and the lower animals as distinct from the 
 cerebro-spinal system, every appearance of a nervous system was very 
 naturally considered as corresponding to the cerebro-spinal. 
 
 But after the sympathetic system was admitted to be independent in 
 its powers in man and the higher animals, physiologists, looking only 
 to resemblance in outward appearance, and not to analogy of function, 
 began to maintain that the nervous system of the lower orders corre- 
 sponded exactly to this, the system of vegetative life of the upper. 
 
 It is now, however, generally believed that where a distinct nervous 
 system is present, and there is an evident separation of the animal from 
 the organic or vegetative functions, in all probability there are three 
 presiding nervous systems : 
 
 1st. The cerebral or brain system. 
 
 2d. The true spinal or excito-motory system of Dr. M. Hall. 
 
 3d. The sympathetic or cyclo-ganglionic system, the system of organic 
 life of Bichat. 
 
 And though it is difficult, most probably on account of its minuteness, 
 
58 COMPARATIVE ANATOMY. 
 
 in many of the lower animals, to demonstrate the existence of the nerv- 
 ous system of vegetative life, as distinct from that of animal life, there 
 is very little doubt that it always exists ; and it has, in fact, lately been 
 demonstrated in many of the lower orders where its presence was not 
 previously even suspected. 
 
 Dr. Grant, in speaking of the nervous system as developed generally 
 in the animal kingdom, says " The nerves of sensation and motion 
 closely accompany each other, forming by their union, cords or columns, 
 or a cerebro-spinal axis ; but the sympathetic nerves, appropriated to 
 the more slow and regular movements of organic life, form a more iso- 
 lated system, and these three systems are developed together, almost 
 from the lowest animals."* 
 
 The following literary history, from Dr. Fletcher's Lectures, of the 
 opinions held concerning the uses of the ganglionic nerves from Galen 
 to Brachet, is so excellent and comprehensive, that I think its introduc- 
 tion in this place will be acceptable to my readers. " Before the time 
 of Galen the ganglionic system of nerves was entirely unknown ; and 
 although by him and his followers, the Arabians, the existence of this 
 system, as well as its supposed origin from the superior maxillary branch 
 of the trigeminal nerve, was pointed out, as well as its other supposed 
 origin from the abductor nerve was subsequently by Eustachius, it was 
 not till the time of Willis that the ganglionic nerves were generally 
 considered as a part of the nervous system at all. 
 
 " Willis, however, still looked upon them as merely an appendage to 
 the cerebro-spinal system, and represented them, both in verbal descrip- 
 tions of them and in his curious diagrams of their distribution, as grow- 
 ing upon the latter ' ut frutex super alio frutice.' And this notion hav- 
 ing been adopted by Vieussens (Neurograph., 1684J, Lancisi (Opera 
 Omnia, 1745), Meckel, senior (Memoires de Berlin, 1745), Zinn (ditto, 
 1753), Hoare (De Ganglia Nervorum, 1772), Scarpa (De Nerv. Gang!., 
 1779), Monro (On the Structure and Function of Nervous Ganglia, 
 1783), Blumenbach (Inst. Physiol., 1786), Chaussier (Exposition, &c., 
 1807), Legallois (Sur le Principe de la Vie, 1812), Beclard (El. d'Anat. 
 Gen., 1823), Wilson Philip (On the Vital Functions, 1817), Mason 
 Good (On the Study of Medicine, 1825), and numerous other writers, 
 both before and since the time that their independence was insisted on 
 by Winslow, it has become a very prevalent custom to regard these 
 nerves as of very secondary importance; and the names imposed upon 
 the system in general, as well as the uses assigned to it, have generally 
 corresponded with this idea. 
 
 " The ganglions of the sympathetic nerve were supposed by Galen, 
 their discoverer, to act as buttresses, in order to strengthen them as 
 they recede from their reputed origin ; by Willis as a kind of diverticula 
 to the animal spirits received from the brain, and also as a means of 
 keeping up a sympathy between distant organs: Vieussens and Meckel 
 adopted the same opinion. 
 
 " Lancisi looked upon them as forcing-pumps adapted to propel the 
 animal spirits along the nerves. 
 
 * Outlines of Comparative Anatomy, Part II. 
 
RADIATA. 59 
 
 "The doctrine of the independence of the ganalionic system was es- 
 poused by Cuvier (Lemons d'Anat. Comp., 1799), and particularly in- 
 sisted on, with his accustomed eloquence, by Bichat (Sur la Vie et la 
 Mort, 1802), who represented all the ganglions of this system as c des 
 centres particuliers de vie organique, analogues au grand et unique cen- 
 tre de la vie animate qui est le cerveau ;' and who further demonstrated, 
 not only that all these ganglions were collectively independent of the 
 cerebro-spinal system, but that each ganglion was independent of every 
 other ; nay, that each nerve proceeding from such a ganglion was in a 
 great measure independent of that ganglion, and even that each point of 
 such nerve was independent of all the rest, and constituted, per se, a 
 distinct focus of nervous influence. 
 
 " Richerand (Phys., 1804), and Gall (Anat. et Phys. du Syst. Nerv., 
 1810), adopted similar tenets ; and they are further inculcated by 
 Wutzer (De Corp. Hum. Gang!., 1817), and Broussais (Journal Univ. 
 des Sc., 1818), the latter in particular describing the ganglionic system 
 of nerves as possessing a peculiar kind of sensibility (i. e., irritability), 
 with which it immediately endows all the organs destined for nutrition, 
 secretion, and the other organic functions, and, by means of its repeated 
 connections with the cerebro-spinal system, all organs of the body. 
 
 " Brachet, in an especial manner (Sur les Fonctions du Syst. Nerv. 
 Gangl., 1823), distinctly represents the ganglionic system of rierves as 
 the seat of ' imperceptible sensation,' and as presiding in an especial 
 manner over the several viscera of the body." 
 
 In directing our attention to the relation which the development of 
 the nervous system bears to the manifestations of consciousness in each 
 individual of the animal kingdom, it is interesting to observe the rela- 
 tive position which the nervous system, in its simplest form, holds 
 to the alimentary canal : we must not, however, attempt to account for 
 this circumstance by supposing that the presence of a nervous system is 
 necessary to the solution, digestion, and assimilation of the alimentary 
 matter ; for these processes are perfectly executed by the fresh-water 
 Polypus, or Hydra viridis, in which there is not the slightest trace of a 
 nervous system. Almost the whole existence of the lowest order of ani- 
 mals appears devoted to the acquirement of food and the reproduction of 
 their species ; apparently they answer no other end in creation than that 
 of elaborating a nutrient material for others that hold a higher rank in 
 the animal kingdom ; and the whole of their vital energies being de- 
 voted to this object, we cannot be surprised that those organs which 
 are expressly constructed for its fulfilment, should be surrounded by, and 
 thus intimately connected with, that system (the nervous) by which the 
 animal is informed of the existence of surrounding things, and is fitted 
 to act upon these to the extent of its limited necessities. 
 
 In the animal which we have last described, the star-fish, it is evident 
 that one of the earliest forms of nervous system which is cognizable to 
 our senses presides over the motive apparatus of the animal. But, let 
 it be remembered, it does not follow that such motions necessarily indi- 
 cate any volition or consciousness on the part of the animal executing 
 them. The nerves of the star-fish, like the spinal nerves in man, may 
 most probably be divided into two classes, the excito and the motory, or 
 
60 COMPARATIVE ANATOMY. 
 
 the incident and the reflex ; the motor nerves arising in the ganglia, and 
 distributed to the arms, the excitor arising round the mouth, and termi- 
 nating in the ganglia. In this individual all the ganglia are of equal 
 dimensions, none predominating in size over, or differing in function 
 from the rest ; there is no concentration of power : all is equally diffused. 
 The office performed by the nervous system, even of this simple animal, 
 cannot be understood without a further knowledge of Dr. M. Hall's view. 
 Our readers will then be better prepared to understand the function of 
 the various ganglia of the Articulate and Molluscous divisions of the 
 animal kingdom. They will also, after seeing these ganglia scattered 
 about the bodies of the lower animals, again recognize them in a more 
 concentrated form in the human being, and thus receive a clue to their 
 analogies in the human being, when they are presented in a more con- 
 centrated form. Dr. Marshall Hall, in the preface to his first work on 
 this subject, thus states his views: "First. That there is a source of 
 muscular action equally distinct from voluntary motion, and from motion 
 resulting from the irritability of the muscular fibre. Second. That there 
 is a series of incident excitor nerves, and of reflex motor nerves, which, 
 with the true spinal marrow as their centre or axis, constitute the true 
 spinal system, as distinguished from the cerebral, through which that 
 muscular action is excited. Third. That the ingestion and egestion of air 
 and of food, and the action of the orifices and sphincters of the body, are 
 dependent upon this system. No physiologist has observed that the 
 action of the larynx and pharynx in deglutition and vomiting, and in 
 respiration, and that of the sphincters, continually depends upon the spinal 
 marrow and certain excitor and motor nerves.* 
 
 " The eyelids close when the eyelash is touched, through the same 
 agency of excitor and motor nerves, and of the spinal marrow." 
 
 Respiration has been shown to depend upon the medulla oblongata. 
 But this part of the spinal marrow has been erroneously supposed to be 
 the source and primum mobile of this function ; whereas Dr. M. Hall 
 believes he has ascertained that the pneumo-gastric is that primum mo- 
 bile, as the principal excitor nerve of respiration : 
 
 " The action of the ejaculators obviously depends upon the same 
 excito-motory or true spinal system." 
 
 The fourth of Dr. Hall's views is, " That the true spinal system is 
 the exclusive seat of convulsive diseases ." 
 
 The fifth is, " That the same system is the seat of action of certain 
 causes of disease and of certain remedial agents" 
 
 Legalloisf and Mr. MayoJ have shown " that distinct portions of the 
 spinal marrow have distinct functions; but these functions have been 
 confounded with sensation and with voluntary and instinctive motion, 
 and have remained both unexplained, and without any application to 
 physiology or pathology." 
 
 Dr. Hall left to others the task of applying his principle to the eluci- 
 dation of the physiology of the nervous system of the lower animals. 
 
 * In order to see the proofs of this remark, the reader need only turn to the justly popular 
 works of Mayo, "Physiology," ed. 3, pp. 113, 114, 361, &c.; and of Magendie, ed. 3 & ] 1, 
 pp.65 68, I32,&c. 
 
 t CEuvres, Paris, 1824, p. 62, &c. J On Human Physiology, pp. 230, 231. 
 
ARTICULATA. 61 
 
 Mr. Grainger was the first who pointed out the instruments by which 
 these excito-motory actions are performed in man, and their analogues 
 in the lower animals. 
 
 In his admirable work on the spinal cord, he thus expresses himself: 
 " The anatomical characters of the invertebrated animals afford, how- 
 ever, the most striking evidence of the true formation of the spinal cord, 
 and corroborate, in a manner not to be mistaken, the account that has 
 been given in the preceding pages, of the anatomical arrangement of the 
 spinal nerves. In the immense division of the Articulata, it is found 
 that the nerves of the body are attached to masses of a granular gray 
 substance, but hitherto the true relations existing on the one hand be- 
 tween the nerves and these masses, and on the other hand between the 
 latter and what is considered as the brain, have not been determined. A 
 careful examination, however, of that descending and, as it were, gra- 
 duated scale which is formed by the nervous system in the animal king- 
 dom, consequently demonstrates that the Articulata possess parts which 
 are the exact analogues of the structures that exist in the Vertebrata. It 
 was surmised by Sir C. Bell, that there exists, from the worm up to man, 
 a series of nerves subordinate to sensation and volition, constituting 
 what that profound physiologist called the regular or symmetrical nerves, 
 a supposition which has been in part realized by the beautiful discovery 
 of Newport, who has proved the identity of the gangliated thread of the 
 Articulata with the spinal cord of the vertebral animals. This writer 
 has not, it is true, referred to any division of the motor and sentient 
 nerves into two orders of fibres, similar to those which are capable of 
 demonstration in the Vertebrata, nor have I been hitherto able to detect 
 such an arrangement; but, when we consider the remarkable intricacy 
 and minuteness of the whole structure in these animals, and recollect 
 how lately even the two roots themselves have been discovered, it may 
 be well permitted us to doubt if the entire anatomy of these nerves is 
 yet known. 
 
 "It is seen on inspection that the nerves are attached, as has already 
 been stated, to the ganglions, which bodies are themselves connected 
 by a few delicate longitudinal threads, which also extend from the upper- 
 most ganglion to the brain. Now from the analogy of the vertebrated 
 animals, it may be assumed that these threads consist in part of longitu- 
 dinal commissures, by which the ganglia are combined in their functions, 
 and in part of true sensiferous and volition filaments, which terminate in 
 the brain. In descending the scale, from the most perfect animal to the 
 lowest classes in which a symmetrical nervous system exists, it is seen 
 that exactly as the motions of the body become independent of the brain, 
 the nerves contain a larger proportion of those fibres (the true spinal) 
 which terminate in the substance of the spinal cord, and fewer cerebral. 
 But it is most erroneous to assert, as some authors have done,* that in 
 the invertebrated animals the spinal cord is not directly continuous either 
 with the brain or with itself; on the contrary, wherever there is a gray 
 mass in the head, however minute, which corresponds in office with the 
 brain, a connection with the nerves through the medium of the spinal 
 
 * Fletcher's Rudiments of Physiology, PI. 2 b, p. 87, 
 
62 COMPARATIVE ANATOMY. 
 
 cord is indispensable to the exercise of that voluntary control over the 
 motions of the body which in these instances always exisls. 
 
 "In the invertebrate animals thus endowed, there is in fact no difference 
 in the type of the cerebro-spinal axis, when contrasted with that of the 
 Vertebrata; there are innumerable varieties of form, but in every instance 
 the essential structures have a real existence."" 
 
 Dr. William Carpenter followed Grainger in this path, and in the 
 fullest and in the most philosophical manner has brought the anatomy of 
 the Mollusca to elucidate this subject. Dr. Carpenter enunciated his 
 views in his inaugural Thesis, printed in 1839. t 
 
 I shall avail myself largely of its contents in the following observations 
 on this subject. In his Introductory Remarks he says, " One of the 
 principal objects which the author has kept in view, has been to ascer- 
 tain how far Dr. M. Hall's doctrine, regarding the distinctness of the 
 excito-motor from the sensori-volitional system of nerves, accords with 
 the data furnished by comparative anatomy." 
 
 One great advantage to be gained by studying the nervous system of 
 the invertebrate class of animals is, that the centres are so completely 
 isolated, and the nerves which they distribute so easily traced, and the 
 organs they supply, that it is much easier to discover the probable office 
 of each individual ganglion than it is in man, where they are so closely 
 packed, and the connections of all so numerous, that it is not easy to 
 decide so accurately over w r hat organs, or sets of organs, each nervous 
 centre presides. 
 
 Our next illustration shall be selected from the Molluscous division of 
 the animal kingdom, not because it comes next in the ascending scale 
 of animal life, but because, from its simplicity, it is best suited to our 
 purpose. It is from the class TUNICATA; in external appearance they 
 seem but little raised above the Sponges; the greater part of them pass 
 their whole lives in one situation, attached, like the Corals, to the rocks 
 many of them are associated on one stalk, like the Polypes. 
 
 These animals are enveloped in a tough elastic tunic (the analogue of 
 the valves of the Conchifera), and within this is found a muscular coat, 
 consisting of fibres crossing each other in various directions, by which 
 compression may be exercised on the contents of the cavity it surrounds. 
 Two openings penetrate these sacs; one, termed the branchial, admits 
 water to the general cavity, partly for the purpose of aerating the blood, 
 and partly to bring food to the digestive orifice ; the other, termed the 
 anal, gives exit to the current which has passed over the respiratory 
 surface, and also to the contents of the intestine and ovaria. These 
 openings are bounded by distinct circular sphincters, with which radiat- 
 ing muscular filaments are intermixed, that extend in longitudinal bands 
 over the surface of the sac. 
 
 By means of this apparatus, the animal is capable of diminishing the 
 capacity of the branchial sac, and thus of ejecting, with considerable 
 force, a part of the water it contains ; whilst the elasticity of the external 
 
 * Observations on tlie Structure and Functions of the Spinal Cord, by R. D. Grainger, 
 1837. 
 
 f Physiological Inferences to be deduced from the Nervous System of the Invertebrated 
 class of Animals. 
 
TUN1CATA. 63 
 
 tunic spontaneously restores its usual dimensions when the contracting 
 power is inactive. No movements of this kind, however, are commonly 
 employed either for the respiratory process or for the prehension of food. 
 
 A continuous and equable current of fluid enters the branchial orifice, 
 and is propelled by the anal, without any other visible physical agency 
 than the movement of the cilia, which cover the aerating surfaces. 
 The mouth, or entrance to the stomach, is situated at the entrance of 
 the branchial sac, and is unprovided with any special sensory apparatus; 
 it seems to derive its supplies from the respiratory current alone, and 
 not to depend upon any prehensile movements; but particles unfit to 
 enter it are probably stopped at the branchial orifice. Moreover, as each 
 animal possesses within itself all the organs necessary for the propaga- 
 tion of its race, and as these appear contrived simply for the passive 
 evolution of germs, no powers of active motion are called into exercise 
 by the performance of this function. 
 
 So far as the regular vital operations are concerned, therefore, we see 
 indications of voluntary actions in these animals, or even of that kind of 
 respondence to impressions which would lead us to suspect the existence 
 of a connected nervous system. But in the simultaneous contraction of 
 the whole muscular sac, which is occasionally witnessec), we can scarcely 
 fail to acknowledge the operation of nervous agency. 
 
 If one of these animals be touched when its cavity is full of water, a 
 jet of fluid is thrown out to some distance, and sometimes a number are 
 so closely impacted together on the rocks, that the impression given to 
 one, causes it suddenly to retract, which acts also on the one next to it, 
 and so on throughout several of them, and each in contracting throws 
 out a quantity of water. We find, accordingly, on examining into the 
 characters of the nervous system, that it is most simple in its structure 
 and distribution. We have here no repetition of parts, as in the Radi- 
 ata, and one ganglion serves as the centre of all the actions to which 
 this system ministers. This ganglion lies between the two orifices, and 
 sends filaments towards each, as well as others that ramify upon the 
 muscular sac, to which they seem almost exclusively confined. 
 
 In fig. 11 are seen the position of the ganglia and the 
 distribution of its filaments in Ascidia mammillata. Fig. n. 
 
 The nervous filaments which pass to the branchial ori- 
 fice, diverge to enclose it, and meet again beyond, so 
 as to form a complete ring. 
 
 The only organs of special sensation that this animal 
 can be regarded as possessing, are the tentacular fila- 
 ments which fringe the interior of the branchial orifice. 
 Although nothing is absolutely known of their function, 
 it would not seem improbable that they are susceptible 
 of impressions from substances entering with the respi- 
 ratory current, which, being propagated at the ganglion, 
 may excite the closure of the sphincters by means of the 
 motor nerves, and thus prevent the admission of inju- 
 rious bodies. Should this be the case, we can hardly system, ieuvier.) a. 
 
 1.1,. ,, , i i Branchial orifice, b. 
 
 regard the action as of more than a sympathetic charac- Anai. . Ganglion, 
 ter, since the closure of the sphincters in the higher ani- .. Tadiating fila " 
 
COMPARATIVE ANATOMY. 
 
 mals is, in like manner, independent of the impulse of volition, although 
 capable of being influenced by it A It would seem probable, too, that by 
 the same sphincters is regulated the quantity of water which shall enter for 
 the supply of the respiratory and digestive organs, in accordance with their 
 requirements, communicated in like manner through the ganglion, and 
 the ciliary movements would appear to be under the same control (al- 
 though not so in the higher animals), since in those beings which make 
 use of them in the acquirement of food, such as the common wheel ani- 
 malcule, they stop and re-commence in such a manner as to prevent the 
 observer from assigning any other cause to their variations. 
 
 Passing from this polype-like Mollusk to one a little advanced in the 
 scale of existence, and which, though still chained to the rocks during 
 its whole existence, has some slight power of taking cognizance we 
 refer to the oyster. It has no locomotive power ; almost the only mus- 
 cular power it enjoys is that by which it closes its shell, its opening 
 being accomplished by the elasticity of a ligamentous hinge. Garner* 
 has stated that distinct, though very simple, organs of vision may be 
 observed on the margin of the mantle. It has long been known to fish- 
 ermen that the shadow of a boat passing over a bed of oysters will cause 
 them to close their shells : this we can hardly suppose would occur, if 
 they were not supplied with some form of the apparatus of vision. 
 
 The sensitive tentacula which guard the alimentary canal are now 
 developed from the true mouth, and two pairs of long flexible tentacula, 
 
 or palpi, with which the mouth is furnished, 
 Fig. 12. seem designed to guard its orifice. 
 
 The principal ganglion in the oyster (fig. 
 12, B) is situated by the adductor muscle, 
 between the branchi; it maybe called the 
 posterior ganglion ; it is the analogue of the 
 ganglion in the creature we have just been 
 examining, (the Ascidia,) and, like it, re- 
 ceives its command from the respiratory 
 surface and the mouth, by the excitor, or 
 afferent nerves, which arise there, and ter- 
 minate in the ganglion. Like it, it stimu- 
 lates to contraction the adductor muscle of 
 the shell. Its analogue in man and the 
 Vertebrata generally, is the medulla oblon- 
 gata, in which the ganglia of the pneumo- 
 gastric nerves are situated. In addition to 
 this ganglion, there are two small ganglia 
 (A) situated near to the mouth, and the ru- 
 dimentary organs of sense which guard the 
 alimentary canal. Whatever consciousness 
 this animal enjoys of external nature, is most 
 probably dependent on these ganglia they 
 are the analogues of the cerebral ganglia in 
 man. The oyster, as we have seen, has no power of locomotion, no in- 
 
 Nervous system of oyster. (Garner.) 
 A A. Anterior ganglia. B. Posterior 
 or branchial ganglion inlobed. a a. 
 Branches to mouth, c. Ditto to gills. 
 d d. Connecting trunks, e. Transverse 
 filaments, uniting anterior ganglia. /. 
 Arch over oesophagus. 
 
 * Linnean Transactions, vol. xvii. part iv. p. 485. 
 
 
CONCHIFERA. GASTEROPODA. 65 
 
 struments of progression ; but in the same class, the Conchifera?, or shell- 
 bearing Mollusks, we find some endowed with the power of moving from 
 place to place. 
 
 The organ, which is a single one, and is called the foot, is a firm mus- 
 cular structure; sometimes it is employed in burrowing in mud and sand, 
 and sometimes in executing sudden and rapid motions true leaps by 
 which the animal is enabled to change its place with great celerity. The 
 interesting point to us is not the existence of the contractile muscular 
 organ, the foot, by which the motion is effected, as the piston of the 
 steam-engine is by the expansive power of the steam, but the existence 
 of a little bit of vesicular neurine, from which this muscle derives its 
 order to contract and move the animal, and without which neurine the 
 muscle would be powerless, paralyzed, and flabby. 
 
 " Wherever the foot exists in the Conchiferse," says Dr. Carpenter, 
 " we find an additional ganglion in close relation with it, being usually 
 situated at its base, and following its changes of position, as well as cor- 
 responding with it in degree of development" the pedal ganglion. 
 
 In these Mollusks we have here, then, the cephalic ganglia, or brain, 
 the instrument of consciousness and director of all voluntary movements ; 
 the posterior respiratory ganglion, or medulla oblongata, belonging to 
 the excito-motory system, directing the respiratory movements; the pedal 
 ganglion, exciting all the instinctive motions of the foot, the analogue 
 of one segment of the spinal cord in man, or one of the ganglia com- 
 posing the jointed cord in insects. " It is important to remark," says 
 Dr. Carpenter, u that whilst the pedal ganglion and the respiratory gan- 
 glion are always connected with the anterior ganglia, or cerebral ganglia, 
 they are never immediately connected with each other. This would 
 seem to indicate that their functions are distinct, though partly depend- 
 ent on the influence of the anterior ganglia." 
 
 The next class of Mollusca, the Gasteropoda, are known to us in the 
 familiar forms of the snail, the slug, and the limpet. These creatures are 
 much advanced, in their relations to the external world, above the oys- 
 ter and the conchiferous Mollusks we have just been considering. They 
 enjoy the sense of sight and smell, and having thus the power of distin- 
 guishing their food, have a more perfect organ of locomotion to enable 
 them to seek and select it. The union of two individuals is necessary 
 for the reproduction of their species, and we find, in accordance with 
 higher powers, larger and more numerous ganglia for their executing 
 their motions. In some of the species, as in the limpet, for instance, we 
 find these centres of power very distinct, while in others, as in the com- 
 mon slug, there is no anatomical line of distinction, and they are so 
 united, that we can only demonstrate their individuality by referring to 
 the nerves connected with them. This fact has an important bearing on 
 the anatomy of the human body, and teaches us that we must not there 
 look for an anatomical line of demarkation as necessary to decide on the 
 individuality of the ganglia. 
 
 We shall find, when we come to the dissection of the medulla 
 oblongata, that there are two ganglia imbedded in its substance, so 
 closely connected, that we can scarcely distinguish them except by 
 5 
 
COMPARATIVE ANATOMY. 
 
 Nervous system of 
 the patella, or limpet. 
 (Garner.) A A. Cephalic 
 ganglia. B B. Branch- 
 ial, c c. Pedal. D. Pha- 
 ryngeal. E. Labial. 
 
 Fig. 14. 
 
 Fig. 13. observing the connection of their nerves. The au- 
 
 ditory and pneumogastric ganglia are .here referred 
 to. In the patella, or limpet, (see fig. 13,) we ob- 
 serve at the base of the tentacula, and rather anterior, 
 therefore, to the ffisophagus, a pair of ganglia (A A), 
 which evidently correspond to the anterior ganglia 
 in the Conchifera, which are connected by a commis- 
 sural band passing over the oesophagus. These, how- 
 ever, not only send nerves to the tentacula, but are 
 also connected with their eyes which are situated at 
 their base. Beneath the cesophagus, and connected 
 by two trunks with each of the cephalic ganglia, we 
 find a broad mass, which, on examination, appears to 
 consist of four lobes placed in a line. 
 
 The two inner ones (c c) send nerves to the foot, and are thus analo- 
 gous to the pedal ganglia of Conchifera. These are connected with the 
 cephalic ganglia by one of the trunks which we observe on each side. 
 Externally to them are the branchial ganglia (B B), which are also con- 
 nected to the cephalic ganglia by a separate trunk, and with each other 
 by a filament, which may be distinctly traced through the pedal ganglia.* 
 
 " Besides these nerves, we find in the patella, 
 as well as among the Gasteropoda in general, a 
 separate system connected with a very important 
 set of organs, the gustatory and the mandieatory, 
 which are but slightly shadowed out among the 
 Conchifera. In these animals we find the oeso- 
 phagus dilated at its commencement into a mus- 
 /f^/W ^\^\\ cular cavity, with a curious rasp-like tongue, 
 */' II I y\\ \ w h* c h se i" ves to reduce the food, often supported 
 upon cartilages, and sometimes furnished with 
 horny maxillaB. The nerves which supply these 
 do not proceed directly from the cephalic gan- 
 glia, but are part of a distinct system, which 
 sends its ramifications along the oesophagus and 
 stomach, and which is occasionally connected 
 with the first by inosculating filaments. In the 
 Limax ater, or common slug, we find the cepha- 
 lic ganglia (A A) united into one large bilobed 
 mass, lying completely above the cesophagus. 
 Another large mass or sub-cesophageal ganglion 
 forms the lower part of the ring, and is connected 
 with the first by two trunks on each side. A 
 little examination will show that this ganglion, 
 like the similar mass in the patella, is composed 
 of two pairs of nerves, having distinct functions. 
 
 Nervous system of the com- 
 mon slug. (Baly.) A A. Cephalic 
 ganglia. B B. Branchial, c. 
 fedal. D. Pharyngeal. 
 
 The branches from the outer portion (B) are principally distributed to the 
 respiratory sac, and this will, therefore, be analogous to the outer or 
 branchial portion of the ganglionic mass in the patella, being, like it, 
 
 " ' 
 
 ^* Garner, be. 
 
 
GASTEROPODA. 
 
 67 
 
 connected immediately with the cephalic by a trunk of its own. The 
 inner portion (c) does not send its branches to the foot in particular, but 
 to the general muscular surface in which this organ is, as it were, lost, 
 and of which the whole body is concerned, in the progressive movement 
 of the body. Hence, we may fairly regard this as 
 a locomotive ganglion. Two small pharyngeal 
 
 Fig. 15. 
 
 ring, 
 
 con- 
 
 ganglia are found within the principal 
 nected, as usual, with the cephalic."* 
 
 The next specimen of a nervous system to which 
 we shall direct our attention, is taken from the third 
 sub-kingdom, the Homo-Gangliata, or Articulated 
 animals of Cuvier. This is almost as simple in its 
 arrangement as that just referred to ; although, in 
 general appearance, it approaches more nearly to 
 that of the higher orders. Fig. 15, taken from Dr. 
 Grant's Outlines of Comparative Anatomy, repre- 
 sents the nervous system of the common sandhop- 
 per, or Talitrus Locusta; and it will be seen that 
 here, likewise, all the ganglia are of nearly equal 
 size, and nearly at equal distances. The cephalic 
 ganglia are the most anterior, and are a little 
 larger than the rest; the respiratory ganglia are on 
 the side, and detached ; and the pedal ganglia, 
 which are numerous, are situated in the separate 
 segments of this jointed body. It will be seen that 
 the cerebral and spinal ganglia, placed on the same 
 side of the mesial line, are connected together by 
 two sets of longitudinal fibres, cerebral columns of 
 volition and sensation. The fibres which connect 
 corresponding ganglia on opposite sides of the me- 
 sial line, are analogous to the corpus callosum in 
 the human brain and transverse fibres in the spinal 
 cord. This form of nervous system is seen in the 
 embryos of the higher orders of the Crustacea. 
 
 The next stept onwards in the evolution of the 
 nervous system consists in the approach and close 
 connection of the two longitudinal cords, and their 
 accompanying ganglia, or to the concentration of 
 these into apparently a single cord as well as single 
 ganglia. This form is beautifully illustrated by that 
 of the Cymothea (fig. 16). 
 
 We have already seen how much the arrange- 
 ment of the ganglia of the Mollusca confirms 
 Dr. M. Hall's theory of an excito-motory system of nerves, 
 recent researches of Mr. Newport into the anatomy of the nervous 
 system of the Myriapoda, completes more perfectly the chain of evi- 
 dence. Indeed, so satisfactory to my mind are his discoveries of the 
 existence of a distinct set of nerves for the execution of the instinctive 
 movements, that I have no doubt whatever that there is exactly the 
 
 * Dr. Carpenter, op. cit. 
 
 15. From Grant's Outlines 
 of Comparative Anatomy. 
 Nervous System of the Ta- 
 litrus Locusla, or common 
 sandhopper. All the gan- 
 glia, eleven in number, are 
 of nearly equal size; the 
 two first, which are the 
 supra-ffisophageal, scarcely 
 exceeding in dimensions 
 any of the others. The 
 ccsophagus runs between 
 the two first pairs of gan- 
 glia. 
 
 16. Also from Grant's 
 Outlines, &c., presents the 
 
 ring very distinct, but the 
 supra-cesophageal ganglia 
 scarcely developed. The 
 two longitudinal cords, with 
 the pairs of ganglia united, 
 so as to form a uniform 
 cord. 
 
 But the 
 
68 COMPARATIVE ANATOMY. 
 
 same simple arrangement in the structure of the spinal cord of all verte- 
 brate animals, not excepting man, though at present we have not been 
 able to unravel it with our dissecting knives, or trace all its component 
 fibres with the microscope. 
 
 The Myriapoda, of which the common centipede is a familiar example, 
 have several cephalic ganglia situated at the anterior extremity of the 
 body, and connected with the organs of sense, the eyes, antenna?, &c. 
 Mr. Newport states,* that in the embryo of Necroph. leophagus (Geophi- 
 lus), longicornis (Leach), at the moment of bursting its shell, the brain 
 is composed of four double ganglia, the centres of a corresponding 
 number of segments, which are then becoming aggregated together, so 
 as to form this single movable portion of the head ot the perfect animal ; 
 so that the brain of the Myriapoda, and probably of all the higher Arti- 
 culata, is in reality composed of at least four pairs of ganglia. The first 
 ganglia being devoted to the nerves of the antenna?, may, I think, be 
 regarded as analogous to those which we shall see in the Vertebrata 
 devoted to the olfactory nerves. The next mass in the perfect insect, 
 as in the embryo, I conclude consists of two pairs, composed of the 
 hemispherical or volitional ganglion, and the optic ganglion. This 
 view of the homology of the second pair of ganglia will be better under- 
 stood by the student when we come to the brain of the Fish. It is very 
 clear that it is not solely the optic ganglion, in as much as it exists even 
 when the organs of vision are entirely wanting, as in the whole of an 
 extensive family of Chilognatha the Polydesmidce. The next pair supply 
 the mandibles and maxillae. Emanating from these ganglia, there are 
 nervous cords, like the crura cerebri in man, which run down and enter 
 into the composition of the spinal cord, similar to those we have just 
 observed in the Talitrus. These, he considers, are the conductors of 
 volition and sensation, and give off minute branches at each segment of 
 the body to each of the spinal nerves : as the powers of volition and 
 perception are very low, so are these instruments very minute. The 
 spinal cord, as a whole, is very large in proportion to the brain, because 
 its ganglia and their own especial nerves, constituting the excito-motory 
 system, or system of instinctive and unconscious movements, are large 
 and predominant. 
 
 The ganglia of organic life, the analogues of the so-called sympathetic 
 nerve in man, are also very fully developed ; distributed in a great part 
 to the salivary glands. 
 
 The visceral ganglia in lulus are of most extraordinary size, being 
 nearly half as large as the brain itself. There are four on each side the 
 oasophagus, closely connected in one series, extended along the cesopha- 
 gus as far as the middle of the first or pro-thoracic segments, giving off 
 branches of nerves to the immense salivary glands, to the oesophagus 
 itself, and surrounding structures. They exhibit the appearance of gray 
 nervous matter inclosed in a distinct theca. 
 
 They communicate with the vagus nerve, which, after passing beneath 
 the brain, forms a minute ganglion immediately behind it, which is also 
 connected to the lateral ganglia by a very minute branch on either side. 
 It then passes along the oesophagus, and forms the second larger rounded 
 
 * Phil. Trans., 1843, p. 248. 
 
MYRIAPODA. 69 
 
 ganglion first mentioned as connected to the last of the lateral ganglia. 
 After this it continues its course backwards, half way along the ffisopha- 
 gus, and then divides into two branches, which are given off, as in in- 
 sects, to the posterior part of this organ, and to the cardiac extremity of 
 the stomach. 
 
 One of the most interesting circumstances connected with the develop- 
 ment of the nervous system in lulus, is the relative size of the brain as 
 compared with that of these ganglia of the viscera. " In these inferior 
 Myriapoda," says Mr. Newport, " in which the power of locomotion is 
 distributed equally to every segment of the body, the brain itself forms 
 but a small proportion of the whole nervous system, and the faculties of 
 sense are less perfect than in insects ; while the nerves of organic life, 
 and their ganglia, are nearly equal in volume (as in lulus) to the whole 
 brain, the organ of volition. The very reverse of this is the case in 
 insects." 
 
 " In those in which the faculties of sense, more especially of vision 
 and smell, and the power of voluntary motion, are carried to their greatest 
 extent as in Volant insects, the gregarious Hymenoptera, Neuroptera, 
 and Lepidoptera the volume of brain bears a much larger proportion to 
 the rest of the nervous system, and the ganglia of organic life a smaller. 
 This is more especially the case in the perfect insect, in -which the 
 volume of the brain is not merely relatively, but actually, increased in 
 size during the changes from the larva to the perfect state ; thus leading 
 to the inference, that the importance of the visceral nerves is gradually 
 diminished in proportion as those of active volition and active existence 
 become augmented.'^ 
 
 " The spinal cord in the Myriapoda is extended from its commence- 
 ment in the crura of the brain, and medulla oblongata, or first sub-ceso- 
 phageal ganglion, to the antepenultimate segment of the body, and is 
 almost uniform in size throughout its whole length. It is slightly larger 
 at its anterior, and smaller at its posterior extremity, than in the middle 
 part of its course. In lulus terrestris it has ninety-six very minute gan- 
 glionic enlargements situated entirely on the under surface of the cord, 
 and so closely approximated together as not to be observable except on 
 very close inspection. Each of these enlargements gives off two pairs 
 of nerves, one of which, on the under surface, is given to the legs, and 
 the other, on the lateral and superior surface, to the sides of the body ; 
 so that the whole number of nervous trunks from the cord, including 
 those from the medulla oblongata, is ninety-four pairs to the head and 
 sides of the body, and ninety-two pairs to the legs, making in the whole 
 186 pairs, or 372 nervous trunks from the cord, exclusive of those which 
 belong more immediately to the brain. Each enlargement of the cord 
 gives off at its upper and lateral surface a single nervous trunk, which 
 passes outwards some distance as a single nerve, but which in reality 
 includes two distinct sets of nerves, that separate as principal trunks at 
 the inner side of the great longitudinal series of abdominal muscles." 
 
 The anterior of these trunks is the analogue of the respiratory nerves 
 of insects, and passes across the upper layer of these muscles, on their 
 visceral surface, giving off to them many minute branches. 
 
 * f\ 
 
 * Op. cit. 
 
COMPARATIVE ANATOMY. 
 
 Fig. 17. 
 
 The Structure of the Cord is thus described by Mr. Newport : " The 
 formation of the great abdominal cord in the lulidae, by the lateral ap- 
 proximation of two distinct portions, is indicated on its upper surface by 
 a slight median sulcus, and on its under surface by a slight longitudinal 
 division between the two approximate ganglia that form each of its en- 
 largements. Each of these lateral divisions of the cord in lulus, as 
 formerly shown in the Scolopendra and other Articulata, is a compound 
 structure, formed of two distinct series of longitudinal series or columns 
 of fibres, which, notwithstanding the different explanation that has been 
 given of their function since I had the honor of first describing them to 
 the Royal Society, are quite distinct from each other, although closely 
 approximated together. By the aid of means superior to those formerly 
 employed in my investigations, I now find that the abdominal cord con- 
 tains other structures besides those already described." 
 
 " In my former communication to the Royal Society, I indicated the 
 existence of fibres that run transversely through the ganglia of the cord 
 in the larva of the common butterfly, and similar structures have since 
 been shown by Dr. Carpenter in other Articulata, and applied to explain 
 some of the reflex phenomena of the nervous system, in accordance with 
 
 the theory promulgated by Dr. M. Hall. But 
 besides these two sets of longitudinal fibres, 
 and the series that pass transversely through 
 the ganglia, there are other structures in the 
 cord that have hitherto been entirely over- 
 looked. These are the fibres that run longi- 
 tudinally, in part of their course, at the sides 
 of the cord, and enter into composition of all 
 the nerves from the ganglia. These fibres I 
 shall designate the fibres of reinforcement of 
 the cord." (Fig. 17,/) 
 
 u The superior longitudinal set of fibres of 
 the cord, which I formerly de- 
 scribed as the motor tract, and 
 to which the function of volition 
 A seems still to be accorded by 
 
 Valentin, Carpenter, and Baly, 
 is extended in lulus, as in other 
 Articulata, as a separate fascicu- 
 lus along the upper surface of the 
 cord ; but in these Myriapoda it 
 is much narrower in proportion 
 to the whole width of the cord 
 than in insects. The fact is in- 
 teresting in reference to its pre- 
 sumed- function. On a cursory 
 inspection, it does not appear to 
 give off any branches, but seems 
 to pursue its course uninterrupt- 
 
 TTnder surface of the cord in Spiro streptus. (New- , i i , i LIT *u f 
 
 port.) a. Inferior longitudinal fibres sensory tract. edly along the whole length OI 
 
 Lai b fibres f reinforcement - c ' Nerves " * Commis - the cord. It does not indeed give 
 
 Upper surface of the cord in Spiro 
 streptus. (Newport.) b. Covering 
 of the cord, e e. Superior longitu- 
 dinal fibres volitional or motor 
 tract. /. Fibres of reinforcement. 
 g. Commissural. 
 
 Fig. 18. 
 
MYRIAPODA. 71 
 
 off filaments to the nerves from a ganglion immediately opposite their 
 origin, while passing over that ganglion, but immediately it has passed 
 one ganglion, it gives off the filaments that proceed to the nerves from 
 the next ganglion These filaments seem almost immediately to join 
 with others that belong to the sides of the cord, and pass out with them 
 into the nerve from the next ganglion along its anterior surface." 
 
 " This is almost precisely the manner in which the filaments from the 
 aganglionic column in the Crustacea are united with those from the gan- 
 glionic, as formerly shown in my description of the nerves in that class, 
 when the existence of the lateral fibres of the cord was unknown to me. 
 The inferior longitudinal or ganglionic set of fibres (fig. 18, a) of the 
 cord, affords many interesting considerations. It is placed, exactly as in 
 insects, on the under surface, but, like the upper series, it is narrower 
 than the whole cord, of which it forms a part. It is formed of a longi- 
 tudinal series of fibres, like the upper track, beneath which it is placed, 
 and from which it is divided by some of the fibres that pass transversely 
 through the cord, and which enter into the composition of the nerves 
 from the ganglion on either side. It appears also to receive filaments 
 from the upper series, and perhaps others are sent from it to the upper, 
 thus decussating each other in the middle substance of the cord when 
 these two longitudinal series are in close apposition ; since it is almost 
 impossible, even in the large nervous cord of Scolopendra, to separate 
 the two tracts from each other, although their distinctness is evinced in 
 their relative size and longitudinal lines of separation." 
 
 " But there is one fact of great interest in regard to these ganglionic 
 series of fibres. Almost the whole of the fibres of which it is composed 
 are traceable in the Iulida3 directly through each enlargement of the cord, 
 which they mainly assist to form. At the anterior part of each enlarge- 
 ment, the diameter of each fibre, or fasciculus of fibres, appears to be 
 slightly increased, and its structure becomes more soft and delicate. 
 While passing through these ganglionic enlargements, occasioned chiefly 
 by their own increased diameter, the fibres take a slightly-curved direc- 
 tion outwards, and then inwards, but are reduced to their original size, 
 and assume the longitudinal direction, on again forming the ganglionic 
 portion of this tract of the cord. This structure of the fibres is well 
 seen in lulidse and Polydesmidffi, as I shall hereafter again have occasion 
 to refer to more especially, with reference to the true structure of gan- 
 glia. The fibres are traceable most distinctly in the lulidaB (fig. 19, i). 
 
 " These are the structures to which I formerly assigned the function 
 of voluntary motion and sensation, and to which I am still inclined to 
 believe they minister, since the fibres of which both are composed are 
 traceable to the crura of the brain. Whether these functions are re- 
 stricted separately to the two structures, as I first imagined, the one to the 
 upper, the other to the inferior series, or whether they are administered 
 to conjointly by both, through an interchange of fibres, it is almost im- 
 possible to determine by any decisive experiment on these animals, 
 although the structures themselves are distinct. But in the absence of 
 experimental proof, there are circumstances connected with the distribu- 
 tion of the nerves to the extremities which seem to indicate that these 
 low forms of Articulata are endowed with a power of sensation and 
 
COMPARATIVE ANATOMY. 
 
 feeling far beyond what has of late been adjudged to them by some 
 physiologists." 
 
 u In some of the gigantic Spirostrepti and Spiroboli the legs are 
 adapted for climbing up the trunks and branches of trees, by the under 
 surface of the first and second basilar joints of the tarsi being developed 
 into a soft cushion or pad, as in some insects ; and to these limbs, I have 
 found the nervous fibres more extensively distributed than to any other, 
 a fact most strictly analogous to that of the distribution of nerves in 
 the tactile parts of the limbs of Vertebrata." 
 
 "Those fibres of the cord which seem to be independent of the sets 
 just described, and which do not appear to have any direct communica- 
 tion with the great seat of sensation and volition the brain are of two 
 kinds, which may justly be regarded as involuntary in their functions. 
 The first of these are the commissural fibres, (figs. 17, g; 18, d,) which 
 pass through the ganglia ; and the second are those which have hitherto 
 been undescribed, and form the sides of the cord (f) in the interspace 
 between the ganglia, or between certain nerves distributed from them 
 the fibres of reinforcement of the cord." 
 
 " The fibres of reinforcement of the cord form the lateral portions of 
 the whole nervous cord of the body, and enter into the composition of 
 all the nerves. They constitute, as it were, circles of nervous commu- 
 nication between two nerves that originate from the cord at a greater or 
 less distance ; and form part of the cord in the interval between these 
 nerves, and bear the same relation to the segments, individually, which 
 the cord itself does to the whole body. They form a part of the nerv- 
 ous trunks which come off from its upper, or aganglionic tract, as well 
 as of those which proceed from the ganglionic enlargements in the 
 lower, and in each instance they bound the posterior side of one nerve 
 and the anterior of another, to which they proceed along the side of the 
 cord, forming in the interspace a part of its structure. Each fibre may 
 thus be traced from its peripheral distributions, in the structures of the 
 external surface of the body, inwards along the course of the nerves, on 
 their posterior surface to the cord, where its direction is altered from 
 that of the nerve transversely inwards, to that of the cord on which it is 
 reflected, and passes longitudinally backward ; thus forming a part of its 
 external surface until it arrives at the root of the nerve, to which it is to 
 be distributed, and along which it again passes transversely outwards, 
 bounding the anterior surface of the nerve to its distribution on the late- 
 ral surface of the body. These fibres of reinforcement form a large pro- 
 portion of the whole cord, and enter into the composition of the upper 
 anterior, and part of the inferior, surface of the root of every nerve in 
 their course inwards to the cord ; and of its posterior and inferior sur- 
 face on their again proceeding outwards. In this manner these fibres of 
 reinforcement connect all the nerves of the cord on one side of the body, 
 as the corresponding fibres do those on the opposite side. They form, 
 as it were, double, triple, or quadruple circles, one within the other. 
 Thus the fibres that pass inwards along one nerve may proceed along 
 the cord to pass outwards again on the front of a second, a third, or a 
 fourth, linking the segments in one continued series of nervous commu- 
 nications independent of the brain. But these communications exist 
 
MYRIAPODA. 73 
 
 only between nerves on the same side of the body, and "not between 
 those on the opposite. The commissure nerves connect the opposite 
 sides of each individual segment, as those of reinforcement do the same 
 sides of two separate segments." 
 
 " Every nerve from a ganglionic enlargement of the cord is thus com- 
 posed of four sets of fibres, an upper and an under one, which commu- 
 nicate with the cephalic ganglia; a transverse or commissural, that com- 
 municate only with the corresponding nerves on the opposite side of the 
 body ; and a lateral set that communicate only with the nerves from a 
 ganglionic enlargement on the same side of the body, and form part of 
 the cord in the interspace between the roots of the nerves. It is by the 
 successive additions of these lateral portions of the cord that its size is 
 maintained almost uniformly throughout its whole length in the elon- 
 gated bodies of the Myriapoda. On examining the cord very closely, I 
 have reason to believe that the upper and inferior sets of longitudinal 
 fibres, the ganglionic and the aganglionic, are somewhat smaller at their 
 posterior than at their anterior extremity, a circumstance readily under- 
 stood in the fact that successive series of filaments are given off from them 
 at each distribution of nerves from the ganglionic enlargements, while 
 the relative size of the lateral portions of the cord appears to be greater 
 in the posterior than in the anterior. On 
 this account I have named these lateral 
 fibres, fibres of reinforcement of the cord. 
 In regard to the identification of these 
 fibres, it may be well further to state that 
 their separate existence is indicated chiefly 
 at the postero-lateral margin of the gan- 
 glia, (fig. 19, y,) where they are seen to 
 form part of the nerves and cord without 
 passing upwards to the brain. In other 
 parts of their course they are not distin- 
 guishable by color, and very rarely by any 
 longitudinal line of separation, from the 
 fibres which form the inferior longitudinal Ganglion and nerves of the spinal 
 
 cpripo r>r rnrHrm nf tViP rnrrl tn whioh thpv cord of Polydesmus maculatus. (New- 
 
 senes, or portion or tne com to wnicn tney port) b covering of the cord. c. 
 
 are approximated; but from Which they Nerves to muscles, d. Posterior nerves. 
 . r .r , , ' .. . ,. ,\ r A fk. Fibres of reinforcement, g h. Corn- 
 are believed tO be distinct, from the tact missural fibres. I. Fibres of the inferior 
 that they do not descend with them tO the or ganglionic tract passing between the 
 
 brain." 
 
 " Their function must be regarded only as reflex, entirely independent 
 of sensation, but capable of being excited into action by external causes. 
 The existence of these lateral fibres in the cord may now fully explain 
 the reflected movement of parts anterior or posterior to an irritated limb 
 on the same side of the body, as the commissural ones do the move- 
 ments of the parts on the side opposite to that which is irritated. The 
 presence of these fibres in the cord of insects I had long suspected from, 
 the curved direction of the fibres that formed the ganglia, and from that 
 of the origin of the nerves, from the aganglionic tract, as figured in my 
 former paper; and although I had communicated this opinion to a friend 
 
74 COMPARATIVE ANATOMY. 
 
 several years ago, I have never, until recently, been able to satisfy my- 
 self of its correctness." 
 
 " This uncertainty of the existence of any structure in the cord that 
 seemed sufficient to explain the reflected movements on the same side 
 of the body, independent of the brain and the nerves of volition and sen- 
 sation, long obliged me to withhold my assent now received respecting 
 these phenomena. Although the fibres that pass transversely through 
 ganglia might explain the fact produced on one side of the body, by the 
 irritation of a corresponding part on the other, there seemed no anatomi- 
 cal structure to account for the movements of distant parts, anterior or 
 posterior to a given point, if the doctrine long received, that each fibre 
 was endowed with but one special function, were correct." 
 
 " Now, therefore, that we find an anatomical structure in the cord 
 that seems to account for these phenomena, I ought, in justice, to state 
 that Dr. Hall, to whom is due the high credit of collecting, comparing, 
 and arranging in one system, numerous facts connected with the reflected 
 movements of animals, as observed by Whytt, Blane, and others, and 
 also by himself, adopting the principle established by our distinguished 
 countryman, Sir Charles Bell, that every nervous fibre is continued un- 
 broken, from its origin to its termination, and is capable only of admin- 
 istering to one special function, conceived the necessity of the exist- 
 ence of special nerves for the reflected movements, and that at the 
 period when I was engaged with Dr. Hall in his experiments on this 
 subject, in 1833, he requested me to examine the cord in the hedgehog, 
 to ascertain the correctness of his opinion. This examination was not 
 made, because at that period I differed from him in attributing the re- 
 flected movements to the agency of another part of the nervous system." 
 
 " Now that the views of Dr. Hall seem proved to be correct, I am 
 desirous of adding this testimony of the acuteness and perception of one 
 who has done much for physiological science." 
 
 Professor Owen's testimony on this subject is most important and 
 satisfactory.* After describing the nervous system of the Crustacea, he 
 says : " Three principal divisions of the nervous system may be defined, 
 according to the views which I entertain of their functions. Thus, ad- 
 mitting from analogy, that the supra-oesophageal ganglionie centre is 
 that in which true sensation and volition reside, the*n those nervous fila- 
 ments which are exclusively connected therewith, and some of which 
 would seem to extend the whole length of the animal along the dorsal 
 aspect of the ganglionic columns, would form with their ganglionic 
 centre the true sensori-volitional system, whilst any other ganglions 
 superadded to the abdominal columns, with the nervous filaments termi- 
 nating in or originating from them, would constitute the system for the 
 automatic reception and reflection of stimuli. The stomato-gastric 
 nerves, connected partly with the brain, and partly with the oesophageal 
 columns, will form a third system, analogous to the great sympathetic 
 or organic nerves of the Vertebrata. In these views I coincide with 
 that ingenious physiologist, Dr. Carpenter, and shall feel happy if their 
 accuracy and soundness have received any additional proof from the 
 
 * Owen's Lectures, vol. i. p. 173. 
 
CRUSTACEA. 75 
 
 facts of Comparative Anatomy, which, in the Hunterian Lectures of 
 1842, were for the first time brought to bear upon this interesting pro- 
 blem." 
 
 From these most interesting discoveries of Mr. Newport, and the im- 
 portant physiological deductions, which are drawn so justly from them, 
 let us turn to a form of nervous system which will serve to instruct us 
 how wonderfully Nature varies her resources according to the task she 
 has to execute, always maintaining real simplicity amidst an almost 
 boundless variety ; teaching us, also, that the shape alone, and general 
 outline of the component parts of a nervous system in the lower animals, 
 will guide us very imperfectly to its analogues in man, and that we must 
 search deeper for a clue to unravel the structure of the human brain. 
 Instead of simply directing our attention to the shape of the ganglia, 
 we must rather consider how far the distribution of the nerves, which, 
 we believe, to be the conductors of the power generated by the ganglia 
 or centres, corresponds in the specimens we select for illustration. Guided 
 by this principle, we can always discriminate the masses of neurine or 
 optic ganglia, in which the optic nerves terminate in each individual 
 where optic nerves exist, and so of all the other centres or ganglia, 
 which, in the higher tribes of animals, especially, are found so closely 
 united that the whole mass appears but as one, when it is called the 
 brain. On the same principle, in the specimen which we shall next 
 attend to, we must observe that the collection of neurine from which 
 the nerves of the extremities arise, though wholly dissimilar in shape, is 
 analogous to the dotted spinal cord of the Myriapoda and the smooth 
 cord of the Vertebrata. In the common crab, the neurine, which, in 
 the last described species, was deposited so as to form a chain of ganglia 
 spread along the surface of the abdomen, is collected into only two 
 masses, the one situated in the head, and the other in the thorax. 
 
 The anterior of these ganglia, the supra-cesophageal, 
 or brain, is small as compared with the posterior ; for Fig. 20. 
 
 the organs of sense, whose nerves terminate in this 
 centre of power, are as yet but imperfectly developed, 
 while the muscular system, deriving its supply almost 
 entirely from the posterior or thoracic ganglion, is 
 large and powerful. 
 
 The anterior ganglion is connected with the poste- 
 rior by two slender nervous threads, volitional and 
 sensory filaments, which, passing on each side of the 
 oesophagus, form with the ganglia the same oesopha- 
 geal ring we have before observed. 
 
 Advancing from this, one of the most simple forms 
 of the nervous system in the Crustacea, we next meet, 
 in some of the insect tribe, with a very decided step 
 towards the concentration of the higher orders ; for 
 the nervous ring round the commencement of the alimentary canal re- 
 ceives additional ganglia on its superior surface, until the whole mass 
 formed by the union of these nervous centres, or instruments of con- 
 sciousness, assumes the appearance, and seems entitled to the appellation, 
 of a brain. 
 
COMPARATIVE ANATOMY. 
 
 The intimate connection and apparent dependence of the organs of 
 sense, as the eye, &c., upon those appropriate masses of cineritious or 
 pulpy neurine in which their nerves terminate, and to which, therefore, 
 we suppose the impressions of light, &c., received on their peripheral 
 expansions transmitted, in order to become perceived by the animal, is 
 beautifully illustrated by the various alterations, which take place in the 
 nervous system of the moth, as it advances from the caterpillar to the 
 perfect insect, or imago. 
 
 It would be inconsistent with my purpose, if I were to expect the 
 
 Fig. 21. 
 
 Fig. 22. 
 
 Fig. 21. Nervous system of the larva of Sphinx Ligustri aAer it has acquired its full growth, and 
 about two days previously to its change to the pupa state. (Newport.) a. The supposed brain, or 
 anterior nodules of the cord. 1. The first ganglion situated in the head, or first segment beneath the 
 nodules. 2, 3, 4, 5. Ganglia of the trunk supplying nerves to the legs and wings. 6, 7, 8, 9, 10, 11. Ganglia 
 of the abdomen, b. Nerves to the mandibles, c. Second pair from the second ganglion, given to the 
 muscles of the neck. d. Third pair, given to the first pair of legs. f. Nerves for the first pair of wings, 
 with two roots ; one from the cord, and one from the third ganglion, and connected also with the trans- 
 verse plexus, g. Second pair of nerves from the third ganglion, given to the second pair of legs. h. 
 Transverse plexus from the third ganglion, ii. Nerves for the second pair of wings, originating, like 
 the first, from two roots, one from the cord, and one from the fourth ganglion, and connected also with 
 branches from the transverse plexus from the third, k. Second pair from the fourth ganglion, given to 
 third pair of legs. I. Nerves from the fifth ganglion, which, in the pupa, are those given to the posterior 
 muscles of the trunk, m. Nerves from the sixth ganglion, which, in the pupa, are those of the anterior 
 muscles of the abdomen, n. The last pair of nerves from the terminal ganglion, given to the rectum and 
 organs of generation. 
 
 Fig. 22. Nervous system of the Sphinx Ligustri, thirty days after changing to the pupa state. (From 
 Newport.) This drawing exhibits the abdominal cords in their shortened state, with only five instead of 
 seven ganglia, the fifth and sixth having passed onwards and become continuous with the fourth. The 
 cords in the trunk and the nerves to the wings are enlarged ; and those nerves which in the larva arose 
 in the second ganglion, are also enlarged, and now originate from the cords, while the first ganglion has 
 advanced very near to the superior lobes of the brain. The terminal ganglion exhibits a very peculiar 
 structure. 
 
 Fig. 23. Nervous system of the perfect insect Sphinx Ligustri. A. Cerebral ganglia. B. Optic nerves. 
 The figures refer to the number of the ganglia, oooo. Respiratory nerves. 
 
INSECTA. 77 
 
 student to follow the description of the various nerves connected with 
 these ganglia, in the present state of his knowledge ; nor do I conceive 
 that such a proceeding would diminish his difficulties in reference to 
 the study of the human brain. It is, however, an important fact in 
 relation to the function of neurine, that the brain of the perfect insect or 
 imago is very much larger than that of the caterpillar. The butterfly is 
 endowed with very perfect organs of sense and locomotive powers, 
 which enable it to roam from flower to flower, and perform the import- 
 ant office of reproduction : its organs of vision are large and complicated. 
 The poor caterpillar has comparatively imperfect organs of sense, and 
 has but one office to fulfil, namely, to procure food and convert it into 
 nourishment for the development of larger nervous centres, and a more 
 highly endowed animal. By reference to these wood-cuts, the student 
 will observe, in fig. 21, the two little cerebral ganglia (a), scarcely larger 
 than the infra-oesophageal or respiratory (1). 
 
 Without following out each different stage in the gradually progressive 
 change which the nervous system of the larva and pupa undergoes pre- 
 vious to its attaining its full development in the imago, he may, after 
 observing the relative size in the larva (fig. 14), and the gradual concen- 
 tration and aggregation of the spinal or locomotive ganglia in the pupa 
 (fig. 22), turn to fig. 23, when he will see it in the imago or perfect insect. 
 
 The cerebral ganglia are now extended transversely, and form, with 
 the first sub-oesophageal ganglion, and the enlarged erura which connect 
 them, one continuous mass around the resophagus and anterior part of 
 the dorsal vessel. The second ganglion has entirely shifted its position, 
 and receded towards the middle of the thorax, and has coalesced with 
 the third, which has entirely disappeared, and seems to have joined in 
 part with both the second and fourth, and the intervening cords. This 
 aggregation of ganglia and cords is situated in the middle of the thorax, 
 and supplies all the muscles in that part of the body. The longitudinal 
 cords are continued from the hinder part of the fifth ganglion, and just 
 before leaving the thorax to enter the abdomen, they give off the nerves 
 which formerly belonged to the sixth ganglion, which is now entirely 
 obliterated. The cords then descend into the abdomen, and immedi- 
 ately give off the nerves that belong to the seventh ganglion, which, 
 with part of the cord that existed between the sixth and seventh ganglia, 
 is also obliterated. The cords are then continued in a direct line along 
 the abdomen, the 8th, 9th, 10th and llth ganglia being situated as in 
 the previous stages. Such is the state of the nervous system of the 
 perfect insect. 
 
 The centre of the nervous system of the sphinx in its perfect condi- 
 tion is covered in by a new structure, and does not lie, as in the larva, 
 in the open cavity of the thorax. 
 
 Our attention having been directed, in the instance of the moth, to the 
 progressive development of the encephalon from the larva to the imago, 
 and to the striking increase in the size, and greater complexity in the 
 form, of the nervous system when the animal becomes fitted to receive 
 impressions from the objects which surround it, which it does through 
 the medium of especial organs of sense, and not by the whole surface of 
 the body, as in the Medusa? and lowest forms of animal existence, we 
 
78 
 
 COMPARATIVE ANATOMY. 
 
 are prepared to appreciate similar changes in some of the higher Mol- 
 lusca, and to inquire how far the nervous organization of these creatures 
 will countenance the opinion that there is an intimate relation between 
 the bulk of cineritious neurine in which each individual nerve of sense 
 
 Fig. 24. 
 
 
 Nervous system of the Pearly Nautilus. (Owen.) The head and anterior muscular part of the body of 
 the Pearly Nautilus (Nautilus Pompilitis, Linn.), laid open from above or behind, and the nervous system 
 displayed, et. The cut edges of the musculo-ligamentous disc which covers the head. B B. The open 
 ends of the digitations. c. Four of the digital tentacles exposed by laying open the canals in which they 
 are lodged, d d. The anterior ophthalmic tentacles similarly exposed at their origins, e. The left ex- 
 ternal labial process. (The corresponding one on the right side has been removed.) /. The external 
 labial tentacles. G. The internal labial tentacles, h. The olfactory laminie. i. The internal labial 
 tentacles of the left side similarly exposed, k. The origin, on the left side, of the muscle which protrudes 
 the jaws. I. The inner concave surface of the great shell-muscles, m. The termination of the right 
 muscle, n. Orifices by which the vena cava communicates with the abdominal cavity, o. The eye laid 
 open. p. The pedicle, q. The pupil seen from within. T. The cut-edge of the sclerotic, s. The retina. 
 . The dark pigment deposited on its anterior surface, and lining the cavity of the globe. 1. The supra- 
 cesophageal ganglion or brain. It is in the nautilus in the form of a simple cord or commissure, to the 
 extremities of which are connected (2 2) the anterior suboesophageal ganglia. 3 3. The optic ganglia. 
 4 4. The posterior sub-resophageal ganglia. 5. Buccal and pharyngeal nerves. 6 6. The nerves which 
 supply the digital tentacles, and in the cuttle-fish the acetabuliferous arms. 7 7. The nerves passing to 
 8 8, the internal labial ganglions. 9 0. The branches to the internal labial tentacles. 10 10. The nerves sup- 
 plying the olfactory laminae. 11 11. The nerves which supply the infundibulum. 12 12. The nerves of 
 the external labial tentacula. 13. The nerves of the great muscles of attachment. 14. The nerves corre- 
 sponding to the par vagum. 15. The branchial nerves. 10. The ganglions communicating with the 
 visceral or sympathetic nerves, and supplying the heart, venous follicles, and abdominal vise ra. 
 
CEPHALOPODA. 79 
 
 terminates, and the perfection of the organ of sense from which that 
 nerve arises. 
 
 However much we may have had reason to be gratified with the evi- 
 dence which our investigations into the development of the moth has 
 afforded us of the existence of such a relationship, we shall be even 
 more delighted with the clear proof of the universality of such a law, 
 which one very interesting class of the Molluscous division of the animal 
 kingdom in particular has lately yielded to the physiologist: I allude to 
 the admirable Memoir of Mr. Owen on the Pearly Nautilus,* and to his 
 account of the structure of the cuttle-fish, published a few months ago ;f 
 and whilst I do so, I gladly express my thanks to this philosophical ana- 
 tomist, for several kind and valuable hints during the progress of this 
 work. 
 
 We shall first consider the relations that exist between the perfection 
 of the organs of the senses, and the bulk and complexity of the central 
 portions of the nervous system in the Pearly Nautilus, and afterwards in 
 the Cuttle-fish, in which they will be found to be still more strikingly 
 displayed than in the former. 
 
 " The brain or supra-oasophageal mass in the Nautilus (fig. 24) con- 
 sists of a transverse cord-like ganglion, from the ends of which three 
 nervous trunks are continued on each side. The anterior pair pass 
 downwards and forwards by the sides of the oesophagus to unite below 
 it, forming a ganglion on either side, which supply the digital processes 
 and tentacles, and give off nerves to the organ of smell and the funnel. 
 The middle and superior trunks dilate into the optic ganglia ; the retina, 
 which terminates that of the left side, is shown. The posterior cords 
 surround the oesophagus in a manner analogous to the anterior pair, 
 forming also two ganglionic swellings, from which the nerves of the 
 great shell-muscle and those of the viscera are given off; the latter 
 nerves are of small size, and are continued down by the side of the 
 great perforated vein, and are analogous in their distribution to the 
 sympathetic nerves and par vagum." 
 
 The organization of the Sepia qfficinalis, or cuttle-fish (fig. 25), is 
 peculiarly interesting, not only from the fact that it offers to our notice 
 the first appearance of an internal skeleton, an apparatus, which, in the 
 Vertebrata, is constructed in intimate relationship with the nervous 
 system, and is often entirely appropriated to its protection ; but we find 
 this rudimentary skeleton supporting a central ganglion of unusual di- 
 mensions, and a nervous system very highly developed in many of its 
 parts. In its general arrangement, however, the nervous system differs 
 but little except in the quantity of neurine composing the cerebral gan- 
 glia from that of the Nautilus, as will be apparent by turning to fig. 18, 
 in which the differences between them are exhibited and made apparent 
 to the eye. In fig. 18 the bristle is placed in the situation of the oeso- 
 phagus, around which the nervous masses are aggregated. 
 
 * Memoir on the Pearly Nautilus (Nautilus Pompilius, Linn.), by Richard Owen, Esq.; 
 published by direction of the Royal College of Surgeons in London, 1832. 
 
 t Descriptive and Illustrated Catalogue of the Physiological Series of Comparative Ana- 
 tomy contained in the Museum of the Royal College of Surgeons in London ; Vol. III. Part 
 I. Nervous System and Organs of Sense, 1835. From one or other of these publications the 
 following particulars, and the figures 24 & 25, are entirely derived. 
 
80 
 
 COMPARATIVE ANATOMY. 
 
 Fig. 25. 
 
 The brain and origins of the principal nerves of a Cuttle-fish (Sepia officinalis, Linn.). "The bristle 
 (10) is placed in the situation of the oesophagus, around which the nervous masses are aggregated. The 
 Drain and optic or reniform ganglions are here developed in accordance with the more complex organ of 
 Vision, and the more extensive locomotive faculties of this higher-organized Cephalopod. A small spheri- 
 cal body, probably analogous to the corpus geniculatum, is appended to the peduncle of the optic ganglion 
 on either side. 
 
 "As the supra-cesophageal cerebral mass is principally in communication with, and is developed to 
 receive the impressions transferred by, the optic nerves, it must be considered as analogous to the bige- 
 minal bodies in the brain of Vertebrata, which parts are first developed in all the higher classes, and from 
 their constancy and magnitude in the cold-blooded Vertebrata, are evidently among the most important 
 parts of the cerebral organ. The medulla oblongata, from which the auditory and respiratory nerves are 
 given off, is in the cuttle-fish situated below the oesophagus: p. The cut surface of the cartilaginous 
 cranium. The ganglion stellatum from which the nerves pass to the soft vascular and sensitive external 
 covering of the Sepia." 
 
 1. The brain, corresponding to the central commissure of the Nautilus. 2 2. The anterior sub-cpsopha- 
 geal mass, or pes anserinus, giving off (5 5) the nerves to the arms. 3 3. The great reniform, or ophthal- 
 mic ganglions. 4 4. The posterior sub-oesophageal mass giving off (G 6) the nerves to the cloak; and (8) 
 the nerves to the viscera. 7 7. The ganglion stellatum. 9 9. Two small spherical bodies attached to the 
 pedicles of the ganglions. 10. Bristle. 
 
 " As the supra-oesophageal cerebral mass," says Mr. Owen, " is prin- 
 cipally in communication with, and is developed to receive the impres- 
 sions transferred by, the optic nerves, it must be considered as analogous 
 to the bigeminal bodies in the brain of Vertebrata ; which parts are first 
 developed in all the higher classes, and from their constancy and magni- 
 tude in the cold-blooded Vertebrata, are evidently among the most im- 
 portant parts of the cerebral organ." A small spherical body, considered 
 by Mr. Owen as probably analogous to the corpus geniculatura, is ap- 
 pended to the peduncle of the optic ganglion on either side. 
 
 "The medulla oblongata, from which the auditory and respiratory 
 nerves are given off, is, in the cuttle-fish, situated below the oesophagus. 
 
 " The anterior sub-cesophageal ganglia give off nerves to the brachial 
 and labial processes ; the posterior sub-cesophageal ganglia send off 
 laterally the large nerves which pass outward to the mantle, and then 
 form on either side the great ganglion, which, from the radiated distri- 
 bution of its filaments, is termed ganglion stellatum." In addition to 
 these there are a pair of nerves which, like those in the Aplysia, descend 
 to the region of the heart, and there form a plexus for the supply of the 
 organs of digestion and circulation, and exhibit a very perfect analogy 
 to the cardiac and solar plexuses of the sympathetic nerve in man. 
 
CEPHALOPODA. 81 
 
 This very general review of the nervous system in these two members 
 of the cephalopodous class of Mollusca shows us, in the first place, that 
 the supra-03sophageal ganglion in the Nautilus has no cranial cavity con- 
 structed for its protection, and that instead of being a distinct rounded 
 mass, as in the Cuttle-fish, it seems little more than a rounded cord or 
 commissure connecting the ophthalmic ganglia, and placed transversely 
 to the oesophagus. These facts by themselves would be of little value 
 as affording data for reasoning on the offices and relations of the nervous 
 system, did we not discover this comparative imperfection in the struc- 
 ture of their brain corresponding with imperfect development of the 
 organs of locomotion and sensation generally. The peculiarities in the 
 structure of the Nautilus are in complete correspondence with this prin- 
 ciple. " The eye," observes Mr. Owen, " is far from presenting those 
 complexities of structure that render it so remarkable an organ in Dibran- 
 ciate Cephalopods. Indeed, it here appears to be reduced to the sim- 
 plest condition that the organ of vision can assume, without departing 
 altogether from the type which prevails throughout the higher classes. 
 For although the light is admitted by a single orifice into a globular 
 cavity or camera obscura, and a nerve of ample size is appropriated to 
 receive the impression, yet the parts which regulate the admission and 
 modify the direction of the impinging rays are entirely deficient." This 
 state of the eye appears to be in harmony with the habits and aptitudes 
 of the animal so far as they are known. On the other hand, the superior 
 locomotive powers of the cuttle-fish demanding more perfect vision, we 
 find not merely the eye more complex and perfect in its construction, 
 but the " centre to which the impressions of the optic nerve are referred, 
 more highly developed." 
 
 In fact, as Mr. Owen observes, (p. 51), " The inferiority of the more 
 intellectual senses, sight and hearing, is in correspondence with the sim- 
 plicity of the brain. If, as I believe, a distinct organ for the latter sense 
 is altogether wanting, the Pearly Nautilus exhibits, in this respect, an 
 obvious approximation to the inferior Mollusks. 
 
 " As the Pearly Nautilus, like the latter group of Mollusks, is also 
 attached to a heavy shell, and participates with them in the deprivation 
 of the locomotive instruments of the Cephalopods, we may thence de- 
 duce the more immediate principle of their reciprocal inferiority with 
 respect to the visual organ ; for what would it avail an animal to discern 
 distant objects, which could neither overtake them if necessary for food, 
 nor avoid them if inimical to its existence ?" 
 
 The following difference in the distribution of the nerves of the Nau- 
 tilus Pompilius and Sepia offidnalls is alsd highly instructive. 
 
 "In those Cephalopods, whose shells are rudimentary and internal, 
 and whose bodies are enveloped in a naked, and, as we may suppose, 
 sensible mantle, the nerves which supply that part radiate from a gan- 
 glion, which, as in the posterior roots of the spinal nerves in the Verte- 
 brata, is interposed on the cord which brings them into communication 
 with the central mass. In the Nautilus, on the contrary, whose body is 
 incased in an insensible calcareous covering, the analogous nerves are 
 wholly expanded on the largely-developed muscles which attach the 
 shell to the body; and these nerves, like the motor filaments of the 
 6 
 
82 COMPARATIVE ANATOMY. 
 
 spinal nerves, pass into the muscles directly from the brain without the 
 interposition of any such ganglion. "* 
 
 The nervous system in the Myeloncephala, or vertebrated class of ani- 
 mals, which derive their name from that beautiful piece of mechanism 
 constructed expressly for the purpose of protecting the central portions 
 of this system, will next engage our attention. This subkingdom in- 
 cludes Fishes, Amphibious animals, Birds, Reptiles, and the Mammalia. 
 
 In these animals the whole skeleton is developed in relation to the 
 nervous system; and we find, as might be expected, the axis or central 
 portions become, by an increase of bulk and gradual concentration of 
 parts, more decidedly elevated above the peripheral. The supra-03so- 
 phageal ganglion now having an appropriate organ, the cranium or skull, 
 for its protection, uniformly passes by the name of brain ; while the re- 
 maining ganglia with their commissures are so closely united that all 
 appearance of a chain is lost, and one nearly uniform cord supplies its 
 place, which, from the situation it holds in relation to the skeleton, 
 namely, within the spinal column, is called the medulla spinalis, or 
 spinal cord. 
 
 We have already observed in some of the Articulata how the gradual 
 union of several ganglia constitutes a tolerably uniform cord, and how 
 also the addition of ganglia to the single pair above the oesophagus 
 which we saw in the sandhopper, so far increased the entire mass of 
 neurine in that situation as to procure for it the title of cerebrum or 
 brain ; so also, even in the Vertebrata, whose organs of sense, the instru- 
 ments by which the individual is brought into relation with the external 
 world, are so much more perfectly developed, we do not find that the 
 brain is separated from the spinal cord by any other line of demarkation 
 than that of a greater disproportion in the size of the ganglia composing 
 it. The further we advance, indeed, we meet with fresh proofs that 
 the brain, even of the highest order of animals, is no more .than a series 
 of ganglia or collections of cineritious neurine, though without any pecu- 
 liar uniformity of size in which the nerves from the different organs of 
 sense terminate, and from which the nerves of volition originate. That 
 these ganglia are larger and more numerous at the anterior than at the 
 posterior extremity of the spinal cord, is simply in accordance with the 
 evident marks of consummate design upon which every living being has 
 been constructed ; for all the organs of especial sensation, as sight, smell, 
 hearing, and taste, are placed in that situation in the body where they 
 have the greatest range for the exercise of their powers, either in that 
 portion which is in advance of the rest of the animal as he moves over 
 the face of the globe, or, as in man, placed so completely above the rest 
 of his frame, that they receive no impediment from it in the performance 
 of their functions. These organs, from the high office they have to fulfil 
 in the sphere of animal life, appear to require a large quantity of cineri- 
 tious matter to accomplish their functions; in consequence of which the 
 anterior extremity of the spinal cord is larger than the posterior. In this 
 simple manner may we account for the relative proportion of the brain 
 and spinal cord throughout the vertebrated class of animals up to man 
 himself. 
 
 * Memoir, &c., p. 51. 
 
j PISCES. 83 
 
 In Fishes the common division of the nervous system into a brain and 
 spinal cord, though arbitrary, it is nevertheless convenient to retain. 
 The two portions in fact exhibit but a slight disproportion in general 
 dimensions, although the mass of the spinal cord, as a whole, is very 
 much more considerable than that of the brain or cerebral ganglia. 
 Leuret states that the proportion of the weight of the brain of the fish to 
 its body is as 1 to 566 Ibs.* 
 
 The spinal cord in fishes bears a very great resemblance to that of 
 man, differing from it only in the circumstance that the superior and in- 
 ferior grooves which separate the cord into two lateral portions are much 
 deeper. The superior groove, indeed, is so deep that it forms an imper- 
 fect canal, the internal surface of which is covered with a layer of gray 
 matter. This canal exists in the human foetus, and communicates by 
 the calamus scriptorius with the fourth ventricle, which in reality is 
 nothing more than a permanent dilatation of it. In the interior of the 
 cord there is vesicular neurine, as in the higher animals, but there is so 
 little difference of color that it easily escapes observation. Under the 
 microscope it may be detected, and also some white fibres running 
 through it at a right angle. These, I suppose, are the excito-motory 
 roots of the spinal nerves. 
 
 The spinal nerves arise from the cord in fishes, by anterior and pos- 
 terior filaments; an arrangement similar to that which is found in man, 
 the posterior roots having, in like manner, a small ganglion connected 
 with them. Mr. Holmes Coote, in his prize essay, states that these 
 ganglia are only found in the cartilaginous fishes. 
 
 The form of the cord varies in the different kinds offish very much in 
 correspondence with the shape of their bodies. In the Tetrodon Mola, 
 a short, thick fish, the spinal cord is not longer than the encephalon ; in 
 the eel it is long and thin ; in the skate it is slightly enlarged opposite 
 the large pectoral fins. 
 
 The cineritious neurine in which the nerves of sense, as the optic, au- 
 ditory, &c., in the Butterfly and Sepia, terminate, and which in these 
 animals, when fully developed, is collected into one rounded mass, the 
 supra-02sophageal ganglion, in the fish is divided into several separate 
 masses, so that almost every nerve terminates in a distinct and appro- 
 priate ganglion ; hence the peculiar appearance, as compared with that 
 of man, which the brain of the fish presents. 
 
 There is in fact no set of organs in the human being which have less 
 resemblance to the corresponding ones of the fish, in mere external 
 appearance, than the masses of neurine contained within the cranium ; 
 and I will venture to assert that there are few circumstances more start- 
 ling to the anatomist who has confined his attention solely to the exami- 
 nation of the human brain, than the first appearance which the brain of 
 a large fish presents to his view on removing the upper surface of the 
 skull. Its minuteness as compared with the great size of the body, the 
 number of its component parts, and their want of that concentration 
 which is so peculiarly striking in the human brain, a concentration, let 
 it be remembered, deeply interesting, but which can only be duly appre* 
 
 * Anatomic compare de systeme nerveux considered dans ses rapports avec intelligence, 
 par Fr. Leuret, torn i. p. 164 (1839). 
 
84 
 
 COMPARATIVE ANATOMY. 
 
 ciated by him who traces with attention the structure of the nervous sys- 
 tem through the chain of beings, all give a mystery and confusion to 
 the subject, which can only be solved by seriously considering and care- 
 fully drawing inferences from those facts which rest upon comparative as 
 well as human anatomy for their support. 
 
 Among these facts there are none more important to us than these, 
 viz. : 
 
 That every nerve of sense, whether it be of the sense of smell, sight, 
 hearing, taste, tact, or of simple sensation, has, at its central extremity, a 
 collection of cineritious neurine, or ganglion. By the central extremity 
 of a nerve we mean that which, in the ordinary language of anatomists, 
 is called the origin of the nerve, but which in strict accordance with phy- 
 siology ought to be called its termination; for the term origin is not 
 merely incorrect as regards the function of the nerves of sensation, but 
 also as regards their development ; all the nerves being formed in the 
 extremities and trunk previous to their connection with the brain and 
 spinal cord, in conformity with the law of concentric development, or 
 development from the circumference to the centre. In the human em- 
 bryo, for example, we find that when the nerves first engraft themselves 
 upon the spinal cord, the external layer of medullary matter is extremely 
 thin, and the nerves appear to be simply in contact with the cord, but 
 that in proportion as new fibrous layers are deposited, the nerve is en- 
 veloped by them, and becomes, as it were, dovetailed into the fissures 
 of the fibres. 
 
 But the brain of fishes does not consist simply of ganglia, in which 
 the nerves of sensation terminate ; there are other parts which must, I 
 think, be viewed as a decided advancement, in accordance with their 
 manifestation of higher instinct and an approach to the intellectual 
 faculties of memory and judgment. These parts are therefore, in all 
 probability, the instruments by which some further process is effected, 
 approaching in its nature to the mental operations of man, such as judg- 
 ment, of course extremely limited in its nature, remembrance of sensa- 
 tions, &c. If this view be correct, these parts must be analogous to the 
 hemispheres of the human brain, for most physiologists of the present 
 day agree with the opinion given by M. Cuvier, in his report to the 
 Academy of Sciences at Paris, on M. Flourens' work, namely, that the 
 cerebral lobes or hemispheres are the organic parts in which the impres- 
 sions made on the organs of sight and hearing become perceptible to the 
 animal, and that probably there too all the sensations assume a distinct 
 form, and leave durable impressions ; that the hemispheres, in short, are 
 the abode of memory, and from this circumstance, therefore, a source to 
 the animal of the materials for judgment. 
 
 Besides these parts, which in all probability are analogous to the 
 hemispheres of the human brain, there is a structure which corresponds 
 to the cerebellum. Its office has not yet been clearly ascertained, though, 
 for reasons to be mentioned hereafter, there can be little doubt that it is 
 in some way or other connected with the production of that combined 
 action of the muscles which is essential to progressive motion, and which 
 would seem to require appropriate nervous parts for its direction and 
 control. 
 
PISCES. ;< 85 
 
 If we do not take this view of the composition of the brain of the 
 fish, we must remain satisfied with the obscurity in which all writers on 
 comparative anatomy have left this subject, and be content to see the 
 chain of progressive development from the lowest animals up to man, 
 broken, by which the study of the nervous system in these animals, instead 
 of assisting us in unravelling the structure of the human brain, would 
 only plunge us into fresh difficulties.* 
 
 Serresf was well aware of the backward state of information in regard 
 to the anatomy of the brain of fishes. He thus expresses himself: 
 
 " Considered as a whole, the encephalon of the fish is the most simple 
 in nature ; it is the most complicated in our writings ; it is an inextricable 
 labyrinth in our books. Why this contradiction between nature and our 
 writings ? There exist many reasons for it ; the principal one, that 
 from which all the others flow, is the infinite variety which the brain of 
 the fish presents to our notice. Nature seems to have employed all her 
 riches on these animals. Their brain varies not only from family to 
 family, but essentially differs from genus to genus ; and even from species 
 to species there is continued metamorphosis going on. These variations 
 do not consist solely in changes of form of position, or of relation in the 
 same elements: some entire parts are transformed, left out, and again 
 reproduced." 
 
 Notwithstanding these prefatory observations of Serres, I confess that 
 he does not appear to me to have considered the structure of the brain 
 from that simple point of view from which I consider it may very readily 
 and very advantageously be regarded. 
 
 One reason for this is, that in most of his descriptions and illustrations, 
 he omits altogether the olfactory tubercles, unless they are very large, 
 as in the skates and sharks, or close to the hemispherical ganglia, as in 
 the eel ; consequently, repeatedly confounds the two. 
 
 Leuret enumerates eight cerebral ganglia: 1. Olfactory; 2. Cerebral ; 
 3. Optic ; 4. Quadrigeminal ; 5. Cerebellum ; 6. Ganglia of the tri- 
 facial ; 7. Ganglia of the seventh and eighth ; 8. Those which exist 
 at the base of the brain between the decussation of the optic nerves. 
 Leuret has fallen into the same error as Serres : for instance, he states 
 that in the brain of the codfish, the olfactory ganglion and the cerebral 
 are united so as to form only one, and in Plate II. he gives the brain of 
 the codfish, omitting the olfactory ganglion altogether, and calling the 
 hemispherical ganglion, " Tubercle ethmoidal, or cerebral ;" and in the 
 figure of the brain of the eel, where the olfactory tubercle is so close 
 that it cannot be omitted, he then designates it, " Tubercle ethmoidal;" 
 and the hemispherical ganglion, "Tubercle cerebral." The difference 
 in the position of the olfactory ganglion is interesting, but it does not 
 deprive it of its title to be considered as a portion of the cerebral mass. 
 
 In order to prove the correctness of this view, let us direct our 
 attention to a few specimens of the brain of fishes, commencing with, 
 the more simple forms, and proceeding gradually to the more compli- 
 
 * It is gratifying to the author to find that this view of the homology and physiology of 
 the cerebral ganglia of the fish, which was first enunciated in the first edition of this work 
 in 1836, is now almost universally adopted. 
 
 f Anatomie Comparee du Cerveau, torn. i. p. 184. 
 
86 
 
 COMPARATIVE ANATOMY. 
 
 Fig. 26. 
 
 cated. For this purpose I have, intentionally, selected the brains of 
 those species which are most easily obtained. 
 
 But, before proceeding to the description of the brain of any particular 
 fish, let me remark, that there is a striking peculiarity in the brain-case or 
 cranium of fishes as regards its relation to the dimensions of the cerebral 
 mass. In most species of fishes, the cavity of the skull is nearly double, 
 and, in many instances, nearly treble, the size of the included brain. 
 In the head of the skate and cod, this difference is particularly obvious: 
 the space, which is left between the surface of the brain and the walls of 
 the cranium, is filled up with a loose cellular membrane containing a 
 quantity of gelatinous fluid, and evidently answers the same purpose as 
 the arachnoid in those instances where the brain is closely surrounded by 
 the bones of the skull. In the sturgeon, again, there is no such vacancy 
 a circumstance which it is important to bear in mind, in order to avoid 
 injuring the brain when opening the skull of this cartilaginous fish. 
 
 The brain of the whiting, haddock, and the cod, are exactly alike. 
 The whiting has been selected, because its skull is soft and easily opened. 
 The skull of the codfish, which are brought to London, is almost al- 
 ways fractured and the brain injured. The fishermen always stun them 
 by a blow on the head. The student, before he removes the brain, had 
 better study fig. 26 : else, he will commit the same error which Serres 
 and Leuret have done, and some physiological writers, who have copied 
 their plates without dissecting the fish, and describe the termination of 
 the olfactory commissures in the hemispheres as the olfac- 
 tory ganglia ; as they either leave them in the skull, when 
 they remove the brain, or, if they examine the brain in situ, 
 they neglect to uncover the ganglia. 
 
 The whiting. If, in this fish, we view the cerebral mass 
 from above, proceeding from before backwards, we observe 
 three rounded masses or nodules of neurine, and a triangu- 
 lar shaped medullary leaflet, which overlaps that fissure of 
 the cord called the fourth ventricle. 
 
 The first pair are the olfactory ganglia, lying on the crib- 
 riform plate of the ethmoid bone, where they are joined 
 by the olfactory nerves, as they are in man. They are 
 about the size of large pins' heads, and their being situated 
 at some distance from the rest of the cerebral mass, is, I 
 suppose, the reason they have escaped the observation of 
 most anatomists, and are not included by Serres in his de- 
 scription of the component parts of the brain in this fish. 
 iory ganglion. B. To me they nevertheless appear to be as decidedly a portion 
 fop- of the cerebral mass as the optic tubercles or ganglia, in 
 which the optic nerves terminate, and which are always in- 
 cluded in the description of the fish's brain. The commis- 
 sure or apparatus of union which connects this ganglion with the rest of 
 the encephalon is thin and thread-like, resembling a nerve in its appear- 
 ance, and about an inch in length. Some authors have stated that the 
 olfactory tubercles in the osseous fishes are generally in contact with the 
 cerebral mass ; but the brain of the whiting, as well as of many others, 
 forms an exception to the rule. The next masses, about the size of a 
 
 Brain of the 
 whiting the size 
 of life, seen on 
 its upper sur- 
 face. A. Olfac- 
 
,, PISCES. 87 
 
 small pea, are analogous to the human hemispheres, and may be desig- 
 nated the hemispherical ganglia : they are connected together by a 
 transverse commissure, the anterior commissure. It is particularly in- 
 teresting to observe how closely these hemispherical ganglia of the 
 whiting correspond with the cerebral hemispheres of the human embryo 
 at the seventh week. These bodies, however, are described by Tiede- 
 mann* as analogous to the corpora striata rather than to the hemispheres 
 of the brain, and by Desmoulins to the optic thalami. With all defer- 
 ence to the talented authors of these opinions, I must say that I do not 
 imagine either of these analogies to be founded in fast. The corpora 
 striata and optic thalami in man and the Mammalia, are structures formed 
 so entirely of fibres intermingled with cineritious neurine, either termi- 
 nating in, or arising from, the hemispheres, that I cannot conceive how 
 they should exist if the hemispheres themselves, from which they derive 
 their origin, and in which they terminate, were altogether absent. 
 
 Nevertheless it is not true, as some authors have stated, that these 
 ganglia always hold an exact relative size to the hemispherical ganglia. 
 
 The next pair of nodules are the optic ganglia or tubercles, analogous 
 to the tubercula quadrigemina in man.f 
 
 Leuret does not employ the term optic lobes as synonymous with 
 tubercula quadrigemina, which most anatomists of the present day agree 
 in considering the true optic tubercles. 
 
 * Tiedemann on the Foetal Brain ; translated by Bennet, p. 230. 
 
 f By the translator of Carus's Comparative Anatomy (Mr. R. T. Gore) it is said, in page 
 240, that the identity of these middle cerebral masses with the corpora quadrigemina is 
 fully proved by a reference to the progress of formation of the same parts in the fostus of 
 man and other Mammalia. In the early periods of the existence of the human fetus, the 
 corpora quadrigemina contain a capacious ventricle, subsequently filled up by the deposition 
 of nervous matter, so as to leave only the narrow passage known as the aqueduct of Syl- 
 vius. This ventricle is covered over by two thin medullary lamina?, in contact with each 
 other, though not united, along the mesial line, and contains elevations or ganglia similar to 
 those here described. (Tiedemann, I c., 186.) According to him, however, they represent 
 not merely the anterior, but rather both pairs of the corpora quadrigemina. Their size is 
 directly proportioned to that of the eyes and optic nerves, being small in the conger eel and 
 burbot, of moderate size in rays and sharks, and considerably larger than the first cerebral 
 mass in the trout, pike, garpike, salmon, carp, uranoscopus, sparus, scorpoene, perch, &c. In 
 the genera Sparus, Scorpaena, Clupea, Mugil, Scomber, Zeus, Trigla, &c., the optic nerve, 
 arising on each side from the middle cerebral mass or optic tubercles, consists of a membran- 
 ous expansion, disposed in longitudinal folds like the leaves of a closed fan, though in- 
 closed within a cylindrical neurilemma, which, however, adheres so loosely as to allow the 
 folds to glide one upon another. In the Trachinus Draco, where the diameter of the nerve 
 is about a line, there are nine or ten folds, which, when expanded, form a membrane 
 nerve is almost in a rudimentary state, its length and the thickness of the neurilemma being 
 eighteen or twenty lines wide. In the pleuronectes, mursenae, rays, sturgeons, &c., the optic 
 proportionally very considerable. In a sturgeon four feet long, the diameter of the nerve 
 was not above three-fourths of a line, and the medullary matter contained within it less than 
 one-fourth of the whole, the rest being formed by neurilemma. In the Ammocetus the nerve 
 is wanting, though there is a rudiment of the eye. (Desmoulins, /. c., p. 325, &c.) In the 
 Cydopterus Lumpus, the nerve on each side consists of from twenty-five or thirty parallel 
 filaments, each covered by a separate neurilemma, and collectively inclosed within a common 
 cylindrical sheath so loosely as to allow of motion one upon the other. The most remark- 
 able circumstance, however, is that the cerebral termination of each nerve is continuous with 
 that of the other ; the extremity of the neurilemma of each filament and the ends of the com- 
 mon sheath of each inosculating, as it were, together. The point of union of the common 
 sheaths of the filaments of each side is connected with the brain merely by very fine cellu- 
 lar tissue, without the interposition of any medullary matter, and so loosely as to admit of 
 being separated by the least eifort. {Desmoulins., I c. t 330, Plate IX. fig. 3.) The nerves in 
 this case do not decussate. 
 
88 
 
 COMPARATIVE ANATOMY. 
 
 These are his words :* "Optic Ganglia. Haller, Vic d'Azyr and Ca- 
 rus, have called them thalami optici ; Camper, cerebral hemispheres ; 
 Scarpa, great tubercles of the brain ; Treviranus, posterior hemispheres; 
 Cuvier, hollow lobes; M. Serres, M. Desmoulins, M. Gottsche, optic 
 lobes. In some fish, in which the optic ganglia are the largest, there is 
 always that white appearance which belongs to a medullary substance. 
 In osseous fishes they are always uncovered ; in the skate and the shark 
 there is a portion concealed by a prolongation of the cerebellum. At 
 first sight, and especially if examined after being in spirit, their appear- 
 ance is throughout the same, but in a fresh state we can trace, upon the 
 internal and superior surface, one of the roots of the optic nerve ; and 
 upon the external inferior surface a second root of the same nerve. 
 They are in exact proportion to the size of the eyes: Gottsche has ob- 
 served in those which have the eyes of unequal size, in the Pleuronectes, 
 for example, sole, turbot, &c., that the optic lobes are unequally deve- 
 loped. If we divide these lobes, we see that they do not constitute 
 really a ganglion, but that they are formed by a very fine fibrous lamina. 
 The optic laminae on one side is adherent on the internal surface to the 
 corresponding laminaB on the opposite side, and at the point of this adher- 
 ence it consists of fibres which run from right to left : these fibres form 
 there a true commissure, and represent the corpus callosum, as we shall 
 see presently. The optic laminae form the walls of a double ventricle, 
 separated, the right from the left, by a small lamina analogous to the in- 
 terventricular lamina or septum lucidumof superior animals. The inte- 
 rior of these ventricles presents different appearances, according to 
 whether it belongs to an osseous or cartilaginous fish. In the former, 
 we perceive first a white commissure which unites the anterior portion 
 of the two optic lobes ; behind this commissure, the anterior prolonga- 
 tions of the spinal cord, which is found below all the cerebral ganglia, 
 to which they serve as the base, leaving between them the infundibulum 
 or lower part of the third ventricle of the mammiferaB ; behind the infun- 
 dibulum, another or posterior commissure, analogous to the preceding; 
 at length, above this commissure, a tubercle, flattened, bilobed, fur- 
 nished with two long appendages of a medullary substance of a whitish 
 gray. The bilobed tubercle represents the tubercula quadrigemina, and 
 below is the aqueduct of Sylvius, which forms a communication between 
 the cavity of the optic ventricles and another ventricle placed under the 
 cerebellum. On each side, the ventricle of the optic lobe presents a 
 small tubercle (tori semicirculares of Haller, the semicircular collar of 
 Cuvier, the anterior internal ganglions of Carus), which is analogous to 
 the corpus striatum." 
 
 " In cartilaginous fish, the cavity formed by the optic lamina does 
 not present any commissure, nor the tubercular quadrigemina very dis- 
 tinctly, but only the infundibulum and the commencement of the aque- 
 duct of Sylvius."t 
 
 M. Serres thus describes the optic tubercles in fish, considering them 
 analogous to the tubercula quadrigemina in man. His words are, 
 " Thus we see the tubercula quadrigemina exist in osseous fish: they 
 are in direct communication by their posterior extremity with the cere- 
 
 * Op. cit., p. 140. * P. 142, op. cit. 
 
PISCES. 89 
 
 bellum, and there is a true processus e cerebello ad testes: by their an- 
 terior part they are continued into a long lamina, which curves upon 
 itself, and covers a large portion. When we examine the brain of the 
 carp, we see behind and within these optic ganglia two oblong bodies, 
 which are nothing but the folded extremity of these lamina?." 
 
 The next division of the whiting's brain is the triangular leaflet, the 
 analogue of the cerebellum or little brain in man. These parts comprise 
 the whole of the nervous masses which can be observed by merely look- 
 ing upon the upper surface of the cerebral mass of the whiting; but if 
 we raise the optic tubercles, we find that instead of their being solid, as 
 they appear, they are hollowed out internally : and by turning them back, 
 we observe two small rounded projections, which appear 
 to be merely continuous portions of the same ganglia, Fig. 27 - 
 bearing some resemblance to the posterior of the quadri- 
 geminal bodies called the testes in the human subject. 
 By raising the cerebellum we also observe that the spinal 
 cord lying beneath it is much thicker than the same part 
 lower down ; in fact, that fresh neurine has been added 
 to it on each side, in the shape of two oval bodies, the 
 nature of which, or the analogy they bear to particular 
 portions of the human brain, it is not easy to discover in 
 the whiting; but, as will be seen afterwards by reference 
 to other fishes, it is highly probable that they correspond Brain of the 
 to the posterior pyramidal bodies or auditory ganglia, to- ^beiE **& 
 gether with the ganglia of the pneumogastric nerves in SeTrlnchio^ 
 man, the branchiogastric nerve in the fish taking its rise trie ganglia dis- 
 from, or being in direct communication with, them. p E y cerebeiium. 
 
 If the whole encephalic mass of the whiting, having - 
 been removed from the skull, be reversed, and the under 
 surface exposed, two oval-shaped cineritious bodies may be observed. 
 u These bodies," says Spurzheim,* c< probably correspond to the gray 
 tubercle (tuber cinereum) of Mammalia. This tubercle, in ttie higher 
 classes of animals, always sends fibres to the optic nerves, which, after 
 this accession, advance in their course of increased size." Carus enter- 
 tained the same opinion, while Cuvier regarded them as the true optic 
 tubercles. The use of the tuber cinereum in man certainly has not yet 
 been ascertained; but it is much more probable that these oval-shaped 
 cineritious bodies of the fish are analogous to them, than to the corpora 
 mammillaria, as conjectured by Serres; for the corpora mammillaria 
 being portions of the fornix in man, cannot be supposed to exist where 
 that structure is wanting, as it is in the fish. 
 
 The brain of the cod so closely resembles that of the whiting that it 
 will not require any particular description ; but I have introduced a draw- 
 ing (after Serres), to show the optic ganglia turned back (fig. 28), exhi- 
 biting the connection of the olfactory nerves with the hemispherical 
 ganglia, and with the continuous fibres of the spinal cord. 
 
 The Carp (fig. 29). On first exposing the brain of the carp, we are 
 struck with the great dissimilarity which it presents to that of the species 
 
 * Anatomy of the Brain, 1826, p. 38. 
 
90 COMPARATIVE ANATOMY. 
 
 of fish last described. Instead of only four divisions, we here distinctly 
 observe no fewer than seven. A little consideration, however, will con- 
 Fig. 28. Fig. 29. 
 
 Fig. 28. (From Serres' Anatomie Comparge du Cerveau.) The brain of the codfish, unfolded to expose 
 the continuation of the spinal cord and its connection with olfactory nerves. B. Hemispherical ganglion. 
 c. Optic ganglion. E. Cerebellum. H. Spinal cord. m. Corpus striatum. 
 
 Fig. 29. -Brain of the carp, removed from the skull, and seen from above. A. Olfactory ganglion. B. 
 Hemispherical ganglion, c. Optic ganglion. D. Testes, or posterior optic ganglion. K. Cerebellum. F. 
 Auditory ganglion. G. Pneumogastric ganglion. H. Spinal cord. j. Pituitary gland. M. Corpus 
 
 vince us that there is no essential difference between the brain of the 
 whiting and that of the carp, but that the analogy is perfect and the chain 
 of structural uniformity yet unbroken. The first pair of nodules, which 
 are small, are the olfactory ganglia, and, like those of the whiting, situ- 
 ated on the ethmoid bone, at some distance from the remainder of the 
 encephalon. The commissure connecting them in a carp seven inches 
 in length was a little more than an inch long. The second pair are the 
 cerebral hemispheres, but extremely small as compared with the same 
 parts in the cartilaginous fishes. The third and fourth divisions evidently 
 belong to the optic ganglia, and not to the hemispherical, for we find the 
 pineal gland situated between the two. The optic ganglia are hollow 
 in all fish, as we have seen in the cod, but in the carp the covering is 
 imperfect, as we see in fig. 29, representing the brain as seen from above: 
 letter c runs to this lamina, and D to the internal portion. At the base 
 of the brain may be observed a large pituitary gland and infundibulum. 
 The cerebellum is the next mass, and immediately behind it are the 
 auditory ganglia, analogous to the posterior pyramidal bodies in man. 
 On each side of these ganglia are placed those bodies from which the 
 branchiogastric nerves arise, analogous to the pneumogastric ganglia, 
 which are placed to the inner side of the restiform bodies in the human 
 subject. These bodies are stated by Cruveilhier* to be of enormous size 
 in the Electric Ray, in whom the branchiogastric nerve is so amazingly 
 
 * Op. cit. 
 
PISCES. 
 
 
 91 
 
 The brain of the eel. 
 seen from above. A. 
 Olfactory ganglion. B. 
 Hemispherical gangli- 
 on, c. Optic ganglion. 
 E. Cerebellum. H. Spi- 
 nal cord. 
 
 Fig. 31. 
 
 developed. The hemispheres, though solid, consist of Fig. 30. 
 two portions, the exterior or cortical substance, the 
 hemispherical ganglia, and a bed of vesicular neurine 
 in the centre, through which white fibres of the cord 
 may be seen spreading towards the circumference, 
 separated from each other by gray neurine. (See fig- 
 30.) It is identical with the corpus striaturn of the 
 human brain. 
 
 In the common eel we have an appearance of va- 
 riety, which simply arises from the circumstance of the 
 olfactory tubercles (which in the whiting, carp, &c., 
 are situated on the cribriform plate of the ethmoid 
 bone, at the distance of nearly an inch from the rest 
 of the cerebral mass) being placed close to the hemi- 
 spheres ; this, and also their being slightly grooved 
 transversely on their upper surface, gives to the whole cerebral mass 
 the appearance of a long chain of tubercles, which have no resem- 
 blance to the component parts of the brain in the 
 last-mentioned fish, so that there appears at first sight 
 to be no analogy ; the number of essential parts is, 
 however, in reality the same, and the analogy between 
 them perfect ; the only real difference consists in their 
 relative size and the distance at which they are situated 
 from one another. (Fig. 30.) 
 
 In the pike, also, the olfactory ganglia are placed 
 close to the hemispherical, and if the olfactory nerves 
 are traced to the nose, they will be seen dividing into 
 several branches, but without forming any bulbous 
 enlargement, passing through a membrane which cor- 
 responds to the cribriform plate of the ethmoid. (See 
 fig. 31.) 
 
 In the cartilaginous fishes the form of the brain ap- 
 proaches so much more nearly to that of the higher 
 orders of animals, that at first sight the cerebral mass 
 in one of the Rays, as the common skate (figs. 32 and 
 33), appears to differ essentially in its component parts 
 from that of one of the bony fishes which we have 
 hitherto been describing particularly. There is, how- 
 ever, no essential distinction; the difference arising 
 solely from the greater concentration of similar or 
 nearly similar parts. 
 
 The olfactory ganglia in the skate are extremely 
 large, as will be seen by referring to the diagram (fig. 
 32). The peduncles are long, and the cerebral hemi- 
 spheres form a more considerable mass, slightly irregu- 
 lar upon its surface, and thus assuming an approach 
 to a convoluted arrangement of the superficies. These 
 hemispheres are solid, as we have seen in the carp ; 
 the white fibres may be seen entering at the posterior 
 extremity, and separated by gray neurine in like man- 
 
 Brain of the pike. A. 
 Olfactory ganglion. B. 
 Hemispherical gan- 
 glion, c. Optic gan- 
 glion. E. Cerebellum. 
 H. Spinal cord. x. The 
 olfactory nerve pene- 
 trating the cribriform 
 plate of ethmoid bone, 
 without any bulbous en- 
 largement. 
 
92 
 
 COMPARATIVE ANATOMY. 
 
 The brain of the skate, removed from the 
 skull, and seen from above. A. Olfactory 
 ganglion. B. Hemispherical ganglion, c. Op- 
 tic ganglion. E. Cerebellum. G. Pneumo- 
 gastric ganglion. 
 
 32 - ner. The optic tubercles have also 
 
 increased in size, and are connected 
 with the hemispheres by distinct me- 
 dullary bands. 
 
 But the cerebellum is found to have 
 undergone the greatest alteration of 
 any part ; for it is no longer a mere 
 triangular leaflet, but is divided into 
 lobes, and partly overlaps the optic 
 tubercles. But the hemispherical gan- 
 glia are not yet separated from the cor- 
 pora striata by any interspace or ven- 
 tricle. This covering is first found in 
 the sharks. The transverse commis- 
 sure is very distinct (see fig. 32). 
 
 In the sharks, the cerebellum is 
 much larger and more complicated 
 than in any other fish. It very much 
 resembles that of the bird, consisting 
 of transverse lamina?. 
 
 The advance in the size and com- 
 plexity of the cerebellum is interesting 
 when we remember the great locomo- 
 tive powers of these fish ; and the fact that they are entirely dependent 
 on these powers, not merely for locomotion, but for their buoyancy, for 
 they do not possess any air-bag, like the osseous fishes. 
 
 On each side of the cerebellum in the skate there is an extensive 
 layer of folded neurine, from which a considera- 
 ble portion of the branchiogastric nerve arises. 
 It is the analogue of the respiratory ganglia in 
 the Mollusca, &c., and the pneumogastric or 
 restiforra ganglia in man ; we shall also find a 
 portion of the nerve corresponding to the fifth 
 nerve of Mammalia connected with it (G). Leuret 
 describes it as partly the branchiogastric gan- 
 glion and partly a ganglion of the fifth pair. Serres 
 considers this structure as forming a portion of 
 the cerebellum. Spurzheim does not agree with 
 him, though he does not form the same conclusion 
 which I have done. 
 
 On reversing the position of the brain (fig. 33), 
 we observe the two small tubercles (i) of medul- 
 lary neurine, believed to be analogous to the 
 tuber cinereum in man, a part whose character, 
 as before stated, has not yet been ascertained. I 
 am glad to find that Leuret agrees with the view 
 of the horaology of these ganglia, which I enunci- 
 ated in my first edition. The pituitary gland (j) 
 is large in this fish, and seen distinctly in fig. 33. 
 From the. Fish, let us direct our attention to 
 
 Fig. 33. 
 
 Brain of the skate seen on 
 

 REPTILIA. 
 
 93 
 
 some specimens of the cerebro-spinal axis in Amphibia. The most fami- 
 liar example of this class is our common frog. 
 
 Fig 34. 
 
 C&D 
 
 Side view of the brain of the frog. A. Olfactory gang-lion. B. Hemispherical ganglion, c & D. Optic 
 ganglion. When c and D occur in the same figure, c signifies anterior optic ganglion. E. Cerebellum. 
 H. Spinal cord. R. Pineal gland. 
 
 In this animal the olfactory ganglia are brought close up to the hemi- 
 spheres, as in the eel (see fig. 30) instead of being at some distance, 
 and connected by long peduncles, as in most other fish. The hemi- 
 spheres (B), larger in proportion than in fish, are nearly double the size 
 of the optic ganglia. They are hollow, and contain within, a distinct 
 corpus striatum, or anterior cerebral ganglion, which will be better seen 
 and better understood in the classes above the Amphibia. The optic 
 ganglia (c and D) are distinct, and covered with a dark membrane. 
 The pineal gland is small but distinct. The cerebellum is peculiarly 
 small, forming only a narrow tongue across the posterior surface of the 
 cord. This simple form of cerebellum, according to Leuret, exists also 
 in the toad, lizard, terrestrial salamander, snake, and newt. 
 
 The pneumogastric and auditory ganglia do not project on the surface, 
 but ganglionic neurine may be seen in their usual situation, when a 
 transverse section is made of the medulla oblongata. 
 
 Reptilia. From this class we may select the turtle : specimens are 
 easily procured, and its brain is extremely simple (fig. 35). The olfac- 
 tory ganglia, instead of being situated on the cribriform plate of the eth- 
 moid bone, are placed, as in the eel, almost close to the hemispheres, 
 and the commissures connecting them are therefore extremely short: 
 they communicate internally with the ventricles. The olfactory nerves 
 pass towards the cribriform plate of the ethmoid, but there is no bulbous 
 enlargement at that spot. They split into small filaments, which pass 
 through separate foramina. The cerebral lobes or hemispheres are larger 
 and more perfectly developed than in the Amphibia or in any of the 
 finny tribes. 
 
 Fig. 35. 
 
 Side view of the brain of the turtle. A. Olfactory ganglion. B. Hemispherical ganglion, c. Optic 
 ganglion. E. Cerebellum. G. Pneumogastric ganglion. H. Spinal cord, j Pituitary gland. 
 
 These ganglia are hollowed, and when opened (see fig. 36) the corpus 
 striatum or anterior cerebral ganglion (M) may be seen : it is of large 
 size. A section of this ganglion exhibits a striated appearance very 
 
94 
 
 COMPARATIVE ANATOMY. 
 
 Fig. 36. 
 
 sirailiar to that in the human being; posterior and external to the ven- 
 tricle is another enlargement (K), which I suppose is the analogue of 
 the thalamus or posterior cerebral ganglion. 
 
 Leuret designates this enlargement in the 
 ventricle of the turtle the corpus striatum, but 
 he says nothing of the smaller projection just 
 exterior to it, and anterior to the optic ganglia. 
 The optic tubercles are placed immediately 
 behind the optic thalamus. The hemispheres 
 are joined to the cerebellum by two medullary 
 processes, the analogues of which, in the hu- 
 man brain, are called the processes e cerebello 
 ad testes; and as these parts form a commissure 
 between the anterior portion of the cerebral 
 mass and cerebellum, I have, in my description 
 of it in the human brain, called it the inter- 
 cerebral commissure. It is from this part that 
 the fourth pair of nerves arise both in man, and 
 the Vertebrata generally. Between the opticle 
 tubercles and the hemisphere is the pineal 
 gland, of an elongated form, soft, consisting 
 only of blood-vessels. 
 
 The cerebellum (E) of the turtle, though 
 distinctly formed, is small, and consisting of 
 a single lamina. It is smooth and convex 
 above, and hollowed below, and, with a slight- 
 ly pointed extremity, covers in the posterior 
 fissure of the cord. The auditory ganglia and 
 respiratory ganglia are scarcely perceptible. 
 The first circumstance is accounted for by the 
 sense of hearing in these animals not being 
 acute ; in fact, all their sensations are pecu- 
 liarly dull, and, in the second place, the "be- 
 soin de respirer," as the French express it, is 
 
 not the violent, uncontrollable sensation which is evidently experienced 
 by fishes, and the higher order of animals, when the access of air is by 
 any accident impeded. Now, I have shown elsewhere that this peculiar 
 sensibility is entirely annihilated, if the pneumogastric nerve be divided ; 
 and it is, therefore, very evident that on this nerve, as a nerve of sensa- 
 tion, the high degree of sensibility peculiar to the respiratory organs in 
 the higher animals depends. The deficiency in these animals of that 
 perfectly developed system of respiratory muscles found in most of the 
 Vertebrata, viewed in connection with the diminutive size of these 
 respiratory ganglia, supports the opinion advanced elsewhere, that from 
 these bodies issue the orders for the respiratory muscles to act. 
 
 It is worthy of remark, in confirmation of the views regarding the 
 office of the cineritious neurine, which I have laid before the reader 
 elsewhere, that the spinal cord of the turtle is immensely enlarged op- 
 posite to the anterior and posterior extremities, the muscles of which 
 are supplied by it, whilst between these points it is contracted to a mere 
 
 Brain of the turtle seen from 
 above, lateral ventricle opened. 
 a. Olfactory nerre. A. Olfactory 
 ganglion. B. Hemispherical gan- 
 glion. C&D. Optic ganglion. E. 
 Cerebellum. F. Auditory 
 on. H. Spinal cord. K. 
 mus nervi optici. M. Corpus 
 striatum. R. Pineal gland. 
 
AVES. 
 
 95 
 
 thread ; the intercostal system of muscles being entirely deficient, and 
 instead of an extensive surface of skin requiring a supply of nerves of 
 sensation, as in man and the Mammalia generally, there is a hard, in- 
 sensible carapace. 
 
 In all the Reptilia the hemispheres are much alike in their smallness 
 and simplicity. They vary a little in shape. In the crocodiles they are 
 wide posteriorly and narrow in front something of a heart shape. In 
 serpents they are wider from side to side. In all the saurians, crocodiles, 
 lizards, &c., and in the serpents, the cerebellum is very small and very 
 simple. 
 
 Birds. The brain and spinal cord in birds are developed after one 
 uniform type, notwithstanding the amazing diversity of external form, 
 habits and instincts of the different species of these creatures. 
 
 The evident advancement in intellectual powers, which this interesting 
 tribe of the animal kingdom exhibits to us, is found to correspond with 
 a greater development of the hemispheres of the brain. The proportion 
 of these to the size of the body, to the other cerebral ganglia, and, 
 lastly, to the spinal cord, is far superior to anything we have met with 
 in the preceding classes. The different ganglia, composing the encephalic 
 mass, are not placed one after another, as in the skull of fishes and rep- 
 tiles, but, on the contrary, are rather placed under one another, and the 
 hemispheres or cerebral lobes are so much increased in size that they 
 cover all the different ganglia of the nerves of sensation; so that on 
 viewing the cerebral mass of birds from above, we observe only two 
 divisions the hemispheres or cerebrum, and the cerebellum ; in some 
 instances the cerebrum is so large as even partly to overlap the cerebel- 
 lum (fig. 37). 
 
 Fig. 37. 
 
 Fig. 38. 
 
 Fig. 37. Side view of the brain of the bird, showing its position in the skull. A. Olfactory ganglion. 
 B. Hemispherical ganglion, c. Optic ganglion. E. Cerebellum. H. Spinal cord. 
 
 Fig. 38. Upper surface of the brain of the woodpecker (Leuret), showing the first commencement of 
 the convolutions. B. Hemispherical ganglion. E. Cerebellum. H. Spinal cord. 
 
 The cerebral lobes in most birds still present a smooth surface, but in 
 some birds there is a slight furrow, which is the first trace we meet with 
 of that folded or convoluted appearance which is so characteristic of the 
 brain of the highest order of animals. The brain of the common fowl, 
 pigeon, magpie, blackbird, loriat and crow, is perfectly smooth (see fig. 
 37); but that of the buzzard and cuckoo is slightly furrowed. In the 
 duck and woodpecker this is distinct (fig. 38); and " in the parroquet it 
 is more distinct (says Leuret) than in any bird I have examined."* 
 
 * Leuret, p. 277. 
 
96 COMPARATIVE ANATOMY. 
 
 The cerebral hemispheres are not hollow, as in fish and reptiles. And 
 let it be remembered, that this convoluted arrangement is adopted 
 simply for the purpose of obtaining a larger surface of cineritious neurine 
 in a smaller space. The amount of surface presented by a convoluted 
 brain, if extended evenly, would cover a very large space, and take up 
 a great deal of room ; it would consequently require a skull of corre- 
 sponding dimensions to contain it, with proportionally large muscles to 
 move the head. Folded backwards and forwards, however, in the 
 beautiful manner in which we find the brain arranged in man and the 
 Mammalia generally, it takes up but little room, and is packed into a 
 comparatively small box, which does not then interfere with the active 
 powers of locomotion, so important to all the higher animals in main- 
 taining their relations with the external world. 
 
 The cerebellum in birds is peculiarly large a fact which tends to 
 confirm the views of many intelligent physiologists of the present day, 
 that it presides over and combines the action of separate muscles so as 
 to produce an harmonious result; for the perfection which the organs of 
 locomotion attain in this class very far surpasses all that we have yet ob- 
 served among fishes and reptiles, and equals at least the degree of develop- 
 ment exhibited by the same organs in any other species or class of living 
 beings ; the cerebellum is divided by transverse furrows into laminaB 
 varying in number from 10 to 20. Leuret names 12 in the partridge, 
 15 in the duck, 16 in the parroquet, 20 in the male magpie. 
 
 Nevertheless the cerebellum of the Bird differs from the same organ 
 in the Mammalia in one important particular ; the lateral lobes of the 
 cerebellum are almost wholly deficient in birds ; in man they are so 
 much developed that the- central portion, consisting of the superior and 
 inferior vermiform processes, has even been described by Reil as con- 
 stituting a mere commissure. The cerebellum of the Bird consists, in 
 many species, of little more than the middle lobe, which, corresponding 
 to the vermiform processes of the Mammalia, proves that these processes, 
 instead of constituting a commissure, form the fundamental, and conse- 
 quently, we may suppose, the most essential portion of a cerebellum. 
 Serres* remarks, that this analogy, which was first observed by Haller, 
 was rejected by Malacarne, and neglected by most subsequent anatomists. 
 The lateral hemispheres, observes the same author, in some birds are so 
 small as scarcely to be visible ; for instance, in the common fowl, the 
 duck, the goose, the wren, canary-bird, and sparrow: but they are very- 
 distinct in partridges, pigeons, swallows, birds of prey, the ostrich, the 
 cassowary and the storks. In general, in birds which elevate and sustain 
 themselves a long time in the air, as the stork, and those whose wings 
 or feet have great power, as the emu, cassowary, and parrots, these 
 hemispheres appear most developed. 
 
 The olfactory ganglia are small in birds, and, as in some fishes, are 
 placed close to the cerebral hemispheres, so that the commissures, or 
 peduncles as they are sometimes called, are peculiarly short, presenting 
 little more than a white line, which runs to the outer side of the hemi- 
 spheres. 
 
 * A/iatomie Compare du Cerveau, vol. ii. p. 372. 
 

 MAMMALIA. 
 
 97 
 
 The optic tubercles, on the contrary, are very large, as are also the 
 nerves which arise from them. 
 
 The medulla oblongata is more than - Fi s- 39 - 
 
 double the size of the spinal cord, both 
 in width and depth ; the corpora pyra- 
 midalia, the olivary bodies and pons 
 Varolii are absent. 
 
 The hemispheres of the brain are 
 connected together by a small trans- 
 verse commissure, consisting of cineri- 
 tious matter on the exterior, of filaments 
 of medullary matter, of the size of a 
 thread, in the interior; the analogue of 
 the anterior transverse commissure in 
 man, (see fig. 39, p,) which represents 
 the two divided ends of it. It has 
 been cut in separating the hemispheres. 
 On the internal surface of the hemi- 
 spheres (those two surfaces which are 
 opposed to each other, and in the hu- 
 man brain are separated by the falx 
 major), we observe some diverging 
 fibres of medullary neurine, which pre- 
 sent themselves as a sort of footstalk at 
 the under part of the hemispheres, but 
 really commence by two portions, the 
 one from the outer edge of the tractus 
 opticus, the other from the inner. That 
 which takes its course to the outer 
 side is connected with the tractus opti- 
 cus, while the internal appears to ter- 
 minate in the tuber cinereum. This structure appears to me analogous 
 to the fornix in man. (See letter N, fig. 39.) 
 
 In the brain of the Bird we again distinctly observe those* collections 
 of cineritious neurine through which the fibres of the anterior and poste- 
 rior columns of the spinal cord proceed in their passage towards their 
 termination in the hemisphere. These nodules or tubercles, which in 
 the human subject are called the corpora striata and thalami nervorum 
 opticorum (fig. 39), may be seen in the Bird by separating the hemi- 
 spheres and breaking down the commissure which connects them. They 
 will then be observed partly covered by the optic tubercles. In birds 
 the corpora striata are very large, the thalami small. As they are more 
 perfectly developed in all the genera of the succeeding class, I shall not 
 at present dwell longer upon the character they exhibit. 
 
 Brain and Spinal Cord in the Mammalia. The division of this class 
 into two sub-classes, the Placentalia and Implacentalia, by Professor 
 Owen, and the philosophical researches of this admirable anatomist, into 
 the organization of the Implacentalia, necessitate our considering them 
 separately. It is found that the brain of the lowest mammal is but little 
 in advance of the Bird ; and that assertion of Cuvier, that the pons 
 7 
 
 The brain of the goose laid open. (From 
 Spur/helm.) On the right hand side may be 
 seen the internal surface of the hemisphere 
 without any section. The white fibres on the 
 surface belong to the fornix or longitudinal 
 commissure. On the left side, a section of 
 the hemisphere has been made, below that 
 called the antrum ovale in the human brain; 
 it lays open the lateral ventricle, exposing the 
 corpus striatum (M) and the thalamus (k). 
 The small transverse commissure, analogous 
 to the anterior commissure in man, is divided, 
 (p). There is no corpus callosum. a. Olfac- 
 tory nerve, b. Optic nerve. B. Hemispheri- 
 cal ganglion, c. Optic ganglion. E. Cerebel- 
 lum. F. Auditory ganglion. N. Longitudinal 
 commissure, or fornix. P P. Great transverse 
 commissure. 
 
98 COMPARATIVE ANATOMY. 
 
 Varolii and corpus callosum are peculiar to the Mammalia, is not appli- 
 cable to the Mammalia as a whole, but only to the Placentalia. (The 
 Implacentalia are divided into Monotremata and Marsupiata.) 
 
 The Monotremata derive their name from their having a common 
 opening for faecal evacuation and the generative function, like the birds ; 
 the ornithorhynchus, or duck-billed platypus, is our most familiar exam- 
 ple. The brain of this animal is extremely simple ; the hemispheres are 
 small and smooth like the bird, the whole brain only bearing a propor- 
 tion to the body of 1 to 130. 
 
 The optic tubercles are covered more completely than in the Bird, 
 and they are partially divided, shadowing forth the complete division 
 into four bodies, which we meet with in the placental Mammalia. "The 
 posterior bigeminal body," says Owen, (Art. Monotremata, Cyc. Anat., 
 Tol. iii. p. 383,) " is much smaller than the anterior, and the transverse 
 depression which divides them is very feebly marked ; the longitudinal 
 groove is equally feeble on the nates, and is altogether absent in the 
 testes, which thus form a single tubercle." 
 
 The commissural apparatus presents the same peculiarity and defi- 
 ciency as in the Marsupiata to be described presently. Thus we do not 
 find any sudden transition from one form of brain to another ; there is no 
 great chasm between the brain in birds and that of the Mammalia. 
 
 Mr. Owen, in his interesting paper on the brain of Marsupiate Ani- 
 mals, published in the Philosophical Transactions, Part I., 1837, has 
 shown that the link between birds and Mammalia is more perfect than 
 was previously believed. 
 
 The commissural apparatus in birds we have already seen is extremely 
 simple, consisting of a mere cord-like transverse commissure and a rudi- 
 mentary fornix. In the rodent, or gnawing Mammalia, as the rat, 
 mouse, squirrel, rabbit, beaver, the hemispheres are almost as smooth as 
 in birds, but the commissural apparatus is nearly as perfect as in man, 
 as the student will perceive when he reads the description of the brain 
 of the rabbit, given a little further on. 
 
 In the marsupiate animals, however, it is very different, for the great 
 transverse 'commissure, or corpus callosum, is scarcely larger than the 
 anterior commissure in the Bird, and the fornix is quite rudimentary.* 
 
 The brain bears a smaller proportion to the body in the marsupials 
 than in any other order of mammals : thus in the Ursine Dasyure it is as 
 1 to 820, in the Wombat as 1 to 614, in the Kangaroo as 1 to 800. 
 Mr. Owen thus states how he was led to the discovery of this important 
 distinction between the structure of the brain in the placental and mar- 
 supial Mammalia. 
 
 " From the fact that the cerebral organ is that which exhibits the 
 most marked degradation of structure in the class of warm-blooded ver- 
 tebrate animals, which are characterized by an oviparous generation, I 
 was induced to suspect, after having ascertained how closely the Marsu- 
 piata approached birds in their mode of generation, that the brain might 
 present in them some corresponding inferiority of structure, as compared 
 with the placental Mammalia. 
 
 * Encycl. of Anatomy, p: 89. 
 
MARSUPIATA. 99 
 
 "An attentive study of the manners of different marsupials in confine- 
 ment, and an inspection of the exterior forms of the brain in some of the 
 species, induced me to allude, in my paper on the Kangaroo, to an infe- 
 riority of intelligence, and a low development of the cerebral organ, as 
 being the circumstances in the habits and structure of these singular ani- 
 mals which were most constantly associated with the peculiarities of 
 their generative economy. I have since the most satisfactory confirma- 
 tion of this coincidence, from repeated dissections of the brains of mar- 
 supials belonging to different genera, and although unable to* explain 
 how a brief uterine existence, and the absence of a placental connection 
 between the mother and foetus, can operate (if it be really effective) in 
 arresting the development of the brain, yet it is a coincidence which has 
 been so little suspected, and is so interesting in various points of view, 
 that I believe the evidence of it will be acceptable both to the physiolo- 
 gist and the naturalist." 
 
 Fig. 40. Fig. 41. 
 
 Fig. 40. Upper surface of the brain of the beaver, reduced one-half. (Owen.) A. Cerebral hemi- 
 spheres, a. Olfactory ganglion, c. Cerebellum. 
 
 Fig. 41. Upper surface of the brain of the wombat, reduced one-half. (Owen.) A. Cerebral hemi- 
 spheres, a. Olfactory ganglion. B. Optic ganglion, c. Cerebellum. 
 
 Mr. Owen compared, step by step, the brain of the Marsupial Wombat 
 and the Rodent Beaver ; and though these creatures are so alike in out- 
 ward form and habits of life, that they have been classed in the same 
 Order by some naturalists, he discovered this most important difference 
 of organization on the outward surface, the brain of the wombat ap- 
 pears more highly organized than that of the beaver, a.s it presents some 
 appearance of convolutions, while the brain of the beaver is quite smooth 
 (see figs. 40 and 41). But in the beaver the hemispheres of the brain 
 are longer, and extend backwards further, so as to cover the optic tuber- 
 cles, which they do not completely in the wombat. 
 
 On separating the hemispheres of the brain in the beaver, we bring 
 into view a broad and distinctly fibrous commissure the great trans- 
 verse commissure or corpus callosum. This may be traced into the 
 .hemispheres on each side, as in the human brain (see fig. 42). On 
 separating the cerebral hemispheres of the wombat, there is no such 
 commissure : not only are optic tubercles and pineal glands uncovered 
 
100 
 
 COMPARATIVE ANATOMY. 
 
 as in the beaver, but the optic thalarai also. Instead of a broad corpus 
 callosum, we perceive, situated deeply at the bottom of the hemispheric 
 fissure, a small commissural medullary band (see fig. 43, n), passing in 
 an arched form over the anterior extremity of the thalami, and extending 
 beneath the overlapping interior or mesial surfaces of the hemispheres, 
 which thus appear, as in the bird, to be wholly disunited. This band 
 of fibres (n) is the analogue of the fornix. " As the great commissure 
 is wanting," says Mr. Owen, " in the brain of the Great and Bush Kan- 
 garoos, the Vulpine Phalanger, the Ursine and Mangles Dasyures, and 
 the Virginian Opossum, it is most probably characteristic of the marsu- 
 pial division of Mammalia." 
 
 Fig. 42. 
 
 Fig. 43. 
 
 Fig. 42. Brain of the beaver, with the substance of the hemispheres remeved to the level of the corpus 
 callosum : reduced one-half. (Owen.) B. Optic ganglia, c. Cerebellum. 1. Corpus callosurn. u. Pineal 
 gland. 
 
 Fig. 43. Brain of the wombat, with the substance of the hemispheres removed to the level of the fornix, 
 except on the right side, where part of the thin internal wall of the lateral ventricle is left; reduced one- 
 half. (Owen.) B. Optic ganglia, a. Olfactory ganglia, m. Fornix. n. Hippocampus major, o. Ante- 
 rior fibres of the tsenia hippocampi connected with the anterior lobes of the hemispheres, p. Plexus 
 choroides. q. Septum lucidum. r. Corpus striatum. 1 1. Optic thalami. u. Pineal gland. 
 
 It is stated in the last edition (1845) of Cuvier's Lecons, in reference 
 to the commissural apparatus in the Marsupiata, that at the same time 
 that the great transverse commissure diminishes, the anterior commis- 
 sure increases to an enormous size; it is, in the brain of the kangaroo, 
 four times larger than the anterior commissure in the brain of the ox, 
 while the size of the brain itself is four times smaller. 
 
 Mr. Owen also gives drawings of two species of herbivorous and two 
 of carnivorous Marsupiata, to show the indications of superior develop- 
 ment which distinguish the brain of the herbivora, in the greater propor- 
 tional development of the cerebrum, its convoluted surface, and the 
 smaller proportional size of the olfactory tubercles. In all species, but 
 especially the carnivorous marsupials, the greater relative size of the 
 vermiform process is deserving of notice, as indicating the approach to 
 the oviparous type of cerebral structure. It is associated with a corre- 
 sponding diminution of the pons Varolii. 
 
RODENTIA. 101 
 
 Mammalia Placentalia. The lowest animals of the true Mammalia 
 are the Rodent, or gnawing animals, such as the rat, rabbit, squirrel, 
 &c., and to them we will now direct our attention. 
 
 The following description of the brain of the rabbit has been minutely 
 given, because this animal is always easily to be procured, and because 
 I am sure that whoever will take the trouble to dissect it, before attempt- 
 ing that of the human brain, will find his path much facilitated by the 
 knowledge and the manual dexterity he will have acquired. 
 
 He will be prepared, too, to take a more correct view of the human 
 brain, and his mind will be divested of many of those feelings of awe and 
 mystery, which have unfortunately been hitherto so constantly associated 
 with its structure. 
 
 When the upper part of the skull of the rabbit is removed, we ob- 
 serve that the cerebral mass consists of three grand divisions: the first 
 and smallest of these comprises the olfactory tubercles; the second, the 
 hemispheres; the third, the cerebellum; the other ganglia remain entirely 
 concealed. The hemispheres are slightly marked on the surface, but 
 not a tall convoluted. (See fig. 44.) On separating the hemispheres, 
 we find them connecting together by a band of medullary neurine, called 
 in the human subject the great transverse commissure, or corpus callosum. 
 
 Fig. 44. Fig. 45. 
 
 Fi"[. 44. Brain of the rabbit, upper surface. A. Olfactory ganglion. B. Hemispherical ganglion. E. Ce- 
 rebellum. H. Spinal cord. 
 
 Fig. 45. Brain of the rabbit; hemispheres turned back, exposing the corpus; striatum and optic 
 thalamus on the right ; the former on the left side covered by the fornix or longitudinal commissure. A. 
 Olfactory ganglion. B. Hemispherical ganglion, c. Optic ganglion. D. Testes, or posterior optic ga"n- 
 glion. E. Cerebellum. K. Thalamus nervi optici. R. Pineal gland, m. Corpus striatura. n. Longitudinal 
 commissure, or fornix. 
 
 If the great transverse commissure be now divided, and the hemi- 
 spheres separated from each other, several parts of importance beneath 
 it will be exposed (see fig. 45). Commencing from the posterior 
 part, we observe just in front of the cerebellum four rounded bodies, 
 the posterior (D) of which are small, not being more than a fourth 
 part as large as the anterior (c). These four bodies are analogous 
 to the single pair of optic tubercles in the bird, and in man are called 
 the tubercula quadrigemina, or the posterior the testes, and the an- 
 
102 COMPARATIVE ANATOMY. 
 
 terior the nates. Immediately anterior to these bodies we find two 
 other rounded projections, the anterior of which is the larger. The 
 posterior (K) is formed by a body which, in the human brain, is known 
 by the name of the thalamus nervi optici, but this is not the true optic 
 ganglion, though it does receive some fibres from the optic nerve. 
 This projection, though principally formed by the optic thalamus, is not 
 solely formed by it; for covering the thalamus, we find a thin layer of 
 medullary neurine, the outer edge of which corresponds to that of the 
 thalamus, so that in this stage of the dissection the thalamus is not really 
 exposed. This band of medullary neurine, inferior longitudinal com- 
 missure, consists of two sets of fibres ; one set appears to correspond to 
 the tenia semicircularis in man, lying between the thalamus and corpus 
 striatum; the other comes from the under and back part of the brain. 
 It rises up from this part, covering in its course a large internal convo- 
 lution, the hippocampal lobe hippocampus major. From this part, we 
 find it passing forwards and inwards, and winding over the surface of 
 the thalamus, and, running in front of it, dips down to" the under part 
 of the brain, forming the anterior pillars of the fornix, and terminates 
 partly in that portion of the spinal cord which in the human subject is 
 known by the name of the crus cerebri, and partly in the thalamus. The 
 beautiful structure just described forms a communication between the 
 anterior and posterior portions of the hemisphere of the same side, and 
 runs along the course of the mesial line. In the brain of man this band 
 has hitherto gone by the name of fornix, but I have named it inferior 
 longitudinal commissure, as being more in accordance with its structure 
 and probable function. If an incision extending in a direction forwards 
 and outwards, be made, commencing at the optic ganglion, completely 
 through this commissure, the optic thalamus will be exposed. 
 
 The projection which is immediately anterior to the thalamus is ana- 
 logous to the corpus striatum of the human brain, a part that has received 
 its name from the striated appearance it presents on a section being 
 made of its substance ; the cineritious neurine being deposited in stria3 
 between the white fibres which are passing from the hemispheres to the 
 anterior columns of the spinal cord. The corpus striatum and thalamus 
 are, therefore, deposits of neurine, through which the component fibres 
 of the anterior and posterior columns of the spinal cord pass in their 
 course from and to the hemispheres, and have been characterized, I 
 think advisedly, by Spurzheim, as ganglia. The corpus striatum should 
 be entitled the anterior, and the thalamus the posterior, cerebral ganglion 
 of the cord. Running near the edge of the thalami, towards the nates, 
 are two white lines, which, turning off at a right angle to cross the 
 mesial line, meet with a very small cineritious body, about the size of a 
 pin's head. This little body is the pineal gland (R) ; the whole structure 
 forms a commissure between the two opposite thalami, and maybe called 
 the pineal commissure. Situated immediately beneath the pineal gland, 
 and between the thalami, is a transverse band, which in the rabbit is 
 not much thicker than a thread, called the posterior commissure, immedi- 
 ately in front of which is a middle band of cineritious neurine, and still 
 further forward is another; these are respectively called the anterior and 
 
RODENTIA. 
 
 103 
 
 Fig. 46. 
 
 middle commissures of the brain, in distinction to the posterior commis- 
 sure. 
 
 The hemispheres having been completely turned back in the perform- 
 ance of this dissection, the student cannot fail to observe that they form 
 a sort of cap to the anterior and posterior cerebral ganglia of the cord, 
 covering them something in the same way that the head of a mushroom 
 does the footstalk ; the space left is the lateral ventricle. The admira- 
 ble contrivance by which the immense quantity 
 of neurine composing the large cerebral ganglia 
 in these animals is lodged in such a circumscribed 
 space as the cranial cavity, must be interesting 
 to the reflecting student. 
 
 If the brain be now removed from the skull, re- 
 versed so as to expose the under surface (see fig. 
 46), and the eye carried along the spinal cord, it 
 will be observed that the cord becomes of nearly 
 double the thickness it possessed within the verte- 
 bral canal. This thickened portion of the cord 
 is called the medulla oblongata, and contains with- 
 in its substance the olivary bodies, the pneumo- 
 gastric ganglia, and the posterior pyramidal or 
 auditory ganglia. Crossing the medulla oblongata 
 transversely is a band of medullary neurine, which, 
 running from one side of the cerebellum to the op- 
 posite, forms the Commissure Of that part, and is Brain of the rabbit, under 
 
 usually known by the name of the pons Varolii w^jJJS^ The^rTfe- 
 w tuber annulare (p v). The spinal cord beyond vo ffiont tL^Te 
 this commissure splits into two portions, which, hippocampus, to which phre- 
 
 . . ! i i nologists have appropriated 
 
 running to the two corresponding hemispheres, the organ of aii 
 
 are called the crura, or legs of the brain (p c). SVnon S& n ne. * 
 
 Between them is the collection of cineritious neu- 
 rine called the tuber cinereum, and immediately 
 
 the eyes, or motores oculo- 
 rum. e m. Corpus mammil- 
 lare. p c. Crus cerebri. p v. 
 ., ,, . , . - Pons varolii. b t. Corpus 
 
 anterior to it the commissure or the optic nerves, trapezoidum. p a. Anterior 
 
 The hemispheres appear divided into two lobes on gSSStJSS' * ': C T ' 
 
 each side, and the fissure of separation is called 
 
 ihefissura Sylvii. The commissure between the olfactory ganglia and. 
 
 the hemispheres is of considerable width, consisting of cineritious and 
 
 medullary -neurine, but it is 
 
 short when compared with Fig. 47. 
 
 that of the carp and whiting. 
 
 The under part of the 
 hippocampal lobes are now 
 distinctly seen, and the great 
 size should be observed. 
 
 In the porcupine and 
 agouti the auditory ganglia 
 are of great size. In the 
 squirrel the hemispheres are 
 
 Smooth (fig. 47), the Olfac- 
 
 tory ganglia large, as also 
 
 Side view of the head and brain of a squirrel. A. Olfactory 
 
 Hemi8 P herical & a ^ lion - E - Cerebellura - "' 
 
COMPARATIVE ANATOMY. 
 
 Fig. 48. 
 
 thai. Thaiamus nervi optki. 
 
 es. Corpus striatum. 
 
 the cerebellum, so that, on a lateral view, the whole encephalon bears 
 
 much resemblance to that of the bird : when this brain is dissected (fig. 
 
 48), the small size of the hemispherical ganglia, in proportion to the 
 
 other cerebral ganglia, is well seen. 
 
 Next to the Rodentia, in the class Mam- 
 malia, is the order Edentata, or toothless 
 animals. This order includes the sloths, 
 and the ext i nct genera of gigantic sloths, 
 such as the megatherium. The brain is 
 simple, and affords no peculiarities of phy- 
 siological interest. 
 
 We next come to the r der Ruminantia, 
 of which the Sheep is a familiar illustration. 
 The facility of procuring the brain of the 
 sheep, and the slight cost at which mul- 
 tiplied dissections of it may be made, in- 
 duce me to bring it under the notice of the 
 student, as affording another characteristic 
 
 Brain of the squirrel: hemispheres link in the chain of cerebral complication, 
 
 from the lower to the higher tribes of crea- 
 tion > 9nd its termination in man. Investi- 
 options of this kind, indeed, ought to be 
 
 i i i i 
 
 pursued through as extensive and varied a 
 series of animals as can be procured ; each offers some peculiarity well 
 worthy of attention, and all confirm the important truth in the science of 
 zoological anatomy, without which human anatomy is but a limited and 
 unsatisfactory pursuit, that every one of the organs through the whole of 
 the animal kingdom is constructed on one uniform and simple plan. The 
 brain of man, which had so long been, and even now remains, an ob- 
 stacle in the path of the teacher and student who restrict themselves to 
 the limits of human dissection, may be shown to have been formed with 
 the same attention to the beautiful simplicity which distinguishes all the 
 varied forms of organized existence. The minute description which has 
 been given of the anatomy of the brain of the rabbit, makes it unneces- 
 sary to dwell with the same attention to detail on each point in that of 
 the sheep ; so that I shall merely mention those particulars in which they 
 differ, and thus point out some others in which the brain of the sheep 
 approaches more in its structure to that of man. 
 
 The upper surface of the cerebral mass of the sheep presents, on each 
 side, three divisions the olfactory ganglion, the hemispherical ganglion, 
 and the cerebellum (see fig. 49). The olfactory ganglia may be seen in 
 front of the hemispheres, as in the rabbit; 'for although the hemispheres 
 have increased so much in size, still they do not yet completely cover or 
 conceal them the olfactory ganglia being also very large. The hemi- 
 spheres are not merely of larger relative dimensions, but their shape is 
 altered : they have lost the pyriform character they presented in the 
 rodent animal, and have assumed more of the oval form which they 
 possess in the human being. Their surface, instead of being smooth, 
 is much convoluted, looking exactly as if it were formed by the folding 
 
RUMINANTIA. 
 
 105 
 
 up a soft but tenacious substance. The cerebellum is not much changed 
 in appearance ; it is oaly samewhat larger in proportion to the cerebrum. 
 
 Fig. 49. 
 
 Brain of the sheep, natural size. (Leuret.) 
 Cerebellum. 
 
 A. Olfactory ganglion. B. Hemispherical ganglion. E, 
 
 The great transverse commissure has increased in accordance with the 
 greater development of the hemispheres ; and when we divide it in the 
 middle, and turn either half back, in order to expose the optic tubercles, 
 the thalami and corpora striata, we find the latter appearing as if they 
 were placed within a circumscribed cavity, so much have the hemispheres 
 increased in size in every direction. The space which is left between 
 the corpora striata and thalami, and the under surface of the hemispheres, 
 has been described in the human brain, under the name of lateral ven- 
 tricle, as if it were a cavity or chamber scooped out of the substance of 
 the brain. But it must be evident to every one who has followed the 
 gradual development of the hemispheres from before backwards, that 
 this space is merely a fissure analogous to those fissures which are met 
 with on the surface of the brain between opposing convolutions, the fossa 
 digitata. We find, in fact, that the spaces denominated lateral ventri- 
 cles are the necessary effect of the drawing back, if I may so express it. 
 
106 
 
 COMPARATIVE ANATOMY. 
 
 of these extensive surfaces of neurine covering the crura cerebri or 
 anterior productions of the medulla oblongata. By the addition of the 
 anterior and posterior cerebral ganglia of the cord (the corpus striatum 
 and thalamus), the structure comes to bear a considerable resemblance 
 to a head of cauliflower included within its capsule of leaves, or, as I 
 have said elsewhere, to the nodulated head of a walking-stick, over and 
 around which a piece of cloth has been tied, and then reflected forwards 
 upon itself. 
 
 The edge of the fornix or longitudinal commissure may be seen lying 
 in the groove between the anterior and posterior cerebral ganglia ; the 
 posterior ganglion, or thalamus, being, however, so completely covered 
 that it cannot be seen until the commissure is completely divided and 
 reflected outwards. If the hemispheres be now turned forward, the 
 cerebral ganglia on both sides will be exposed, with the pineal commis- 
 sure, and tubercula quadrigemina. Crossing the fissure between the 
 posterior cerebral ganglia, (absurdly called the third ventricle,) the com- 
 missura mollis, or middle commissure, will also be brought into view. 
 
 Fig. 50. 
 
 Brain of the sheep removed from the skull, and lying oh its upper surface, siz< 
 
 rnglipn. B. Hemispherical ganglion. E. Cerebellum, i. Tuber cinereum a. 
 Optic nerve, c. Third nerve d. Fourth nerve, e. Fifth nerve. /. Sixth ner 
 
 size of life. A. Olfactory 
 a. Olfactory commissure. 
 
 !>. Optic nerve, c. Third nerve d. Fourth nerve, e. Fifth nerve. /. Sixth nerve, g. Seventh, facial . 
 
 h. Eighth, auditory, i. Ninth, glosso-pharyngeal. j. Tenth, par vagum. k. Eleventh, lingual, x. Pons 
 
 Varolii. 
 
 . 
 
 On the base or under surface of the brain we observe that the olfac- 
 tory ganglia or tubercles (see fig 50) are very highly developed ; they 
 are, in fact, nearly three times as large as those of the human subject, a 
 size which appears to correspond with the complicated structure of the 
 nose in this animal, and to be in proportion to the acuteness of their 
 sense of smell. The olfactory commissures are short and thick, scarcely 
 a line's breadth being left between the tubercle and the point where 
 they are united to the under surface of the hemispheres. These com- 
 missures extend backwards to the hippocampal lobes, which is some way 
 further than the point where they are first attached to the surface of the 
 cerebrum. We need go no further to prove the absurdity of still denomi- 
 nating analogous parts in the human being, nerves. The olfactory ganglia 
 themselves are composed of medullary and cineritious neurine. 
 
RUMINANTIA. 
 
 Fig. 51. 
 
 The pons Varolii (#), or tuber annulare of Willis, is small in the sheep 
 compared with the same part in man : here it is not more than three 
 lines in breadth. The corpora mammillaria are united so as to appear 
 like a single body. The tuber cinereum is not particularly distinct ; 
 through its centre we find a sort of funnel-shaped tube passing, called 
 the infundibulum, which joins a rounded 
 structure situated on the sphenoid bone, 
 called the pituitary gland. The character 
 or analogy of the last-mentioned parts is 
 extremely obscure, and there is a mystery 
 here which has not yet been unraveled. 
 The medulla oblongata, like that of the 
 rabbit, is very thick in comparison with the 
 spinal cord. 
 
 The anatomy of the medulla oblongata 
 presents many points of interest. But in 
 order to understand them it is necessary to 
 anticipate a little. If the reader will refer 
 to my description of the part in man, he 
 will find that the surface, viewed anteriorly 
 and externally, presents those projections 
 named, from their shape, the corpus pyra- 
 midale, the corpus olivare, and corpus 
 restiforrn. The corpus pyramidale is part 
 of the anterior column of the cord, which 
 must not be considered an isolated body or 
 ganglion, but merely an appearance caused 
 by the decussation which the fibres of the 
 
 column take at this part. They do not descend perpendicularly on the 
 same side, but they cross over to the opposite side, decussating with 
 their fellows; the corpora pyrarnidalia in the sheep are small. The 
 corpus olivare is a true ganglion a collection of cineritious neurine. 
 The corpus restiforme contains a ganglion which is connected with the 
 pneumogastric nerve ; it is the homologue of the branchiogastric gan- 
 glion in fish. It may be called the pneurnogastric or restiform ganglion. 
 
 If the posterior surface of the medulla is examined, a fourth projection 
 may be seen projecting on each side of the mesial line, of a pyramidal 
 form the posterior pyramidal bodies, or auditory ganglia (F F). 
 
 Thus it will be found that the medulla oblongata contains on each 
 side three ganglia, while each vertebral section of the spinal cord only 
 contains two, the anterior and posterior peaks of gray matter. 
 
 The distinction between these last-named ganglia is better seen in 
 some of the lower Mammalia, after making a transverse section, than in 
 man. I believe that in all the Mammalia, except the monkey, the ele- 
 phant, and the porpoise, the corpora olivaria do not project on the sur- 
 face, and hence the assertion by some anatomists, that they are wanting 
 in most of the Mammalia. 
 
 Longet says, p. 390,* " The olivary bodies attain their highest deve- 
 
 * Anatomie et Physiologic du systeme Nerveux de Thomme et des animaux Vertebras, 
 
 Medulla oblongata and pons Varolii 
 of the sheep. Nos. 1, 2, and 3, with the 
 lines, mark the sections, the surfaces of 
 which are exhibited in the next figure 
 (52). The lines are not drawn at right 
 angles to the cord, as they should be 
 /. Sixth nerve, j. Tenth, par vagum. 
 k. Eleventh, lingual. Y. Corpus trape 
 zoidum. 
 
108 
 
 COMPARATIVE ANATOMY. 
 
 lopment in the human species ; it is often impossible to perceive these 
 eminences in other Mammalia." 
 
 " Having carefully examined," says Rolando, "the place where these 
 eminences ought to be, I can assert that they are not to be met with in 
 the ox, pig, sheep or goat." 
 
 Carus affirms u that they are wholly absent in most Mammalia, or at 
 least that they do not present the arborescent appearance of white and 
 gray neurine which they do in man." 
 
 I have found these ganglia in the sheep, horse, calf and cat, and I 
 have no doubt that they exist in all Mammalia. 
 
 " Gall," says Longet, " has certainly exaggerated their volume in the 
 calf; they are sufficiently apparent in the apes, but especially in por- 
 poises and in the dolphins." 
 
 In the sheep the corpora olivaria do not project on the surface. They 
 are best detected by a transverse section ; and they will be found, not 
 on the side of the pyramidal bodies, but behind (see fig. 52) ; s repre- 
 sents the appearance they exhibit. It is taken from a drawing which I 
 made with Mr. Grainger. We afterwards examined it under the micro- 
 scope, and found the ganglionic corpuscles very beautifully distinct. Its 
 exact longitudinal extent I cannot assert, but there 
 was no appearance of it in a section made just 
 above s, No. 3 ; fig. 52 exhibits what I believe 
 is its inferior extremity. In the human subject 
 they are much larger, though the neurine is folded 
 into a small space, but if extended it would oc- 
 cupy nearly one inch in breadth. The auditory 
 and pneumogastric ganglia are also very distinct 
 (same fig., F arid G). Finally, there is an ap- 
 pearance on the surface of the medulla to which 
 there is nothing analogous in the human brain. 
 This is produced by a transverse fibrous band 
 running just below, and parallel to, the pons Va- 
 rolii, from the restiform bodies to the edge of the 
 anterior columns (see fig. 51) : Y is called the 
 corpus trapezoidum. It is met with in all Mam- 
 malia, except the ourang-outang, chimpanzee, 
 and man. 
 
 The cerebral nerves take precisely the same 
 origin in the sheep as in the human subject, and need not, therefore, be 
 dwelt upon in this place; although in dissecting the brain of the sheep, 
 reference may be very advantageously made to the base of the human 
 brain for assistance in discriminating several of the particular pairs of 
 nerves. 
 
 We have now seen enough of the anatomy of the brain of the lower 
 animals to understand how we ought to study it in man ; we have traced 
 it from a most simple form up to what would have appeared a very com- 
 plex one if we had not seen all the connecting links. The study of 
 
 par F. A. Longet, Laureat de 1'Institute de France, Academie des Sciences, Doct. en Mede- 
 cine de la Faeulte de Paris, Prof. d'Anatomie et de Physiologic, Chirurgeon de la Maison 
 Koyale de Saint Dennis, &c., 1842. 
 
 Three sections of the me- 
 dulla oblongata of the sheep. 
 See fig. 51. F F. Auditory 
 ganglion. G. Pneumogastrie 
 ganglion, s s. Olivary body. 
 
PACHYDERMATA. 
 
 109 
 
 these links must assist us in the study of the human brain. In a mere 
 anatomical point of view we might abandon our comparative anatomy 
 and proceed at once to man ; but in a physiological and philosophical 
 point of view we shall find it interesting to glance at the characteristic 
 features of the brains of those Mammalia which remain undescribed be- 
 tween the Ruminantia and the human race. 
 
 The Pachydermata or thick-skinned animals are the next in order, of 
 which the Horse is our most familiar example ; fig. 53 is taken from 
 
 Fig. 53. 
 
 External surface of the brain of the horse, reduced one-half. (Leuret.) s. Fissura Sylvii, which is 
 bifurcated. I, II, III. Those figures which are placed before the fissura Sylvii indicate each of the ante- 
 rior convolutions; and I, II, III, IV, behind, indicate the four posterior convolutions. -4-. Point of re-union 
 of the posterior convolutions I and II behind the fissure of Sylvius, o. Supra orbital convolution. 1 h. 
 Hippocampal lobe, or inferior projection of the internal convolution, c g. Corpus geniculatum. 1, 2, 3, 
 indicate the three lobes of the cerebellum, e. Olfactory ganglion, o. Optic nerve, m. Third pair. p. 
 Fourth ditto, t. Fifth ditto, u. Sixth ditto, f. Seventh, facial. I. Eighth, auditory, g. Ninth, glosso- 
 pharyngeal. v. Tenth, par vagum. h. Eleventh, lingual, s. Twelfth, spinal accessory, x. Pons Varolii. 
 
 Fig. 54. 
 
 Longitudinal sectipn of the brain of the horse, through its centre, showing its internal surface, reduced 
 one-half. (Leuret.) A. Anterior convolution, p. Posterior ditto, i. Internal ditto, surrounding the cor- 
 pus callosum, united to the anterior convolution before, and posteriorly and inferiorlyto the hippocampal 
 lobe. e. Olfactory ganglion, c c. Corpus callosum divided in the centre, c o. Commissura mollis. g p. 
 The letters are on the optic thalamus, the line leads to the pineal gland, t q. Optic tubercles ; behind 
 these is the divided cerebellum, exhibiting the arbor vitse. 
 
 Leuret. At one glance the student will perceive that the brain is of a 
 high character. (The drawing is reduced one-half.) The cerebrum is 
 large, and the convolutions are numerous. It is rounder and more ele- 
 vated than that of the ox, though in both there is more brain anterior to 
 
110 
 
 COMPARATIVE ANATOMY. 
 
 the corpus callosum than behind it. It covers the tubercula quadrige- 
 mina and a part of the cerebellum. The internal parts are the same as 
 in the sheep. The arrangement of cineritious and medullary neurine in 
 the cerebellum is the same as in man. A perpendicular section exhibits 
 the appearance called the arbor vitaB, and shows an immense surface of 
 cineritious neurine. The olfactory ganglia are of great size, as also their 
 commissures and the hippocampal convolutions. The medulla oblongata 
 is large (see fig. 55). The pyramidal eminences are distinct ; there is 
 
 Fig. 55. 
 
 Fig. 5G. 
 
 Fig.' 56. Medulla oblongata of the horse. Figures the same. The lines are numbered to indicate the 
 sections exhibited in fig. 56. No. 2 impinges on the bifurcation of the anterior pillars. T. Corpus pyra- 
 midale. \v. Corpus restiform. u. Cms cerebri. c. Third pair of nerves, e. Fifth ditto. /. Sixth ditto. 
 The line crossing the medulla transversely below the root of this nerve marks the lower edge of the cor- 
 pus trapezoidum. g. Seventh, facial, h. Eighth, auditory, j. Tenth, par vagum. k. Eleventh, lingual. 
 
 Fig. 56. Sections of the medulla oblongata of the horse. For position, see fig. 55. Nos. 1. 4, and 5 
 have been placed by mistake with the inner or mesial edge of the section to the right instead of to the 
 left, as in Nos. 2 and 3. G. Pneumogastric ganglion. F. Auditory ganglion, s. Olivary body. 
 
 
 
 no appearance of corpora olivaria on the surface, but a section reveals 
 them clearly. This position, as compared with those in the human 
 being, is curiously altered (see fig. 56, Nos. 2 and 3). This fact is to 
 me a convincing proof that they are imbedded in the motor tract, and 
 that they do not form any line of physiological demarkation. I have 
 taken a great deal of pains to work this matter out, and ascertain what 
 is the homology of these bodies. The conclusion I have arrived at is, 
 
PACHYDERMATA. 
 
 Ill 
 
 that they are the ganglia of the lingual nerves, and that the great extent 
 of cineritious neurine which exists in them in man has relation to the 
 multiplied movements of the organ of speech. 
 
 There are objections to this theory, and among others their great ex- 
 ternal size in the elephant (see fig. 57). In this figure, the great pro- 
 
 Fig. 57. 
 
 Medulla oblongata of the elephant ; sketched from a preparation in the College of Surgeons. 8. Corpus 
 olivare, T. Corpus pyramidale. w. Corpus restiform. x. Pons Varolii. c. Third pair of nerves, e. 
 Fifth ditto, g. Seventh, facial, h. Eighth, auditory, i. Ninth, glosso-pharyngeal. j. Tenth, par vagum. 
 k. Eleventh, lingual. 
 
 jection they form on the surface of the medulla is very well shown ; and 
 it is most likely that this projection is caused by a great quantity of gan- 
 glionic neurine within : but without a section this cannot be positively 
 asserted. Again, their large size in an animal whose intelligence ap- 
 proaches nearer to that of the human being than that of any of the lower 
 animals, is curious and interesting. The olivary bodies are very distinct 
 in the apes ; but in some Carnivora, as the bears, they are not so well 
 formed ; in others, as the lynx, badger, and seal, the internal border is 
 
112 COMPARATIVE ANATOMY. 
 
 confounded in their whole length with the pyramidal bodies, and only 
 distinguishable by the origin of the twelfth pair of nerves. (Cuvier, 
 Lemons.) 
 
 There is a preparation of the brain of the elephant in the Museum of 
 the College of Surgeons, 1331, but it is not sufficiently dissected to 
 render its internal anatomy distinct. Mr. Owen gives an account of it, 
 and from that the following is taken. It is an interesting account, and 
 confirms an opinion I advanced many years ago, that the hemispherical 
 ganglion is positively not relatively larger in man than in any other 
 animal. 
 
 The absolute size of this organ in the Asiatic elephant exceeds that of 
 man. But the proportion which the cerebrum bears to the rest of the 
 brain, and especially that part of the hemisphere which forms the roof 
 and sides of the lateral ventricle, is much less. 
 
 "The hemispheres are broad and short, with a considerable develop- 
 ment of the natiform protuberance. The convolutions are comparatively 
 small and numerous. The anfractuosities are also deep, extending in 
 some cases more than two-thirds of an inch into the substance of the 
 brain. The hippocampus is comparatively smaller than in the ass, and 
 the corpus striatum larger. The ventricle is continued into the olfactory 
 bulb. The cerebellum is of considerable width, and its surface increased 
 by numerous and complex anfractuosities. The tuber annulare corre- 
 sponds in size to the development of the lateral lobes of the cerebellum. 
 The corpora olivaria are remarkably prominent. The olfactory nerves and 
 the fifth pair, which supply the proboscis, are remarkable for their pro- 
 digious size; whilst the optic nerves, and those which supply the mus- 
 cles of the eye, are as remarkable for their small size." 
 
 The brain of the Getacea, which form the next group in the animal 
 kingdom, must now engage attention. Of this class the porpoise affords 
 the most convenient illustration. This creature, which to the vulgar is 
 no more than a large fish, the enlightened physiologist admits into the 
 same grand division of the animal kingdom to which man himself be- 
 longs. Bringing forth its young in a state requiring, long after birth, the 
 protecting care of the mother, higher intellectual endowment is implied 
 than we can expect in fishes and reptiles, whose spawn is generally 
 abandoned by the parent as soon as it is shed, and in accordance with 
 these manifestations of higher powers we find the cerebral mass deve- 
 loped upon the same plan, and presenting nearly the same appearances 
 and arrangement of parts, as some of the most perfect of the terrestrial 
 Mammalia, and even as the brain of man himself. 
 
 Looking at the superior part of the cerebral mass of the porpoise, as 
 represented in fig. 58, we observe two divisions, the cerebrum (1) and 
 cerebellum (7) ; the whole surface is convoluted as in the human brain, 
 and although the convolutions are smaller, the sulci between them are 
 of considerable depth; its shape is peculiar, from its great lateral width 
 as compared with that of the human being or sheep, for the cerebral 
 hemispheres taken together are even longer from side to side than from 
 before to behind. The dimensions of the cerebellum are great in com- 
 parison with those of the cerebrum, the whole cerebellum bearing a pro- 
 portion to one hemisphere of the cerebrum as two to two and a half. 
 

 CETACEA. 
 
 
 113 
 
 Fig. 58. 
 
 This is owing to the great size of the lateral lobes: the middle lobe or 
 processus vermiformis is small, as will be seen by fig. 58. The posterior 
 lobes appear to be wanting, as in the sheep, by which the cerebellum is 
 left partly uncovered. 
 
 The great transverse commissure or corpus callosum (6) is strikingly 
 short from before back- 
 wards, measuring a little 
 more than one- fourth of 
 the whole length of the 
 hemisphere, if we except 
 that portion which curves 
 downwards in front, and 
 which is about a third of 
 the length of the horizontal 
 portion, so that the tuber- 
 cula quadrigemina or optic 
 tubercles (4 and 5) are en- 
 tirely uncovered by it, and 
 on removing the arachnoid 
 and pia mater, are to be ob- 
 served between its poste- 
 rior edge and the cerebel- 
 lum, nearly a third larger 
 than those in the human 
 brain ; the posterior pair, 
 or testes (5), are nearly 
 double the size of the an- 
 terior or nates (4). 
 
 In the brains of the 
 Mammalia we have alrea- 
 dy examined, the Rodentia, Ruminantia, Pachydermata, we found the 
 relative size of the optic tubercles the same as in man, viz., the anterior 
 larger than the posterior; but generally in the Cetacea and Carnivora the 
 posterior are the largest. The kangaroos resemble the herbivorous Mam- 
 malia in this respect. 
 
 The pineal gland (9) is small but distinct, as well as its commissure. 
 A perpendicular section having been made through the transverse com- 
 missure a little to the left side of the mesial line, and a horizontal one 
 carried through one of the hemispheres on a level with it, the thalamus 
 nervi optici(3) and corpus striatum(2) are exposed, the latter scarcely 
 a fourth part as large as the former. The fornix, which is small, has 
 been divided, and with the exception of its anterior pillars and the sep- 
 tum lucidum, removed in making the above section. There is no pos- 
 terior cornu to the lateral ventricle. 
 
 The plexus choroides is very peculiar, being transversely folded, like 
 the branchiae of a bivalve (see Preparation 1332, College Museum). 
 
 Has this arrangement of blood-vessels special relation to the brain, or 
 is it merely a part of those arterial plexuses which are found so large in 
 the thorax, and exist in the spinal canal and about the head, as reservoirs 
 
 Brain of the porpoise, half of the left hemisphere removed, 
 opening the lateral ventricle. 1. Section of the left hemi- 
 sphere, exposing the left ventricle, containing 2. Corpus 
 striatum, or anterior cerebral ganglion ; the line between this 
 and the next is not very distinct. 3. The posterior cerebral 
 ganglion or optic thalamus. 4. The anterior quadrigeminal 
 bodies, optic tubercles, or nates. 5. The posterior quadrige- 
 minal bodies, optic tubercles or lestes. 6. Great transverse 
 commissure, or corpus callosum. 7. Cerebellum. 8. Spinal 
 cord. 9. Pineal gland. 
 
 
 
114 
 
 COMPARATIVE ANATOMY. 
 
 of arterial blood for the animal when diving? A similar arrangement 
 exists in the whale. 
 
 Base of the Brain (see fig. 59). The fissura Sylvii (s) is deep ; the 
 middle lobe very large, and projecting more than in the sheep. But the 
 hippocampal convolutions are much smaller, and do not present the 
 same distinctness. 
 
 The pons Varolii or commissure of the cerebellum (p v) is large in 
 proportion to the whole cerebral mass, and is about the same size as this 
 part in man, according with the great development of the lateral lobes 
 of the cerebellum. 
 
 The medulla oblongata presents more points of interest and instruction 
 than any other part. In the first place it is more than double the size of 
 the spinal cord, a circumstance which partly depends on the large size 
 of the corpora olivaria, and partly on the magnitude of the posterior 
 pyramidal bodies. 
 
 The corpora olivaria (H) are so amazingly developed, that, instead of 
 being separated from each other, as in the human being, by the corpora 
 pyramidaHa, they overlap and cover these so completely as even to 
 come into contact with each other in the median line (see fig. 59). 
 
 The lingual nerves are not 
 of proportional size, but the 
 pneumogastric nerves are 
 about double the size of 
 those of man. If the cor- 
 pora olivaria be carefully 
 elevated, the anterior col- 
 umns of the spinal cord 
 will be seen decussating 
 beneath and posterior to 
 them. 
 
 The arrangement of the 
 fibres of the anterior and 
 posterior columns, as re- 
 gards their course towards 
 the cerebellum, and the 
 share they take in the for- 
 mation of the corpora resti- 
 formia, is perfectly identical 
 with the disposition of the 
 
 Fig. 59. 
 
 Base of the brain of the porpoise. (Leuret.) This figure 
 exhibits the absence of olfactory nerves, the large size oi the 
 pons Varolii, also the olivary bodies, and their juxtaposition 
 ial line. oo. Orbital convolution, p. c. Cruscerebri. 
 
 on the mesia 
 
 p v. Pons Vurolii. 
 
 s. Fissura Syl 
 r convolutio 
 o. Optic nerve. 
 
 the antero-posterior convolutions. 
 Olivary bodies, 
 
 L A. Anterior portion of 
 IP. Posterior ditto. H. 
 
 same parts in the human 
 brain, which will be found 
 described so fully further 
 on, that it will be unneces- 
 
 sary to dwell upon it here. The accordance is, nevertheless, extremely 
 interesting as confirming those views I have advanced on the subject of 
 the communications between certain parts of the medulla oblongata and 
 the cerebellum. 
 
 Origin of the Nerves in the Porpoise. The olfactory nerves are en- 
 tirely absent. 
 
 The optic are smaller than those of man; their origin is the same. 
 

 CARNIVORA. 
 
 . 
 
 115 
 
 The 3d, 4th, 5th, and 6th, are also exactly similar. 
 
 The 7th, or facial, is the same both in size and origin. 
 
 The 8th, or auditory, is nearly double the size of that in the human 
 being. 
 
 The 9th, or glosso-pharyngeal, is large. 
 
 The 10th, or par vagum, is at least double the size it presents in 
 man. 
 
 The spinal accessory is rather small. Its origin is the same as in 
 man. 
 
 The llth, or lingual, is rather large. Its origin is from the anterior 
 columns of the cord close to the corpora olivaria. 
 
 In the different genera of Whales, John Hunter tells us that the brain 
 differs much in size. The thalami are large, but the corpora striata are 
 small. The fibrous neurine of the hemispheres may be distinctly traced 
 through the" inner layers of the hemispherical ganglion. 
 
 In the piked whale the whole brain was found to weigh four pounds 
 and ten ounces. 
 
 The Carnivora form the next group in the animal kingdom, consisting 
 of the bears, martens, dogs, cats, and seals. The number of ganglia and 
 commissures constituting the encephalon of these animals is the same in 
 all. There is no great peculiarity as regards their relative size. In the 
 common cat (see fig. 60), the olfactory ganglia (e), as we might expect, 
 
 Fig. 60. 
 
 Side view of the brain of the common cat. (Leuret.) e. Olfactory ganglia. 0. Optic nerve. A A A. 
 Anterior portion of longitudinal convolutions, p p p. Posterior of ditto, s is opposite the fissura Sylvii; 
 a line from s divides these two sets of convolutions, -f-. Union of the two. o. Orbital convolution. 
 
 are enormous. The hippocampal lobes are also large. The hemi- 
 spheres cover the optic tubercles, and partly overlap the cerebellum. 
 The hemispherical ganglion is much convoluted. The convolutions are 
 described further on. The anterior and posterior quadrigeminal bodies 
 are of nearly equal size, the anterior being rather the longest from before 
 backwards. " In the lion the posterior, though smaller in longitudinal 
 diameter, are broader, and rise above the level of the anterior pair." 
 (Owen.) In the seal the olfactory ganglia are small, but not absent, as 
 in the Cetacea, though the form of the brain resembles in its roundness 
 that of these creatures. The hemispheres do not entirely cover the cere- 
 bellum, which is large, especially its lateral lobes. The corpora oliva- 
 ria maintain the same central position as in the porpoise, but they do 
 not project on the surface. The corpus trapezoidum., that oblong por- 
 tion of the medulla oblongata running transversely inferior and parallel 
 
116 
 
 COMPARATIVE ANATOMY. 
 
 Fig. 61. 
 
 Side view of the brain of the hedge- 
 hog. A. Olfactory ganglion. B. Hemi- 
 spherical ganglion. E. Cerebellum. 
 H. Spinal cord. 
 
 Fig. 62. 
 
 to the pons Varolii, between the fibres of which facial and auditory 
 nerves emerge, is of remarkable size in all the genus Fells. (Owen.) 
 In the group Insectivora, hedgehogs, moles, &c., the brain retrogrades, 
 as will be seen by referring to fig. 61, which 
 represents the brain of the hedgehog. The 
 olfactory ganglia (A) are enormous compared 
 with the hemispheres. The hippocampal 
 lobes are very large, corresponding with the 
 olfactory ganglia. The hemispherical gan- 
 glia are quite smooth and free from convolu- 
 tions ; the cerebellum is large and well de- 
 veloped. 
 
 The Cheiroptera, or hand-winged animals, 
 the bats, come next. The brain of the bat (fig. 62) closely resembles 
 in outward appearance that of the bird. The olfactory ganglia (A) are 
 
 larger, but the hemispheres (B) are very small 
 and smooth ; the cerebellum is peculiarly 
 large. 
 
 Next to the Cheiroptera below, and to Man 
 above, we have the Quadrumana, the lemurs, 
 baboons, apes, and monkeys. No general 
 observations will describe the characteristics 
 of the brain in this class beyond what apply 
 to the Mammalia generally : for the brain of 
 the highest, namely, the chimpanzee, ap- 
 proaches nearly to that of man ; while some of the lowest appear to be 
 little raised above those of the rodents and insectivora, as regards the 
 convolution of its surface. 
 
 Mr. Owen, in his paper on the Marsupiata, already referred to, gives 
 a drawing of the brain of a monkey (Midas rufimanus}\ the surface of 
 whose brain is smooth, with the exception of one short longitudinal fis- 
 sure extending but a short distance on the hemisphere from before back- 
 wards : at the same time it must be stated that this brain is above that 
 of the rodents, &c., inasmuch as it covers the cerebellum. 
 
 The outline of the brain of Mammalia, as viewed from above, presents 
 three principal varieties. In one it is almost circular this includes the 
 ourang outang, the seal, and the porpoise. In another it is oval, more 
 or less elongated, as in the lion, beaver, and sheep. While in a third 
 it is almost triangular or heart-shaped, the anterior lobes being remark- 
 ably narrow, as in the ferret, in the opossum, and in the rabbit. The 
 forms have no relation to the different orders of the Mammalia, as the 
 examples which have been mentioned show.* 
 
 There are a few parts of the encephalon on which I have thought it 
 well not to say much in the description of the brain individually, but 
 which it may be well to consider collectively. 
 
 Corpora Geniculata. The tubercles which will be pointed out in man 
 as forming a third pair, under the name of the corpora geniculata interna, 
 become in monkeys, in dogs, and in other Carnivora, as large as those 
 
 Side view of the brain of the bat. 
 A. Olfactory ganglion. B. Hemi- 
 spherical ganglion. E. Cerebellum. 
 H. Spinal cord. 
 
 * Cuvier, Le9ons, 2d eel., 1845. 
 
 ' .: . ,' . 
 
 
 

 VENTRICLES. H7 
 
 of the other pairs ; but they are small or scarcely visible in the Rumi- 
 nantia. They are very large in the horse, and always joined to the testes 
 by a strong fibrous fasciculus, which appears to pass under the optic 
 nerve and terminate in the optic thalarai. In the monkeys, especially 
 in the ourang outang and the baboon, we find the corpora geniculata in- 
 terna also receiving a fasciculus from the nates, and giving out a root 
 which runs low enough to unite itself with the principal cord of the optic 
 nerve. 
 
 The corpora geniculata externa are much less constant than the in- 
 terna, and their projection, already much effaced in the monkey, is no 
 longer distinguished in the other classes from the projection of the optic 
 thalamus under the ribbon of the nerve which conceals it. 
 
 Optic Thalami. The size of these ganglia, the optic thalami, appears 
 to be in direct relation with the size of the folds of the hemispheres. 
 This is especially observable in the dolphin, where the hemispheres are 
 of considerable size and thickness. 
 
 The pineal gland does not present any remarkable difference. It is 
 sometimes elongated into a cylinder, as in the ox and the seal ; some- 
 times triangular, prismatic, or cordiform, as in the sheep and the horse ; 
 or conical, as in the monkey: it is generally small in the Garni vora. Its 
 fasciculi, from their origin on the upper surface of the optic thalami to 
 the anterior commissure, may be distinctly traced. In the opossum, the 
 fasciculi at the origin of the gland are large, and form a projection on 
 the superior edge of the optic thalami. Many anatomists affirm to never 
 having met with earthy concretions in any animal, analogous to those 
 which are seen in the pineal gland in man. 
 
 Corpora Striata. These bodies scarcely differ, in all the Mammalia, 
 except in size ; they are separated from the optic thalami by a very marked, 
 and sometimes by a very deep, furrow, in which are lodged the taenia 
 semicircularis and the pillar of the fornix, and their size is in general very 
 similar to that of the optic thalami. In the dolphin, however, the dis- 
 proportion is considerable; the corpus striatum is much less prominent 
 and less voluminous than the optic thalamus. 
 
 Corpus Callosum, Fornix, and Hippocampal T^be. The corpus callo- 
 sum and the fornix, like the striated bodies, do not differ much in size. 
 The hippocampal lobes are generally larger in proportion in Mammalia, 
 but their surface does not present the same swollen appearance as in man. 
 The corpus callosum, in some instances, seems to be developed, as 
 regards its size, in relation to the corpus striatum ; as we have already 
 seen in the brain of the porpoise, which has large hemispheres, a pro- 
 portionally small and thin corpus callosum, and a very moderately-sized 
 corpus striatum. 
 
 Ventricles. There is no digital cavity in the lateral or anterior ven- 
 tricles, except in man and the apes. Its presence depends on that of the 
 posterior lobes; but in the seals and dolphins, where the posterior part of 
 the hemisphere is considerable, it descends into the temporal fossa, thus 
 exhibiting a rudiment of the digital cavity in the brain of man. 
 
 The lateral ventricle, in most Mammalia, is continued anteriorly into 
 the hollow tube of the olfactory commissure, the third and fourth ven- 
 tricles not presenting any remarkable difference. 
 
118 COMPARATIVE ANATOMY. 
 
 The mammary tubercles are often very distinct, as in the Callitrix, one 
 of the squirrel-monkeys, the lion and the lynx : they are more frequently 
 blended into one, as in the hyrax, stag and lama.* 
 
 It has been already explained that the convoluted hemispherical gan- 
 glia are the parts with which the intellectual powers are more immediately 
 connected; and as the ganglia increase in size, they become altered from 
 mere rounded points, like peas, to folded surfaces. The principal change 
 which we have to observe in tracing the form of the brain from the 
 Rodentia up to Man, is in the relative proportion of the hemispherical to 
 the rest of the cerebral ganglia, and in the size, number, and direction 
 of the convolutions. It is stated by Leuret,f that the cerebral convolu- 
 tions of the Mammalia are alike in the same animal, and that the Mam- 
 malia may be classified by the similitude of their cerebral convolutions. 
 The classification which is founded upon these convolutions differs in 
 many essential points from that which is based upon the form of their 
 organs of prehension ; it associates animals of corresponding faculties, 
 and separates those which differ in this respect. The cerebral convolu- 
 tions have many well-marked types, which may easily be traced one 
 into the other. 
 
 No portion of the study of the brain is at first sight so unpromising, 
 unsatisfactory and puzzling, as that of the convolutions ; they appear so 
 complicated, indefinite, confused, and countless, that few can be induced 
 even to consider the subject. If, however, they will take the trouble 
 to investigate it a little, they will be rewarded, by finding it much more 
 simple than it at first sight appears. 
 
 In order to understand the various forms which the convoluted surface 
 of the brain assumes in different animals, we will suppose the hemispheres 
 to be a flat layer of soft material, such as a piece of putty; but as this 
 is not always at hand for the purposes of illustration, take a piece of cloth, 
 and a small lozenge-box. In the lowest animals the brain is smooth : 
 to imitate this, the cloth may be cut the size of the box, and it will go 
 in without folding, and be smooth like the brain of the rat or hedgehog. 
 But a little higher in the scale of animals, as in the agouti, for instance, 
 the surface is not quite, smooth ; there is one slight longitudinal furrow 
 
 (fig. 63). We may now cut the cloth a little 
 larger than the box, and one very slight fold 
 is sufficient to get it in. A little higher in the 
 animal scale, and we find two or three folds, 
 but all still in the longitudinal direction ; in 
 the same way then to imitate these, the cloth 
 must be cut still larger, and folded longitudi- 
 nally. Still rising in the scale, the brain goes 
 on increasing ; we must now, therefore, as 
 the additional size is given by additional 
 length, make transverse as well as longitudi- 
 nal folds. Suppose a surface to have been 
 folded thus, like the upper figure, but which 
 cannot be packed in the box because it is a 
 
 * Cuvier, Le$ons, vol. iii. p. 99, 2d ed, 1845. f Op. cit., vol. i. p. 451.] 
 
CONVOLUTIONS. . 119 
 
 little too long for it; we then bend it a little in the opposite direction: 
 the effect would thus be to produce a transverse furrow, as in the lower 
 figure ; and this, in fact, is the next step in the complication of the 
 convolutions. At first, these folds are very short, and only connect the 
 longitudinal folds together; but in the higher animals, elephants, apes, 
 and man, they are so large that they divide the longitudinal convolutions. 
 
 We may now turn to the anatomical facts, and see if we can realize 
 and digest them ; and we do so the easier for the above most homely 
 illustration ; I trust it will be forgiven, even by those who, unlike the 
 author, could have understood them without some such clue to their 
 meaning. 
 
 These explanations will, I think, be easily understood as we proceed, 
 by referring to the following figures, taken from Leuret. To assist in 
 remembering the course of the convolutions, and their variety in different 
 species, we may consider the longitudinal foldings as the result of pres- 
 sure from above and below; the transverse foldings, from before and 
 behind. 
 
 It is a curious coincidence, to say the least of it, that as the longest 
 heads in the human species contain the most active and intellectual brains, 
 so is the greatest advance from the lower form of brain to the higher 
 made by lengthening the brain, as shown by the transverse foldings. It 
 is an old saying, and a true one, in speaking of a clever man, " He is a 
 long-headed fellow." 
 
 Professor Owen, in a paper communicated to the Zoological Society 
 as far back as 1833, began a classification of the convolutions of the 
 brain. His paper was simply entitled, u The Anatomy of the Cheetah, 
 Felisjubata." He continued his observations to the feline and canine 
 race. They are very clear, and point out the same longitudinal furrow- 
 ing which was afterwards described by Leuret, as will be shown further 
 on. I have thought it better to follow the latter, as his descriptions are 
 more extended, and quite confirm the observation of Professor Owen, 
 who observes, that the constancy manifested in the disposition of the 
 convolutions, as to their form, extent, and symmetrical arrangement, 
 argues strongly in favor of the conclusion that the folding of the hemi- 
 spherical substance in the progress of development follows a determinate 
 law. 
 
 A classification of animals in relation to their convolutions, will be found 
 to accord with the extent of their intelligence; animals may be divided 
 into groups, in accordance with the form of their convolutions. 
 
 Thejirst group includes animals taken from different families, viz., the 
 Cheiroptera or Bats (fig. 62), the Insectivora (61), the Marsupiata (fig. 40), 
 the Monotremata, and especially the Rodentia (41, 47). They correspond, 
 as regards the absence of convolutions, to those birds which have but 
 little intelligence. 
 
 In the second group there are still no convolutions, but there are 
 depressions which announce, as it were, their approach. The animals 
 which compose this group are from the Rodentia, the Insectivora, and 
 the Marsupiata. Besides the fissura Sylvii, which is here more promi- 
 nent than in the first group, there are depressions upon the cerebral lobe 
 
120 
 
 COMPARATIVE ANATOMY. 
 
 Fig. 63. 
 
 Upper surface of the brain of 
 the agouti. (Leuret.) Slight trac- 
 ing of the longitudinal convolu- 
 tions. A. Olfactory ganglia. B. 
 Hemispherical ganglia. E. Ce- 
 rebellum. H. Spinal cord. 
 
 which have a certain regularity, as may be seen in the examination of 
 the brain of the hare and agouti. 
 
 On each side of the median furrow, which 
 extends from before to behind, we see a parallel 
 furrow which circumscribes a portion of cere- 
 bral substance, having almost the aspect of a 
 convolution: this is well seen in the agouti 
 (fig. 63). In the beaver (see fig. 40) we see some 
 furrows less prolonged but more deep, having 
 the same direction as those in the hare and 
 agouti. Gall and Spurzheim were in error 
 when they stated that the number of convolu- 
 tions is in relation to the volume of the brain; 
 for instance, in the brain of the ferret there are 
 five convolutions very distinct, three external, 
 one internal, an anterior or supra-orbital ; yet the 
 brain is not equal to that of the squirrel, which is 
 without convolutions or furrows, and it is much 
 inferior to that of the hare, of the porcupine, of 
 the paca, agouti, beaver, &c. These latter have 
 a brain more voluminous than the ferret and the 
 polecat. Nevertheless, it is generally true that 
 those species of animals which have the most 
 voluminous brains, have also the convolutions 
 and undulations most numerous and varied. 
 
 M. Leuret illustrates his views regarding the cerebral convolutions by 
 a demonstration of the convolutions of the brain of the fox (see fig. 64), 
 exhibiting the external face of the right hemisphere of the brain : s, 
 
 marks a deep furrow, pass- 
 ing obliquely upwards and 
 backwards the fissuraSyl- 
 vii. There is a rounded 
 body surrounding this fis- 
 sure this is the first con- 
 volution ; a second, third, 
 and fourth, are placed one 
 above the other, making 
 four convolutions; before 
 these, placed in front, there 
 is a fifth (o), the supra-orbi- 
 tal. The sixth, and last 
 (i), forms at the under part 
 of the middle lobe the hip- 
 pocampal convolution. If 
 we compare this brain with that of the bear, we find that the fissura Syl- 
 vii is larger, but there is the same proportion to the rest of the brain. 
 Instead of there being four lateral convolutions, as in the fox, there are 
 only three, though at first sight the brain appears more complicated. 
 Fig. 65, representing the upper surface of the brain of the fox, shows 
 
 Brain of the fox. (Leuret.) e. Olfactory ganglia, o. Optic 
 nerve, o. Orbital convolution. A A A. Anterior ditto. P P P. 
 Posterior ditto, s s. Fissura Sylvii. 1 2. Cerebellum. 
 
CONVOLUTIONS. 
 
 121 
 
 Fig. 65. 
 
 Upper surface of the brain of the fox. (Leuret.) 
 Fissura Sylvii. 
 
 the completion of the fourth convolution, of which fig. 64 shows the 
 internal and posterior part. 
 
 The third group contains the fox, wolf, &c. The convolutions of the 
 brain of the wolf are the same 
 in number as those of the fox, 
 only there are more numerous 
 depressions, and a very pro- 
 longed furrow upon the third 
 external convolution, in the spot 
 where in the fox there is only a 
 rudiment of a depression. Leu- 
 ret states that he has compared 
 the brains of dogs of different 
 species, and he has always found 
 the same type, the same convo- 
 lutions, without any difference 
 but in the number of the depres- 
 sions, and extent of the undu- 
 lations ; this difference corre- 
 sponds to the volume of the 
 brain. 
 
 Fourth group. All animals 
 of the genus Cat and Hyena are 
 comprised in this group. As in 
 the preceding group, the smaller 
 the brain, the fewer the convolutions and depressions. There are many 
 essential differences with regard to the cerebral convolutions between 
 the fox tribe, which includes the dogs, and waives, and the cats. In 
 these latter (fig. 60), we find four external longitudinal convolutions, one 
 internal, and one supra-orbital. But, contrary to the arrangement in the 
 brain of the foxes, these convolutions have many points of union, which, 
 I believe, arises from the greater length of the ganglion requiring it to 
 be pushed up together in its long axis : at the place marked s in fig. 60, 
 there is a furrow, which represents the fissura Sylvii ; this furrow is very 
 much developed in the panther, in the lion, and all the large species of 
 this genus. 
 
 Fifth group. They are varied, but they have this common point of 
 resemblance that the number is only five, three external, one supra- 
 orbital, and the fifth internal. 
 
 The civet forms a very natural and easy transition between the bears 
 and the foxes. The genet forms a transition between the brain of the 
 civet and that of the marten. 
 
 In the coati there are but three external convolutions ; the first is of 
 unequal size in different parts of its extent : behind the fissura Sylvii it 
 is very much enlarged; above that fissure it recedes upon itself, and re- 
 mains partly below the anterior portion of the second convolution. The 
 same disposition is met with in the weazel, the marten, the otter, and 
 the bear. 
 
 The second convolution is in an inverse ratio to the first, being larger 
 before than behind. 
 
122 COMPARATIVE ANATOMY. 
 
 The third convolution, simple and regular in the ferret, has in the 
 polecat a fissure behind, which is replaced on the two sides. The coati 
 has more depressions. Viewing the brain of the ferret, weazel, coati, 
 badger, and polecat, above, a transverse fissure may be seen to cut the 
 mesial fissure, like the letter V. The convolution in front of this fissure, 
 which forms the anterior point of the brain, is a portion of the internal 
 convolution, which, commencing at the hippocampal lobe, runs back- 
 wards, embraces the corpus callosum, and rising anteriorly to unite with 
 the superior convolution. Above the orbit is the last convolution, the 
 supra-orbital ; it is furrowed for the olfactory commissure. 
 
 The brains of the fifth group form a sort of transition between the 
 foxes and the sheep. 
 
 The sixth group includes only the ichneumons. 
 
 The seventh group includes the two-toed sloth, the ai or three-toed 
 sloth, the African ant-eater, phascolomys or wombat, and the hyrax or 
 coney. In none of the animals composing this group do we meet with 
 a single transverse furrow. 
 
 The eighth group includes the pteropus, or fox-like bat, kangaroo, 
 orycteropus. 
 
 Ninth group. The brain of the genus Sheep, including the Ruminan- 
 tia (figs. 49 and 50), which forms the ninth group, has in reality only 
 four convolutions ; one internal, one infra-orbital, two external, which 
 have numerous divisions, some depressions, and a form very undulating. 
 It is a sort of amplification of the brain of the orycteropus. 
 
 The convolutions of this group, in their general aspect, do not resem- 
 ble those of the foxes, cats, or bears ; they have more analogy to the 
 convolutions in the human brain. Viewed above, we observe the lon- 
 gitudinal foldings much doubled up, so as to produce many transverse 
 folds. 
 
 We cannot attempt to follow out all the minute varieties in the con- 
 volutions of the tenth, eleventh, and twelfth groups of M. Leuret, which 
 includes the pigs, the seals, and the Cetacea, but proceed to the thir- 
 teenth group. With the exception of suborbital convolutions, the con- 
 volutions of the brain of animals below this group are all directed from 
 before to behind they traverse the brain longitudinally. Between these 
 convolutions in many brains there are points of union, a sort of solder- 
 ing or joint ; they are found in the cat, bears, otter, sheep (fig. 49), 
 &c. ; but all are parallel, none are placed transversely to the brain, cut- 
 ting the longitudinal convolutions into two parts, and dividing them 
 into anterior and posterior convolutions. This division of the longitudi- 
 nal convolutions, this addition of new convolutions, is found only in the 
 elephant, the apes, and in man (see figs. 66 and 67, and the descrip- 
 tions). 
 
 Fourteenth group. In the apes, and especially the monkeys, the con- 
 volutions are not so undulating and voluminous as in the elephant and 
 whale ; thus they appear at first sight to be further from man than the 
 latter : but a little attentive observation soon dispels this illusion. The 
 general form of the brain of the monkey, its development behind, the 
 extent and degree of inclination of the fissura Sylvii, form a brain as an 
 embryonic perfectioning of the brain of man, whilst the brain of the ele- 
 
CONVOLUTIONS. 
 
 123 
 
 pbant, and especially that of the whale, considered in their different rela- 
 tions, descend towards the form of the brain of other Mammalia. 
 
 Fig. 66. 
 
 IICA 
 
 Internal surface of the right hemisphere of the Indian elephant. (Leuret.) c c. Corpus callosum. nil. 
 Internal convolution. This convolution, above and behind the corpus caHosum, sends a prolongation,-}-, 
 which is united to the superior convolutions, s s s s. Leuret states that he has never met with this disposi- 
 tion of the convolutions, except in man, the ape, and in the elephant. This portion cuts the antero-poste- 
 rior convolutions into two portions, of which some are anterior and the others posterior, m.p, III.P. Third 
 posterior convolution. IV.P, IV.P. Fourth posterior convolution. m.A. Third anterior convolution, iv. 
 Fourth anterior convolution. " Suppose," says Leuret, " that all the superior convolutions, s s s s, and the 
 prolongation, -{-? of the internal convolution are obliterated, the fourth anterior convolution might be united 
 to the fourth posterior convolution, the third to the third, and we should have one of the groups of con- 
 volutions of the brain of the Ruminants and Solipedes." Reduced one half. 
 
 The ape has three anterior convolutions (i. A, n. A, in. A., fig. 68), 
 three posterior (i. P, n. P, in. P, fig. 68), two superior (s s, s s), one 
 internal, and the supra-orbital convolutions, also corresponding to those 
 in man (figs. 73-4-5). The orbital convolutions always exist; they are 
 larger and better divided than in the inferior animals, but they do not 
 show the same regularity as the others. 
 
 " The brain of the chimpanzee," says Mr. Owen, "in the relative 
 proportions of the different parts, and the disposition of the convolutions, 
 especially those of the posterior lobes, approaches nearest to the human 
 brain ; it differs chiefly in the flatness of the hemispheres, in the com- 
 parative shortness of the posterior, and in the narrowness of the anterior 
 lobes." 
 
 It also approaches nearer to the human brain than that of the other 
 Mammalia, in the absence of the corpus trapezoidum (see College pre- 
 
124 
 
 COMPARATIVE ANATOMY. 
 
 paration 1338), which, I observe, exists in the brain of many of the apes, 
 though I cannot affirm that the chimpanzee is the only exception. 
 
 Fig. 67. 
 
 The cerebral surface of the right lobe of the brain of the Indian elephant. (Leuret.) s s. Fissura Sylvii. 
 I.A, II.A. III.A. Three anterior convolutions. They all have a common origin from the convolutions s s s, 
 which is the most anterior of the superior convolutions. Behind the superior convolutions s s s, there is 
 a fissure, the analogue of which exists in man and the ape, and which Leuret calls the fissure of Rolando. 
 Below this fissure are seen some voluminous superior convolutions, s' s' s" s", which, like the convolu- 
 tions s s s, intercept the continuity of the anterior with the posterior convolutions. I.P, I.P. First posterior 
 convolution situated behind the fissura Sylvii, and'which is reunited to the convolution I.A. if the superior 
 convolutions do not exist, n.p, n.p. Second posterior convolution, in. P. Third posterior convolution. 
 p o. Supra-orbital convolution. Leuret states that he has taken great pains to have the size of the draw- 
 ing accurate. The cut is reduced one-half. 
 
 " The number, form, arrangement, and relations of the cerebral con- 
 volutions," says Leuret,* " are not formed at hazard : every family of 
 animals has a brain formed in a determinate manner, arid the difference 
 of opinions on this subject arise from the want of attentive examination 
 of a sufficient number of brains. Observation has thus shown what strict 
 induction had led us to conclude. How, indeed, can we believe, that 
 the most important organ of the economy, that by which the manifesta- 
 tions of intelligence operate, to which is attributed the instincts and pas- 
 sions, has not a fixed organization, and as invariable as that of other 
 parts. Each group of brains has a type which is proper to it, and this 
 type is especially manifested by the form of its convolutions." 
 
 " In the foxes the divisions are clear and well marked ; in the cats 
 
 * Op. cit, p. 399. 
 
CONVOLUTIONS. 
 
 125 
 
 the divisions are less, but still the forms are fixed and very simple ; in 
 the bears and martens there is a tendency to another form, complete pre- 
 servation of some convolutions, which I have called primitive, on ac- 
 count of their simplicity, and disposition of some of the others to unite 
 and present undulations. In the next type, the fundamental separations 
 are less numerous and of greater variety in their details for the different 
 groups to which the wombat, kangaroo, roebuck, pig, seal, and whale 
 belong. Next, as in the elephant, an entire addition to the general 
 forms, with an infinite development of details. In the ape a still more 
 perfect type, nearer to man, but incomplete and rudimentary." 
 
 Fig. 08. 
 
 Left side of the brain of the baboon (Singe Papio). (Leuret.) s s. Fissure of Sylvius, running obliquely 
 from before backwards, s K. Fissure of Rolando, sss, s's's'. The two superior convolutions. LA, 
 it. A, in. A. First, second, and third anterior convolutions, arising all three from the same superior convo- 
 lution. I.P, H.P, III.P. First, second, and third posterior convolutions. The first, Jong, isolated, and 
 turned round above the fissura Sylvii, and directed towards the first anterior convolution, from which it 
 is separated by the lowest part of the superior convolutions. The second and third convolutions are car- 
 ried above and behind the cerebellum, and are in part confounded one with the other, -f- Point of re- 
 union and prolongation of the superior convolution, s' s' s', with the prolongation of the internal convo- 
 lution. 2. Lateral lobe of the cerebellum. 3. Third lobe of the cerebellum, orjloeons. 
 
 "In each family, as a general rule, the more the brain increases, the 
 more it divides, the more also it acquires undulations. The fox, the 
 domestic cat, the weazel, the ferret, the roebuck, the peccary, each re- 
 presents the first step of a scale, at the summit of which is the dog, the 
 lion, the otter, the hyrax, and the boar. In its class the elephant is at 
 the summit ; but I know of no animal which can be placed at the oppo- 
 site end. In its' own class the lemur is very low, the ape very high, and 
 man very far above the ape. However, there are some large brains 
 which do not represent a perfect type of some small brains of the same 
 class. Thus, that of the ox is not more perfect than that of the sheep, 
 that of the whale is not above that of the porpoise." "Are there inter- 
 
126 COMPARATIVE ANATOMY. 
 
 mediate degrees," modestly says Leuret, " between all these brains? 
 Are there any forms of brain different from those that I have described? 
 Observations more extended can alone resolve these questions, which 
 are of the deepest interest for anatomy and psychology." 
 
 Cerebral Vessels. In the Mammalia, below the human subject, the 
 brain is not supplied by the same set of blood-vessels. In man, we find, 
 the two internal carotid and two vertebral arteries, distributing their 
 branches almost entirely to the brain ; but it is by no means invariably 
 the case throughout the class of mammals. Without pretending to give 
 a minute account of these varieties, I shall briefly refer to some of the 
 
 most interesting. 
 
 When we have advanced to the study of the cerebral vessels in man, 
 we shall meet with a beautiful contrivance to avert the force of the 
 heart's action on the brain. The carotid and vertebral arteries, instead 
 of running directly in a straight line from the heart into the skull, are 
 bent twice nearly at a right angle, thus twice changing a perpendicular 
 to an horizontal course. In some of the lower animals the cat, for 
 instance the vertebral artery is turned as in man. But, in addition 
 to this arrangement of these vessels, we meet with another of great phy- 
 siological interest, and evidently intended to serve the same purpose. 
 This is formed by the division of the carotid artery within the skull into 
 numberless small vessels, which, meeting again, form a most wonderful 
 net-work rete mirabile and well has it been thus named. It was 
 first discovered and described by Galen. A trunk is formed by the 
 union of these vessels, which supplies the brain. We shall have occa- 
 sion to consider the formation of this rete again, when we have turned 
 our attention to some of the peculiarities regarding the relative size and 
 distribution of the carotid and vertebral arteries. The carotid arteries 
 are subject also to much variety. 
 
 Sometimes the common carotid arteries bifurcate, as in man, into 
 external* and internal carotids, the latter maintaining a large calibre. 
 Sometimes, as in some of the baboons, the common carotid, after having 
 given off the usual branches of the external carotid, enters the cranium 
 as the internal, which in other instances appears like a subordinate 
 branch of the external carotid. In the common porpoise, the large size 
 of w ? hose brain we have already observed, the carotid divides nearly as 
 in man, with merely the exception that it gives off the superior thyroid 
 and a cervical branch first. 
 
 In the tiger, the internal carotid is not given off until the common 
 carotid has distributed the usual branches of the external.* 
 
 The internal carotid does not give off the ophthalmic artery in the 
 Carnivora, Rodentia, Rurainantia, or Pachydermata. This vessel ascends 
 into the orbit through the foramen lacerum orbitare inferius, which is 
 very large. 
 
 In those ruminants in whom the rete mirabile exists, a true internal 
 carotid can scarcely be said to be present, but its place is supplied by 
 two vessels on each side, one of which enters the skull by a foramen 
 which corresponds to the foramen rotund u in and foramen orbitare supe- 
 
 * Cuvier, Lemons, ed. 1839, t. vi. 
 
CEREBRAL VESSELS. 127 
 
 rius, the other through the foramen ovale. In the pig, the largest of the 
 two vessels passes through the foramen lacerum basis cranii, and a 
 smaller one through an interior portion of the same foramen. The caro- 
 tid canal is absent in all cases where the plexus is present; but its 
 absence does not necessarily indicate the presence of a plexus. 
 
 The vertebral artery is subject to much variety both in regard to its 
 origin, distribution and size; in some animals, as the hedgehog, it arises 
 from the common carotid. 
 
 In this animal, and in the hybernating Rodentia, it is much larger 
 than the carotid ; also in some other of the Rodentia, as the rabbit. In 
 these cases, the basilar artery forms nearly the whole of the circle of 
 Willis, furnishing the anterior as well as the posterior arteries of the 
 brain.* This fact is important in reference to experiments made with 
 ligatures on the internal carotids, and the deductions from them in rela- 
 tion to the physiology of the brain. 
 
 Professor Rapp, of Tubingen, f states, that " the vertebral arteries do 
 not reach the brain in all those animals that possess a rete mirabile." 
 In Ruminants, the vertebral arteries usually enter the spinal canal, be- 
 tween the second and third cervical vertebrae, without piercing the dura 
 mater of the cord : they then join, but separate again almost immediately : 
 in the calf and goat, these arteries are connected by transverse branches ; 
 this union seems to indicate a basilar artery, although it does not take 
 place in the skull, nor internal to the dura mater. Each artery, after 
 having given off twigs to the various muscles, joins on the atlas the 
 condyloid artery, a branch of the external carotid, which comes through 
 the condyloid foramen into the skull; then, without piercing the dura 
 mater, turns backwards, receives the vertebral arteries, then passes 
 through a foramen in the atlas, anastomoses with a branch of the exter- 
 nal carotid, and is distributed to the muscles at the back of the neck. 
 This union of the vertebral arteries, with a twig of the external carotid, 
 is remarkable, and explains why, in an animal in whom no blood is car- 
 ried to the brain by the vertebral arteries, both common carotids may 
 be tied without causing the death of the animal. This operation has 
 been performed by Parry on sheep." 
 
 In the stags and chamois there is a considerable anastomosis between 
 the rete mirabile, the condyloid artery, and a vessel in which the anterior 
 spinal artery terminates ; the anastomosing branch passing through the 
 jugular foramen into the skull. 
 
 In the calf, also, there is an anastomosis between branches of the 
 vertebral artery and rete mirabile (see fig. 69, E). 
 
 The rete mirabile may be exposed in the skull of the sheep and calf, 
 which are convenient for the purpose, by raising the dura mater on each 
 side of the sella turcica, and then opening the cavernous sinus. If the 
 vessels are filled with red wax, they present the beautiful appearance 
 represented in fig. 69. This plexus is surrounded by the venous blood 
 of the sinus, the sixth pair of nerves running through it. The vessels of 
 the rete anastomose freely: in the swine, beneath the pituitary gland ; 
 posterior to it in the goat, stag, sheep, and roe. 
 
 * Cuvier, ed. 1839, vol. vi. p. 118. t Meckel's Archives for 1827, p. 5. 
 
128 
 
 COMPARATIVE ANATOMY. 
 
 This rete mirabile has a different appearance in different animals, so 
 that when separated from the skull it cannot be recognized as coming 
 from any particular animal. In the calf the vessels forming the plexus 
 are comparatively thick, and make numerous abrupt curves. In the goat 
 and chamois they are in this respect most like the calf; in all these the 
 net is very close. In the stag it is more open. In the sheep the vessels 
 are thin, and very numerous and straight. We have a good preparation 
 of it, from this animal, in the Museum of St. Thomas's Hospital, made 
 by Sir Astley Cooper. In the fetus it is comparatively larger than in the 
 full-grown animal, corresponding with the size of the brain. 
 
 Fig. 69. 
 
 
 ,-;:, 
 
 Rete mirabile of the calf. (Rapp.) The cavity of the skull and the spinal canal are opened ; the brain, 
 spinal cord, and dura mater have been removed. A. The cerebral carotid arteries arising from the rete 
 mirabile. B. The vertebral arteries in the spinal canal, c c. The vertebral arteries passing through the 
 foramen in the atlas. D. Branches of the vertebral arteries passing forwards under the dura mater to 
 anastomose with the arteria condyloidea, forming thus u plexus which is connected to the rete mirabile. 
 E. Arteria condyloidea. 
 
 Professor Rapp found the vessels slightly atrophied in cases of partial 
 destruction of the brain by the coenurus cerebralis. The cerebral carotid 
 is formed by a union of all the twigs of this plexus. The artery always 
 penetrates the dura mater on the side of the pituitary gland, and then 
 forms the circle of Willis, and gives off branches perfectly similar to 
 those in man. From the posterior portion of the circle arises a vessel, 
 which has erroneously been called the basilary, but is really the anterior 
 artery of the spinal cord. 
 
CEREBRAL VESSELS. 129 
 
 Rapp found this plexus in the stag, roe, the fallow-deer, chamois, the 
 goat, sheep, and calf, and oxen. He considers that the arrangement of 
 the foramina in the base of the skull in the camel indicates its existence 
 in this animal, but he has not had the opportunity of seeing the parts in 
 a recent state. It exists also in swine, but it does not occur in other 
 Mammalia besides the Ruminantia and swine. Cuvier's statement cer- 
 tainly differs from this: he says that this vascular arrangement appears 
 to occur in most of the Carnivora, but is absent in the elephant and 
 beaver. According to Carus it is present in most Mammalia, and Willis 
 says it exists in the dog, the fox, cat, &c. ; but this is a mistake, for it 
 does not occur in the dog, fox, badger, weazel, otter, or hedgehog, or in 
 the domestic cat. But it has been found by Mr. Quekett in the leopard. 
 Neither is it found in man, the apes, horse, elephant, or the Rodentia. 
 In the domestic cat there is an arterial plexus beneath the orbit, anterior 
 to the articulation of the lower jaw, which sends anastomoses through the 
 supra-orbitar fissure to the carotis cerebralis in the cranium, which is 
 thus enlarged immediately after entering the skull at the anterior and 
 internal extremity of the petrous bone. Rapp found a similar rete mira- 
 bile of the ophthalmic in all Ruminants, but not in swine; this ophthalmic 
 rete mirabile is formed out of the arteria ophthalmica, a branch of the 
 external carotid : it lies between the musculus suspensorius and the rectus 
 superior; out of this net arise the ciliary arteries; it is peculiarly beauti- 
 ful in the sheep, and smaller in the goat. In the horse the carotids do 
 not enter through a carotid canal, but through a foramen lacerum, and 
 are then united by a thick transverse branch before penetrating the dura 
 mater. 
 
 Harwood suggested that'the office of this plexus was to moderate the 
 pressure of the blood against the brain in those animals in whom the 
 position of the head was constantly depending. But Rapp does not agree 
 with him, though he allows that it will moderate pressure; but that it 
 has no relation to position. 
 
 In the horse this result is obtained by the strong bendings of the 
 cerebral carotid and by the vertebral arteries which also supply the brain. 
 
 It was supposed to be absent in the giraffe, and this, in connection 
 with the mode in which this animal obtains its food from the branches 
 of trees, instead of stooping to crop it from the ground, was considered 
 an additional argument in favor of Harwood's opinion. Mr. Quekett, 
 of the College of Surgeons, has, however, succeeded in injecting and 
 clearly demonstrating its existence. 
 
 
130 
 
 PART III. 
 
 PKOTECTIVE APPARATUS OF THE HUMAN BEAIN. 
 
 FROM" what has been already said regarding the important office of the 
 cerebro-spinal axis, our reader will be prepared to find in man some 
 special and beautiful provision for its protection. 
 
 The materials which form the protective apparatus may be classed 
 under three heads: 1. The osseous or bony. 2. The membranous. 
 3. The aqueous or fluid. The bony apparatus of protection in the lower 
 animals, as, for instance, in many insects, in the lobster and crab tribes, 
 &c., is formed by a simple hardening of the general covering or integu- 
 ment of the body ; and the skeleton which is thus formed is called a 
 dermal or skin skeleton. The inconvenience of such an arrangement 
 must be evident, when we consider that this skeleton must be cast off 
 periodically in order to allow the animal to increase in size. The lob- 
 ster throws off its shell, and draws its limbs out of their calcareous cover- 
 ings, as we do our legs out of our boots. But during the period while 
 the new skeleton is growing, the animal is left in a miserably weak and 
 helpless condition, an easy prey to its enemies. 
 
 In the higher animals the skeleton is as much a part of the living crea- 
 ture as the soft skin, muscles, or other living tissues, and is placed 
 within the body, increasing as the organs which it protects increase in 
 size. 
 
 The osseous framework which in man appears so complicated, and 
 performs, with its connecting ligaments and attendant muscles, so many 
 and such various offices, as prehension, mastication, locomotion, &c., 
 in the simple form in which it first appears in the animal kingdom, is 
 first a tube of cartilage, or a jointed column inclosing the spinal cord, 
 without appendages or limbs for other functions. This is called the ver- 
 tebral column. Its presence in the animal kingdom is so clear a mark 
 of a comparatively high development of the nervous system, that physi- 
 ologists, as we have already seen, divide animals into two great groups, 
 the Invertebrata, or creatures without vertebrae ; and the Vertebrata, or 
 animals possessing a vertebral column. It would not be consistent with 
 the plan of this work to enter into a description of the mechanism of the 
 vertebral column in the different classes of animals. If we once entered 
 on this subject, the abundance of matter, and the interest attaching to it, 
 would render it very difficult to us to abandon it. We shall, therefore, 
 merely remark that the cerebro-spinal axis in man is situated in a long 
 bony canal, which is expanded superiorly into a cavity of considerable 
 size. The difference in the dimensions of the two portions of this canal 
 
MEMBRANES, ETC. 131 
 
 has led anatomists to divide it in their descriptions, the upper portion 
 being called the skull or cranium, the lower the vertebral or spinal canal. 
 Now, though in man this division seems even natural, the two portions 
 differing so entirely in size and general appearance, still if we observe 
 the same parts in the lower orders of animals, and trace their alterations 
 of form and capacity as the organs which they contain increase in size, 
 and require a change in the shape and extent of the cavity which con- 
 tains them, we shall find that the bones composing the human skull are 
 simply vertebraB in a more expanded form, and exhibit those alterations 
 in shape which adapt them to the increased size of the organ they are 
 formed to protect.* 
 
 The student, in considering the relation of this osseous envelop to 
 the brain, must bear in mind its vital properties that the skull, which 
 so beautifully protects this delicate organ by its physical hardness, is 
 modeled in its form and shape by a soft substance like the brain. The 
 facts which have been accumulated of late years, showing that the form 
 of the skull alters at different periods of life, are extremely interesting 
 and important. As illustrating the physiology of the brain, they will be 
 referred to hereafter. If the brain were not protected by an internal 
 skeleton, this, of course, could not take place; and, even in the present 
 day, it is not uncommon to hear the opponents of phrenology ridicule 
 the idea of the soft brain producing any impression on the hard skull. 
 
 As the following description of the anatomy of the cerebro-spinal 
 mass in the human being is intended to assist those who are commencing 
 their studies, the best mode of opening the skull and vertebral canal so 
 as to reach without injury, and to expose the structure of, the nervous 
 masses contained within them, shall next be explained. 
 
 The student should place the subject on its face, and, raising the 
 head, rest the chin upon a block, so as to fix it in a horizontal position. 
 
 An incision must then be made through the scalp, extending across 
 the vertex from ear to ear. The anterior part of the scalp may then be 
 forcibly torn, instead of being dissected, from the skull over the face, 
 and the posterior over the occiput, which will save much time; but 
 some force is required to effect this reflection of the integuments. 
 
 A deep groove must be made with the saw through the outer table 
 and diploe, commencing half an inch above the superciliary ridges an- 
 
 * This opinion, that the cranium is formed by a series of vertebrae, originated with Peter 
 Frank (see Edinb. Med. Surgical Journal, vol. xliii. p. 288), (Epit. de Curand. Horn. Morb., 
 lib. ii. p. 42), and Burdin (Cours il'Etudes Medicales, Paris, 1803, tome i. p. 16); and was 
 afterwards espoused by Kielmeyer (Ulrich, Annotationes quaedam de Sensu ac Significa- 
 tione Ossiurn Capitis, Berlin, 1816, p. 4), Dumeril (Magazine Encyclopedique, tome in 
 1S08), and Goethe (Zur Naturvvissenschaft, Band i. p. 250), and more or less fully illus- 
 trated by Oken (Ueber die Bedeutung der Schadelknocken, Jena, 1807 ; Isis, 1820, No. VI. 
 p. 552), Spix (Cephalogenesis, Munich, 1815), De Blainville (Bulletin de la Soc. Philorn., 
 1816, p. Ill, and 1817), Geoffroy St. Hilaire (Philosophic Anatomique, Paris, 1818-22), 
 Carus (Lehrbuch der Zootomie, Leipzig, 1818, p. 164), Meckel (Beytrage zur Vergleichen- 
 den Anatomic, Band ii. Stuck ii.), Schultz (De Primordiis Systematis Ossium, &c., Halle, 
 1818, p. 13), Bojanus (Isis, 1818, p. 301; 1819, p. 1364), and Burdach (Vierter Bericht von 
 der Anatomischen Anstalt zu Koenigsberg, Leipzig, 1821). Arnold also adopts this princi- 
 ple, but confines himself to the views given by Oken, Cuvier, Carus, Spix, and Meckel, con- 
 sidering that the cranium consists of three vertebrae only; not, therefore, agreeing with 
 Geoffroy St. Hilaire, who believes that he can there demonstrate the parts of nine vertebras. 
 
132 HUMAN BRAIN. 
 
 teriorly, and extending round the entire skull to the protuberance of the 
 os occipitis posteriorly. 
 
 A small axe should next be used to break the inner table, which is 
 much better than sawing it entirely through, as being less likely to injure 
 the dura mater and brain, and as permitting the skull to be more firmly 
 fixed again when replaced after the dissection is completed. 
 
 The skull-cap being removed, a dense fibrous membrane is perceived 
 beneath it, rough on its surface owing to the torn extremities of the 
 vessels which connected it to the internal table of the skull; for this 
 membrane, which is the internal periosteum of the cranial bones, and in 
 the young subject connected at the edges of the several bones with the 
 external periosteum, adheres to the bones so closely that they are with 
 difficulty separated. The glistening membrane thus exposed is called 
 the dura maler^ from the density and firmness of its texture, and from an 
 idea that it was the origin or mother of all the other fibrous membranes 
 of the body.* 
 
 On the surface of this membrane are some small rounded bodies, 
 which certainly were undeserving of notice if they had not received the 
 grand title of glandule PacchioniA These are scarcely observable in 
 the young subject, and in the old are most probably a morbid appear- 
 ance. The dura mater should next be cut through carefully all round 
 with a pair of scissors, on a level with the divided edge of the skull. 
 On being turned back over the upper part of the brain, we discover that 
 its under surface is smooth and polished ; a circumstance which does 
 not arise from any peculiarity in the texture of its internal surface as 
 opposed to the external, but from the presence of a serous membrane, 
 called the tunica arachnoidea, which, like all serous membranes, is a 
 thin diaphanous web, covering the contained viscus, and reflected from 
 thence on to the internal surface of the walls of the containing cavity- 
 The next membrane, therefore, which we observe covering the brain 
 when the dura mater is raised, is that portion of the arachnoid^ which, 
 from its investing the brain, may be called the tunica arachnoidea cere- 
 bralis or investiens, in contradistinction to that portion which lines the 
 
 * Portal iv. 2. The membranes of the brain, by the Greeks, were called meninges, the 
 Greek word fjtnwy% simply signifying a membrane. The term mater, or mother, originated 
 with the Arabs, and the credit of having shown that the dura mater does not accompany the 
 nerves in their passage from the skull, and that the membranes in general are therefore not 
 continuous with it, is due to Ludwig. 
 
 f So called after Pacchionus, who first described them as glandular structures destined to 
 secrete a peculiar lymph : he even went so far as to state that their, secretory ducts terminate 
 in the longitudinal sinus. Cruveilhier (Anat. Descript., tome iv.) acknowledges our igno- 
 rance of their nature, but scarcely regards them as a morbid production : their seat is in the 
 subarachnoid cellular tissue. 
 
 Wengel, (De penitiori structura cerebri hominis et brutorum,) p. 17, 1812, says, after de- 
 tailing the opinion of Malacarne in support of that of Pacchionus, " Eorum ortus absque 
 dubio a morboso statu, inconstans incertus, ex octate aliisque fortuito accidentibus cireum- 
 stantiis est." En. Anat., vol. iii. 345. 
 
 Dr. Todd considers them as morbid products. " That they are," says this writer, " the 
 product of a chronic, very gradual irritation, due to more or less frequent functional excite- 
 ment of the brain itself." " They are peculiar to the human subject. Nothing similar to 
 them has been found in any of the inferior classes of animals." 
 
 J Portal, iv. 2. The arachnoid derives its name from its extreme delicacy and its resem- 
 blance to a cobweb ; it was first described as a special membrane in 1 565, by the Dutch 
 Society, among the members of which was Swammerdam, the celebrated naturalist. 
 
PROCESSES OF THE DURA MATER. 133 
 
 dura mater and is called the tunica arachnoidea reflexa. The further 
 description of this membrane will be postponed until we have completed 
 that of the dura mater. The dura mater forms several processes in the 
 interior of the skull, some of which are best seen after the removal of 
 the brain as directed further on, but which it will be in order to describe 
 at once. 
 
 The dura mater consists of two layers united by cellular tissue, the 
 external of which forms, as described, the internal periosteum of the 
 bones of the skull. The separation between these two portions is per- 
 fect in the vertebral canal, though at the internal surface of the atlas, the 
 spinal dura mater and periosteum of the vertebral canal meet together, 
 and adhere so as to exhibit in the skull the appearance of one membrane. 
 Dr. Knox, in the Lancet of the 19th October, 1839, remarks, that in 
 some animals the vascularity of the external layer is very striking, as in 
 certain Cetacea the Rorqual, for example where there is a perfectly 
 distinct vascular layer between the dura mater, properly so called, and 
 the Calvarium. This is not surprising, when we consider the vast 
 thickness of the bones of the skull in these creatures. 
 
 Processes of the Dura Mater. The internal layer is inflected down- 
 wards between the two symmetrical halves of the brain, forming what 
 has been called, from its sickle-like appearance, the falx major of the 
 dura mater (FM, figs. 70 and 71). This structure may be said to com- 
 mence from the crista galli of the ethmoid bone, where it is, generally, 
 about half an inch in width, though it varies in different subjects ; from 
 this point it extends backwards, gradually becoming wider in its pas- 
 sage, and being connected through the medium of the periosteal portion 
 to the frontal, parietal, and occipital bones. On reaching-the transverse 
 ridge of the occipital it splits into two lateral portions, which are at- 
 tached posteriorly and laterally to the transverse ridge of the occipital 
 bone, while anteriorly it is attached to the superior angles of the petrous 
 portions of the temporal bone, from which points it stretches itself up to 
 the posterior clinoid processes of the sphenoid, leaving a space between 
 its under surface, and that portion which covers the superior angles of 
 the temporal bone, through which passes the fifth pair of nerves. 
 
 This portion of the dura mater is called the tentorium (T, fig. 70), and 
 forms an extended surface on which the posterior lobes of the hemi- 
 spheres rest; and by which the cerebellum, which is situated beneath, is 
 protected from the superincumbent pressure of the brain (fig. 71): con- 
 sequently, the tentorium so far resembles in its office the falx major, 
 which prevents one hemisphere from pressing on the other when the 
 head is inclined to either side. 
 
 Extending down along the mesial line of the occipital bone beneath 
 the tentorium, there is another process analogous to, but much smaller 
 than, the falx major; it separates the two lobes of the cerebellum, and 
 has received the name of the falx minor ; it commences on the internal 
 surface of the occipital bone, at the point where the transverse and 
 longitudinal ridges meet, and extends to the edge of the foramen mag- 
 num. 
 
 The veins, which return the blood from the substance of the brain, 
 are protected from the pressure of that organ, by the stretching of the 
 
134 HUMAN BRAIN, 
 
 
 
 dura mater over deep grooves in the bone, and by the mechanism of 
 the falciform processes and tentorium of the dura mater, through the 
 internal lamina of which they pass immediately after quitting the pia 
 mater ; the spaces formed for their reception by this peculiar arrange- 
 ment of the dura mater are called sinuses, and require the attention of 
 the student. There are fifteen sinuses in all. 
 
 Fig. 70. 
 
 Vertical section of the human head, and cervical portion of the spinal column. (Breschet.) This draw- 
 ing shows almost all the various sinuses of the brain, the falx major, and the tentorium of the dura mater. 
 
 I. Superior longitudinal sinus. 2. Inferior ditto. 3. Straight sinus. 4. Lateral ditto. 5. Inferior petrosal 
 sinus. 6. Superior ditto. 7. Circular sinus. 8. Venous plexus at the commencement of the spinal canal 
 upon the anterior surface of the posterior arch of the atlas. This plexus communicates externally with 
 the external vertebral veins, and with the venous plexuses which these vessels form on the transverse 
 processes, and below with the large spinal veins or anterior longitudinal vertebral sinuses; before witli 
 the transverse sinuses on the basiiary process of the occipital bone; posteriorly with the posterior occi- 
 pital sinuses; lastly, they terminate in the lateral sinuses, close to the jugular foramen. 9. Communica- 
 tion of this plexus with the jugular vein through the anterior condyloid foramen. 10. Torcular Herophili. 
 
 II. Vena magna Galeni. 12. Anterior longitudinal sinus of the vertebral canal. 13. Pterygoid venous 
 plexus. F M. Falx major. T. Tentorium. 
 
 The superior longitudinal (1, fig. 70), which is the largest, com- 
 mences at the foramen caecum of the frontal bone, and, passing back 
 along the upper edge of the falx major, reaches the transverse ridge of 
 the os occipitis, where it usually enters the right lateral sinus. Its shape 
 is triangular, and the openings of the veins, which enter contrary to the 
 course of the blood within it, may be distinctly seen on the interior. 
 Surrounding these openings are small fibrous cords (the cordce. Willisii}^ 
 adapted to keep the openings permanently free for the regular passage 
 of the venous blood, any obstruction to the normal circulation of which 
 endangers the life of the individual, by producing congestion of the 
 brain. Running parallel with the superior longitudinal sinus, but along 
 the inferior edge of the falx, we find a much smaller sinus, called the 
 
SINUSES. 
 
 inferior longitudinal (2, fig. 70). This also terminates generally in the 
 left lateral sinus (4, fig. 70) ; previously, however, to its reaching this 
 sinus, and when it is passing between the two layers of the tentorium, 
 it receives the name of the straight sinus (3, fig. 70). 
 
 The course and extent of the lateral sinuses are distinctly marked in 
 the dry skull; for they groove the transverse ridge of the occipital bone, 
 and then crossing the posterior inferior angle of the parietal, reach the 
 internal surface of the mastoid portion of the temporal bones, in which 
 they are deeply imbedded, and thus effectually protected from the pres- 
 sure of the cerebellum ; they again cross a small portion of the occipital 
 bone, and finally terminate at the foramina jugularia, beyond which they 
 form the internal jugular veins: these sinuses have frequently another 
 outlet for their contents, by means of the foramen maStoideum, and the 
 vein which commences at this opening usually joins some of the deep- 
 seated veins of the neck. 
 
 On each side of the sella turcica a considerable space is left between 
 the dura mater and the bone, called the cavernous sinus; this cavity is 
 not, however, constructed solely for the protection of the venous circula- 
 tion. It contains the carotid artery, and guards, from the pressure of 
 the brain, some of the cerebral nerves, in their passage to the orbit. 
 The nerves, which are thus protected, are the third, fourth, first division 
 of the fifth, and the sixth pairs. 
 
 The blood of the cavernous sinus, separated from the nerves by the 
 lining membrane which is common to the whole venous system, flows 
 into a sinus, called the inferior petrosal (5, fig. 70), a name derived from 
 its proximity to the petrous portion of the temporal bone. The inferior 
 petrosal sinus takes its course along the edge of the basilary process of 
 the os occipitis, and terminates in the internal jugular vein. This sinus 
 is connected with its fellow by a short sinus, the transverse. The supe- 
 rior petrosal sinus (6, fig. 70) deeply grooves the posterior edge of the 
 superior angle of the temporal bone, and terminates in the lateral sinus. 
 
 Surrounding the pituitary gland in the sella turcica there is a circular 
 sinus communicating with the cavernous sinus, called the circular sinus 
 of Ridley (7, fig. 70). 
 
 The occipital sinuses, the last we have to mention, are situated on 
 each side of the foramen magnum, and terminate at the point where the 
 straight sinus and lateral sinus become conjoined ; the triangular space 
 left just before their junction is called the torcular Herophili(10, fig. 70). 
 
 Arteries. These are derived from numerous sources ; anteriorly there 
 is a small branch from the ethmoidal, and another larger branch from 
 the ophthalmic, just as it enters the orbit. In the centre of the skull 
 there are also two branches, the smallest coming through the foramen 
 lacerum medium, and derived from the ascending pharyngeal artery. 
 The larger branch, which is the principal artery of the dura mater, called 
 the middle meningeal, is given off by the internal maxillary, and pene- 
 trates the skull at the foramen spinosum of the sphenoid bone : this 
 winds through a deep groove in the sphenoid and parietal bones up to 
 the top of the skull. The posterior division derives its supply from the 
 vertebral occipital and posterior aural arteries. 
 
 Nerves of the Dura Mater. Cruveilhier (tome iv. p. 539), Haller, 
 
136 HUMAN BRAIN. 
 
 Wrisberg, and Lobstein, denied the existence of any nerves to the dura 
 mater, while Vieussens, Winslow, Lieutaud, Portal, Valsalva, and others, 
 say that they observed some, but without giving a very satisfactory de- 
 scription. Cruveilhier states he recognized on each side of the mesial 
 line two nervous filaments, extending from the fifth pair up to the vici- 
 nity of the superior longitudinal sinus ; a third nervous filament occupy- 
 ing the thickness of the tentorium cerebelli, but whose origin could not 
 be demonstrated. 
 
 Arnold has also described and delineated, and Pappenhein (Valentin, 
 Repertorium, vol. v. p. 87) states, that this membrane is supplied by 
 branches from the fourth pair, the frontal branch of the ophthalmic, the 
 superior maxillary division of the fifth, and the Vidian. 
 
 The arachnoid'membrane lines the dura mater, and covers the convo- 
 luted surface of the brain without dipping between the convolutions. It 
 also covers the figurate surface* at the point where these two portions 
 are continuous, as at the foramen of Bichat, as it is called, after the 
 justly-celebrated man who first described it. The situation'of this open- 
 ing is between the anterior and superior portion of the cerebellum, and 
 the under and posterior part of the cerebrum, as will be better under- 
 stood when these parts have been described and the relations of the 
 arachnoid explained. 
 
 F. Arnold, ima paper translated by R. Knox, with commentaries, loc. 
 cit., after quoting various opinions on this subject, says " I entirely 
 assent to the accuracy of Bichat's description, and think that the arach- 
 noid proceeds to join the epithelium of the ventricles, as the amnion is 
 in distinct continuation with the epidermis of the foetus. In the dog, 
 sheep, pig, calf, I have always found the foramen of Bichat to be a 
 rounded opening, as described by him, and in which lies the vena 
 magna of Galen. Burdach's idea is readily refuted by an appeal to the 
 universal arrangement of serous membranes. But I cannot venture to 
 affirm with Bichat that the investing membrane of the ventricles is a 
 serous membrane. It seems to hold the same relation to the substance 
 of the brain as the epidermis does to the corium ; the serous membrane, 
 or arachnoid, merely unites with the epithelium of the ventricles. This 
 union of different membranes happens in woman, in respect to the peri- 
 toneum, and in birds and fishes. The nature of the ventricular epithe- 
 lium is ever opposed to that of serous membranes, as being perforated 
 by numerous blood-vessels." And Dr. Knox, eodem loco, says : u The 
 connection of the cerebral arachnoid with the great cerebral fissure of 
 Vicq d'Azyr and Bichat, may be described in this way: Commencing 
 with the base of the brain, where the fissure commences, and tracing it 
 upwards towards the upper surface, the arachnoid will be found to pass 
 directly over the fissure, without in the slightest degree dipping into it; 
 and this is a fact just as evident, and as easily made out, as that other 
 fact, viz., that the arachnoid does not descend between the cerebral con- 
 volutions. But on tracing it quite up to the part of the fissure which is 
 situated between the corpora quadrigemina and back part of the fornix 
 and corpus callosum united, it is evident that the arachnoid does form 
 
 / 
 
 * The difference between the two surfaces of the brain will be thoroughly explained 
 hereafter. 
 
MEMBRANES, ETC. 137 
 
 a short canal, precisely in the situation of, and around, the vena magna 
 Galeni. How far this canal penetrates it is somewhat difficult to deter- 
 mine ; in some of the brains I have examined, it scarcely proceeded an 
 inch, in others less ; but, however this may be, it is, I think, unques- 
 tionable that Bichat committed a great error in supposing that this canal 
 proceeded into the interior of the ventricles, and that thus a passage was 
 established between the ventricular cavities and the general serous cavity 
 of the arachnoid. If we now return again to the commencement of the 
 fissure at the base of the brain, and raise up the arachnoid from off the 
 pia mater, which here, as elsewhere, lies directly beneath it, it will be 
 found, I think, that the arrangement of this membrane (the pia mater) is 
 very similar, in respect to the fissure, as with the common cerebral con- 
 volutions and anfractuosities. For first, a portion of it passes directly 
 across the fissure; secondly, a process is sent inwards, to form the cho- 
 roid plexuses and velum interpositum ; and, thirdly, at the edges of the 
 fissure the pia mater, besides adhering very closely at the edge, trans- 
 mits a perfectly transparent and extremely delicate layer, filamentous 
 and cellular, but not vascular, which, investing the opposing surfaces of 
 the ventricular walls, constitutes the proper ventricular membrane; in 
 short, the processes of the pia mater, which dip in between the convo- 
 lutions, might almost be considered as analogous to the choroid plexuses, 
 so similar are they in their arrangement, and perhaps, also, in their func- 
 tions. A similar analogy subsists between the ventricular lining mem- 
 brane, and that investing the opposing surfaces of the convolutions." 
 
 With this account by Dr. Knox I perfectly agree. . 
 
 Cruveilhier* denies the continuity of the arachnoid membrane with 
 the ventricular membrane, and the existence of the foramen of Bichat. 
 
 Burdachf describes the arachnoid as not entering into the ventricles; 
 that the epithelium which covers them is too delicate to be continuous 
 with it, and that which appears to be so, is rather to be considered as a 
 sheath (Gefasscheide) derived from it.f 
 
 The reflected or parietal portion of the arachnoid is closely attached to 
 the dura mater, but the tissue cellulo-vasculaire or sub-arachnoid is in- 
 terposed between the visceral or investing portion, and the pia mater of 
 the spinal cord. The two internal surfaces of the arachnoid are closely 
 in contact, and the bag which is between them is generally empty. But 
 not so the sub-arachnoideal cavity, for this contains the important cere- 
 bro-spinal fluid. The cerebral portion of the arachnoid adheres very 
 intimately to the pia mater at certain points, leaving in the intervals a 
 considerable space for the accumulation of the liquid. It sinks into the 
 great longitudinal fissure of the brain, lining the surfaces which bound it 
 on either side, and passing across from right to left beneath the inferior 
 margin of the falx, and above the great transverse commissure. In the 
 same way, at the base of the brain, it passes over the fissura Sylvii, and 
 diamoftd-shaped space. 
 
 Beneath the arachnoid is situated the pia mater, a membrane which 
 
 * > -* ; 
 
 * Op. cit., t. iv. p. 700. | Page 24, vol. ii. op. cit. 
 
 J Mr. Rainey has demonstrated the existence of a very abundant supply of branches 
 from the sympathetic nerve to the arachnoid; his paper is well worthy of perusal: Med.- 
 Chir. Trans., vol. xxix. p. 85. . 
 
138 HUMAN BRAIN. 
 
 is constructed solely for the purpose of supporting the vessels distributed 
 to the superficies of the central masses of the nervous system, which are 
 so numerous that they require an especial tissue for their support. This 
 structure dips between the convolutions of the brain, at the same time 
 closely investing its external surface ; it passes also over those surfaces 
 which, from the old method of slicing the brain from above downwards, 
 appear as if they formed the walls of cavities in the interior, and in some 
 of these situations it has received peculiar names ; among the most 
 remarkable of its portions thus indicated, we may mention the plexus 
 choroides in the lateral ventricles. Dr. Todd* informs us " that very 
 numerous and tortuous blood-vessels are contained in these processes, 
 forming a plexus which has given name to the folds themselves. The 
 surface of each choroid plexus presents many slight projections or folds, 
 resembling villi, in which are contained loops and plexiform anasto- 
 moses of minute vessels, very similar to the arrangement of the vessels of 
 the villous processes of the chorion of the ovum, or those of the tufts of 
 the placenta. These vessels are surrounded by an epithelium which has 
 much the appearance of that of serous membranes. From the great 
 number of these vessels, and from the delicate nature of the epithelial 
 covering which surrounds them, it is plain that the choroid plexuses are 
 well suited, either for the purpose of pouring out fluid, or of absorbing 
 it. The epithelium may be best seen by examining the edge of a fold. 
 It becomes very distinct when acted upon by acetic acid. As its parti- 
 cles are very delicate, and consist only of a single layer, they are easily 
 detached. The cells of the epithelium are most of them six-sided, and 
 contain a clear nucleus, or several minute granules. Valentin states that 
 cilia may be seen playing upon this surface, especially in the embryo. 
 I have observed the peculiar punctiform or spiniform formations to 
 which he alludes, which look like the remains of former vibratile cilia." 
 
 Otto, in his Compendium of Pathological Anatomy,! states in gene- 
 ral, that these two membranes, the arachnoid and pia mater, are insepa- 
 rably united in the greatest part of the circumference of the brain in 
 adults, and that they are at all times in organic connection throughout 
 by means of fibre-mucous tissue of various length. 
 
 It will be instructive to dwell for a few moments upon the admirable 
 adaptation of these three cerebral membranes to the ends of their forma- 
 tion. The dura mater forms a support which is sufficiently firm and un- 
 yielding to retain the brain accurately in its normal position, while its 
 processes are still capable of yielding to a certain extent, like the strong 
 springs of a carriage, under any violent concussion. 
 
 The arachnoid, lining the dura mater and covering the surface of the 
 brain, wholly prevents friction, which would otherwise be inevitable, 
 and thus answers, in its situation, the same end as the synovial mem- 
 branes with their lubricating secretion in the various joints of the body, 
 for the brain is never in a quiescent state, but is constantly rising and 
 falling with a slight pulsating motion. 
 
 The immediate agents in the production of these movements appear 
 to be the circulating and respiratory systems, and the motions are 
 
 * Loc. cit. f Translated by M. I. F. South, p. 373, note i. 
 
CEREBRO-SPINAL FLUID. 139 
 
 therefore twofold; the one occasioned by the pulsations of the heart, the 
 other by the movements of* the chest ; for at the moment that cavity 
 begins to be contracted for the expulsion of the air, the return of the 
 blood from the brain is temporarily impeded ; and, on the other hand, 
 when the chest begins to be expanded during inspiration, its flow is in 
 a corresponding degree accelerated. This subject has been much and 
 carefully investigated, as a reference to the following catalogue of authors, 
 who have written expressly on it, given by Meckel, in vol. iii. p. 722, 
 of his Anatomy, will prove. Schlichting, De Motu Cerebri, in the 
 Mem. Pres,., torn. i. p. 113 ; Lorry, Sur les Mouvements du Cerveau et 
 de la Dure-mere, same collection, torn, iii., Mem. i. p. 277, Mem. ii. p. 
 344 ; Haller, Experim. ad Motum Cerebri a Refluxu Sanguinis natura, 
 in his Opusc. Phys., torn. i. p. 231; Lamure, Sur la Cause des Mouve- 
 ments du Cerveau, in the Mem. de Paris, 1753 ; Richard, in the Jour, 
 de Med., torn, xxix., 1768, Aout, p. 140; Ravina, De Motu Cerebri, in 
 the Mem. de Turin, 1811 ; Portal, Mem. sur un Mouvement qu'on peut 
 observer dans la Moelle epiniere, in his Mem. sur plus. Maladies, 
 torn. ii. p. 81; Magendie, Sur un Mouvement de la Moelle epiniere 
 isochrone a la Respiration, in his Jour, de Phys. Exper., torn. i. p. 200. 
 
 The pia mater in the skull is of just sufficient thickness to support the 
 vessels without interfering with the motions of the brain : but in the 
 vertebral canal it is much denser, affording a better support to the cord, 
 and thus performing the same office that the neurilemma, or investing 
 membrane of the nerves, does to these organs in their extended course 
 through all parts of the body. 
 
 The cerebro-spinal fluid next deserves our attention. The existence 
 and situation of the fluid were first discovered by Haller ;* it was more 
 clearly described by Cotunnius, in a memoir entitled " De Isehiade 
 Nervosa Commentarium," and published subsequently by Sandifort,. 
 among other theses. This anatomist was struck with the divsproportion 
 of the spinal canal and its contents, and revolved in his own miad how 
 the space was occupied. These statements must have been almost for- 
 gotten. Magendie has, however, entered more minutely into the whole 
 physiology of the matter. He first published his discoveries ia I827 r 
 in his Journal de Physiologic, and more fully subsequently in 1842, as 
 a separate quarto treatise, with plates. He has shown that if, during life > 
 the arches of the vertebra are removed in a horse, dog, or other animal, 
 and the dura mater of the spinal cord punctured, there are jets of a fluid, 
 which previously had made the sheath tense. Immediately afterdeath the 
 same may be observed, but in a few hours the greater part of tfoe fluid 
 is imbibed by the surrounding tissues. 
 
 The student must have already seen that the brain does not com- 
 pletely fill the cranium, that the spinal cord is very far from occupying 
 the whole vertebral canal. In old persons, particularly in such as have 
 sunk into a state of dementia, the condition of brain is very striking ; 
 the convolutions are narrow, and shrunk. The digital fossae are large, 
 and contain fluid. The seat of this fluid is not in the cavity of the 
 arachnoid ; there are two distinct localities. First, in the interspace 
 
 * Element. Physiolog., vol. iv. p 87. 
 
140 HUMAN BRAIN. 
 
 between the arachnoid and pia mater. Second, in the cavities of the 
 cerebrum and cerebellum in the human subject ; and likewise in those 
 of the olfactory nerves, optic lobes, and spinal cord, of some animals. 
 
 Thus it will be seen that, closely as the arachnoid in many points 
 resembles the other serous membranes, it differs in this important point 
 that, instead of adhering closely to the organ it invests, as the peri- 
 cardium does to the heart, it is separated from the brain by a tolerably 
 wide interspace, in which the fluid is situated.* The whole spinal cord 
 is bathed in this fluid, forming a layer, wider in some parts, narrower in 
 others, according to the shape of the canal and size of the cord in differ- 
 ent places. One result of its presence, even in those situations where it 
 is least abundant, is, that the nerves float in it, and are thus kept sepa- 
 rate from each other, instead of being in close contact, as they appear 
 in the dead subject. In the skull the disposition of the fluid is similar, 
 and the nerves are bathed in it, in their exit from the cranium, as in the 
 spinal canal. 
 
 There are some situations where it accumulates in such large quanti- 
 ties, that they may be called confluences. 
 
 1st. The largest and most posterior, situated below and behind the 
 cerebellum. 
 
 2d. The inferior Between the crura cerebri. 
 
 3d. Superior Above and on the sides of the pineal gland. 
 
 4th. Anterior Between the decussation of the optic nerves. 
 
 5th. Lateral This bathes the semilunar ganglion of the fifth pair. 
 
 It is still a question whether there is any communication between the 1 
 fluid of the ventricles and the sub-arachnoid. Magendie states "that 
 there is an opening of communication at the calamus scriptorius." Dr. 
 Todd does not believe in the existence of this opening! he says, "It is 
 not necessary to have recourse to such a supposition to account for the 
 transmissibility of fluid from one cavity to another, for the pia mater is 
 evidently hygrometric, and will readily admit of the passage of the fluid 
 through it by endosmose and exosmose." 
 
 There is no reason for doubting that this fluid can change its position 
 during life. This fact has not escaped the observation of Dr. Burrowes, 
 who remarks, (p. 50, on Disorders of the Cerebral Circulation, &c., 
 1846,) " Pathological states of the spinal column in children, and ex- 
 periments upon animals, afford opportunities for observing the changes 
 in the site of the cerebro-spinal fluid under various modifications of 
 pressure. In spina bifida it may be remarked that the spinal tumor 
 swells and becomes tense during prolonged expiration, as also during fits 
 of coughing and crying. If a graduated pressure be made upon the 
 tumor with one hand, and the fontanelles of the child be examined with 
 the other, in proportion as the spinal swelling decreases, so is a swelling 
 of the brain perceived, accompanied by symptoms which usually result 
 from pressure on the brain and spinal cord." 
 
 Magendie, in his estimate of the quantity of this fluid, agrees pretty 
 closely with Cotunnius. It varies according to the age and size of the 
 patient, and usually bears an inverse proportion to the volume of the 
 
 * British and Foreign Medical Quarterly Review, October, 1842. 
 
REMOVAL OF THE BRAIN. 141 
 
 encephalon ; seldom less than two ounces, and often amounting to five. 
 In old age, with atropny of the brain, to eight, ten, and twelve ounces. 
 Magendie regards the pia mater as the source of the fluid. When this 
 fluid has been removed, the renewal is rapid, as in the case of the hu- 
 mors of the eye, being completely secreted again in twenty-four hours. 
 
 The use of this fluid must be obvious to every thoughtful mind. It is 
 a mechanical protection to the brain and spinal cord against the violent 
 shocks and vibrations to which it is occasionally exposed. How differ- 
 ent would be the condition of the brain without this soft cushion, or the 
 cord of it hung within the spinal canal, without such a yielding and pro- 
 tecting wall. The poor invalid, whose bones from emaciation are nearly 
 through his skin, will bear his testimony to the value of a fluid couch, if 
 he has had the advantage of being removed from an ordinary bed to Dr. 
 Arnott's water bed. Again, let the medical student enter an anatomical 
 museum, and observe how beautifully the preparations of the spinal 
 cord float in the spirit, unexposed to the shocks and blows to which they 
 would be subject if the fluid were drawn off the bottles, and they were 
 left hanging surrounded merely by the air. 
 
 Chemical Analysis of the Cerebro- spinal Fluid, by Lassaigne. 
 Water 98-564 
 
 Albumen . ^- . \\** 
 
 Osmazome . . i-'tmx- 
 
 Hydrochlorate of soda and potass . 
 Animal matter and phosphate of soda 
 Carbonate of soda and phosphate of lime 
 
 0-088 
 0-474 
 0-801 
 0-036 
 0-017 
 
 99-980 
 
 Removal of the Brain. The next step is to remove the brain from the 
 skull, which must be done with great care, as the nerves which are 
 passing from the cavity of the cranium are easily torn through, unless 
 divided with a very sharp knife or pair of scissors. 
 
 The fingers of the operator should be insinuated under the anterior 
 lobes, and the cerebral mass raised with great care ; the first pair of 
 nerves which he will observe are the olfactory, running forward to the 
 cribriform plate of the ethmoid bone, from which they must be carefully 
 detached. The next pair are the optic, which are observed gliding un- 
 der the anterior clinoid processes, and quitting the skull at the optic 
 foramina, where they may be divided, as well as the internal carotid 
 arteries, which are situated immediately on their outer side. The next 
 are the third or common oculo-muscular nerves; these penetrate the 
 dura mater midway between the anterior and posterior clinoid processes. 
 Immediately after their division, a structure, called the infundibulum, 
 which runs directly down to the pituitary gland in the sella turcica, must 
 be cut through. 
 
 The next pair are the fourth; these will be best seen by gently raising 
 the edge of the tentorium ; and being the smallest of the cerebral nerves, 
 they require great care when they are divided. The tentorium itself 
 must next be cut through: and the nerves situated in the fossae of the 
 
142 HUMAN BRAIN. 
 
 skull under it, will be discovered in the following rotation, namely, the 
 fifth, to the outer side of the posterior clinoid processes, just crossing 
 the superior angle of the petrous portion of the temporal bone. 
 
 The sixth, situated on a plane internal to and beneath the fifth, pene- 
 trating the dura mater about half an inch below the posterior clinoid 
 process. 
 
 The seventh and eighth, or facial and auditory nerves, pass on a plane 
 beneath and to the outer side of the fifth, through the foramen auditivum 
 internum. 
 
 The ninth and tenth, or glosso-pharyngeal, and par vagum, with the 
 spinal accessory, are immediately below the last ; and the eleventh, or 
 lingual, lie rather lower down, but to the inner side. These being 
 divided, the spinal cord and vertebral arteries must be cut through by 
 pushing the knife as low down into the vertebral canal as can be con- 
 veniently effected. 
 
 The left hand of the operator (his right being engaged in supporting 
 the brain) must then be placed beneath the cerebellum, leaving the 
 spinal cord between his middle and ring finger, and the whole encephalon 
 be removed.* 
 
 Removal of the Spinal Cord. For the purpose of removing the spinal 
 cord, the student had better make an incision through the skin directly 
 over the spinous processes of the whole vertebral column ; and next 
 dissecting the muscles from them and the surfaces of the arches, he will 
 be able to use the saw, with which he must cut completely through the 
 arches of the two or three lowermost cervical vertebra on both sides ; 
 having entirely removed these, he can divide the remainder of the arches 
 by means of a strong pair of bone scissors made expressly for the purpose. 
 
 Having thus opened the whole of the vertebral canal, he will observe 
 the dura mater completely investing the cord, but not in contact with 
 the arches of the vertebra, from which it is separated by a layer of soft 
 reddish fat, which is most abundant in the sacral region. The spinal 
 plexus of veins is lodged in this soft bed. 
 
 The dura mater forms a complete canal for the medulla spinalis, and 
 also branches off with each of the spinal nerves, which it accompanies 
 as far as the vertebral foramina, to the edges of which it is attached, each 
 attachment performing to the whole the office of ligaments, which retain 
 the cord accurately in its normal situation. At the lower extremity of the 
 vertebral canal in the sacrum, it ends in a bluntish point by fibrous pro- 
 cesses which are attached to the os coccygis. These, like the stay-ropes 
 of the mast of a vessel, steady the cord in the interior of its bony case. 
 
 The Arteries, which are very numerous, are derived from the verte- 
 bral, the occipital, deep cervical, intercostal, lumbar and sacral arteries, 
 and supply not merely the membranes, but the substance of the cord. 
 The veins are very numerous and large, forming intricate plexuses, 
 which are more numerous in the cervical and lumbar than in the dorsal 
 region. They have been accurately described and beautifully figured 
 by Breschet; anteriorly they form on the bodies of the vertebra large 
 sinuses, long known as the longitudinal spinal sinuses. The cross 
 
 * These last directions apply only in those cases where the pupil is unavoidably pre- 
 vented removing the spinal cord in connection with the brain. 
 
MEMBRANES OF THE CORD. 143 
 
 branches opposite the centres of the bodies of the vertebrae communicate 
 with long venous canals which traverse the spongy texture of these 
 bones (see fig. "70, 12). 
 
 They differ from the sinuses of the brain, in not being enclosed in two 
 layers of the dura mater. 
 
 The cord may next be removed in connection with the brain by cut- 
 ting through the" dura mater and each spinal nerve, as it quits the canal, 
 commencing with the lowest sacral, and then drawing it through the 
 foramen magnum. 
 
 Having removed the cerebro-spinal axis from its canal, the dissector 
 must proceed carefully to divide the dura mater along the mesial line, 
 and he will then observe the arachnoid loosely investing the cords, and 
 forming, by the addition of some tendinous fibres, a tooth-like ligament 
 between the anterior and posterior roots of each of the spinal nerves, 
 called, from its appearance, the ligamentum denticulatum. This struc- 
 ture is considered by F. Arnold to be formed by processes of the dura 
 mater, similar to those which are met with in the skull. By Dr. Knox 
 it is considered as analogous to certain tendinous shining cords connect- 
 ing the cerebral arachnoid to the pia mater. To me it appears evidently 
 a continuation of the arachnoid with some superadded fibres, and serves 
 the purpose of hanging the cord to the interior of the canal of the dura 
 mater. It also affords additional protection to the soft and yielding 
 neurine of which the whole spinal nervous mass consists, retaining it in 
 its situation, and supporting, but without exerting the slightest pressure 
 upon it. 
 
 The arachnoid being now carefully removed, the dissector will find a 
 tolerably firm membrane underneath it ; this is the pia mater, which is so 
 much less vascular than that investing the cortical structure of the brain, 
 that some anatomists have considered it as a distinct membrane. When, 
 however, we consider that the exterior of the cord is formed of medul- 
 lary, and not of cineritious, neurine, which is so much more vascular, 
 we can understand the reason of the vessels being fewer in number, and 
 thus account for the existence of a pia mater altered in its general 
 appearance. 
 
 The pia mater sends processes with the nerves, which, forming their 
 material and investing membrane, constitutes what is called the neurilemma 
 of the nerve. At the inferior extremity of the cord, the pia mater tapers 
 off to a point, and is prolonged as a fibrous string to be inserted into the 
 dura mater. It is called the filiform prolongation of the pia mater. u The 
 late Dr. Macartney," says Dr. Todd,* " used to regard it as highly elastic, 
 but my friend Mr. Bowman has called my attention to the fact, that it 
 consists almost entirely of white fibrous tissue, which cannot confer elas- 
 ticity; and if a portion removed from the cord be stretched, it will be 
 found to possess very little elasticity; but if the cord be held up by the 
 filiform prolongation, and a slight jerking movement be communicated 
 to it, it may be made to dance about as if by the elastic reaction of the 
 filiform process. The movements which may be thus produced are very 
 well calculated to deceive, and Dr. Macartney must have founded his 
 
 * LOG. cit. 
 
144 HUMAN BRAIN. 
 
 opinion upon that experiment alone, omitting to try the effect of stretching 
 a detached portion of the process. The fact is, that when the cord is 
 suspended in this way, the pia mater becomes stretched, and its anterior 
 and posterior portions are approximated and the cord flattened. When 
 it is raised with a jerk, this tension of the pia mater is diminished, and 
 the cord returns to its previous state until it again stretches the pia mater 
 and becomes once more flattened, producing a degree of reaction which 
 favors its elevation, but which alone would be insufficient for that pur- 
 pose." 
 
 Thus, it appears that the elastic reaction which Dr. Macartney attri- 
 buted to the filiform process, is in reality due to the compression and 
 consequent flattening of the cord by the tension of the pia mater. It 
 should be stated further, that this process is not formed of pia mater alone, 
 but also of a continuation of the ligamentum denticulatum on each side. 
 
145 
 
 PART IV. 
 
 WEIGHT OF THE HUMAN BRAIN. 
 
 IN tracing the gradual development of the nervous system of the 
 animal kingdom up to man, the student will have observed, in all the 
 specimens ordinarily within his reach, the actual inferiority as regards 
 size and weight of the brain, even of the higher animals, as compared 
 with man. The brain of the horse, for instance, is not merely smaller 
 relatively to the body than that of the human being, but actually so. 
 Indeed, the only exception to this rule is met with in the brain of the 
 elephant and the whale the brain of the elephant weighing from 8 to 
 10 Ibs. ; and, according to Rudolphi, that of a whale, 75 feet long, 
 (Balcena mysticetus,) weighed 5 Ibs. 10J oz., but that of a narwhal, 17 
 to 18 feet long, (Monodon monoceros,) only 2 Ibs. 3 oz. 
 
 It is to be remembered that these observations apply to the encephalon, 
 the whole brain, and not to the hemispherical ganglia, which we believe 
 to be the portion immediately connected with the intellectual powers. 
 
 Agreeing with Professor Muller, that all the primitive fibres of the 
 nerves of volition and of sensation are actually continued into the brain, 
 I believe that the great bulk of the brain of brutes is made up of the 
 fibrous neurine which traverses their body in the form of nerves. At 
 the same time it is to be remembered that the great bulk of the nerves 
 of animals is composed of strong membranous envelops to each fibre, 
 and not solely of neurine. The increase of size which is thus given to 
 a nerve is well seen in the portio dura or facial nerve of the human- 
 subject. Compare this nerve at its origin in the medulla oblongata, 
 before it can receive a covering from the pia mater, and the same nerve 
 after it has quitted the skull by the stylo-mastoid foramen. 
 
 Many observations have been made on the weight of the huma-n brain, 
 from the time of Haller to the present period ; the latest and most ex- 
 tensive are by that indefatigable and excellent physiologist, Dr. John 
 Reid, published in the London and Edinburgh Monthly Journal of Me- 
 dical Science for April 1843. Dr. Sims, who has an excellent paper 
 on Atrophy and Hypertrophy of the Brain, in vol. xix. of the Medico- 
 Chirurgical Transactions, after giving the conclusions of Haller, Soem- 
 merring, and Sir Wm. Hamilton, gives tables of his own. From these 
 sources we learn that the average weight of the adult human male brain 
 is about 3 Ibs. That it increases from 1 year old up to 20. Between 
 20 and 30 there is a slight decrease on the average ; afterwards it 
 increases, and arrives at its maximum between 40 and 50; to old 
 age the brain gradually decreases in weight. Tiedemann, in his paper 
 10 
 
146 HUMAN BRAIN. 
 
 on the brain of the negro,* states that the hrain of the adult male varies 
 between 3 Ibs. 2 oz. and 4 Ibs. 6 oz. The brain of men who have 
 distinguished themselves by their talents, is often large; the brain of 
 Cuvier weighed 4 Ibs. 11 oz. 4 dr. 30 gr. troy weight; that of Dupuy- 
 tren 4 Ibs. 10 oz. troy weight. The brain of an idiot, 50 years of age, 
 weighed only 1 Ib. 6 oz. 4 dr.; and another, 40 years of age, weighed 
 but 1 Ib. 11 oz. 4 dr. The female brain usually is lighter than the male. 
 It varies between 2 Ibs. 6 oz. and 3 Ibs. 1 1 oz. Tiedemann never met 
 with a female brain that weighed 4 Ibs. The female brain weighs on an 
 average from 4 to 6 ounces less than that of the male; and this differ- 
 ence is already perceptible in the new-born child. 
 
 It is curious that Rudolph Wagner, whose name as a physiologist 
 stands deservedly high, should make the following statement regarding 
 the growth of the brain :f " With the second dentition in the course of 
 the seventh and eighth years, the brain seems to attain its complete de- 
 velopment in point both of form and weight, and its several parts now 
 represent the relations which they preserve through the whole of after- 
 life." Dr. Willis has the following excellent observations on this pass- 
 age: "This is surely a physiological error; on taking measurements of 
 the heads of fifteen children, between 7 and 8 years of age, I find the 
 mean circumference to be 20^ inches; but the mean circumference of 
 the head in ten children between 13 and 14 years of age in the same 
 school, taken as they stood, and without selection, is 21^ inches. If 
 the size of the skull represent the size of the brain, therefore, the brain 
 is not so large at 8 years of age as it is at 14 ; neither is it so large at 
 14 or 15 as it is at 20 and 25. On making the inquiry at several of the 
 large hat shops of the metropolis, whether or not there was any differ- 
 ence in the sizes of hats required for boys of between 7 and 8 years of 
 age, and full-grown men, I was assured there was a very considerable 
 difference: that the sizes of youths of 7, 8, and 9, were what are desig- 
 nated the 6|, 6f , and 6f sizes, whilst for grown men the mean average 
 size is about 7, or from that to 7J. The numbers here represent the 
 mean between the long and the lateral diameters of the head. A London 
 hatter says: ' The head I have always found to attain its full dimensions 
 in accordance with the bodily frame. I fix the utmost limit my experi- 
 ence will allow at 25 years. The more general period of full attainment 
 of size is between 17 and 23. Many heads are at their full size at the 
 age of 16.'" 
 
 The Tables which follow over leaf are from Dr. Reid. 
 
 * Phil. Trans., 1836. t P- cit -> P- 616 - 
 
 7 M ' 
 
WEIGHT OF THE BRAIN. 
 
 147 
 
 TABLE I. 
 WEIGHT USED AVOIRDUPOIS. 
 
 Exhibiting the Heaviest, Lightest, and the Average Weight of Encephalon, Cerebellum, and 
 Cerebellum with Pons Varolii and Medulla Oblongata, at different ages, in '253 Brains. 
 Though individual female brains are not unfrequently found to be heavier than indivi- 
 dual male brains, yet as the average male brain is several ounces heavier than the average 
 female brain, it is necessary that these be ranged in separate tables; the more especially 
 wheii the number of brains at different ages, weighed in the two cases, do not correspond. 
 
 
 
 a 
 
 HEAVIEST. 
 
 LIGHTEST. 
 
 AVERAGE. 
 
 
 Age. 
 
 iber weigh 
 
 Bj 
 
 1 
 
 Ill 
 
 CJ 
 
 2. 
 a 
 te 
 
 Q. 
 
 bellum. 
 
 s-3 
 
 1!| 
 
 1 
 1 
 
 'u 
 
 g rf 
 
 ill 
 
 
 
 E 
 
 1 
 
 
 Pi 
 
 1 
 
 
 o 
 
 I' 1 ! 
 
 1 
 
 1 
 
 i" 
 
 
 / 
 
 Years. 
 14 
 
 5 
 
 oz. dr. 
 45 4 
 
 oz. dr 
 4 10 
 
 oz. dr 
 5 6- 
 
 oz. dr. 
 27 8 
 
 oz.dr 
 
 2 8 
 
 oz. dr. 
 3 
 
 oz. dr 
 39 4| 
 
 oz. dr. 
 3 13* 
 
 oz. dr. 
 4 6| 
 
 
 
 5-7 
 
 3 
 
 47 10i 
 
 5 1 
 
 6 
 
 40 12 
 
 4 
 
 4 9 
 
 43 10 
 
 4 7 
 
 5 6 
 
 
 
 710 
 
 6 
 
 52 14 
 
 5 
 
 5 11 
 
 40 12 
 
 4 
 
 4 10 
 
 46 2| 
 
 4 lOf 
 
 5 10ft 
 
 
 
 1013 
 
 3 
 
 51 2 
 
 5 2 
 
 6 2 
 
 43 8 
 
 4 9 
 
 5 6 
 
 48 7s 
 
 4 14 
 
 5 12 
 
 
 
 1316 
 
 5 
 
 50 2 
 
 5 8 
 
 6 8 
 
 43 10 
 
 
 
 5 10 
 
 47 8f 
 
 
 
 6 li 
 
 
 
 1620 
 
 6 
 
 56 
 
 6 1 
 
 7 2 
 
 48 
 
 4 8 
 
 5 8 
 
 52 lOf 
 
 5 4i 
 
 6 6 T *j 
 
 A 
 
 
 2030 
 
 25 
 
 58 
 
 6 
 
 7 
 
 45 8 
 
 4 12 
 
 5 4 
 
 50 9| 
 
 5 3i 
 
 6 2 
 
 !/ 
 
 3040 
 
 23 
 
 62 8 
 
 5 14 
 
 8 8 
 
 40 10 
 
 4 6 
 
 5 1 
 
 51 15i 
 
 5 3i 
 
 6 4i 
 
 %\ 
 
 
 4050 
 
 34 
 
 53 8 
 
 6 4 
 
 7 10 
 
 34 
 
 4 8 
 
 5 6 
 
 48 13i 
 
 5 3| 
 
 6 4 T 6 r 
 
 
 
 5060 
 
 29 
 
 59 
 
 7 
 
 8 4 
 
 39 
 
 4 8 
 
 5 4 
 
 50 2 
 
 5 5 T 8 ff 
 
 6 2 \ 
 
 
 
 6070 
 
 8 
 
 60 4 
 
 6 3 
 
 7 4 
 
 40 
 
 4 2 
 
 5 2 
 
 50 6f 
 
 5 
 
 6 2" 
 
 
 
 70 and 
 upwards 
 
 ! 7 
 
 54 10 
 
 5 8 
 
 6 8 
 
 43 8 
 
 4 8 
 
 5 4 
 
 48 4f 
 
 4 14 
 
 5 14f 
 
 
 
 Total male"} 
 
 
 
 
 
 
 
 
 
 
 
 
 
 brains > 
 
 154 
 
 
 
 
 
 
 
 
 
 
 
 . 
 
 weighed _) 
 
 
 
 
 
 
 
 
 
 
 
 . 
 
 24 
 
 6 
 
 42 
 
 4 
 
 4 10 
 
 32 
 
 3 5 
 
 3 15 
 
 37 9 
 
 3 9^ 
 
 4 5 
 
 
 
 57 
 
 3 
 
 41 8 
 
 4 
 
 4 8 
 
 36 
 
 3 5 
 
 4 
 
 39 1 
 
 3 11 
 
 4 8f 
 
 
 
 78 
 
 3 
 
 43 14 
 
 4 10 
 
 5 9 
 
 40 8 
 
 4 4 
 
 5 
 
 42 7i 
 
 4 7| 
 
 5 5 
 
 
 
 1013 
 
 1 
 
 43 8 
 
 5 2 
 
 6 2 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1316 
 
 1 
 
 41 
 
 4 8 
 
 5 8 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1620 
 
 8 
 
 49 12 
 
 5 8 
 
 6 4 
 
 41 8 
 
 4 12 
 
 5 6 
 
 44 ni 
 
 4 14 
 
 s nil 
 
 
 
 2030 
 
 18 
 
 50 
 
 5 2 
 
 6 2 
 
 39 2 
 
 4 
 
 4 12 
 
 45 2f 
 
 4 m 
 
 5 9* 
 
 d 
 
 
 3040 
 
 23 
 
 51 
 
 5 8 
 
 6 8 
 
 39 14 
 
 4 2 
 
 5 
 
 44 li 
 
 4 13* 
 
 5 11 
 
 j 
 
 
 4050 
 
 18 
 
 50 6 
 
 6 
 
 7 
 
 36 12 
 
 3 12 
 
 4 4 
 
 44 I0f 
 
 4 14 
 
 5 144 
 
 < ( 
 
 
 5060 
 
 5 
 
 48 6 
 
 4 12 
 
 5 15 
 
 43 4 
 
 4 4 
 
 5 2 
 
 45 44, 
 
 I 7* 
 
 5 8| 
 
 1 
 
 
 6070 
 
 1 
 
 46 10 
 
 5 2 
 
 6 
 
 36 2 
 
 4 2 
 
 5 
 
 42 14f 
 
 4 10ft 
 
 5 9 
 
 
 
 70 and 
 upwards 
 
 i 2 
 
 46 
 
 5 1 
 
 6 
 
 31 1 
 
 3 10 
 
 4 5 
 
 38 8^ 
 
 4 5 
 
 5 2* 
 
 
 
 Total , 
 
 
 
 
 
 
 
 
 
 
 
 
 
 female / 
 
 qq 
 
 
 
 
 
 
 
 
 
 
 
 
 brains ( 
 
 *7l7 
 
 
 . 
 
 
 
 
 
 
 
 
 
 ^ 
 
 weighed ' 
 
 
 
 
 
 
 
 
 
 
 
 An examination of Table I. does not afford any support to the supposition of some, that the 
 cerebellum attains its maximum weight at seven years of age, and the cerebrum its maximum 
 weight nearly at the same period, or only a little later. There appears to be little dou.bt, 
 however, from all the facts which have been collected on this subject, that the brain arrives 
 at its maximum weight sooner than the other organs of the body, and, to judge from a few' 
 measurements we have made of the length of the corpus callosurh, the depth of the gray 
 matter, the length, breadth, and depth of the corpus striatum and thalamus, we would be 
 
148 
 
 HUMAN BRAIN. 
 
 inclined to conclude that the relative size of these parts is the same in the young person as 
 in the adult. We believe that there can be little doubt that the relative size of the brain to 
 the other organs, and to the entire body, is much greater in the child than in the adult. In 
 Table III. will be found the results we have obtained on this point. In Table II. we find 
 less difference between the relative weight of the encephalon and cerebellum, at different 
 periods of life, than we had been led to expect from some statements which have been made 
 upon this question. The data we have collected do not entitle us to speak positively, but as 
 the other statements to which I refer seem principally to rest upon the vague and uncertain 
 measurements of the eye, we may reasonably request to be allowed to suspend our opinion 
 of their accuracy, until we have a sufficient amount of materials brought before us to justify 
 us in giving a decided judgment. In looking over the column of the average weights of the 
 encephalon, at different ages, in Table I., we can not fail to experience some surprise at the 
 difference between the average weight of that organ in the male, between 1 6 and 20 years 
 of age and between 40 and 50, but we cannot for a moment have any hesitation in deciding 
 that this must arise from sources of fallacy incident to insufficient data. In the group be- 
 tween 40 and 50 years of age some brains much below the average weight are found, and 
 there can be no doubt that it is to this accidental circumstance that we must attribute the 
 diminution in the average weight of the brain in that group. Among the females, we find 
 a decided diminution in the average weight of the brain above 60 years of age, while, 
 among the males, this is not apparent until a later period. We certainly did expect also to 
 find a similar diminution in the average weight of the male brain above 60 years of age, for 
 we are perfectly satisfied, as the tables containing the individual facts will show, that we 
 more frequently meet with a greater quantity of serum under the arachnoid and in the lateral 
 ventricles in old people, than in those in the prime of life. We are also satisfied, from an 
 examination of the notes we have taken at the time the brains were examined, that a certain 
 degree of atrophy of the convolutions of the brain over the anterior lobes, marked by the 
 greater width of the sulci, was more common in old than in young persons. We have, how- 
 ever, frequently remarked these appearances in the brains of people in the prime of life, 
 who had been for some time addicted to excessive indulgence in ardent spirits. 
 
 TABLE II. 
 
 Relative Weight of Encephalon to Cerebellum, and to Cerebellum with Pons Varolii and 
 Medulla Oblongata, at different ages, in 172 bodies.* 
 
 
 MALE! 
 
 k 
 
 
 
 | 
 
 FBI 
 
 1ALES. 
 
 
 
 
 
 Cerebel- 
 
 
 
 
 Cerebel- 
 
 
 
 
 Number 
 
 lum with 
 
 Number 
 
 Cerebel 
 
 Number 
 
 lum with 
 
 Number 
 
 Ages. 
 
 Cerebellum 
 
 weighed 
 
 pons Va 
 rolii and 
 
 weighed 
 
 luiu 
 
 weighed. 
 
 pons and 
 medulla 
 
 weighed. 
 
 
 
 
 medulla. 
 
 
 
 
 oblongata 
 
 
 1 to 5 years 
 
 1 to lOf 
 
 5 
 
 to 8J f 
 
 5 
 
 1 to9 T 9, 
 
 4 
 
 to 8j$ 
 
 5 
 
 57" 
 
 9 A 
 
 3 
 
 8 F 
 
 3 
 
 1 10j 7 A 
 
 2 
 
 8 i 
 
 3 
 
 7 10 
 
 9 1 5 ? 
 
 I 
 
 8jV 
 
 5 
 
 1 9 
 
 3 
 
 8 
 
 3 
 
 10 13 " 
 
 9f 
 
 3 
 
 8 i 5 j 
 
 3 
 
 
 
 
 
 
 
 
 
 13 15 
 
 9 TT 
 
 1 
 
 JH 
 
 4 
 
 
 
 
 
 
 
 
 
 16 20 " 
 
 9j$ 
 
 4 
 
 8 T 7 
 
 4 
 
 1 9ft 
 
 5 
 
 T| 
 
 5 
 
 20 30 " 
 
 9|' 
 
 13 
 
 8| 
 
 13 
 
 1 9 ZJ 
 
 12 
 
 8 
 
 12 
 
 30 40 " 
 
 9 M 
 
 11 
 
 
 11 
 
 9 fr 
 
 15 
 
 8ft 
 
 15 
 
 40 50 
 
 V* 
 
 23 
 
 8* ? 
 
 23 
 
 9 1 
 
 9 
 
 7*1 
 
 9 
 
 50 60 
 
 ||| 
 
 ]7 
 
 4 
 
 17 
 
 10 
 
 4 
 
 8 f 
 
 4 
 
 60 70 
 
 1 10ft 
 
 5 
 
 N 
 
 8 
 
 9 3 8 <T 
 
 11 
 
 7 l 
 
 11 
 
 70 & upwards 
 
 1 9f 
 
 5 
 
 8 ^ 
 
 7 
 
 8 lf 
 
 2 
 
 
 2 
 
 2 years 
 
 __ 
 
 __ _ 
 
 __ 
 
 
 
 1 10 S V 
 
 4 
 
 1 8i 
 
 4t 
 
 4 months 
 1 year 
 
 1 11 
 
 1 
 1 
 
 8 9 ff 
 
 1 
 1 
 
 
 
 
 
 
 
 
 *" In ascertaining the relative weight of the cerebellum to the encephalon, those encephala 
 only were selected in which the cerebella were also weighed The same plan was also 
 followed in ascertaining the relative weight of the cerebellum with pons and medulla oblon- 
 gata to the encephalon. 
 
 t Three of the youngest cases included in the above Table given separately. 
 
WEIGHT OF THE BRAIN, 
 
 O5 Ox 
 
 O O 
 
 *- CO tO i-i 
 
 O O O CO 
 
 3 
 
 ! 
 
 COCOCOCOCOCOtOi *| CO CO CO CO CO I 
 
 OOOOOxJ^COOlOCO OO COCiOO^lO'Ox 
 
 as to ox oo >. co ' co ' 
 
 it* rfi. ^ CO CO CO 1 M* 1 
 
 CO K- CO < OX 
 
 IO *. OS > CO ' CO ' 
 
 00 CO CO CO CO tO 1 h- 1 
 
 ,. ~4 (O ,_. tO 00 to OO 
 
 01 O 4-^ <31 -J CO Or 4^ 
 
 CO CO CO CO I-" i-i 
 
 tocotototo^-l i-*| cocotocotoi-* 
 
 i- OX i-i OOOOOiO5COO5&Gi-iOi 
 
 o>to*.a>*>.co' co 
 
 ' o' 
 
 I 1 
 
 ^l a_ 1 &o co 1 to 1 to 
 
 Ox | (0 1 CO (0 
 
 ll 
 
 
 > c* 
 
 a p 1 ^ I 
 
 i 
 
 si 
 
 M 
 
 s 
 
 R 
 
 t 
 
 II 
 
 II 
 
 I 
 &* 3 
 
 1 
 
150 
 
 HUMAN BRAIN. 
 
 TABLE IV. 
 
 Average weight of the Encephalon, &c., between 25 and 55 years of age, in the two 
 
 sexes, and the average difference between them. 
 Males, 53 brains weighed. Females, 34 brains weighed. 
 
 Average weight of Encephalon 
 
 . . Cerebrum - - - 
 
 . . Cerebellum - - 
 
 , Cerebellum with 
 
 and medulla oblongata j 
 
 Male. 
 
 oz. dr. 
 50 3, or 
 3 Ibs. 2 oz. 3 dr. 
 
 - 43 15| 
 
 - 5 4 
 pons ) 
 
 6 3| 
 
 Female. Difference in favor 
 
 of the Male. 
 oz. dr. oz. dr. 
 
 44 8$, or 5 11 
 2 Ibs. 12oz. 8idr. 
 38 12 5 3| 
 
 4 12* 7 
 
 5 12 7$ nearly. 
 
 TABLE V. 
 
 Relative weight of Encephalon to Cerebellum, and to Cerebellum with Pons Varolii 
 and Medulla Oblongata, between 25 and 55 years of age, in the two sexes. 
 53 male, and 34 female brains weighed. 
 
 Male. Female. 
 
 as 1 to 9f as 1 to 9* 
 1 8 1 7 
 
 .Relative weight of Encephalon to cerebellum - - - 
 
 Encephalon to cerebellum with pons and medulla 1 8^ 
 
 From this table it would appear that, in the female, the average cerebellum is rela- 
 tive to the encephalon, a little fceavier than in the male. 
 
 TABLE VI. 
 
 Relative Weight of the entire Body to the Encephalon, the Heart, and Liver, in the 
 two sexes between 25 and 55 years of age. 
 
 Number 
 Encephalon. weighed. 
 
 Male - - - as 1 to 37$ 
 Female - - 1 35 
 
 33 
 15 
 
 as 
 
 Heart. 
 1 to 1691 
 1 176 
 
 Number 
 
 weighed. 
 
 37 
 
 12 
 
 Number 
 
 Liver. weighed. 
 
 1 to 35| 31 
 
 1 39 7 
 
 As far as this Table enables us to judge, it would appear that though the average 
 male brain is absolutely heavier than that of the female, yet that the average female 
 brain, relative to the weight of the whole body, is somevyhat heavier than the average 
 male brain. 
 
 TABLE VII. 
 
 In 9 Males, between 27 and 50 years of age, who died either immediately, or within 
 a few hours after accidents and other external causes of sudden death, arid who 
 had been previously in good health, the following results were obtained: 
 
 Average weight of 
 
 Average of ence- 
 
 Average of 
 
 body (9 weighed). 
 
 phalon (6 weighed). 
 
 cerebellum 
 (4 weighed). 
 
 
 oz. dr. 
 
 oz. dr. 
 
 9st. 8 Ibs., 3i oz., or 
 
 52 4|, or 
 
 5 7 
 
 134 Ibs. 3$ oz. 
 
 3lbs.4oz.4f dr. 
 
 
 Average of heart 
 (9 weighed). 
 
 oz. dr. 
 12 6 
 
 Average of cerebellum with 
 pons and medulla (5 weighed). 
 
 oz. dr. 
 6 6 
 
 or, taking the average of the 
 
 four cases only in which the 
 
 cerebellum was taken, 
 
 6 oz. 7$ dr. 
 
 Relative weight of body to encephalon (6 weighed) -, - - - - as 1 to 40f 
 
 . . to heart (9 weighed) ....... 1 173| 
 
 encephalon to cerebellum (4 weighed) ... l 9| 
 
 .. tocerebellum with pons and medulla (5 weighed) 1 8 T 6 ? 
 
 Though the data from which the above Table is constructed are very limited, yet 
 we may be allowed to remark, that the greater relative weight of the encephalon to 
 the bod'y, in those emaciated by disease, than in those cut off while in possession of 
 health and muscular vigor, which it indicates, is what we would expect from other 
 considerations. There is little difference in the relative weight of the cerebellum to 
 the encephalon in the two classes of cases. 
 
WEIGHT OF THE BRAIN. 151 
 
 My friend and colleague, Dr. T. B. Peacock, has also published some 
 admirable tables in the Monthly Journal of Medical Science, for 1846, 
 from which he draws the following conclusions : 
 
 " 1st. The encephalon in the adult male weighs, on an average, 50 
 oz. 3-25 dr., or 3 Ib. 2 oz. and 3 T 3 g 4 T drachms avoirdupois, and exceeds 
 in weight that of the female by 5 oz. 4-95 dr., the latter weighing on an 
 average 44 oz. and 14-3 dr., or 2 Ib. 12 oz. 14^f dr. 
 
 14 Of 131 male brains weighed, the heaviest was 62 oz. 12 dr., or 12 
 oz. 8-75 dr. above the mean ; the lightest was 34 oz., or 16 oz. 3-25 
 dr, below it. 
 
 " Of 74 female brains, the extremes were 54 oz., or 9 oz. 1-7 dr. 
 above the average, and 36 oz. 12 dr., or 8 oz. 2-3 dr. below it. 
 
 44 Of the male encephala, 8'3 per cent, were under 45 oz. in weight, 
 74-04 per cent, weighed between 45 and 55 oz., and 17-5 per cent, ex- 
 ceeded 55 oz. in weight. 
 
 44 Of the female encephala, 54 per cent, weighed under 45 oz., 45-9 
 per cent, were between 45 and 55 oz. in weight, arid none exceeded 
 55 oz. 
 
 "Note. A comparison of these averages with those deduced by Dr. 
 Reid, will show that they correspond very closely, though the numbers 
 on which the calculations are based are considerably extended. They 
 do not differ, also, very greatly from the conclusions of Sir William 
 Hamilton, Dr. Sims, and Dr. Clendenning. Sir W. Hamilton estimated 
 the weight of the adult male encephalon at 3 Ib. 8 oz. troy, and the 
 female at 3 Ib. 4 oz., which are nearly 48 oz. 5 dr., and 43 oz. 15 dr. 
 avoirdupois. On calculating the weights of the brain in the two sexes 
 separately, from the observations published by Dr. Sirns, I find the male 
 brain, in 54 persons between 20 and 60 years of age, to average 47 oz. 
 13 dr., and the female brain in 58 persons, 44 oz. and 10 dr. Dr. Clen- 
 denning states the male brain in persons between 21 and 60 years of age 
 to average 45'85 oz., and the female 41'25 oz. These several averages, 
 together with those deduced by Professor Reid and myself, range be- 
 tween 45f oz. and 50J oz. for the male, and 41 J oz. and nearly 45 oz. 
 for the female. 
 
 44 Tiedemann,* whose actual observations amount to only 52 (35 males 
 and 17 females), states the weight of the adult European encephalon to 
 vary in the male between 3 Ib. 2 oz. and 4 Ib. 6 oz, troy, or 41 oz. 12 
 dr. and 59 oz. 5 dr. avoirdupois, and in the female, between 2 Ib. 8 oz. 
 and 3 Ib. 11 oz. troy, or 35 oz. 2 dr. and 51 oz. 11 dr. avoirdupois. 
 
 44 The want of accurate information, as to the number of observations 
 on which their calculations are based, of the weights employed, and of 
 the ages of the persons, render the statements of the older anatomists, 
 as to the weight of the encephalon, of little value. Soemmerring states 
 4 Cerebrum et cerebellum, resecta medulla spinali statim pone nervum 
 lingualem medium pondo sunt librarum duarurn ad tres libras ; sunt 
 enim alia cerebra pondere librarum duarum et unciarum quinque cum 
 dimidia, alia'librarum trium et unciarum trium cumtribus quartis. Aliis 
 (referring to the weights of brain assigned by Haller, Elementa Physio- 
 
 * Phil. Trans., vol. cxxvii. p. 497. 
 
152 HUMAN BRAIN. 
 
 logiae, t. iv., p. 10) observala sunt cerebra librae unius cum dimidia, aliis 
 pondus librarum quinque superantia, quod posterius vero baud verisimile 
 videtur, nisi forte diverse hexagio res rite iriterpretari possit.' (De cor- 
 poris humani fabrica, t. iv., f. 38.) He adds, in a note, 'In universum 
 quidem Hallerus cerebrum pondere esse librarum quinque autumat, 
 rectius certe quatuor, si de pondere pharmaceutico Germanico sermo est. 
 Certe enim inter plura quam ducenta cerebra a me disquisita nullum 
 inveni quod quatuor sit librarum.' From this it appears that Soemmer- 
 ring employed the German or Nuremberg pound of 5524*8 grains, and 
 the weights which he gives consequently vary between 31 oz. and 41 
 oz. and 14 dr. avoirdupois, much below the estimates of more recent 
 observers ; but as he imagined the brain to attain its full development 
 at 3 years of age, and has not specified that the weights referred to were 
 those only of adults, we may infer that he included in his calculation 
 the brains of persons in early life. The estimate of the Wenzels seems 
 more nearly correct: 'Pondus encephali humani, quale id de quinto 
 vitse anno ad summam usque hominis senectutem plerumque invenitur, 
 pondus viginti quatuor millium granorum non superat. * * * Totius 
 cerebri pondus inter viginti et viginti duo millia; cerebri strictius dicti 
 inter octodecern et viginti millia granorum plerumque variat.' (De 
 penitiori structura Cerebri Hominus et Brutorum, f. 267.) The weight 
 of the encephalon thus given, is from 45 oz. 12 dr. to 50 oz. 5 dr. 
 avoirdupois; and, as including persons in early and advanced life, and 
 of both sexes, is sufficiently exact. The weight of the encephalon is 
 estimated by Portal at 48 oz. 3J dr. avoirdupois; and by Meckel, if 
 his weight be the German lb., at 43 oz. and 11 dr. avoirdupois. M. 
 Lelut* estimates the weight of the encephalon of the male adult at 1320 
 grammes, or 46 oz. 10 dr. avoirdupois ; and M. Parchappef at 1323 
 grammes, or 46 oz. 11 dr.; and that of the female at 1210 grammes, 
 or 42 oz. 11 dr. avoirdupois. 
 
 U 2d. The human encephalon appears ordinarily to attain its maximum 
 of development at from the 20th to the 25th year ; throughout the 
 middle period of life it displays little variation, but a very marked de- 
 crease in weight obtains in advanced age. This conclusion is uniformly 
 borne out by the weights of the encephalon at different ages in both 
 sexes ; nor do the tables afford any support to the opinions of Soemmerring, 
 the Wenzels, and Sir W. Hamilton, that the brain arrives at perfection 
 in or before the 7th year. Though it may occasionally happen that the 
 brain of a person in early life shall be found as heavy as are ordinarily 
 the brains of adults, yet the average of the weights of several brains 
 between 10 and 20 years of age, is uniformly less than that afforded by 
 the brains of persons between 25 and 55 years of age4 
 
 "Note. The gradual increase in the weight of the encephalon up to 
 adult age, accords with the conclusions of Dr. Sims, and with the views 
 
 * Gazette Medicale de Paris, 2 serie, t. v., 1837, p. 146. 
 
 t Ibid. See also M. Parchappe's Memoir, t. x. 1842, p. 650, where he gives the weight 
 of the encephalon in males, 1352 grammes; and in females, 1229. 
 
 J These results accord with Dr. Reid's previous inferences. The decrease in the weight 
 of the encephalon in advanced life, is, it will be observed, much more marked in females 
 than in males. 
 
WEIGHT OF THE BRAIN. 153 
 
 of Gall and Spurzheim. Soemmerring, however, from one observation, 
 inferred that the brain attained its full weight at three years of age, and 
 the Wenzels at 7. The latter age has also been regarded by Sir W. 
 Hamilton as the probable term of growth of the brain. The present 
 observations further confirm the inference, that, contrary to the supposi- 
 tion of the Wenzels and Sir W. Hamilton, the encephalon decreases in 
 weight in advanced life. In reference to Sir W. Hamilton's observa- 
 tions, it may be remarked that the actual weights of human brains can 
 alone form just data for conclusions; and that it seems scarcely possible 
 that any method of ascertaining the size of the brain from examination 
 of the skull can be free from fallacy* an objection especially applicable 
 to estimates so formed of the weight of the brain in advanced age, when, 
 as is well known, the ventricular cavities and subarachnoidal cellular 
 tissue often contain much fluid. 
 
 " 3d. The excess of weight of the male over the female encephalon, 
 is observed at an early age, and continues throughout the course of life. 
 This inference is applicable after the commencement of the second year ; 
 before that period the data are too imperfect to allow of any conclusions 
 being founded upon them. 
 
 "4th. The average weight of the cerebrum in adult males, is 44 oz. 
 3-4 dr., and in females, 39 oz. 3'3 dr. ; the cerebrum of the male, there- 
 fore, exceeds in weight that of the female by 5 oz. 0-1 dr. 
 
 " 5th. The cerebellum, with the pons Varolii, and medulla oblongata, 
 averages in adult males, 6 oz. 40-5 dr.; in females, 5 oz. 10 5 dr. the 
 excess in the male being 9-55 dr. 
 
 " 6th. The cerebellum alone, calculated from Professor Reid's obser- 
 vations, averages in the adult male 5 oz. 2-6 dr., and in the female 4 
 oz. 12-4 dr. the difference being 6*2 dr. 
 
 " 7th. It has been seen that the encephalon may be regarded as at- 
 taining its maximum of development at from the 20th to the 25th year, 
 and declines in weight in advanced life. The same law obtains in re- 
 ference to the development and decline of its several portions. It would, 
 however, appear probable that the cerebellum, with the pons Varolii and 
 medulla oblongata, arrive at their full growth somewhat earlier than the 
 cerebral hemispheres. This surmise is supported by the weights of the 
 former portions of the brain between 10 and 20 years of age, exceeding 
 in females their weight in the adult, and being in males very slightly less 
 than their weight in the adult. The results given in the tables are, how- 
 ever, unfavorable to the idea of Sir W. Hamilton, that the cerebellum 
 attains its maximum of development at about the 7th year an opinion 
 opposed also by the weights of the cerebellum alone, as given by Pro- 
 fessor Reid. 
 
 " 8th. The excess which obtains in the weight of the encephalon of 
 the male over that of the female, exists also in each of the several por- 
 tions of the brain the cerebrum, the cerebellum, with the pons Varolii 
 and medulla oblongata, and the cerebellum alone, being uniformly heavier 
 
 * Sir W. Hamilton states his observations to have been founded "on inductions from 
 above 60 human brains, and from nearly 300 human skulls of determined sex, the capacity 
 of which, by a method I devised, was taken in sand, and the original weights of the brain 
 thus recovered.'' Monro's Anatomy of the Erain, 1831. 
 
154 HUMAN BRAIN. 
 
 in the male than in the female. The excess in the weight of each of 
 these portions of the brain in the male over their weight in the female, 
 maintains a very similar ratio, a fact opposed to the conclusion of Sir 
 W. Hamilton, 'that almost the whole difference in the weight of the 
 male and female encephali lies in the brain proper, the cerebella of the 
 two sexes absolutely being nearly equal ; the preponderance being rather 
 in favor of the female.' 
 
 " 9th. The relative proportion of the encephalon to the whole body 
 undergoes a gradual decrease from infancy to adult age ; and averages 
 in males, at from 25 to 55 years of age, I to 37-2, presenting during this 
 period a range of from 1 to 79-98 to 1 to 25-2, according to the state of 
 emaciation or corpulence of the body weighed. 
 
 " In females the average during adult life is 1 to 33'5, and the extremes 
 1 to 44-8 and 1 to 24-1. It will be seen that, as before remarked by 
 the Wenzels and Tiedemann, the female brain, though absolutely lighter 
 than that of the male, maintains a higher proportion relatively to the 
 weight of the body. 
 
 " 10th. The proportions, relatively to the whole body, of the cere- 
 bellum with the pons Varolii and medulla oblongata, and of the cerebellum 
 alone (as shown by Dr. Reid's observations), also gradually decreases 
 from infancy, and at adult age the former averaged in males 1 to 277' 1, 
 presenting the extremes of 1 to 424-7 and 1 to 244-5. 
 
 "The proportion in adult females is 1 to 290-7, and the extremes 1 
 to 326- and 1 to 213-3. 
 
 " Tiedemann found the relative proportion of the encephalon to the 
 body in adults as 1 to 35 and 1 to 45, and the extremes 1 to 22 and 1 to 
 50 to 100. 
 
 "llth. The proportion which, in the adult, the cerebellum with the 
 pons Varolii and medulla oblongata bear to the whole encephalon, is 1 to 
 7-8, and is nearly the same in the two sexes, being as 1 to 8-057 in the 
 male, and 1 to 7-87 in the female. 
 
 " Dr. Reid had been led to infer that the cerebellum with the pons 
 Varolii and medulla oblongata was relatively to the encephalon heavier, 
 in a somewhat higher proportion, in the female than in the male, being 
 as 1 to 7-9 and 1 to 8-6 respectively. His calculations are, however, 
 founded on the weights of 53 male and 34 female brains, while the present 
 tables include 96 and 58 weights. From my own observations separately, 
 the proportions are as 1 to 7-98 in females, and 1 to 7-93 in males. 
 
 " 12th. The ratio of the weight of the cerebellum alone to that of the 
 whole encephalon, is, in the male, between 25 and 55 years of age, 1 to 
 9-58, and in the female 1 to 9-34. 
 
 " 13th. The relative proportion of the cerebellum to the cerebrum in 
 adults of the two sexes, as calculated from Dr. Reid's data, is in males 
 1 to 8-37; in females 1 to 8'28. Sir W. Hamilton states, 'that the 
 cerebellum in the female is in general considerably larger in proportion 
 to the brain proper than in the male; in the female it is as 1 to 7-6, in 
 the male as 1 to 8*4.' The calculations now given show the weights of 
 the cerebellum with the pons Varolii and medulla oblongata, and of the 
 cerebellum alone, to be, relatively to that of the whole encephalon, 
 somewhat higher in females than in males. This inference is not, 
 
WEIGHT OF THE BRAIN. 155 
 
 however, confirmed by the observations of M. Parcbappe ; and the dif- 
 ference which, from the present data, appears to exist, is much less than 
 was supposed by Sir W. Hamilton. It is, therefore, very questionable 
 how far the excess of weight in females can be regarded as constituting 
 a general rule. 
 
 " 14th. Though the data now published are defective in weights of 
 the whole encephalon and its several portions, in infants and young per- 
 sons, they render it most probable that the ratio of the cerebellum alone 
 or with the pons Varolii and medulla oblongata, to the cerebrum and 
 encephalon, undergoes but little change during the^whole period of life, 
 after the expiration of the first year. Further observations are required 
 on this point ; the facts at present recorded are, however, opposed to 
 the surmise, that the cerebellum attains its complete state of develop- 
 ment at a period much anterior to that of the rest of the brain." 
 
156 
 
 PART V. 
 
 - ,f^ j 
 
 CONFIGURATION OF THE ENCEPHALON. 
 
 BEFORE the student begins to trace the medullary fibres of the cere- 
 bro-spinal axis, in order to ascertain the connections and relations of one 
 part with another, as well as those of the cineritious with the medul- 
 lary neurine, it will be desirable to take a general view of the external 
 form and appearance of the entire brain and spinal cord. He will thus 
 become acquainted with the different elevations and depressions observ- 
 able on its surface. Our predecessors, till lately, confined their attention 
 almost entirely to external appearances, and to such as are produced by 
 section, and obtained but an imperfect idea of the real structure of the 
 organ; but we must not fall into the opposite error, and neglect the 
 observation of outward form as wholly unnecessary or unphilosophical. 
 We must only be on our guard at the same time not to confound the 
 i study of mere outward configuration with a knowledge of internal 
 structure. 
 
 In studying the configuration of the cerebral mass, we shall find it 
 advantageous to divide its surface into two portions, the one external 
 and convoluted, the other internal, which presents appearances of so 
 precise a form that it may be called the Jigurate; the convoluted, as 
 will be explained afterwards, forming a sort of envelop or wrapper to 
 the figurate. 
 
 The relative positions of the different portions of the brain within the 
 human skull are well seen by making a perpendicular section of the 
 skull and brain from before to behind. Fig. 71 represents such a section ; 
 and although the student is not supposed to be acquainted with all the 
 ganglia shown in this drawing, it will be found instructive to study it 
 generally, and refer to it again hereafter. 
 
 After removing the brain and spinal cord from the skull and vertebral 
 canal, by dividing the nerves as they pass through their appropriate fora- 
 mina, the student should place the brain upon its upper surface, which 
 will expose what is usually called the base of the brain (fig. 72), and the 
 anterior surface of the spinal cord. By the term spinal cord we mean 
 all that portion of the cerebro-spinal axis which is contained within the 
 vertebral canal, and which, it will be seen, occupies the whole of the 
 cervical and dorsal regions; but in the sacral and (he lower portion of 
 the lumbar, its place in the canal is occupied by the nerves supplying 
 the lower part of the trunk and the inferior extremities. The appear- 
 ance produced by the collection of the large nerves in the interior of the 
 canal, from its resemblance to a horse's tail, is called the cauda equina 
 
SPINAL CORD. 
 
 157 
 
 (see fig. 81). The size of the cord varies: in the cervical region it is 
 widest, and in the middle of the dorsal narrowest, widening again at 
 the lower part of the dorsal, and then gradually tapering off to a point 
 opposite the second lumbar vertebra, where it appears to terminate in a 
 
 Fig. 71. 
 
 Side view of a mesial section of the human skull, nasal, oral, and laryngeal cavities, the vertebral 
 caiial and brain. B. Hemispherical ganglion, or convoluted surface of the brain. E. Cerebellum, 
 showing the arbor vitse. F M. Falx major of the dura mater. J. This letter is placed on the sphenoid 
 bone, just in front of the sella turcica and pituitary gland. From this body, which is represented as a 
 white rounded knot, there is a white tubular-looking body, extending up to the brain the infundibulum ; 
 this is large. The rounded body behind, is the corpus mammillare. H. Spinal cord. K Thalamus nervi 
 optici ; above the letter is the commissura mollis. N. Septum lucidum, which conceals the corpus stria- 
 turn; the white line behind the letter is the anterior pillar of fornix. p. Corpus callosum. x. Pons 
 Varolii. 
 
 single nerve, the ligamentum filiforme, just described. Anatomists have 
 rather differed in opinion as to the exact limits of the cord superiorly : 
 physiologically speaking, it extends to the hemispheres ; but guided by 
 its external configuration we may describe its superior boundary as 
 formed by the corpus olivare, with which the medulla oblongata com- 
 mences. After passing through the foramen magnum into the skull, the 
 spinal cord becomes very much enlarged, and changes its name to that 
 of the medulla oblongata (figs. 72, 85). At the upper edge of the me- 
 dulla oblongata a large knot or thick band of medullary fibres of about 
 an inch in width will be observed passing over and bounding it ; this 
 structure is the commissure of the cerebellum, or pons Varolii (x). The 
 cerebellum (E), or little brain, is the oval-shaped body, to which this 
 structured is attached laterally, and which lies beneath the tentoriuin 
 when in its normal situation in the skull (see fig. 71). 
 
 At the upper edge of the commissure of the cerebellum we observe 
 two rounded bands, about half an inch in thickness, emerging from be- 
 
158 
 
 HUMAN BRAIN. 
 
 hind the commissure, and spreading as they pass forwards and outwards 
 to be lost beneath the convolutions of the hemispheres ; these are called 
 the crura cerebri (u u, fig. 72). At the point where the crura are first 
 covered by the convolutions, we observe on either side a thin band of 
 medullary neurine, about three lines in width, crossing them ; these two 
 bands gradually approach each other, and, apparently joining, form what 
 is called the commissure of the optic nerves ; the bands themselves go by 
 the name of the tractus optici. The line from e crosses this band on the 
 left side. A space is thus left between the divergence of the crura cere- 
 bri and the convergence of the tractus optici, of a diamond shape, within 
 which we observe two white rounded bodies, called, from their appear- 
 ance, the corpora mammillaria seu albicantia (c), anterior to which bo- 
 dies, and partly surrounding them, we observe a layer of cineritious 
 neurine, the tuber cinereum or pons Tarini (), in the centre of which is 
 a funnel-shaped body, the infundibulum, or pituitary process, by which 
 it is attached to the pituitary gland (see fig. 71, j). 
 
 Fig. 72. 
 
 Base of the human brain. A portion of the middle lobe on the left side has been removed to show the 
 tractus opticus and crus cerebri. a r. Three roots of olfactory nerve, b. Ojmc aerve. Iq. Locus quacl- 
 ratas. e. Corpora albicantia; the white, funnel-like body in front of these is the infundibulum. a. Tuber 
 cinereum. c. Third pair of nerves, d. Fourth ditto, e. Fifth ditto. /. Sixth ditto, g. Seventh ditto, 
 facial, h. Eighth ditto, auditory, i. Ninth ditto, glosso-pharyngeal. j. Tenth ditto, pneumogastric. k. 
 Eleventh ditto, lingual. L. Twelfth ditto, spinal accessory. A. Olfactory ganglion. B. Hemispherical 
 ditto. D. Orbitar convolution. E. Cerebellum. H. Spinal cord. s. Olivary body. T. Pyramidal ditto. 
 u. Crus cerebri. x. Pons Varolii. at. Anterior lobe. ml. Middle lobe. pi. Posterior lobe. FS. Fis- 
 sui-a Sylvii. 
 
 Behind the corpora mammillaria is a layer of medullary neurine, called 
 the substantia perforata posterior, from its being perforated for the pas- 
 sage of vessels, and posterior to another similar spot ; it cannot be seen 
 in this figure. On either side of the diamond-shaped space described, 
 
BASE OF THE BRAIN. 159 
 
 we observe the mass of convoluted cineritious neurine, denominated the 
 hemispheres of the brain. These are considered as divided into three 
 lobes on each side ; the division between the anterior lobe (a 1} and the 
 middle lobe (m 1) is well marked by a fissure, called the fissura Sylvii 
 (F s), which corresponds to the lesser wings of the sphenoid bone. This 
 fissure may be traced to the outer surface of the jiemispheres, where its 
 depth is considerable. The fissura Sylvii commences near the mesial 
 line, under the tractus opticus, in a broad, quadrilateral, perforated 
 space, to which the student will be frequently directed in the description 
 of the convolutions. This spot is called the locus perforates anterior, or 
 locus quadrilateralis (lq). The division between the middle and poste- 
 rior lobe (p I) is more arbitrary, and corresponds to the superior angle 
 of the petrous portion of the temporal bone in the interior of the skull. 
 
 The description of the arteries, though seen in this view of the brain, 
 will be given after the whole account of the configuration and dissection 
 of the brain is completed. 
 
 The different pairs of cerebral nerves may also be seen in this view, 
 but as their exact connections will be minutely described after the student 
 has become accurately acquainted with the real structure of the cerebral 
 mass, it is unnecessary to dwell upon them now. 
 
 The dissector may now reverse th,e position of the brain by placing it 
 upon the base : he will then observe the upper surface of the hemispheres 
 divided by a deep fissure, into which the falx major of the dura mater 
 passes (fig. 71), and by separating the hemispheres he will perceive at 
 the bottom of the fissure a white band of medullary matter, called the 
 great commissure of the cerebrum, or corpus callosum (fig. 77, p). 
 
 Let us next direct our attention to the convoluted surface of the brain, 
 which is formed by the folding of the hemispherical ganglion. In the 
 following account I shall follow Leuret and Foville; though I cannot 
 attempt the minuteness of this latter author, who devotes forty pages to 
 his description. 
 
 All the convolutions may be said to spring from that spot at the base 
 of the brain which, situated in the fissura Sylvii, is called the quadrila- 
 teral spot, or substantia perforata anterior. This fact is interesting when 
 we revert to the development of the hemispherical ganglion ; whether we 
 trace the permanent forms it assumes in the various genera of animals, 
 or in its transient forms during the evolution of the human embryo. At 
 this spot we first observe this ganglion as a mere point; see the brain of 
 the fish (figs. 26, 29, 30, 31) and the brain of the embryo of nine weeks: 
 and from these small beginnings it gradually assumes its enormous size 
 and convoluted form. See also the explanation of the formation of the 
 Ipteral ventricles (figs. 79 and 80). 
 
 In attempting to classify the convolutions of the human brain, it is not 
 pretended that they will be found alike in all brains, but as regards their 
 main form and direction there is considerable uniformity. The variety 
 will be found not so much in the longitudinal foldings, which in the 
 human brain assume a crescentic figure, but in the transverse or anasto- 
 mosing foldings. 
 
 The convolutions are not even exactly alike on both sides of the brain. 
 Curiously enough, we find them almost in exact correspondence in the 
 
160 
 
 HUMAN BRAIN. 
 
 brain of the monkey and the idiot, and even in some of the lowest of 
 the negroes. 
 
 There are four orders of convolutions. The first order of convolutions 
 contain only one ; this is seen in a lateral view of the brain, looking from 
 within outwards, after a section has been made through the mesial (see 
 fig. 72). 
 
 It may be describee as commencing anteriorly from the substantia 
 perforata anterior, or the quadrilateral perforated spot locus perforatus 
 quadrilateralis ; A B the commencement of this convolution, and D' its 
 termination. It will be seen to spring from the base of the brain at the 
 posterior extremity of the anterior lobe. It then runs upwards and turns 
 (/) round the corpus callosum (i), runs (b b) along its upper surface, winds 
 down behind its posterior margin, descends to the base of the brain, ter- 
 minating close to where it began, namely, at the opposite border of the 
 fissura Sylvii, and therefore without crossing it. 
 
 Fig. 73. 
 
 Internal surface of the left hemisphere of the brain. The great transverse commissure divided in the 
 mesial line. (Foville.) c' T. Corpus callosum. R. Septum lucidum. v. Anterior pillar of the fornix. z. 
 Anterior commissure divided. T. Convex surface of the optic thalamus. w. Aquauductus Sylvii. s. 
 Pineal gland, x. Peduncle of pineal gland. N. Section of crus cerebri. M. Corpus mammillare. K'. 
 Tuber cinereum. K. Section of the chiasma of the optic nerves. L. Optic nerve, i. Olfactory nerve. 
 A. Quadrilateral perforated space, a. Internal part of the quadrilateral space, where the septum lucidum. 
 is united to it. B, bbb', B', D'. Vertical section of the convolution de 1'ourlet (superior longitudinal com- 
 missure). B. Beginning of this convolution. D'. Its termination, named the temporal tuberosity. B'. 
 Crotchet of this tuberosity. D", DDDDD, dd, D,D'". First convolution of the second order, forming the 
 eccentric circumference of the internal surface of the hemisphere, of which the convolution de 1'ourlet 
 forms the concentric circumference D". The origin of the great convolution of the second order. D'". 
 Indicates the termination of this convolution in the summit of the temporal lobe. cccc. Convolutional 
 branches. of the third order crossing the internal surface of the hemisphere, uniting the convolution de 
 1'ourlet to the great convolution of the second order. EE. Branch of the third order, uniting the convolu- 
 tion de 1'ourlet to the great convolution of the second order in the quadrilateral group. FF. Branch of the 
 third order, forming the peduncle of the triangular group, extending from the convolution de 1'ourlet to 
 the great convolution of the second order. G Y. Last branch of the third order, uniting the convolution 
 de 1'ourlet to the great convolution of the second order in the cerebello temporal zone of the hemisphere. 
 H. Anfractuosity of the internal surface running up to the eccentric border of the hemisphere. H'. An- 
 fracluosity of the same kind, forming a fissure between the crossing group and the quadrilateral group, 
 p. Fissure posterior to the quadrilateral group. 
 
CONVOLUTIONS. 161 
 
 In following this convolution, the student will find that its course is 
 exactly similar to that which the whole hemispheres take, as will be de- 
 scribed in my explanation of the formation of the ventricles of the brain 
 (see figs. 79 and 80, p. 195). This convolution contains within it the 
 superior longitudinal commissure, and marks its direction. It is the 
 hem or ourlet of Foville. This convolution he calls le cir convolution de 
 Vourlet. 
 
 We have already seen this as one of the primary convolutions of the 
 brain of the fox. 
 
 The second order of convolutions comprehends two. They arise, like 
 the last, from the quadrilateral space and also from the last convolution, 
 from which they spring like buds from a branch. The convolution DD D, 
 p, D, d d y (fig. 73,) forms the external margin of the circle of the hemi- 
 sphere, just as the first convolutions form the internal margin of the 
 circle ; this is the great convolution. It may be said to run from the 
 fissura Sylvii to the anterior extremity of the hemisphere, and then 
 mounting up, forms the upper part of the hemisphere; and the edge of 
 the median fissure running forwards terminates at the extremity of the 
 temporal lobe (see fig. 74, N, A, D", V I, D G, BG, DG, qq, o ; fig. 76, 
 aaaa a', D', GG G). 
 
 In the brain of new-born infants, and particularly in foetuses of seven 
 months, this line of convolution is without any sinuosity. In this re- 
 spect it resembles the simple longitudinal convolutions of the lower ani- 
 mals. Its complexity is occasioned by its enormous length, requiring 
 to be again and again folded transversely to get it into its allotted space 
 (see figures at page 123). 
 
 The second convolution of the second order forms the circumference 
 of the fissura Sylvii (see fig. 74, Y, K, i, P P, p, v, E). It presents in its 
 course two divisions, which again subdivide into three. The first forms 
 the anterior lip of the fissure of the external border of the orbitar triangle 
 delineated horizontally ; it is moderately winding, and terminates at the 
 junction of the horizontal orbitar region with the convex vertical region 
 of the outer part of the frontal lobe. This convolution we have seen 
 also in the lower animals (see figs. 60 and 64). 
 
 This convolution in man, like the last-mentioned, is so long, that in 
 its many transverse foldings we lose sight of its original simplicity. 
 
 The convolutions of the third order may be divided into two sets ; the 
 first are situated without exception on the internal surface of the hemi- 
 sphere, and in the internal portion of the fissura Sylvii. They form a 
 sort of anastomosis between the convolutions of the first and second 
 order (fig. 73, cc c, E, F, G, Y, E E, FF). These vary in numbers from 
 five up to eight; Foville says they never exceed nine. These numerous, 
 tooth-like processes from the convolution of the superior longitudinal 
 commissure induced Rolando to call it processo cristato. The second set 
 are within the fissura Sylvii, and occupy the space called by Reil Insula. 
 
 Few of those who dissect the human brain in the old way are aware 
 of the depth, breadth, and riches, if I may so express it, of the fissura 
 Sylvii: they know it only as a slight fissure at the base of the brain, 
 separating the anterior and middle lobes. But those who remove the 
 pia mater from the brain previous to immersing it in alcohol are well 
 
162 
 
 HUMAN BRAIN. 
 
 aware that this fissure extends upwards from the base of the brain, on 
 the side of it, nearly to the posterior extremity of the vertex. 
 
 The sides of this fissure are not smooth ; and as if every chink and 
 cranny should be occupied, to get this enormous convoluted ganglion 
 into the skull, the whole of this fissure is occupied with a distinct set of 
 convolutions. These are pyramidal in form, with their apices towards 
 the fissure, and their bases radiating outwards, as to a circumference of 
 a circle. They may be partly seen in fig. 74 (c c c) ; but better seen in. 
 fig. 75 (c c c c). 
 
 Convolutions of the Fourth Order. The distinctive character of the 
 convolutions of the fourth order is, that they have no direct connection 
 with the convolutions of the first order, that they are employed to fill the 
 space left between the two great lines of the second order. 
 
 Fig. 74. 
 
 This figure represents the external surface of a cerebral hemisphere. (Fqville ) This hemisphere is 
 remarkable for the rich development of its convolutions. E', y, K, i, p, v, E, indicate the convolution en- 
 circling the fissura Sylvii second convolution of the second order, c, c, c. The convolutionary folds 
 of the rnsula seen between the lips of this fissure, which are slightly separated, x, N, A, D", I'l, D, G, B, D', 
 p, G, q g, o', indicate the great convolution encircling the hemisphere first convolution of the second 
 order. All the convolutions on the convexity of the hemisphere run from the convolution around the 
 fissura Sylvii to that convolution which encircles the hemisphere. The convolutions which join the 
 second with the first convolution belong to the fourth order. Independently of their connection with the 
 two convolutions of the second order they anastomose sometimes together, Y, t", H, A. Transverse 
 supraciliary convolution running from the anterior angle of the fissura Sylvii to the internal part of the 
 posterior extremity of the hemispheres, i, i. Transverse medio-parietal convolution extending from the 
 second curve of the convolution around the fissure of Sylvius to the twist in the great convolution of the 
 second order, corresponding to the anfractuosity which on the internal surface of the hemisphere sepa- 
 rates those crossing from the quadrilateral group. P, P, P, p'. Transverse occipital convolution extending 
 from the sharp angle of the fissure of Sylvius to the posterior extremity of the hemisphere. K, K, K. An- 
 terior transverse parietal convolution situated immediately in front of the transverse medio-parietal. 
 s, s, 1,1'. A branch extending anterior from K, K, K, and anastomosing, a, /, /', with the great convolu- 
 tionary band first convolution of the second order. L', s', I' 1 . A branch which, running from K, K, K, 
 anastomose with the transverse supra-ciliary convolution. +, A small branch joining the two above- 
 named branches. B, R. Posterior transverse parietal, o, o, o. Short convolutions uniting the extremity 
 of the second convolution of the second order to G, q q, o' the last portion of the great convolution of the 
 second order. 
 
 In order to understand these convolutions it is necessary to consider 
 them as prolongations of the convolutions of the third order, below the 
 two convolutions of the second order (see figs. 74 and 76, N N, 1 1, K K, 
 
CONVOLUTIONS. 
 
 L L) ; and in fig. 76, running directly across the upper surface of the 
 brain (i i), also K, which is more irregular and uncertain than the last. 
 
 Fig. 75. 
 
 This figure represents the external surface of the cerebrum, the central part of which is covered by 
 the irisula. (Foville.) j. Lower part of the fissura Sylvii. c, c, c ; c, c, c. Insula. B, B, B, B. Direction of 
 the great layer of converging fibres of the hemisphere, a, A, A.J,j, A, A, b. Layer of eccentric fibres of 
 the lateral surface of the cerebrum, a. Temporal tuberosity of the convolution de 1'ourlet. D. Cut end 
 of a bend in the convolution around the fissure of Sylvius. 
 
 The first region in which these are found is the orbitar triangle, at the 
 base of the brain (see fig. 74, E H). 
 
 The second is the great convex space bounded before by the anterior 
 border of the above Triangle (see fig. 74, I", HA), and behind by a line 
 extending from the posterior angle of the fissure of Sylvius to the pos- 
 terior point of the hemisphere (see fig. 74, p, P, P, D'). 
 
 Lastly, the third region, also slightly convex, extends from this line 
 to the extremity of the temporal lobe (see fig. 74, D', v, o'). 
 
 This fourth order is especially characteristic of the human brain, from 
 their transverse direction, and their being supplementary to the longitu- 
 dinal foldings. 
 
 Fig. 76. 
 
 CL' 
 
 Superior surface of the left cerebral hemisphere. D. Anterior extremity. D'. Posterior extremity. , 
 o, o, a'. Superior segment or middle of the great convolution of the second order, e, i, G'. Small frag- 
 ment of the convolution which encircles the fissura Sylvii second convolution of the second order. i,"t. 
 Transverse medio-parietal convolution. D, H, A, h. Transverse supraciliary convolution. G, G, G. Trans- 
 verse occipital. All these transverse convolutions come from the encircling convolution of the fissura 
 Sylvii to the great convolution of the second order. K. Anterior incomplete transverse convolution, s. 
 Posterior. /,/',/". Simple convolutional line ou the side of the fissure divided by its course from with- 
 out to within, and joining by its branch F', the great convolution of the second order; and by its branch 
 K", the transverse supraciliary convolution, g, g. Line of union of the transverse occipital convolution 
 to the great convolution of the second order. This cerebral hemisphere has been figured as an example 
 of moderate development of the convolutions on the convexity of the brain. (Foville.) 
 
164 
 
 HUMAN BRAIN. 
 
 Figurate Surface of the Brain. To study this surface, the student 
 should now make a section with a large knife, of one of the hemispheres 
 of the brain, on a level with the corpus callosum, (say the right hemi- 
 sphere,) cutting from the mesial fissure horizontally outwards: theipor- 
 tion removed must not be thrown away. This section exhibits what is 
 called the centrum ovale, and exhibits the disposition of cineritious and 
 medullary neurine in this portion of the brain. The cineritious forms a 
 sort of bark round the white substance ; and hence it has been called 
 the cortical substance of the brain (see fig. 77, B B B B). This cortical 
 substance is, in fact, the hemispherical ganglion, the analogue of which 
 the student will remember as a mere rounded point in the fish, in man 
 enormously developed. 
 
 Fig. 77. 
 
 View of the lateral ventricles of the brain. A section has been made of the hemispheres of the brain 
 on a level with the great transverse commissure, showing the centrum ovale. The great transverse 
 commissure, PP, has been left in the mesial line, and extending a little on the right side. On this side the 
 centre of the lateral ventricle, LV, is opened and the anterior cornu, ac. On the left side, the posterior 
 cornu, PV, and the commencement of the descending cornu, efe, are also exposed. In the body of the 
 lateral ventricle, on the left side, may be seen on the outside the corpus striatum, MM; next to it, taenia 
 semicircularis, t<r, partly covering the veni Galeni, vg; next to this is the thalamus nervi optici, K, from 
 the surface of which the plexus choroides has been removed, but still partly covered by the central por- 
 tion or body of the fornix, N. A piece of flat black whalebone runs under the fornix from one ventricle 
 into the other, occupying the natural position of the plexus choroides ; on the right side the ventricle is 
 partially covered by the corpus callosum, and the body of the fornix is concealed, but the plexus cho- 
 roides, pc, has been left. The vena Galeni, vg, is uncovered by the partial removal of the Ueuia semi- 
 circularis. 
 
FIGURATE SURFACE. 165 
 
 In making an examination of the brain for pathological observation, 
 this section is one of great importance, exhibiting clearly the color of 
 this ganglion ; and it is hoped that, for the future, medical men will not 
 omit in their accounts of post-mortem appearances, a detail of the con- 
 dition of this ganglion. It is, indeed, extraordinary, that, in almost all 
 the accounts published in this country, of the condition of the brain in 
 insanity, not one word is said of the general condition or color of this 
 ganglion, though all physiological evidence proves that it is the portion 
 of the brain with which the intellect is immediately connected. 
 
 The next step in the dissection is to make a longitudinal incision, as 
 represented on the right side of the mesial line in fig. 77, commencing 
 a little posterior to the anterior edge of the corpus Qallosum, and ex- 
 tending backwards in a line parallel to the mesial line as far as the 
 posterior edge of this commissure. This great transverse commissure 
 may be seen in fig. 99, partly dissected. This incision must be made 
 carefully, and not extend deeper than a line or two. It will open what 
 appears to be a circumscribed cavity: it is a fissure called the lateral 
 ventricle (fig. 77, LV). This space must not, however, be viewed by 
 the student in the light of a cell or cavity, situated in thfe interior of 
 the brain, the walls of which are formed by the cerebral mass ; he must 
 consider it resulting merely from the contact of the different surfaces of 
 the brain. And this fissure is analogous, in fact, to the fissure between 
 the two hemispheres which contains the falx major of the dura mater, 
 or the space between the cerebrum and cerebellum ; the only difference 
 being that the last mentioned spaces are between the external or convo- 
 luted surfaces of the brain, instead of between the under part of the 
 great transverse commissure and the upper part of what has been called, 
 in distinction to the convoluted, the figurate or figured surface of the 
 brain. 
 
 It is quite true that, in one sense, it is a cavity with walls sufficiently 
 perfect to be capable of containing fluid ; but the important point for the 
 student to understand is, that these walls are not entirely formed by 
 neurine, and that its power of containing fluid arises simply from the 
 mode in which the arachnoid membrane is reflected from the figurate 
 surface on to the convoluted surface. It is in this way that we have a 
 circumscribed cavity, formed from a mere accident in structure, which, 
 in the constitution of the brain, amounts to no more than an irregular 
 but extensive fissure, analogous, in all respects, to the fissures between 
 the different convolutions of the cerebrum. Though it may not, per- 
 haps, be possible for the student, who has only advanced thus far in the 
 dissection of the brain, to have a clear idea of the difference between 
 the figurate and convoluted surfaces, I have considered it advisable to 
 arrest, in the very first instance, any ideas that might arise in his mind 
 as to the ventricles of the brain being perfect cavities, whose walls are 
 wholly formed by the substance of the organ itself. The terra ventricle 
 alone is sufficient to mislead any one who dissects these parts for the 
 first time. 
 
 The figurate surface of the brain is so named, in contradistinction to 
 the convoluted surface, from the projections which compose it presenting 
 regular forms and having received individual names, generally derived 
 
166 HUMAN BRAIN. 
 
 from some trifling peculiarity of appearance, some fancied resemblance 
 to another part, or erroneous views of their functions ; nevertheless, 
 however incorrect these titles may really be, it would not be advisable to 
 attempt any sudden and total rejection of them ; all we shall do will be 
 to couple with them other appellations which have relation to the struc- 
 ture and function of the part they are used to indicate. 
 
 A portion of the figurate surface, and what is usually called the body 
 of the lateral ventricle, having been exposed by the removal of a portion 
 of the transverse commissure, we will consider these parts in order (see 
 figs. 77 and 78). 
 
 Commencing anteriorly, the first of the component parts of the figurate 
 surface which presents itself to our observation is the anterior cerebral 
 ganglion, or ganglion of the anterior or motor columns, the corpus 
 striatum (M M), whose under surface we have to examine. It is pear- 
 shaped, the base of the pear being forwards and inwards, and the apex 
 or small end lying backwards. Anterior to this ganglion is a deeper 
 portion of the ventricle, the anterior cornu (a c}: it is separated from its 
 fellow on the opposite side by a portion of the longitudinal commissure 
 called the septum lucidum (s I, fig. 77 No. 1, fig. 78). Between the two 
 layers of the septum lucidum is the fifth ventricle (5 v). Posterior to 
 this anterior cerebral or motory ganglion is a vascular membrane, the 
 plexus choroides (p c) ; this membrane, notwithstanding its grand name, is 
 merely the continuation of the pia mater, as will be seen a little further on ; 
 if this membrane is raised (see the left side of fig. 77), another large gan- 
 glion may be seen (the posterior cerebral), presenting a white surface, and 
 rounded from the thalamus nervi optici (K), through which the posterior or 
 sensory columns pass previously to their expansion in the hemisphere and 
 termination in the hemispherical ganglion (fig. 77, B). 
 
 The whole of the thalamus is not yet exposed, the posterior portion 
 being covered by the fornix (see the left side). The thalamus nervi optici 
 is larger in man than inany other animal, and as we have traced it upwards 
 we have found it in many of the higher Mammalia, as in the horse, sheep, 
 &c., assuming a triangular form, at first so narrow that we find it in the 
 mole almost of the form of a scythe. These two ganglia are not so closely 
 united in some of the lower animals as in man : in the cat the separation 
 is very evident, and still more so in the mole. 
 
 Between these two ganglia is situated a narrow band of medullary 
 neurine, called, from its appearance, the taenia semicircularis (fig. 77, t c, 
 fig. 78, 4) ; the fibres composing the band are connected with the supe- 
 rior longitudinal commissure, and are considered by Spurzheim as the 
 media connecting the conveying fibres, or fibres of communication, 
 between the two hemispheres and anterior and posterior cerebral ganglia 
 (see fig. 101,5). Beneath the taenia semicircularis is a large vein, the 
 vena Galeni, so called after Galen (fig. 77, v g ; 78, 3). At the pos- 
 terior extremity of the thalamus, and extending rather beneath this gan- 
 glion, are two rounded bodies, which are called the external and internal 
 geniculate bodies ; at first sight they appear as if they were a portion 
 of this ganglion, but I believe that they are merely in opposition. They 
 will be better seen in a further stage of the dissection. 
 
 Overlapping the internal and posterior part of the posterior cerebral 
 
VENTRICLES. 
 
 Fig. 78. 
 
 167 
 
 K: 
 
 In this drawing may be seen all the ventricles of the brain. The upper part of both hemispheres have 
 been removed with the corpus callosum on a plane a little below that commissure, and the section ex- 
 hibited in the last drawing. The posterior lobe of the left hemisphere of the cerebrum has also been 
 removed. The cerebellum has been entirely removed, in order to show the posterior surface of the 
 medulla oblongata. On the right side the hemisphere has been cut away still lower, to expose the 
 posterior and descending cornuae of the lateral ventricle. A piece of bristle is passed from the fourth 
 ventricle through the iter a quarto ad tertium ventriculum. Thus is shown the posterior fissure of the 
 cord, PF, suddenly dilated, 1st, into the fourth ventricle, 4<& y, or calamus scriptorius; 2dly, into the iter 
 a quarto ad tertium ventriculum; 3dly, into the third ventricle, 3d v; and 4thly, into the fifth ventricle, 
 5 v. In the fourth ventricle may be seen two pyramidal bodies, the auditory ganglia, F; the white lines 
 crossing them are the roots of the auditory nerves. The iter a quarto ad tertium ventriculum is first 
 bounded above by the inter-cerebral commissure, i&c; 2dly, by the optic tubercles, DC, carrying the 
 pineal gland, R. The bristle emerges in the third ventricle, bounded above by the fornix, which is 
 removed, and laterally by the optic thalami, K, on the edges of which may be seen the peduncles of the 
 pineal gland. Anteriorly the third ventricle is bounded by two rounded cords, NN, the anterior pillars 
 of the inferior longitudinal commissure fornix. In front of these is another narrow chink or fissure, 5, 
 the fifth ventricle. The white lines, which bound this cavity, are the cut edges of that portion of the 
 longitudinal commissure which is called the septum lueidum. On either side of the mesial fissure are 
 the lateral ventricles, 2 2, with their eornua, anterior, AH, middle descending, De, and posterior, PO. BB. 
 Hemispherical ganglion, or cortical substance of the brain, c. Anterior optic ganglion, nates ; D. Poste- 
 rior ditto, testes covering the iter a tertio ad quartum ventriculum. F. Auditory ganglion in the fourth 
 ventricle, 4th. v. H. Spinal cord. K. Thalamus nervi optici, posterior cerebral ganglion. M M. Corpus 
 striatum, anterior cerebral ganglion, o. Pineal commissure. R. Pineal gland, i&c. Inter-cerebral com- 
 missure, or processus e cerebeao ad testes, covering the iter a tertio. s c. Soft commissure, commissura 
 mollis. LV. Lateral ventricles. 3d v. Third ventricle; \th v. Fourth ditto; 5 v. Fifth ditto. These three 
 are all dilatations of PF, posterior fissure of the spinal cord. 1. Septum lueidum. a portion of the inferior 
 longitudinal commissure or fornix. This is represented much too thick. 2. Anterior pillars of fornix 
 divided. 3. Vena Galeni. 4. Taenia semicircularis. 5. Corpus striatum divided. 6. Hippocampal 
 lobe, or hippocampus major. 7. Taenia hippocampi, or descending pillar of the fornix. 8. Corpus den- 
 tatum. 9. Emminentia collateralis. All these last are situated in the descending cornu of the lateral 
 ventricle. 10. Hippocampus minor in the posterior cornu of the lateral ventricles, d. Fourth pair of 
 nerres, pathetic, h. Eighth pair, or auditory. 
 
168 HUMAN BRAIN. 
 
 ganglion or thalamus, there is a sharp band of medullary neurine; this 
 structure is a portion of the inferior longitudinal commissure or fornix 
 (figs. 77, 78, N, 101, E). The connections and precise character of this 
 commissure I shall not describe at present, being anxious to give a 
 connected and uninterrupted view of the figurate surface, merely re- 
 marking that the width and extent of the superior portion of the fornix 
 or inferior longitudinal commissure may be observed by dividing the 
 remainder of the transverse about one-third from its posterior edge in 
 the direction of the cerebellum. Before doing this, the student may 
 consider that he has now seen the contents of the body of the lateral 
 ventricle corpus striatum, vena Galeni, tsenia semicircularis, thalamus 
 nervi optici, plexus choroides, and fornix. On removing the rest of the 
 transverse commissure, the fornix will be found to extend on each side 
 nearly an inch from the mesial line, narrowing considerably towards its 
 anterior extremity. It will also be found extending downwards and 
 outwards into a narrow curved chamber, continuous with the lateral 
 ventricle, called the descending cornu (fig. 77, 7). The descending 
 cornu extends first backwards, then outwards, forwards, and inwards, 
 thus forming a curve, the convexity of which is backwards and out- 
 wards, the concavity forwards and inwards. As the student is still re- 
 quired to describe, at his examinations, the contents of this cavity, they 
 may be thus enumerated as also six in number (see fig. 78). Their 
 anatomical and physiological relations will be explained with the com- 
 missures. The contents of this cornu all take the curve of the cavity, 
 and may be described from within outwards : A slight projection ; 1st. 
 Emminentia collaterals (9) ; 2dly. Hippocampus major (6), terminating 
 below in 3dly. A club-like extremity of the body Pes hippocampi; 
 4thly. TaBnia hippocampi (7), a continuation of the fornix, on raising 
 which, the gray neurine of the convoluted surface at the base of the 
 brain may be seen serrated by the entrance of blood-vessels ; 5thly. 
 Fascia dentata(9); Gthly. Plexus choroides, lying over all these. The 
 lateral ventricle also extends backwards, the posterior cornu forming a 
 curve, convex outwardly, concave internally ; the projection on its inner 
 wall is called the Hippocampus minor (10). 
 
 The right side of the longitudinal commissure must next be completely 
 divided, cutting towards the upper surface of the cerebellum, and the 
 divided portions turned to either side, separating them about half an 
 inch. The consequence of this section will, in the first instance, be the 
 further exposure of the pia rnater, and a view of the exact point where 
 it quits the convoluted to join the Jigurate surface ; the convoluted sur- 
 face, which the pia mater quits, is the upper surface of the cerebellum. 
 The narrow space left between the under surface of the posterior edge 
 of the inferior longitudinal commissure and the upper surface of the cere- 
 bellum, is called the foramen of Bichat, and the pia mater in this situa- 
 tion is known by the name of velum interpositum. This membrane, the 
 velum interpositum, must now be very carefully raised, and immediately 
 underneath and connected with it will be found a small rounded body 
 about the size of a pea, consisting of cineritious neurine, the pineal 
 gland R, and frequently containing in its interior some gritty matter 
 called the acervulus cerebri ; it forms, together with two white bands, 
 
FIGURATE SURFACE. 
 
 169 
 
 hitherto known by the title of the peduncles (o) of the pineal gland, con- 
 nected to it, a commissure between the optic thalami. The whole 
 structure may be called the pineal commissure. Beneath this commis- 
 sure are situated the optic tubercles, which in man, as we have seen in 
 the Mammalia generally, are four in number, instead of being simply 
 binary, as in fishes; these tubercles are usually known by the term cor- 
 pora quadrigemina. The anterior of these are the largest, and are called 
 the nates (c), the posterior the testes (D). 
 
 The geniculate bodies may now be seen more distinctly, the external 
 the smallest, the internal the largest. A band of medullary neurine may 
 be seen running from the testes to the external, and from the nates to the 
 internal. The optic nerves send fibres into their substance, to be de- 
 scribed elsewhere (fig. 106). 
 
 Fig. 79. 
 
 Fig. 80. 
 
 Fig. 79. A. Medulla oblongata. B. Pons Varolii. c. Tubercula quadrigemina. with the fibres of the 
 posterior columns passing in front. D. Crus cerebri, fibres of the anterior columns. E. Thalamus, or 
 posterior striated body. F. Anterior striated body. G. Substance of the hemisphere, springing out from 
 the front of the anterior corpus striatum. H. Space between the striated bodies and the hemispheres 
 caused by the introduction of a small piece of wood. i. The two surfaces, being in contactinthe natural 
 state. K. Fissura Sylvii. 
 
 Fig. 80 represents the same parts shown by a transverse section through the centre of one side of 
 the brain. 
 
 By gently raising the anterior edge of the cerebellum with his knife, 
 (and this must be done with great care, to avoid injuring the fourth pair 
 of nerves (d), which lie immediately beneath,) the student will observe, 
 passing from the optic tubercles backwards and downwards to the cere- 
 bellum, a broad band of medullary neurine, thick laterally, but extremely 
 thin in the centre ; so great is the difference in the texture of these two 
 portions, that the central has been callec) the Valve of Vieussens ; the 
 direction of the component fibres is, however, the same in both. This 
 structure in the aggregate must be regarded as a commissure, connect- 
 ing the cerebrum and cerebellum, and I have designated it, therefore, 
 the inter-cerebral commissure (i & c, see fig. 78). A more minute de- 
 scription of its fibres will be found under the head of commissures. 
 This view of thefigurate surface of the brain will remind the student of 
 the tubercular form of the brain of the fish, to which it bears some re- 
 semblance, exhibiting 1st. Corpus striatum, the anterior the motor 
 ganglion of the spinal cord. 2d. Thalamus nervi optici the posterior 
 or sensory ganglion of the spinal cord. 3d. The inter-cerebral commis- 
 
170 HUMAN BRAIN. 
 
 f 
 
 sure and cerebellum. The olfactory tubercles which in the fish are ex- 
 posed, the hemispheres being too small to cover them, are concealed in 
 this view of the human brain, as indeed were the rest, until the hemi- 
 spheres were divided and turned back. The relation of the hemispheres 
 to the ganglia of the cord, or corpora striata and optic thalami, will be 
 easily understood by referring to the accompanying diagram, where the 
 convoluted surface is represented as commencing at the fissura Sylvii, 
 from which it is traced, first forwards then upwards, then backwards to 
 the posterior extremity, and then forwards again under the striated 
 bodies to the fissura Sylvii. 
 
 We may thus compare the corpus striatum and thalamus nervi optici, 
 or anterior and posterior cerebral ganglia, to the head of a stick, to the 
 neck of which, just below the knob, is attached a piece of folded linen 
 (represented by the hemispheres, in the human subject an immense sur- 
 face), which is first drawn forwards, next turned backwards, and again 
 brought forwards so as to form a complete covering to the head. 
 
171 
 
 PART VI. 
 
 DISSECTION OF THE HUMAN BRAIN AND SPINAL CORD. 
 
 Spinal Cord, or Medulla Spinalis. The student should not attempt 
 the dissection of the brain and spinal cord until he has prepared it, by 
 hardening it in alcohol, dilute muriatic and nitric acids, or salt and 
 water. Cruveilhier recommends, instead of hardening the brain by 
 artificial methods, to expose its structure by jets of cold water thrown 
 upon it ; though he allows that results obtained by this method confirm 
 those furnished by the study of its structure when hardened by alcohol.* 
 
 In conformity with the principles which induced me to preface the 
 study of the cerebro-spinal axis in the human being with a demonstra- 
 tion of the progressive development of the nervous system by tracing it 
 in some of the simplest animals, we shall commence this division of our 
 labors with an account of the configuration and structure of that por- 
 tion of this system which, protected by the vertebral column, is known 
 by the name of spinal cord. Without an accurate knowledge of the 
 component parts of the cord, no one can ever comprehend the intricate 
 structure and mode of composition of the other portion of the system, 
 which, included within the cranium, is therefore entitled the encephalon, 
 or brain. 
 
 The spinal cord consists of two halves or corresponding portions, 
 placed, as regards the mesial line of the body, laterally to each other, 
 and united anteriorly by a central commissure composed of medullary 
 neurine (fig. 82, No. 1). The fissures separating these two halves of 
 the cord are designated the anterior and posterior fissures of the spinal 
 cord. 
 
 The anterior fissure differs from the posterior in being wider, more 
 distinct, and therefore more easily demonstrated, though it is not so deep 
 at the upper part of the spinal cord as the posterior ; it deepens, how- 
 ever, as we descend, and is the deeper of the two towards the sacral 
 end of the cord. The pia mater, which closely invests the cord, dips 
 into the anterior fissure, but nevertheless requires to be carefully dis- 
 sected off before the cleft can be distinctly shown. As the sides of the 
 posterior fissure are in closer contact than those of the anterior, more 
 difficulty is met with in introducing the point of the scalpel into the 
 posterior fissure without injuring the medullary substance. It is curious 
 that so much difference of opinion should have existed among anatomists 
 
 * Cruveilhier, t. iv. 560, op. cit., states, that the earliest description of the spinal cord 
 worthy of mention is that of Huber, (J. Huber de medulla spinali: Goettingcen, 1741), and 
 that it served as the basis of the labors of Haller. 
 
172 HUMAN BRAIN. 
 
 as to the character of these fissures, Haller almost doubting the existence 
 of the anterior one, whilst Chaussier states that it is deeper than the pos- 
 terior ; and Gordon and others, again, stating that in point of depth 
 there is scarcely any difference between them. Connected with the 
 spinal cord, there are thirty-one pairs of nerves, each nerve being in 
 communication with the medulla spinalis by two sets of filaments, which, 
 
 in the ordinary language of anatomists, 
 
 Fig - 8L are called the anterior and posterior roots 
 
 of the spinal nerves (see fig. 81). But 
 viewing the connection of these nerves 
 with the cord in strict accordance with 
 the functions which they severally per- 
 form, it would be more correct to say that 
 the anterior filaments alone arise from the 
 cord, and that the posterior terminate 
 there ; for the anterior filaments have 
 been proved by Sir Charles Bell and Ma- 
 gendie to be the conductors of the will to 
 section opposite the root of the fifth spi- the voluntary muscles : thev are, in fact, 
 
 nal nerve. 1. Anterior or motor root of , J . J 3 .' 
 
 the spinal nerves. 2. Posterior or sensory the instruments 01 Volition, the CXperi- 
 
 guon f the spinal nerves ' with ments of the physiologists named having 
 
 proved, that, after the division of the an- 
 terior filaments, the limb to which their continuation as nerves is trans- 
 mitted becomes perfectly paralytic as regards voluntary motion. 
 
 The posterior roots again convey sensation through the medium of the 
 cord to the seat of consciousness, the cerebral hemispheres. 
 
 The anterior roots are much smaller than the posterior. The posterior 
 are further distinguished from the anterior in the circumstance of their 
 passing through a distinct ganglion previous to their connection with the 
 cord (see fig. 81). The spinal nerves, however, have been lately proved 
 to be not merely continuous with the constituent fibres of the medullary 
 or fibrous neurine of the cord, but with the gray neurine which is con- 
 tained in its interior, as will be described a little further on. 
 
 Transverse Section. A transverse section of the cord demonstrates 
 clearly that, with the exception of the anterior and posterior fissures, it 
 it solid throughout. Nevertheless different anatomists have maintained 
 that there was a canal in the interior of it, some not giving it any precise 
 situation, and others, as Portal and Morgagni, describing it as being 
 situated in the middle of the cord, lined by a delicate membrane. Gall 
 and Spurzheim, in their folio work, described two canals running through 
 the whole length of the cord, not communicating with each other, nor 
 with the ventricles, but terminating in a cul-de-sac about the size of an 
 almond in the optic thalami. Spurzheim has since stated* that such 
 canals were produced by the action of the blow-pipe. The canal which 
 exists in the foetal state is but a dilatation of the posterior fissure, and is 
 gradually diminished by the deposition of neurine; for the pia mater by 
 which it is secreted forms a deep fold posteriorly, the secretion first com- 
 mencing from the concave internal surface anteriorly, and being con- 
 tinued till this surface becomes level and the whole cord solid. 
 
 * In the Anatomy of the Brain, 8vo., London, 1820, translated by Dr. Willis. 
 
DISSECTION OF THE SPINAL CORD. 
 
 173 
 
 I am glad to find that, notwithstanding the opinions of Drs. Stilling 
 and Wallach regarding the existence of a canal, and this in the gray 
 substance, my denial of its existence is supported by the observations of 
 Dr. Todd, who says, " I have never, after numberless experiments, been 
 able to see it." P. 635, op. cit. 
 
 The transverse section shows that the cord which externally seems 
 composed alone of fibrous neurine, contains in its interior a considerable 
 deposit of the pulpy matter. 
 
 The quantity of gray matter included differs very much in different 
 portions of the cord, as may be seen in fig. 82, Nos. 1, 2, 3, 4, 5, 6, 7, 
 8 ; a circumstance which I have before adverted to as throwing some 
 light on the different offices of each kind of neurine. The arrangement 
 of the cineritious neurine is definite and clear, the shape of the included 
 mass, which is best seen by a transverse section, something resembling 
 two C's placed back to back and connected by a narrow line thus, )-(. 
 The anterior horns do not reach the surface of the cord ; but the posterior, 
 extending completely through its substance, attain the surface at those 
 points where the posterior roots of the spinal nerves are connected with 
 the cord (see fig. 82, No. 1). 
 
 Fig. 82. 
 
 Sections of the spinal Cord. 1. Opposite the third cervical vertebra, with the anterior and posterior 
 foots of the spinal nerves, and the white transverse commissure. 2. Opposite the fourth ditto. 3. Oppo- 
 site the seventh ditto. 4. Opposite the fifth dorsal vertebra. 5. Opposite the eighth ditto. 6 Opposite the 
 tenth ditto. 7. Opposite the eleventh ditto. 8. Opposite the first lumbar vertebra. A. Corda equina. 
 This last section exhibits very clearly the great diminution in the quantity of fibrous neurine in this part 
 of the cord, as compared with the cervical region; the bulk of the cord being maintained by the large 
 quantity of vesicular neurine. The diminution in the quantity of fibrous neurine is, of course, the result 
 of its having been gradually distributed by the nerves ; each nerve from the first cervical downwards 
 carrying off a few filaments. 
 
 . 
 
174 HUMAN BRAIN, 
 
 This cineritious neurine must be regarded as constituting a chain of 
 ganglia, and not as one continuous ganglion; each set of spinal nerves 
 having its own individual nervous centre corresponding to its osseous 
 centre or vertebra. It is only by thus regarding the composition of the 
 cord that we can account for the uniformity in the number of the cervical 
 vertebras in Mammalia; the number of the bones being regulated by the 
 number of nervous centres requiring protection. The reason that these 
 are uniform in Mammalia is, that in this class only is there a perfect 
 muscular diaphragm, with a phrenic nerve, having its specific number 
 of roots and corresponding number of ganglia. The anatomical con- 
 tinuity of this gray matter, and its physiological or functional separation 
 into distinct ganglia or centres, is another fact of importance to show 
 that we must not look for anatomical lines of separation in order to 
 establish distinction of function. 
 
 If we attempt to divide the medullary neurine of each half of the cord 
 into two portions or columns, the separation may be easily made without 
 the slightest division of its fibrous neurine; and in order to facilitate the 
 description of the ultimate course of the fibres of the cord in that portion, 
 to be spoken of hereafter under the title of medulla oblongata, we may 
 consider them as separate parts under the name of antero-lateral and pos- ; 
 terior columns, as these names seem calculated to excite attention to the 
 exact relative position of these two tracts of medullary neurine. The 
 antero-lateral is so much larger than the posterior, that it not merely 
 constitutes almost the whole of the anterior portion, but also the side 
 of the cord. The relative proportion of the antero-lateral and posterior 
 columns varies, however, in different portions of the cord. In the cer- 
 vical region, for example, the antero-lateral is nearly double the size of 
 the posterior. In the lower part of the dorsal and upper part of the 
 lumbar regions, again, it is not more than one-fourth larger. 
 
 By a transverse section of the cord we are also enabled to observe a 
 set of medullary fibres, which, running horizontally across the cord from 
 one side to the other, connect the corresponding halves together. This 
 is the commissure of the cord before spoken of, and bears a perfect ana- 
 logy to the great transverse commissure of the brain. This commissure 
 forms the floor of the anterior median fissure (fig. 82, No. 1). 
 
 The student must next become acquainted with the connection of the 
 anterior and posterior roots of the spinal nerves with the gray matter of 
 the cord ; but he must not expect to dissect this easily himself, as it can 
 only be discovered when the animal has not been dead more than an 
 hour or two, and we have therefore no chance of exhibiting it in the 
 human subject. Gall was the first to assert that the spinal nerves are 
 connected with the gray matter. 
 
 Bellingeri was, I believe, the first who demonstrated the double origin 
 of the spinal nerves from the gray as well as the white matter of the 
 cord.* The reader will find an admirable analysis and review of the 
 contents of his papers in vol. 42 of the Edinburgh Medical and Surgical 
 Journal, from which I have taken the following account : Bellingeri 
 believed that the filaments of the posterior roots of the spinal nerves have 
 
 * C. F. Bellingeri de Medulla Spinali, 1823. Experiments in Nervorum Antagonismum 
 habita a Carolo F. Bellingeri, 1824. 
 
ROOTS OF THE SPINAL NERVES. 175 
 
 in the human subject at least three different origins, viz. from the pos- 
 terior peaks of gray matter, from the posterior lateral fissures, and from 
 the posterior columns of the cord. The anterior roots, he states also, 
 have threefold connection with the antero-lateral columns, but he does 
 not clearly make out their connection with the cineritious neurine. 
 
 Notwithstanding this announcement by Bellingeri in 1823, the fact 
 was not established, or generally believed in this country, till 1837, 
 when Mr. Grainger published his interesting and philosophical treatise, 
 entitled, " Observations on the Structure and Functions of the Spinal 
 Cord," in which he distinctly enunciates this important truth. And as 
 I have carefully tested his assertion by several dissections, I feel no 
 hesitation in giving my testimony to the fact that both the anterior and 
 posterior roots are connected with the gray matter of the cord. 
 
 Rolando entertains some curious opinions regarding the arrangement 
 of the medullary fibres, describing them as if they constituted an exten- 
 sive surface folded up ; and he gives a drawing of its supposed appear- 
 ance in a bullock. Cruveilhier considers it to be laminated, but that 
 each lamina is separate from its neighbor an observation which he re- 
 marks is confirmed by pathological analogy.* 
 
 Mr. Grainger says " In considering the interesting phenomena re- 
 lated by Dr. M. Hall, it occurred to me that it might be possible to 
 demonstrate the separate existence of what he has called the incident 
 and reflex fibres ; and I was thence induced to dissect, with much care, 
 the two roots of the spinal nerves. After repeated examinations, I satis- 
 fied myself that each was connected both with the external fibrous part 
 of the cord, and the internal gray substance. The following is what 
 appears to be the structure : After the two roots have perforated the 
 theca vertebralis, and so reached the surface of the cord, it is well 
 known that their fibres begin to separate from each other ; of these fibres 
 some are lost in the white substance, whilst others entering more deeply 
 into the lateral furrows are found to continue their course, nearly in a 
 right angle with the spinal cord itself, as far as the gray substance in 
 which they are lost. But this arrangement has no resemblance to the 
 distinct division into fasciculi depicted by Mr. Mayo; on the contrary, 
 it is with great care only that small, delicate, and individual threads or 
 striae, as it were, are traced, dipping into the lateral fissure, and at 
 length joining the gray matter. This difficulty is owing to the fact, that 
 whilst the fibres on the outer surface of the pia mater adhere very in- 
 timately with that strong membrane, on its inner surface the neurilemma 
 becomes so extremely delicate that the fibres lose much of their firm- 
 ness, and break on the application of the least force ; an accident which 
 always happens if the pia mater be raised from the surface of the spinal 
 cord beyond the point where the nerves are attached. When the fila- 
 ments have penetrated into the fissure, they Jose their rounded figure and 
 become flattened, and are then seen passing to the gray substance at a 
 right angle to the longitudinal fibres of the cord. It is extremely diffi- 
 cult, owing to the delicacy of the parts, to determine the exact relations 
 which exist between the above filaments and the gray matter ; but in a 
 
 * IV. 561, op. cit. 
 
176 HUMAN BRAIN. 
 
 few dissections I have been able to see these fibrils running like delicate 
 striae in the gray substance. In one instance, the fibres being more dis- 
 tinct than usual, an appearance was presented having a remarkable re- 
 semblance to that which is seen on making a section of the corpus 
 striatum in a recent brain, after the manner of Spurzheim. My friend 
 and colleague, Mr. Cooper, in this case counted distinctly five separate 
 fibrils passing from the anterior root of the nerve ; and there were some 
 other fibres derived from the same root, which were not so plainly seen. 
 
 " From numerous examinations I am induced to believe, that when- 
 ever the white fibres of the nervous system become connected with the 
 gray substance, whether in the different masses of the brain, in the 
 spinal cord, or in the ganglions, the arrangement is similar to what is 
 seen in the section of the corpus striatum, to which reference has just 
 been made. The fibres become, as it were, incrusted with the gray 
 matter, a disposition which may even be seen by a careful inspection in 
 the convolutions of the cerebrum, in which the radiating fibres of the 
 crus cerebri are observed like delicate striae. In examining the roots of 
 the nerves, I have always relied on the assistance of the naked eye only, 
 avoiding, for fear of deception, the use of a lens ; it also appeared to be 
 preferable to dissect the parts quite in their recent state, so that the 
 natural structure was entirely preserved. The method of Reil, which 
 is so useful in tracing the fibres of the brain, is quite inapplicable in the 
 present case ; and Bellingeri has shown that the use of acid renders it 
 very difficult to distinguish the nervous filaments from the blood-vessels. 
 
 " The structure above described I had ascertained several months ago, 
 and had, at that time, demonstrated it to several of my friends ; but on 
 visiting Germany I found so much skepticism, or rather disbelief, as to 
 the alleged connection with the gray matter, more especially as regards 
 the anterior root, that I very carefully repeated the dissections several 
 times with the aid of an excellent anatomist, Professor Bischoff, of Hei- 
 delberg, to whom I am much indebted for the facilities he afforded me 
 of prosecuting the inquiry. In every instance in which the parts were 
 sufficiently favorable for examination, I distinctly traced the connection 
 of both roots with the gray substance ; and it is very satisfactory to me 
 to be able to confirm this by the testimony of Professor Bischoff', who 
 although he had shared in the doubts before mentioned, has given me 
 his permission to state that he is convinced, by his own examinations, 
 that the structure above described really exists. 
 
 " From careful dissection, I am convinced that it is only a part of the 
 fibres belonging to the two roots which are attached to the gray substance, 
 and that a considerable number of threads are lost in the fibrous part of 
 the cord. The exact mode of their connection, however, with the latter 
 substance is not known."* 
 
 The fibres of the spinal cord are very simply arranged, lying parallel 
 to each other, in consequence of which they are easily stripped off, 
 leaving the surface beneath smooth and regular, so that, as Sir Charles 
 Bell observes, u It appears that the superficial layers furnish the roots of 
 the higher nerves, and that the lower layers go off to the roots of the 
 nerves as they successively arise." 
 
 * P. 34, op. cit 
 
DISSECTION OF SPINAL CORD. 177 
 
 The following observations from Dr. Todd are worthy of attention, as 
 coming from such a pains-taking physiologist ; at the same time I must 
 again repeat my conviction of the accuracy of Mr. Grainger's account, 
 p" 660. " This question respecting the precise relation of the roots of 
 the nerves to the cord, is one of those in which physiology in a certain 
 sense takes the lead in anatomy. Experiment has made it certain, that 
 while the spinal cord serves as a propagation of nervous power to and 
 from the brain, as in the ordinary sensations and voluntary movements 
 of the trunk and extremities, it is likewise capable of acting as an inde- 
 pendent nervous centre, and that movements of a very definite character 
 may be produced in parts connected with it, even after all communica- 
 tion between it and the brain has been cut off. And it has been, 
 supposed by one of the zealous laborers in this department of physiology, 
 that a distinct series of nervous fibres is devoted to each class of actions, 
 those, namely, of sensation and volition, and those which are independent 
 of the brain. Mr. Grainger was the first who offered a distinct solution, 
 of the anatomical problem which arose out of the hypothesis. Probable 
 as his explanation appears to be, a candid review of the observations 
 which have been hitherto made obliges me to state my opinion, that the 
 question is still sub ju dice, and that further research is necessary to prove 
 unequivocally, that of the fibres composing the roots of the nerves, some 
 pass upwards and enter the brain, and others do not pass beyond the 
 gray matter of the spinal cord ; and this inquiry demands more than 
 ordinary care, for the mind of an observer would be easily biased by so 
 attractive a theory as that above referred to." 
 
 Dr. Julius Budge, a private teacher of physiology in Bonn, but well 
 known as an industrious contributor to physiological science, has pub- 
 lished, in Muller, Archives for 1844, a most important paper regarding 
 this disputed point. With the assistance of Mr. Grainger, I have followed 
 him in his observations, and we both can speak most decidedly as to 
 their accuracy. Fig. 83 is from two drawings made at one time from thin 
 slices of the cord of the frog with the sptnal nerve. It strikingly corre- 
 sponds with those of Dr. Budge, whose figures I had not access to at 
 the time, and I had not seen them for above a twelvemonth, so that my 
 own may be considered as affording independent testimony. Dr. Budge 
 quotes the observations of Drs. Gall, Keuffel,.a pupil of Reil, Bellingeri, 
 Rolando, Weber, Valentin, and Stilling, to show that though they had 
 discovered the connection of the roots of the spinal nerves with the gray 
 substance of the cord, they had not demonstrated the continuity of their 
 fibres with those of the columns of the cord up to the brain. Dr. Budge's 
 observations were made on the frog ; and while he acknowledges the 
 great difficulty of tracing these fibres, he satisfied himself, by repeated 
 dissections, that the nervous fibres do not run, as Stilling asserts, trans- 
 versely, but go forwards towards the brain. 
 
 He generally took the conus terminalis of the frog's cord, on account 
 of its tentiity. He found a change in the color of the fibres from a blu- 
 ish gray to a yellowish gray ; also in size from ^j^th of a line to ^oth 
 and jo^th. These changes are, no doubt, owing to the attenuation of 
 the supporting membrane, as the tubules enter into the composition of the 
 cord, where the presence of the membrane is not required, as in the 
 12 
 
178 
 
 
 HUMAN BRAIN. 
 
 nerves. This change in the thickness and strength of the membrane is 
 undoubtedly one great cause of our difficulty in tracing the continuity 
 of these fibres with a dissecting knife. In taking the root of a dorsal 
 nerve, he found it dividing into two fasciculi, one superficial and the other 
 deep. The superficial forms a sort of twisted curve, and then ascends 
 towards the brain. (See figs. 83 and 84.) The deeper plunges into the 
 
 Fig. 83. 
 
 Fig. 84. 
 
 Fig. 83. Anterior root of the spinal nerve of the frog, showing the twisted arrangement of the fibres 
 at tJieir junction with the cord, and the continuity of fibre towards the bfaiu. A. Spinal nerve. H. Spinal 
 cord. cf. Cerebral fibres, sf. Spinal ditto, v m. Vesicular neurine. 
 
 Fig. 84. Portion of the spinal cord and nerve. (Budge.) Magnified 300 times, d. Tenth spinal nerve. 
 a. The upper portion, dividing into two fasciculi, cerebral fibres, b. The lovver fasciculus, curving through 
 the vesicular neurine of the spinal cord, spinal filameuts. 
 
 gray substance, through which it passes onwards also to the brain; this 
 latter part I doubt, as I believe that these terminate here. It is this twist 
 in the fibres which renders it so difficult to trace their continuity, and hence 
 have arisen the doubts which have been lately thrown out on this subject. 
 If the fibres of volition and sensation could not be traced continuously 
 through the nerves and the cord up to the brain, then are all the dis- 
 coveries of Sir Charles Bell impotent and inconclusive. But they are 
 no t so Nature never contradicts herself; and I maintain that even if 
 \ve could not detect it with our dissecting knives and magnifying lenses, 
 the simple pathological fact known to all, that sanguineous effusion into 
 one corpus striatum causes paralysis of the opposite side of the body, is 
 quite sufficient to prove it. 
 
 Foville* gives the following account of the connection of the spinal 
 nerves with the spinal cord : u The lines of insertion of the anterior 
 and posterior nerves that we have pointed out as dividing each half of 
 the spinal marrow into three surfaces, now merit our attention. When 
 we consider them superficially, we could believe that they sprung from 
 a superficial groove, from the bottom of which the roots are detached. 
 This appearance is shown particularly upon the line of the origin of the 
 posterior roots ; but with the anterior we quickly perceive that there 
 exists simply a perforation of the superficial layer very fine in this place, 
 
 * P. 136, op. cit. 
 
 
CONNECTION OF THE SPINAL NERVES. 179 
 
 and that the roots traverse this layer to go to another. To demonstrate 
 this fact, we may, after having considered the anterior in their continuity 
 with the substance of the cord, draw them slowly and with caution : we 
 thus distinguish very clearly the nervous layer which traverses these 
 anterior roots. The width of this layer is sufficient to banish any doubt 
 on the subject. The demonstration of a nervous layer traversing, at the 
 same time, a part of the posterior roots, is not so easy. The narrow line 
 from which it appears these roots are detached, particularly in infancy, 
 is very different from the neighboring surfaces: instead of presenting a 
 white color, distinct from the regions which it separates, the posterior 
 line, and the anterior also, but in a less degree, presents in the infant a 
 clear gray color, semi-transparent, across which we see a part of the 
 nervous roots penetrate a certain depth, and contrast their perfect white 
 color with clear gray semi-transparent tint of the matter they traverse; 
 but by looking with attention, aided by the microscope, an extremely 
 fine white layer covering the gray. Besides, in plunging obliquely a 
 stylet into the thickness of this gray substance, and raising it in the direc- 
 tion of the origins of the nerves, the white nervous layer which covers 
 the subjacent gray matter is stretched and torn. This observation seems 
 sufficient to repel the idea of the existence of a furrow from which the 
 roots of the spinal nerves leave." Restates distinctly that the posterior 
 roots combine with the white fibrous superficial portions of the posterior 
 columns, which form the posterior limits of their roots, that the other 
 portion of the posterior roots plunge into the gray substance visible on 
 the whole layer of these origins, and the anterior roots, like the posterior, 
 plunge into the spinal marrow, and partly unite with the fibrous substance 
 and partly with the gray. The spinal marrow of the infant is the best 
 for these observations. 
 
 Foville, after stating that it is an established principle that all the 
 nerves arising from the same column have analogous functions, in ac- 
 cordance with the fact that there are three fasciculi in the spinal cord 
 from the lumbar region to the brain, arranges the nerves thus: " 1. 
 Nerves of the posterior fasciculus ; 2. Nerves of the anterior fasciculus; 
 3. Nerves of the middle fasciculus. He divides the nerves of the poste- 
 rior column into common and special : the common are attached to the 
 posterior fasciculi and common ganglia ; the special to the same fasciculi, 
 but also to special ganglia. The special ganglia are the cerebrum and 
 cerebellum ; the auditory and trigeminal for the cerebellum ; the optic 
 and olfactory for the cerebrum. He describes the spinal accessory as 
 belonging to the lateral column of the cord, and the trigeminal and 
 pathetic to it in the cranium.* 
 
 From the statement which has been made regarding the different func- 
 tions of the anterior and posterior roots of the spinal nerves, the one 
 being destined for motion, (he other for sensation, it follows as a neces- 
 sary consequence that the anterior and posterior fibres of the cord, now 
 the continuity of the fibres of the nerves with their respective columns 
 is proved, must perform corresponding offices; in other words, that the 
 constituent fibres of the anterior and posterior portions of the cord are 
 
 * Foville, op. cit., p. 493. 
 
180 HUMAN BRAIN. 
 
 themselves implicated, the one in the production of motion, the other in 
 the conduction of what is called common sensation. 
 
 These two portions of the cord are, however, so closely united to- 
 gether that they seem to constitute no more than a single organ, although 
 performing as distinct offices, in reference to the nervous system, as 
 the arteries and veins do in the vascular ; the motor columns of the spi- 
 nal cord, in fact, .commencing from the cineritious matter which forms 
 the cortical or exterior portion of the convolutions of the cerebrum and 
 cerebellum, and terminating in the substance of the voluntary muscles, 
 the sensory columns commencing in every texture of the body and ex- 
 tending to the same points from whence the anterior arise, to wit, the 
 cineritious matter of the cerebrum, just as the arteries convey the blood 
 to all parts of the body and the veins return it, the arteries commencing 
 at the heart and ending in the capillary tissues ; the veins commencing 
 in the capillary tissues of every organ, and terminating in the heart. 
 
 Anatomists used to dispute the question as to whether the spinal cord 
 should be considered as arising from the brain, or the brain be regarded 
 as an enlargement of the spinal cord. Phanagoras, as quoted by Galen,* 
 from the fact of his dissecting the brains of serpents and fishes, regard- 
 ing the brain as a production of the spinal cord; while later authors, 
 Hippocrates, Vesalius, Willis, Varolius, Haller, Zinn, Sabatier, Winslow, 
 Portal, Chaussier, and Cuvier, have maintained the opposite opinion. 
 On the other hand, we find Tiedemann and Serres maintaining, as the 
 fathers of anatomy did, the same opinion, from a belief that the spinal 
 cord is formed before the brain, which opinion is decidedly refuted by 
 Rolando, who states that the rudiments of the cerebro-spinal system, 
 from its earliest appearance, is always larger at its anterior or cerebral 
 extremity than elsewhere ; and that Tiedemann was deceived in conse- 
 quence of the cord arriving more rapidly at a state of perfection from 
 the greater simplicity of its structure. As a third opinion, I may men- 
 tion Gall and Spurzheim, who consider that the brain no more arises 
 from the spinal cord than the spinal cord does from the brain ; that they 
 are, in fact, several existences. This last opinion appears to me correct 
 as regards the cineritious neurine, but not in reference to the medullary. 
 Indeed, when we consider the different offices performed by the two 
 columns, it is clear, as regards the function of the cord, that the anterior 
 columns ought to be described as commencing in the brain, and the pos- 
 terior as terminating there. 
 
 Gall and Haller have compared the spinal cord in man with the series 
 of ganglia in insects and in worms, and as it appears to me, with justice; 
 for although Gall may have erred in stating that there are actual enlarge- 
 ments in the spinal cord of the Vertebrata, opposite the origin of the 
 nerves, nevertheless the offices of these centres must be analogous in 
 both divisions of the animal kingdom : and I cannot accord with that 
 usually accurate anatomist, M. Cruveilhier, in regarding them as merely 
 the analogues of the ganglia at the posterior roots of the spinal nerves 
 ui man. 
 
 The gray matter in the interior of the cord is quite sufficient in itself 
 
 See Cruveilhier, p. 50. 
 
STRUCTURE OF THE MEDULLA OBLONGATA, 
 
 181 
 
 Fig. 85. 
 
 to establish their identity, and the reason why this gray matter or gan- 
 glionic portion is not moulded into knobs or swellings opposite each nerve 
 in the Vertebrata, as it is in the Articulata, is because the same quantity 
 of gray matter thus arranged would offer a greater diameter, and, con- 
 sequently, require a much wider canal, a more bulky vertebral column, 
 and a larger muscular apparatus to move it. But nature, in this instance, 
 as in every other, concentrates her instruments of power, and husbands 
 her materials. 
 
 Cranial Division of the Cerebro- Spinal Axis. The spinal cord must now 
 be followed into the skull, and its connection with the cerebral mass in- 
 vestigated. In strict accordance with the course of the nervous influence, 
 we ought to describe the voluntary or motory strands from above down- 
 wards, and those for sensation, or the sensory, from below upwards. 
 But as this mode of proceeding, even if the exact line of demarcation 
 between them had been ascertained, would greatly increase the difficul- 
 ties which unavoidably surround every mode of study in this compli- 
 cated organ, we must not attempt a plan which, however correct in a 
 physiological point of view, would not assist us in our endeavors to 
 obtain correct ideas of its anatomical structure. At the same time it 
 must not be forgotten, that when we speak 
 of the anterior columns as running up to be 
 connected with the cerebrum and cerebel- 
 lum, our language is not merely metaphorical, 
 but is positively physiologically incorrect. 
 
 Medulla Oblongata. The spinal cord, 
 shortly after its entrance into the skull, be- 
 comes considerably enlarged, and changes 
 its name to medulla oblongata (see fig. 85). 
 This will be found upon section to be entire- 
 ly altered as regards the arrangement of the 
 cineritious neurine contained in its interior. 
 And here let it be distinctly understood that 
 this enlargement is not occasioned by any 
 swelling of the fibrous or medullary portion, 
 but by the deposit of cineritious neurine in 
 
 greater quantity than it is met with in the composition of the cord; by 
 the deposition, too, of this constituent of the nervous system in separate 
 and isolated points or masses, a circumstance which does not appear 
 to me to have received the attention which I cannot help thinking it 
 deserves. The view I am inclined to take of the character of the parts 
 comprising the medulla oblongata, is simply this: in addition to the co- 
 lumns for motion and sensation, there are here deposited, and imbedded 
 to a certain extent in its substance, six ganglia, three on each side, an- 
 terior, lateral and posterior. The anterior are ovoid bodies, which derive 
 the name of olivary (corpora olivaria) from their form. 
 
 We have seen the anterior ganglia in most of the Mammalia, though 
 not always u cropping out on the surface," as the geologist would say. 
 The lateral are the ganglia of the pneumogastric nerves (ganglia resti- 
 formia). We have seen them in. the Yertebrata generally, and more 
 
 Medulla oblongata. s. Olivary 
 ganglion. T. Pyramidal eminence, 
 w. The restiforrn body to the outer side 
 of the last-mentioned. 
 
182 
 
 HUMAN BRAIN. 
 
 86 - distinctly separated from the posterior in some of 
 
 the more bulky Mammalia, where the motor and 
 sensory columns are larger than in man. 
 
 The posterior ganglia are found in the fissures 
 at the back part of the cord, which is known by 
 the name of the fourth ventricle (see fig. 86). 
 They form two projections of a pyramidal form* 
 (see fig. 78, F). In these terminate the auditory 
 or eighth pair of nerves posterior pyramidal 
 bodies, or auditory ganglia. They have been 
 remarked in the fish under the title of tubercles 
 of the fourth ventricle. f 
 
 The arrangement of the cineritious neurine in 
 the olivary bodies will be understood by referring 
 to figs. 86 and 87, where the beautiful contrivance 
 which has been adopted in the arrangement of the 
 cineritious neurine in this ganglion is exhibited. 
 A transverse section (fig. 86) shows the neurine 
 forming a waving line, open internally, but pre- 
 senting a convexity outwards and forwards ; a 
 longitudinal section (fig. 87) still shows a waving 
 line, but the convexity outwards, the concavity 
 inwards. This arrangement is of exactly the 
 same kind as that employed in the hemispherical 
 ganglia, namely, a contrivance by which an ex- 
 tensive surface of neurine is packed into the small- 
 est space. The cineritious neurine of this ganglion 
 appears, indeed, as if it were crumpled up to ac- 
 commodate it to its confined situation. 
 
 The olivary bodies are not isolated ganglia, 
 but, like the rest of the cerebral ganglia, more or 
 less united ; they are connected, by means of some 
 of the longitudinal fibres of the antero-lateral 
 columns, with the cord below and the brain above 
 (fig. 87, ot,ot)0t}. These fibres constituting the 
 olivary columns, are on a plane posterior to the 
 posterior division of the pyramidal bodies, which 
 they come in contact with, and then diverge from 
 them again. It has been said that in the crus ce- 
 rebri these olivary columns appear to divide into 
 two portions, the one passing forwards above the 
 
 * Ruysch describes the restiforrn bodies under the name of posterior pyramidal ; and 
 Rolando describes the internal lamina of the restiforrn todies by that name, and even warns 
 the reader against confounding them with the restiibrm bodies. 
 
 t Foville says, " The restiforrn body is incontestably a prolongation of the posterior fascicu- 
 lus of the spinal cord. The olivary body, and small filaments in the interval of which it is 
 situated, are evidently continuous with the antero lateral columns of the spinal cord." P. 312. 
 " The olivary eminences are but a part of the lateral fasciculus, containing in their interior 
 a double festoon of yellow substance. The superincumbent white layers which compose 
 the exterior of the olivary bodies may be easily traced to the superior parts of the lateral 
 fasciculus." This author does riot propound any theory of the probable office of this gan- 
 glion. 
 
 Sections of the medulla ob- 
 longata at the situations indi- 
 cated by transverse lines in 
 fig. 85. F. Auditory ganglion 
 or posterior pyramidal body. 
 G. Pneumogastric ganglion, 
 s. Olivary ganglion. The gray 
 matter in sections 5. 6, and 7, 
 show the gradual deposit of 
 the anterior and posterior 
 peaks of the gray matter of 
 the spinal cord. 
 
STRUCTURE OF THE MEDULLA OBLONGATA. 
 
 183 
 
 locus niger, the other ascending to the tuberctila quadrigemina and 
 thalami nervi optici ; but this description is not physiologically correct. 
 The greater part of the olivary column, for reasons stated further on, 
 must be considered a part of the motor tract. 
 
 Fig. 87. 
 
 The special object of this drawing is to show the relative course of the pyramidal and olivary portions 
 of the motor tract through the pons Varolii and cms cerebri, as exhibited by a longitudinal section. It 
 also shows a most important point in the anatomy of the medulla oblongata, namely, the connection of 
 the motor root of the fifth nerve, we, with the olivary tract, c. Anterior optic tubercle D. Posterior ditto. 
 E. Cerebellum. K. Optic thalamus. M. Corpus striatum. p. Corpus callosum. s. Olivary body. T. Pyra 
 midal ditto, x. Pons Varolii. i & c. Inter-cerebral commissure, or processus 6 cerebello ad testes. 
 b b. Optic nerves, e. Third pair. / n. Locus m'ger. m e. Motor root of the fifth pair, o t. o t,o t. Olivary 
 tract, one portion running up to the optic tubercles; another running through the pons Varolii. p t, p t. 
 Pyramidal tract running through the pons Varolii, the continuation of which through the corpus striatum 
 is marked m t. 
 
 The true olivary columns are placed to the outer side of the sensory 
 tract.* 
 
 These olivary columns connect together the origins of the third, 
 fourth, and fifth pair, the auditory nerves, pneumogastric, glosso-pharyn- 
 geal, and lingual nerves. These extensive commissural connections of 
 the olivary ganglia render my supposition regarding their office still more 
 probable. If it is their office to preside over the movements of the 
 tongue as an organ of speech, we can quite understand the necessity of 
 its being closely connected with all the ganglia of special sensation. 
 
 Dr. Todd considers " that the olivary columns constitute the funda- 
 mental part of the medulla oblongata, that on which its action as a dis- 
 tinct centre depends." 
 
 Gall described this fasciculus of fibres ascending from the olivary bo- 
 dies through the pons Varolii. Rolandof distinctly denies that any such 
 fibres are to be met with ; at the same time he suggests that the fibres 
 so described are most probably "the anterior cords of the medulla spi- 
 nalis, which are compressed, as it were, between the peduncles of the 
 cerebellum and olivary bodies." 
 
 In the sheep, the horse, the calf, and the cat, I find (see figs. 52 and 
 56) that there is a wavy line of gray matter in the very centre of the 
 
 1847. I have again and again dissected these parts, and I am quite convinced of the 
 
 8. 
 
 Toreno, 1828. 
 
 accuracy of my description, though in opposition to some high authorities. 
 I Saggio sopra la Vera Struttura del Cervello, 2d edit., vol. i. p. 53. 
 
184 HUMAN BRAIN. 
 
 corpus pyramidale, which is clearly the analogue of the corpus olivare 
 in man. In the porpoise, as already mentioned, this deposit of gray 
 matter holds the same situation, only that it forms a projection on the 
 surface, which it does not in the horse and calf. In the horse it is some 
 distance from the pons Varolii, and much nearer the origin of the lingual 
 nerve than the pneumogastric. The difference of its position in the hu- 
 man subject I conceive simply arises from the difference in its size, 
 which in man is so great that it is pushed upwards to the surface. 
 
 Dr. John Reid,* in an interesting paper, entitled, " On some points in 
 the Anatomy of the Medulla Oblongata," was, I believe, the first to 
 point out that u the olivary is a motor column." I have carefully inves- 
 tigated this point since my first edition : I fully agree with him ; also in 
 the important fact that the motor root of the fifth pair arises from it, 
 which I made out, without being aware that he had previously disco- 
 vered the same. The origin of the motor or non-ganglionic root of the 
 fifth pair of nerves has long puzzled anatomists, and we find a different 
 description in most anatomical works. One of the latest and more care- 
 fully detailed is by Dr. B. Alcock, of Dublin, in the Encyclopaedia of 
 Anatomy ; it is too long to extract as a whole. He traces both roots 
 down to the medulla oblongata, saying that u having traversed the crus 
 cerebelli, they are both attached below and behind it to the same part as 
 the greater packet (the sensory division) and posterior to it." He states 
 that there is a slight eminence at the point of junction of the two roots, 
 from which two cords descend, " one for each column of the spinal mar- 
 row," one portion into the posterior column, the other into the anterior. 
 Now it appears to me that Dr. Alcock has traced the olivary column 
 down as the motor root of the nerve. At the same time it should be 
 understood that the above short account does not do justice to the very 
 full and minute description which Dr. Alcock has given, and which the 
 anatomist should peruse for himself. In fig. 87, the reader will see the 
 connection of the motor root of the fifth, as easiest displayed by dis- 
 section. 
 
 The ganglia restiformia, or the ganglia of the pneumogastric nerves, 
 which form such a prominence in the skates and some olher fishes, do 
 not form any projection on the surface of the medulla oblongata of the 
 human subject. They are covered by the fibres of the corpora resti- 
 formia ; their relative situation, and the anatomical line of demarkation 
 between them and the auditory ganglia, may be seen distinctly in a trans- 
 verse section of the medulla oblongata at this part (fig. 86). 
 
 The ganglion restiforme (G) I have little doubt is an important organ 
 in the function of respiration, for the pneumogastric nerve, which both 
 terminates in it and arises from it, like the spinal nerves, is a com- 
 pound nerve ; it is a nerve of sensation in relation to the sensibility of 
 the lining membrane of the respiratory organs, the "besoin de respirer" 
 is dependent upon it; it is also a nerve of motion, in as much as the 
 muscles of the larynx and the muscular tissue of the trachea, bronchi, 
 and stomach, are under its control. So far, then, the opinion of Mayo, 
 referred to further on, that nerves of sensation and motion supplying the 
 
 Edinburgh Medical and Surgical Journal, January, 1846, vol. Iv. p. 15. 
 
 -.;..' : . 
 
STRUCTURE OF THE MEDULLA OBLONGATA. 185 
 
 same parts are connected with one deposit of cineritious neurine at their 
 central extremity, is confirmed in this instance. It is therefore highly 
 probable that the gray matter at the posterior part of the cord (G) is a 
 central point, from whence emanates that peculiar power which the sys- 
 tem of respiratory nerves conducts, and by which they call the respiratory 
 muscles into action independently of volition'. In support of the opinion 
 that the respiratory muscles are dependent on this portion of the medulla 
 oblongata for their stimulus to contraction, the results of two or three 
 experiments may be related. 
 
 A section of the spinal cord made above the origin of the intercostal 
 nerves simply annihilates, as regards the respiratory movement, the 
 power of the intercostal muscles. A section above the phrenic nerve 
 induces paralysis of the diaphragm also; while a section exactly at the 
 origin of the par vagum, and therefore through the medulla, occasions 
 a total cessation of every respiratory movement, and instant death. If 
 the section, however, be made above this point, then the whole of the 
 respiratory movements take place as usual. Is it not, then, from this 
 point, and this only, that they draw their power of motion ? A section 
 of the par vagum produces no such immediate effect; the section must 
 destroy the restiform ganglion before total interruption to the respiratory 
 action can take place. 
 
 For the proofs that the sensibility of the air-passages is dependent on 
 their connection with the encephalon through the intervention of the par 
 vagum, I must refer my readers to Brachet's* researches on this interest- 
 ing subject. 'f-i < 
 
 The relation of the antero-lateral and posterior columns of the spinal 
 cord to these ganglia of the medulla oblongata, must next be studied, as 
 this will be the clearest method we can adopt for arriving at a knowledge 
 of their connection with the cerebral mass. 
 
 For this purpose let the pia mater be carefully dissected off from the 
 surface of one-half of the spinal cord, and, in so doing, all the nerves 
 on one side may be removed ; those on the opposite, however, being 
 sedulously avoided. In removing this membrane, where dipping into 
 the anterior fissure, as described in the directions for dissecting the cord, 
 the student will find, about an inch and a half from the pons Varolii, 
 several medullary bands crossing the anterior median fissure obliquely 
 from one side of the cord to the other ; these bands belong to the ante- 
 rior columns: and this crossing of their fibres from one side to the other 
 is technically called the decussation of the pyramidal bodies (see fig. 85). 
 
 This fact of the decussation of the anterior columns or motory tract of 
 the spinal cord is extremely important, and particularly interesting in a 
 pathological point of view, explaining, as it does, the fact, that disease 
 of the right side of the brain almost uniformly produces paralysis of the 
 left side of the body, and vice versa. Hippocrates himself mentions the 
 fact, that lesions on one side of the head were often observed to occa- 
 sion palsy on the opposite side of the body ; but Aretaeus was the first 
 who attempted to explain it, by supposing a decussation of the nerves 
 at their origin in the brain. Dion Cassius is the next who speaks of a 
 
 * Recherches Experimentales sur les Fonctions du Systeme Nerveux Ganglionaire, par 
 J. L. Bracket, 1834, p. 135. 
 
186 HUMAN BRAIN. 
 
 decussation of the cerebral nerves and spinal cord ; but with him the 
 subject dropped, and the attention of the medical world was only recalled 
 td the fact in 1581, by Fabricius Hildanus. The true decussation of the 
 pyramidal bodies, however, was first described by Mistichelli, in 1709 ; 
 it was noticed by Petit in the year following, and at a later period by 
 Lieutaud, Santorini, and Winslow. The same authors also speak of 
 other decussations, but probably on mere supposition. 
 
 " Modern anatomists," says Dr. Spurzheim, " before Dr. Gall and 
 myself, were divided in opinion upon the subject of decussation. Many 
 admitted the fact, but no one pointed out the place of its existence. 
 Vicq d'Azyr, for example, confounds the simple transverse fibres between 
 the two halves of the spinal cord with the true decussation of the pyra- 
 midal bodies. Many others, among the number Prochaska, Barthez, 
 Sabatier, Boyer, Dumas, Bichat and Chaussier, have, in the most posi- 
 tive terms, denied the decussation of the pyramidal bundles altogether, 
 as we have shown in our reply to the Report of the Committee of the 
 French Institute upon our Anatomical Memoir."* 
 
 Rolando entertains some curious ideas on the subject of the pyramidal 
 bodies; for he states, page 60 of the work referred to, that " the pyra- 
 midal bodies must not be considered as a division of the principal cords 
 of the spinal marrow, since these fasciculi of medullary fibres are not in 
 any way continuous with the fibres of the medulla, which it is easy to 
 see. The fibrous fasciculi, and the roots, so to speak, of the pyramids, 
 begin on the anterior face of the medulla spinalis fourteen or sixteen 
 lines below the annular protuberance, and the anterior columns run 
 behind them. It seems that Tiedemann has been led to admit the con- 
 tinuation of the pyramids with the anterior columns, from the decussa- 
 tion observed at this point: however, the fact that the fibres of the 
 pyramids only have their origin from that point at which the crossing is 
 perceptible, forms a strong argument against the received disposition; 
 since it is very evident that if they only arise from this point, they cannot 
 pass to the opposite, or be continuous with the fibres of the spinal mar- 
 row." In addition to which, Rolando states that his observations on 
 the chick confirm his opinion that the pyramidal bodies are merely placed 
 upon the spinal marrow. 
 
 Burdachf describes the pyramidal bodies as consisting of fundamental 
 and decussating fibres; the fundamental fibres he derives from t\\z floor 
 of the anterior median fissure : in this particular he appears to me in error, 
 and for this simple reason the floor of the median fissure, as I have 
 already stated, is formed by transverse commissural fibres, and the supe- 
 rior edge of this commissure of the cord is distinct immediately below 
 the point of decussation, but without any fibres to be seen ascending 
 from it. 
 
 Burdach, however, is perfectly right in describing certain fibres of the 
 anterior columns, which form the edge of the anterior median fissure, 
 and enter into the composition of the pyramidal bodies, as continuing 
 the course along the same side of that fissure without crossing it.f , 
 
 * See Spurzheim's Anatomy, p. 147. 
 
 t Vom Baue und Leben des Gehirns. Leipsic, 1822, vol. ii. p. 31. 
 
 j Cruveilhier, who admits the decussation of the pyramidal bodies, nevertheless denies 
 
PYRAMIDAL BODIES. 187 
 
 The decussating fibres of the pyramidal bodies are derived from the 
 antero-lateral columns behind the anterior roots of the spinal nerves, and 
 in front of the posterior peaks of gray matter. Ascending from this posi- 
 tion in the cord towards the mesial line to decussate with their fellows 
 on the opposite side, they pass to the inner side of the main portion of 
 the anterior columns, which here retreat from the mesial line to make 
 way for them. The lateral columns, then, in passing from the posterior 
 and outer side of the cord towards the inner, are overlaid by certain fibres 
 of the anterior columns. Some of these fibres of the anterior columns 
 ascend like those of the pyramidal bodies through the pons Varolii to the 
 cerebrum ; but encountering the olivary bodies in their way, they are 
 split by them, and, forming an envelop for them, have been called by 
 Burdach, Hullenstrange, or envelop, or shell cords. Other fibres from 
 the anterior columns, which will be more minutely described elsewhere, 
 run up to the cerebellum. 
 
 There are, it is true, a few cases on record, in which no decussation 
 of the pyramidal bodies has been discovered; but such cases must be 
 viewed as exceptions to a general rule. Let the student, then, distinctly 
 understand, that the pyramidal figure, which appears drawn, as it were, 
 on the anterior surface of the cord, and gives rise to the term corpus 
 pyramidale, is simply caused by the crossing over of the constituent 
 fibres of the antero-lateral columns from one side to the other; that it is 
 not occasioned, as is the projection of the corpus olivare, by the addition 
 of fresh masses of either cineritious or medullary neurine, as supposed by 
 Rolando. Though the term pyramidal body is objectionable, as implying 
 the existence of an independent or distinct structure, nevertheless, as 
 the term has been so long sanctioned, we must continue to employ it, 
 at the same time considering it merely an appearance necessarily pro- 
 duced by the oblique overlaying of certain constituent fibres of the cord. 
 
 The decussating fibres of the spinal cord are therefore not merely the 
 fibres of the anterior columns, but also those of the lateral columns: the 
 posterior surface of these decussating fibres may be seen from behind by 
 separating the sides of the posterior median fissure; and I cannot help 
 thinking that it must have been this view of the decussation of the pyra- 
 midal bodies which Sir Charles Bell mistook for a true decussation of the 
 posterior columns. For I have looked frequently, but in vain, for any 
 such decussation of the posterior columns. 
 
 A view of the section of the cord at this point will, I think, be found 
 very interesting, .as showing the relation of the decussating fibres to the 
 gray matter (see Nos. 5 and 6, figs. 85 and 86). 
 
 Line of Demarkation between the Tracts of Sensation and Motion. 
 Although the different offices performed by the anterior and posterior 
 roots of the spinal nerves have been, I think, clearly ascertained, and as 
 it is also evident that the spinal cord consists of tracts of neurine whose 
 office is the same as the nerves which are connected with them, and 
 therefore that there are portions of the cord which perform functions as 
 distinct from each other as the arteries and veins, still anatomists are not 
 yet agreed as to the line of demarkation between them. Sir Charles Bell, 
 
 that they are continuous with the anterior columns. P. 594, t. iv., he says, " Que les pyra- 
 mides anterieures ne sont en aucune facons continues aux cordons antrieures de la Moelle." 
 
188 
 
 HUMAN BRAIN. 
 
 Fig. 88. 
 
 for instance, in a paper published in the 135th vol. of the Philosophical 
 Transactions, states that he regards the lateral portion of the antero- 
 lateral columns as a part of the tract for sensation, and I have no doubt 
 of its correctness. The circumstance of there being no decided anato- 
 mical line of division between the two columns, is not of itself an argu- 
 ment against the correctness of this view ; for it is quite possible that 
 perfect distinctness of parts, as regards their function, without any visible 
 line of separation between them, may exist. We must always bear in 
 mind that the neurine which composes the cord, is supported and clothed 
 by a perfect though delicate membrane, which, pervading its substance 
 in every direction, is undoubtedly as capable of separating masses of 
 neurine endowed with distinct powers, and ordained by nature to execute 
 distinct offices from each other, as any fissure, however wide, or mem- 
 brane, however thick. The presence of such gross and palpable parti- 
 tions, it is true, would save us some trouble in discovering the line of 
 deraarkation, but would not necessarily make it in any way more efficient. 
 They are not the less distinct organs because of our ignorance of their 
 respective limits, any more thagi a nerve of motion is one of sensation 
 because we are incapable of unraveling the fibres of each from their 
 common investing membrane. 
 
 That the boundary line between the two organs of sensation and 
 voluntary motion comprised within the spinal cord cannot be formed by 
 
 the posterior peak of gray matter, is very de- 
 cidedly proved by the fact that a portion of 
 the fifth pair of nerves, which we know to 
 be a nerve of sensation from the beautiful ex- 
 periments of Mayo and Sir Charles Bell, is 
 not connected with the posterior, but with 
 the lateral columns. This is seen in fig. 94. 
 Some have supposed that the olivary bo- 
 dies divide the motor from the sensory co- 
 lumns ; but we have seen in the medulla of 
 the horse, &c., that the position of the above 
 ganglion varies, and is accidental : in some 
 actually imbedded in the pyramidal tracts. 
 In the human subject we often find the fibres 
 of the anterior columns diverging at these 
 bodies, and meeting below them, as will be 
 seen in fig. 88. 
 
 The antero-lateral columns within the spi- 
 nal canal consist of fibres, which simply lie 
 parallel to each other without interlacing like 
 the filaments of a nerve ; so that if a portion 
 of the cord (previously hardened in alcohol) 
 
 This drawing exhibits an unusual, , .*, r * . ,. . i 
 
 hut instructive, separation of the be taken in the tOTCepS, it Splits Up WltnOUC 
 
 any difficulty, and the fibres themselves do 
 
 >' a PP ear to . be to [' bu' ""fly t he " 
 
 brane Connecting them. ll thlS mOUC Ot 
 fibres of the anterior columns seen .. , , I t \ 
 
 x. Pons Varoiii. proceeding, however, be attempted on the 
 medulla oblongata, we find, that the fibres, 
 
 form body, some of the cerebellar 
 fibres of the ant 
 
 on the surface, 
 
 turued 
 
CEREBELLAR FIBRES OF THE SPINAL CORD. 
 
 no longer maintaining an even parallel course, easily break off; and 
 great care, therefore, is required to trace them to their destination, for 
 some begin to take one course and some another. 
 
 Before attempting to dissect them, the student had better digest the 
 following outline of their course and destination. Each lateral half of 
 the spinal cord consists of a posterior column and an antero-lateral co- 
 lumn. The antero-lateral column is divisible, physiologically, into two 
 portions, the anterior half of the cord or two-thirds of the antero-lateral 
 column forming the motor tract, the posterior third of the antero-lateral 
 column being half of the sensory tract. 
 
 The anterior or motor tract is anatomically further divisible, viz., into 
 two columns, fhe pyramidal and olivary. Both of these give fibres to 
 the cerebrum and cerebellum. 
 
 Besides these fibres of the antero-lateral columns, which may be de- 
 scribed under the title of cerebral and cerebellar fibres of the anterior or 
 motory columns, there is another set which, in the spinal cord, occupies 
 a completely lateral position, being separated from the posterior columns 
 by the posterior peaks of gray matter. These were regarded by Sir 
 Charles Bell as the cerebral strands of sensation; cerebral, because, as 
 will be explained a little further on, they terminate in the cerebrum ; of 
 sensation, because the posterior roots of the spinal nerves are connected 
 with them. 
 
 All the fibres of the posterior columns, or those columns which are 
 separated from the rest of the cord by the posterior peaks of cineritious 
 neurine and the groove of the'posterior roots of the spinal nerves, take 
 their course directly to the cerebellum ; none of them whatever can 
 be traced to the cerebrum. Both these portions of the sensory tract 
 will be traced to the cerebrum after the description of the course of the 
 anterior columns is concluded. 
 
 Let us first follow the fibres of the spinal cord which go to the cere- 
 bellum. Of the fibres which run from the antero-lateral columns to the 
 cerebellum, there are evidently two sets, one superficial and one deep. 
 
 The superficial, which may again be divided into two sets, are de- 
 rived from the pyramidal columns, the deep from the olivary columns. 
 The former cross the surface of the cord immediately below the corpus 
 olivare, and may generally be seen without dissection ; they are more 
 distinct in the sheep, bullock, and horse, than in man, in whom they 
 form a very thin layer emanating from the corpora pyramidalia, and I 
 have no doubt that they actually decussate with their fellows of the op- 
 posite side, forming in fact part of the apparatus of decussation, though 
 I have not yet positively ascertained the fact. 
 
 The second of the superficial set of fibres take the same direction : 
 only, instead of crossing the cord immediately below the corpus olivare, 
 they run to the inner side of the corpus olivare, and then ascending to 
 the cerebellum, they form the outer part of the corpus restiforme. 
 
 The deep set of fibres from the antero-lateral columns to the cerebel- 
 lum, are the most posterior of the whole mass of fibres composing this 
 portion of the spinal cord. They are separated from the posterior co- 
 lumns by the posterior fissure, from which the posterior roots of the 
 
190 
 
 HUMAN BRAIN. 
 
 spinal nerves emerge ; this fissure they cross in their passage to the 
 cerebellum, obliterating it entirely. 
 
 Fig. 89. 
 
 Fig. 90. 
 
 Fig. 89. This figure exhibits those fibres from the anterior columns which, ascending to the cerebel- 
 lum, connect the motor tract with that portion of the cerebral mass. E. Cerebellum, x. Pons Varolii. 
 T. Pyramidal eminences, s. Olivary bodies, w w. Corpus resti forme, its surface having been carefully 
 scraped, in order to show the superficial cerebellar fibres of the anterior columns. They'ure represented 
 rather more distinct and thick than they really appear, though their course, direction, and relation to 
 the olivary body, are faithfully given. 
 
 Fig. 90 displays a deeper view of the same fibres, and the connection of the sensory root of the fifth 
 pair of nerves with the lateral portions of the spinal cord, and the passage of this root behind the cerebel- 
 lar fibres of the anterior columns, w w. The corpus olivare having been raised, those fibres which run 
 behind that body are exposed. The figures are the same as the last, with the exception of s e, designat- 
 ing the sensory root of the fifth pair of nerves, and p, which designates the fibres from the posterior co- 
 lumn forming part of the restiform bodies, or processus 6 cerebello ad medullam oblongatam. 
 
 Thus it will be perceived that one portion of the antero-lateral co- 
 lumns for there is yet another portion of these columns to be described 
 on reaching to within a small distance of the corpus olivare, splits 
 into three sets of fibres : one, the most anterior, which passes through 
 the pons Varolii, as will be described presently, may be designated the 
 cerebral fibres of the anterior columns ; a second set, which may be en- 
 titled the superficial cerebellar fibres of the anterior columns, passing 
 over the surface of the medulla oblongata, are usually seen without dis- 
 section. 
 
CEREBELLAR FIBRES OF THE ANTERIOR COLUMNS. 191 
 
 Rolando* describes the superficial cerebellar fibres of the anterior 
 columns, those which are seen without dissection, (the processes arci- 
 fonnes of Santorini,) under the name of " filamenti arciformi," saying, u I 
 believe that I ought to give such a name to numerous filaments which 
 are seen to issue from the transverse fibres of the annular protuberance 
 precisely at the same spot where the anterior cords penetrate into its 
 cejntre. The filamenti arciformi nevertheless descend and partly cover 
 the above-mentioned cords, expanding on the corpora olivaria, and ex- 
 tending even to the median fissure, by which they remain separated from 
 each other. Such a disposition is constantly observable in quadrupeds, 
 in which the said filaments are extremely distinct, although no mention 
 has hitherto been made of them." Rolando does not, however, trace 
 them, as he might have done, to the cerebellum instead of describing 
 them as descending from the pons Varolii. 
 
 The third or deep cerebellar fibres of the antero-lateral columns, pro- 
 ceeding in company with those of the posterior columns, form about a 
 fourth part of the whole diameter of the restiform bodies. 
 
 From the above description it will be remarked that the anterior 
 columns of the cord, which have hitherto been spoken of as simply 
 passing up through the pons Varolii or commissure of the cerebellum, to 
 be connected with the cerebrum,! are described as passing also to the 
 cerebellum. In a paper which was read before the Royal Society in May 
 1836, and published in their Transactions, part 2d, for 1836, 1 proved 
 that they were connected with the cerebellum as well as with the cere- 
 brum, as allowed by Mr. Mayo and Mr. Owen, to whom my prepara- 
 tions were referred. Since that time I have had the opportunity of 
 showing the same preparations to many of the first anatomical teachers 
 in England, who consider the point fully established. They are now 
 deposited in the Museum of the College of Surgeons. The corpora 
 restiformia, or the processuse cerebello ad medullam oblongatam, are not 
 therefore, as they have usually been described, bodies which are formed 
 solely by the posterior columns: nor are they bodies which consist of 
 fibres from the posterior columns, to which some fibres from the anterior 
 columns are added, the additional fibres lying perfectly parallel to those 
 of the posterior columns ; but they are bodies which consist of fibres 
 that interlace in rather an intricate manner, the interlacing fibres consist- 
 ing of some from the antero-lateral and some from the posterior columns. 
 
 It is rather curious that Rolando should have approached so nearly to 
 the discovery of the fibres above described, as connecting the anterior 
 
 * Op. cit., vol. i. p. 147. 
 
 { Meckel speaks of the anterior columns, as dividing into two halves, an anterior and 
 posterior; these he describes as running up to the inner side of the corpora olivaria, on a 
 plane with the fourth ventricle. Besides which, he states that a smaller fasciculus, which 
 Gall describes as being occasionally absent, after touching the above bodies, ascends to the 
 corpora quadrigemina. Mr. Mayo is almost the only author who points out the fact, that the 
 restiform bodies are not alone formed by the posterior columns, though the exact course of 
 the additional fibres he was not aware of, for he describes the superficial fibres spoken of 
 above, as descending instead of ascending. In his second edition of his Outlines of Physi- 
 ology, p. 273, he says, "On cutting through and stripping down the corpus restiforme, it is 
 found to carry with it the posterior lateral furrow; the anterior lateral furrow terminates 
 among fasciculi which are continuous with the corpus olivare." The observations he omitted 
 in his 3d edition. 
 
192 HUMAN BRAIN. 
 
 columns with the cerebellum, and yet have just fallen short of under- 
 standing them, as is even more evident by the further perusal of other 
 passages in his writings; for at p. 142 he remarks: " All anatomists 
 agree in saying that the posterior surface of the olivary body is in con- 
 tact with the superior surface of the peduncles of the cerebellum. Ma- 
 lacarne observes, however, that they are separated from them by means 
 of a medullary layer of the shape of a half-moon. To my thinking, this 
 question has been too superficially examined. No anatomists who have 
 especially studied the brain have detected that between the said olivary 
 bodies and the inferior peduncles of the cerebellum are placed fasciculi 
 of medullary fibres which are continuations of the anterior cords of the 
 medulla spinalis. This omission appears to me to have arisen from their 
 not having paid sufficient attention to the direction of the fibres and fila- 
 ments of which these are composed. If the anterior cords of the medulla 
 spinalis be carefully examined a little below the pyramids, we see that 
 they send fibres from the anterior median fissure to the posterior lateral 
 fissure, which forms the line behind which issue the posterior roots of 
 the spinal nerves, and as the said columns advance upwards, they contract. 
 The fibres that were previously expanded become convergent, and are 
 found compressed between the pyramidal bodies and the cineritious 
 tubercles;* and following them upwards, they are found strongly com- 
 pressed, and, as it were, hidden between the corpora olivaria and the 
 inferior peduncles of the cerebellum, on which account they have eluded 
 the minute investigations of anatomists among these parts. For in order 
 to see these fibrous cords distinctly, which are flattened externally and at 
 the same time a little curved, it is necessary to separate the olivary bodies 
 from the inferior peduncles of the cerebellum: in this place they are 
 covered by the arciform filaments, to be spoken of shortly. Then, above 
 this point, if you wish to follow the fibres of the said cords downwards, 
 it is easy to see that anteriorly they are directed towards the inferior ex- 
 tremities of the olivary bodies and the pyramids, in order to form that 
 portion of the medulla spinalis which folds into the anterior median 
 fissure; whilst these find themselves in contact with the inferior pedun- 
 cles of the cerebellum they bend backwards, carry themselves towards 
 the posterior surface of the cineritious tubercles, and go to form the 
 posterior lateral fissure. It is more difficult to follow the anterior 
 cords towards the superior region of the medulla oblongata" At this 
 point his observation has failed him, for instead of tracing them, as he 
 might have done, to the cerebellum, he.goes on to say : u But one may often 
 succeed in seeing them when they bend over the superior extremity of 
 the olivary bodies, where is formed that space which Malacarne has called 
 the fossa quadrilatera. Nevertheless, it is only by means of transverse 
 sections, made and repeated at like distances, that the anatomist will 
 obtain an exact idea of their arrangement at the part in question ; in this 
 manner they may get behind the above-mentioned cords, although hidden 
 in the cineritious substance of the annular protuberance."! 
 
 The best method of dissecting the medulla oblongata, with a view of 
 demonstrating clearly the existence of those fibres which connect the 
 
 * The cineritious tubercles are described as bodies situated on the lower part of the resti- 
 form bodies. 
 
 f Op. cit., p. 149. 
 
FUNCTION OF THE CEREBELLUM. 193 
 
 anterior columns with the cerebellum, is, either to split the posterior 
 column from the antero-lateral column, by raising only the posterior 
 columns, or, in other words, that portion which is between the posterior 
 lateral and posterior median fissure, about two inches below the pons 
 Varolii ; and drawing the portion thus separated very carefully up to- 
 wards the cerebellum, the dissector will find that the splitting will be 
 stopped before the cerebellum is reached by the superficial cerebellar 
 fibres of the anterior columns, unless so much force is used that the 
 superficial fibres are torn through without observation. Or another mode 
 of dissecting them is to trace the sensory root of the fifth pair of cerebral 
 nerves through the pons Varolii, down to its connection with the posterior 
 portion of the antero-lateral column, in doing which a layer of fibres will 
 be met with in the medulla oblongata about the thickness of hogs' bristles, 
 running from beneath the olivary bodies on the outer side of the above- 
 mentioned root of the fifth pair of nerves, to the cerebellum, forming a 
 portion of the restiform body in their progress (fig. 90, w w). 
 
 The first set of superficial cerebellar fibres are represented (fig. 89, 
 w w) passing upon the surface of the corpus restiforme. The second, or 
 deep, set of the cerebellar fibres are represented cut through in their 
 passage to the cerebellum, just as they cross the sensory tract of the fifth 
 pair (fig. 90, w w). 
 
 The fibres just described as connecting the antero-lateral columns of 
 the cord with the cerebellum, are peculiarly interesting when viewed in 
 relation to the functions of the cerebellum. For although it is true that 
 its functions have not yet been clearly ascertained, the experiments of 
 Flourens, Bouillaud, Magendie, and others, and the numerous cases on 
 record in which disease of the cerebellum has been followed by paralysis, 
 all tend to prove that the cerebellum is in some way or other connected 
 with the regulation of muscular action, most probably, as before hinted 
 at, that it has the power of combining the action of individual muscles 
 so as to effect an harmonious result, such as is necessary to enable us to 
 stand, walk, &c. Even Broussais, in his lecture on Phrenology, published 
 in the Lancet, July 30th, 1836, acknowledges that the cerebellum is an 
 instrument connected in some degree with the combined action of the 
 muscles, though merely in relation to the act of copulation. Their pre- 
 sence also proves the weakness of Mr. Walker's theory of the function 
 of the posterior columns, as derived from the supposed fact that the pos- 
 terior columns alone are connected with the cerebellum. 
 
 This circumstance is also at variance with the opinions of M. Foville, 
 who reasons that the cerebellum must be concerned in the phenomena 
 of sensation, because the posterior columns are alone connected with it;* 
 while Dr. Prichard,in his treatise on Insanity, and other disorders of the 
 Mind, p. 482, after speaking of Foville's doctrines, and their foundation 
 
 * Diet, de Med. et de Chirurg. Prat., tome vii. p. 202, art. EITCEPHALE. " Or nous voyons 
 les cordons posterieurs de la moelle, affectes a la sensibilite, se prolonger dans le cervelet; 
 les cordons anteiieurs, afTectes au mouvement, s'entrecrosier dans les pyramides, poursuivre 
 apres cet entrecroisement leur marche vers le cerveau, dans 1'epaisseur duquel ils pene- 
 trent tres profondement ; et nous trouvons ainsi une raison anatomique de supposer que lo 
 cervelet doit avoir remplir un role tres-important dans les phenomenes relatifs a la sensi- 
 bilite, tandis que le cerveau jouirait d'une influence directe et centrale sur la production des 
 mouvements volontaires." 
 
 13 
 
194 
 
 HUMAN BRAIN. 
 
 upon what he considers an established fact in anatomy, says, with the usual 
 caution of such a highly-talented observer: " In the present state of these 
 researches, it would be a rash attempt to draw inferences with any degree 
 of confidence; but I may be allowed to remark that the general bearing 
 of facts seems to direct towards the conclusion that the two great organs 
 inclosed within the skulls of vertebrated animals, belong respectively to 
 the two principal functions of animal life, which are, first, sensation, 
 conscious perception, and the physical phenomena related to intelligence ; 
 and, secondly, those of voluntary motion. This, however, can only be 
 
 Fig. 91. 
 
 Tliis is from a dissection of a brain which had been hardened in spirits of wine It represents the 
 base of the brain with the course of the fibres from the pyramidal or motor columns, on the left side ex- 
 posed continuously from the pyramidal body (T), through the pons Varolii (x), which has been partly re- 
 moved on that side, forming (u) the under part of the crus cerebri, plunging to the corpus striatum (M), 
 emerging (mm mm) from thence, and running forwards, forwards and outwards, outwards and back- 
 wards, to the whole extent of the hemispherical ganglion (B B B). The course of some of the fibres of the 
 superior longitudinal commissure, and also some of the fibres of the great commissure, are shown. B B B. 
 Convoluted surface of the brain, or hemispherical ganglion. K. Thalamus optici divided. L N, L N. 
 Anterior cornua of the lateral ventricle separated by N, septum lucidum. M M. Corpora striata. N. Antfrior 
 pillars of the fornix running from the c a, corpora albicantia. P p. Posterior extremity and under surface 
 of the great transverse commissure, or corpus callosum. P P. Fibres continued to the posterior lobe. 
 A P. Anterior extremity of ditto, s. Corpus olivare. T. Corpus pyramidale. v u. Crura cerebri. w w 
 Corpus restiforme. x X. Pons Varolii, x. divided end of it, where it enters the cerebellum, a c. 
 Anterior commissure, divided a little to the right of the mesial line. g. Groove in the corpus striatum, 
 from which it has been removed, e. Third pair of nerves. fs *. Fissura Sylvii. A n. Descending 
 fibres of the fornix over 'the hippocampal convolution. 
 
MOTOR TRACT. 195 
 
 considered as a probable opinion. Such it has long been thought by 
 many physiologists ; and though the grounds on which this conclusions 
 rests, appear to be more secure than they formerly were, the proof is still 
 detective. " 
 
 The anterior portion of the anterior columns, that which is usually 
 called the corpus pyramidale (T, figs. 72, 85), may be now traced through 
 the pons Varolii ; but before doing so, the student had better make him- 
 self acquainted with the structure of the commissure : for this purpose 
 let him refer to the description of the commissures. 
 
 If the student pull upwards by means of a scoop director, the inferior 
 edge of the pons Varolii from the anterior column, or corpus pyramidale , 
 he will find it contracted as it enters this commissure to a small, strong, 
 rounded cord. 
 
 Following this cord behind (see fig. 91, and description) the most 
 superficial fibres of the pons Varolii, or beneath them as he dissects, and 
 tearing them backwards towards the cerebellum, he will soon find that 
 the fibres of the anterior columns diverge from one another, and become 
 separated by the transverse fibres of the commissure through which he 
 is now tracing them. This is best seen by fig. 87. It is also im- 
 portant that he should be aware, in performing the above dissection, 
 that these fibres from the spinal cord take a curved direction through 
 the pons Varolii, the convexity forwards; otherwise he will be liable to 
 tear them by going too deep at the central part of their course, taking 
 them from above to below. 
 
 The fibres thus traversing this body (for, as I have mentioned else- 
 where, it cannot be considered a mere apparatus of transmission or 
 corn mis sure) y emerge beyond it, and at its upper edge, form the under 
 portion of a structure, which has been already noticed under the old 
 name of crura cerebri(u), and which, diverging from its fellow of the 
 opposite side, forms the outer and posterior boundary of the diamond or 
 lozenge-shaped space of the base of the brain (see fig. 72). 
 
 The crura cerebri, thus viewed from below, appear to be mere round 
 flattened cords, consisting only of fibrous neurine derived from the an- 
 terior columns. A perpendicular section, (as represented in fig. 92, In) 
 demonstrates the presence of some very dark pulpy neurine; this has 
 been called the locus niger ; I would rather designate it the ganglion of 
 the third pair of nerves : for a portion of the central extremity of this 
 nerve traverses this gray matter, and is split by it into five or six fila- 
 ments, which become connected with a portion of the inter-cerebral 
 commissure, as described further on. Posterior to this ganglion are 
 more white fibres : these belong to the posterior portion of the lateral 
 column, the sensory columns of Sir Charles Bell. 
 
 These right and left anterior columns, in their passage through the 
 pons Varolii, are separated from each other by a peculiar structure, first 
 described by Sir Charles Bell, and represented in the Philosophical 
 Transactions for 1834, as resting with its edge on the commissure of the 
 cerebellum, and extending its fibres directly backwards, so as to form a 
 striated leaf, separating the two great longitudinal tracts which pass be- 
 tween the medulla oblongata. 
 
 In making sections of the pons Varolii, it is a curious fact that those 
 
HUMAN BRAIN. 
 
 parts, which appear gray on a transverse section, are white on a longi- 
 tudinal, and vice versa. 
 
 The next step in the dissection is, to remove the arachnoid and pia 
 mater from the fissura Sylvii, through which fissure the dissector may 
 insert his fingers, and raising the middle lobe tear, through its connec- 
 tions with the anterior so completely as to enable him to turn it back 
 over the posterior. This will expose a white flattened band crossing the 
 crus just where the body plunges into the cerebrum (see fig. 72, on the 
 left side) ; this band is called the tractus options, and is placed between 
 the commissure of the optic nerve, and its cerebral connections; let this 
 be divided, and the handle of a scalpel or scoop of a director be placed 
 on the surface of the crus, and then removing the neurine which over- 
 laps the crus, the student will be enabled to trace further the motor tract 
 of fibres of the anterior column. By gradually removing the neurine 
 which still covers them, he will expose some medullary fibres running 
 from before backwards ; these belong to the great transverse commissure 
 or corpus callosum. On removing these he will come to a large deposit 
 or bed (M M), if we may so express it, of cineritious neurine, through which 
 the anterior columns pass, exactly in the same manner that the sensory 
 fibres of the fifth pair do through the semilunar ganglion already referred 
 to in the sphenoido-teraporal fossa. This collection of neurine is the 
 ganglion of the anterior columns or motory tract, and is commonly known 
 by the name of the corpus striatum (MM). In all the figures these letters 
 designate it. By gradually scraping the substance of this ganglion away, 
 and carefully following the white fibres, the exact course of the motory 
 tract (m, m, m, m] will be exposed. In the course of scraping the cine- 
 ritious neurine away, a rounded band of medullary neurine will be ex- 
 posed, taking its course from the circumference of the brain forwards 
 and inwards : this band is the commencement of the anterior commis- 
 sure (ac). 
 
 The motory fibres, which are thus traced into the substance of the 
 corpus striatum or anterior cerebral ganglion of the cord, spread as they 
 emerge from its external edge, and pursuing their course in different 
 directions like the rays of a fan, some passing forwards, others outwards 
 and others backwards, terminate ultimately in the cineritious neurine 
 composing the convoluted surface of the hemispheres, the hemispherical 
 ganglia, fig. 91, B B B. 
 
 When the student has not the opportunity of tracing these fibres of the 
 pyramidal bodies, or anterior columns of the cord, in a brain hardened 
 in spirit, he will obtain a very good view of their course, and especially 
 their relation to the corpus striatum, by a perpendicular section from the 
 medulla oblongata through the pons Varolii, crus cerebri, corpus striatum, 
 and hemisphere of the brain, in the direction indicated by the dotted 
 line, A B, in fig. 91. The appearance which this section exhibits is re- 
 presented in fig. 92. This is a useful section when we examine the brain 
 for pathological investigation; it gives a continuous view of the motor 
 and sensory tract, and readily exposes any morbid appearance in its 
 course. Gall and Spurzheim have given a very beautiful representation 
 of this tract, as viewed from below, in their larger work on the brain. 
 
 
MOTOR TRACT. 
 
 197 
 
 Cruveilhier* describes these columns as passing through the thalami 
 nervorum opticorum in addition to the corpora striata. The same author 
 also refutes the opinion of Reil, Gall, and Spurzheim, that these fibres 
 are reinforced, as it were, or augmented by their passage through the 
 corpora striata. 
 
 Fig. 92. 
 
 The brain is laid on its upper surface, and a section has been made longitudinally through the medulla 
 oblongata, pons Varolii, cerebellum, anterior and posterior cerebral ganglia, fornix and corpus callosum, 
 anterior commissure and left hemisphere of the brain, in the direction indicated by the dotted line in fig. 
 91. i & c. Inter-cerebral commissure. CD. Optic tubercles. E. Cerebellum and corpus dentatum. K. 
 Optic thalamus. M. Corpus striatum. N. Fornix. p. Corpus callosum. s. Olivary body. T. Corpus 
 pyramidale. u. Crus cerebri. x. Pons Varolii. a. Olfactory ganglion, ac. Anterior commissure, o t. 
 Olivary tract, p t. Pyramidal tract, s t, s t. Sensory tract. 
 
 Wenzel, with his usual accurate minuteness, enters into the question 
 of the relation of the cortical substance of the brain to the white fibre, 
 in the following words :f "Utrum cinerea substantia quaB in exteriore 
 cerebri ambitu reperitur, cum ilia ex qua partes in interiore cerebro sitse 
 constant, cohaerent nee ne ?" He sums up his observations as follows :J 
 "Substantia cinerea interiorum cerebri partium, nominatim striatorum 
 corporum, et colliculorum nervorum opticorum nullo totius sui ambitus 
 loco, cum ea quaa ad exteriorem cerebri ambitum pertinet substantia 
 cinerea immediata coherent." 
 
 The anterior division of the antero-lateral columns of the spinal cord, 
 or the motory tract of neurine, has thus been traced from the point where, 
 going by the name of corpus pyramidale, it forms part of the medulla 
 oblongata 1st. Through the pons Varolii or commissure of the cerebel- 
 lum ; 2dly. Forming the inferior part of the crus cere*bri ; 3dly. Plung- 
 ing into the anterior cerebral ganglion or corpus striatum ; and 4thly, 
 and lastly. Quitting this ganglion in order to reach the hemispherical 
 ganglion, or the cineritious neurine of the convoluted surface of the 
 hemispheres. The posterior division of the same column has been 
 traced to the cerebellum. It now remains to trace the middle divi- 
 sion in its upward course from the olivary bodies through the pons Va- 
 rolii to the cerebrum, forming in its course connections with the optic 
 tubercles and thalami. 
 
 * Op. cit., p. 716. 
 
 t Op. cit., p. 64. 
 
 Op. cit., p. 
 
198 HUMAN BRAIN. 
 
 The student, after he has traced these fibres of the anterior columns, 
 must return to the medulla oblongata, and slice off the surface of the 
 corpus olivare, commencing his incision at the lower part of this body 
 and carrying it up through the pons Varolii into the outer side of the 
 crus cerebri: by this section he will first expose the interior of the oli- 
 vary bodies (figs. 87, 92, s), surrounded by the fasciculi of white fibres, 
 one set passing before and one behind them. These two fasciculi re- 
 uniting at the upper edge of the olivary bodies, pass through the pons 
 Varolii (o , o ), on a plane posterior (deeper in the present position of 
 the brain), to the pyramidal columns; they are separated from these 
 columns by about a quarter of an inch of the substance of the pons Va- 
 rolii. Some of the fibres of these fasciculi of the olivary columns, viz., 
 the most anterior, again join the pyramidal columns at the upper edge 
 of the pons Varolii, forming a portion of the outer part of the crus cere- 
 bri. These fibres run partly behind, partly on the outside, partly through 
 the locus niger; they lie anterior and external to the sensory tract of the 
 antero-lateral columns described further on (see fig. 87). 
 
 This fasciculus has been described by Reil* under the title of Fillet. 
 This author describes them as continuous with both the corpora olivaria 
 and pyramidalia. 
 
 These fibres, as they traverse the pons Varolii, separate into two por- 
 tions ; one passes inwards to join its fellow, so as to form a curvilinear 
 stratum of fibres immediately below the optic tubercles. 
 
 The other portion, described by Mayo as the fasciculus of the olivary 
 body, ascends to the crus cerebri, and passes through the locus niger. 
 Sir C. Bell describes this fasciculus as entirely emanating from the olivary 
 body. This description does not altogether accord with my own dissec- 
 tion : for after many repeated and patient dissections of the lower ex- 
 tremity of this fasciculus, I invariably found that most of its fibres passed 
 either partly before, or partly behind ; the former being frequently con- 
 tinuous with the pyramidal columns, the latter with the antero-lateral, 
 though a portion of these fibres clearly run into the olivary bodies, as 
 may be seen in fig. 87, o t. 
 
 The most accurate mode of dissecting these fibres, and the least liable 
 to error, is to make a section of the pons Varolii and medulla oblongata, 
 previously removed from the rest of the brain, including a piece about an 
 eighth of an inch in lateral width, or half of the corpus pyramidale and 
 corpus olivare ; in that way these fillets are exposed : and then tearing 
 this piece downwards, commencing; the rent in front of the fillet, and 
 thus separating it from the pons Varolii, its fibres may be traced con- 
 tinuous with the pyramidal bodies and running in front of the olives ; a 
 second rent made behind the fillet will separate it from the portion of the 
 lateral columns which ascend to the thalarni, and show those fibres 
 which run behind the olivary bodies. Dr. Reid, in his excellent paper 
 on the medulla oblongata, (Ed. Med. and Surg. Journal, 1841,) de- 
 scribes these olivary columns; but he does not state that they go through 
 the olivary bodies, or that there is any connection between the fibres of 
 the columns and the gray matter of the olive. 
 
 * Op. cit., p. 94, part ii. 
 
OLIVARY COLUMNS. 199 
 
 This author points out more clearly, I believe, than any one else, the 
 motor character of this tract; and this seems to confirm my view, that it 
 is a portion of the antero-lateral. I am, however, inclined to believe 
 that some of these fibres are commissural between the olivary bodies and 
 the optic ganglia; though I do not quite understand, if there is a func- 
 tional connection between the fibres and the olivary bodies, that they do 
 not stream through the vesicular neurine as the motor tract does through 
 the corpus striatum, &c. Mayo, in his beautiful plates of the brain, 
 though he exhibits these columns (which he, like others, designates as 
 olivary), running round the olives, but not through them, nevertheless 
 speaks of them as derived from them. 
 
 In the section on Comparative Anatomy, I have adduced, I think, suffi- 
 cient evidence to show that the position of the olivary bodies varies 
 considerably, and in some animals they are even imbedded in the pyra- 
 midal bodies, which goes far to show the physiological identity of the 
 great mass of the olivary and pyramidal columns. 
 
 Dr. Reid says, and I fully agree with him, " If we trace these olivary 
 columns downwards, we observe that they form attachments to the an- 
 terior roots of the first and second cervical nerves, and that they continue 
 their course onwards in the line of the other anterior roots of the spinal 
 nerves. We can, then, have little difficulty in arriving at the conclusion 
 that the olivary is a motor column. On tracing this column upwards, 
 we find that where it embraces the olivary body, the portio dura is at- 
 tached to its outer margin, and the hypoglossal and abducens nerves are 
 partly attached to its inner margin, and partly to the outer margin of the 
 pyramidal column. On tracing the two roots of the fifth pair, the smaller 
 or motor root can be followed to that portion of the olivary column which 
 proceeds to the optic lobes, sometimes running down the outer or ex- 
 ternal edge of the pons, to reach the portion of the olivary columns already 
 mentioned as it emerges from the external margin of the pons; at other 
 times its course is observed by a greater or less number of the transverse 
 fibres of the pons crossing it. The trochleator nerve is attached to the 
 internal margin of the same band of fibres when it has ascended the pro- 
 cessus e cerebello ad testes, and is about to enter the optic lobes. "* He 
 also describes the connection of the portio dura, lingual and abductor 
 nerves with the inferior portion of it. 
 
 The olivary column is then a compound tract, commissural and nervous. 
 The commissural portion emanates from the interior of the olivary bodies, 
 (see fig. 87,) and this I shall designate the olivary commissure. The 
 nervous portion belongs to the motor system of nerves, and is physiolo- 
 gically a portion of the pyramidal tract. 
 
 Dr. Reid describes, and I think justly, the pyramidal columns as pass- 
 ing into the middle columns after their decussation ; he describes the 
 arciform fibres as going to join the posterior or cerebellar column as I 
 first described them, but he is in error in attributing to Santorini, Gall 
 and Spurzheim, Rosenthal and Rolando, a knowledge of the fact that 
 they form a communication between the anterior portion of the cord and 
 cerebellum, which I consider an important anatomical discovery alone 
 due to me. 
 
 * Ed. Med. and Surg. Journal, Jan. 1, 1841. 
 
HUMAN BRAIN. 
 
 Fig. 93. 
 
 We must now return to the medulla oblongata for the purpose of trac- 
 ing those tracts of neurine which Sir Charles Bell has proved to be em- 
 ployed in conducting sensation. It has been already stated that in the 
 composition of the spinal cord we can observe no line of demarkation by 
 which the tract of sensation may be distinguished from that of motion, 
 but that a portion of the cord anterior to the posterior fissure is distinctly 
 ascertained to be appropriated to this function ; I shall assume, therefore, 
 that the line of demarkation is about the middle of the lateral aspect of 
 the cord, and that the sensory column, or tract of sensation, consists of 
 two portions, the one posterior to the fissure referred to, and conse- 
 quently named the posterior column, the other anterior to it, constituting 
 part of the antero-lateral column. These two portions had better be 
 traced separately. Commencing with the posterior division, or, in other 
 words, the posterior columns, we find them ascending to the cerebellum, 
 and in their course to that mass forming a portion of a body previously 
 noticed in describing the anterior columns, viz., the corpora restiformia. 
 In their passage to the cerebellum, as a portion of the constituent fibres 
 of these bodies, they are partly overlapped by, arid partly interlace with, 
 those fibres from the anterior columns which, ascending to the cerebel- 
 lum, connect the motor or voluntary tract of the spinal cord with the 
 cerebellum as well as with the cerebrum ; and let me again repeat that 
 the fibres which compose the corpora restiformia are not arranged 
 
 in the simple, regular, parallel 
 manner in which we find them 
 in the body of the cord, but 
 interlace, forming rather an in- 
 tricate plexus. 
 
 The cerebral fibres of the sen- 
 sory columns. The remaining 
 portion of the tract of sensa- 
 tion, or that portion of the sen- 
 sory column which, in the spinal 
 cord, is anterior to the fissure, 
 from which the posterior roots 
 of the spinal nerves emerge, 
 and whose line of demarkation 
 from the motor tract is about 
 the middle of the lateral aspect 
 of the cord, must next be traced 
 to its destination. In the first 
 place we find it sending a few 
 fibres, like the posterior col- 
 umns, to the cerebellum; the 
 rest of its fibres ascend princi- 
 pally to the cerebrum. 
 
 The proof that the columns, 
 which we are now about to trace 
 to the cerebrum, form a portion of the tract of sensation, is derived from 
 the fact that the sensory root of the fifth pair of nerves arises from it, see 
 
 This drawing is from a dissection made on a piece o 
 brain which had been hardened in spirits. It exhibits the 
 course of the sensory columns from the medulla oblongata 
 to the thalamus. Their function I consider proved by the 
 fact that the sensory root of the fifth pair of nerves is con- 
 nected with them. c. Anterior optic tubercle. D. Poste- 
 rior ditto. I & c. Inter-cerebral commissure, or processus 
 cerebello ad testes. H. Spinal cord. K. Thalamus op- 
 tici. M. Corpus striatum. u. Crus cerebri. w. Corpus 
 restiforme. x x. Pons Varolii. ft. Optic nerve, c. Third 
 pair, b c. Locus niger. p t. Pyramidal, or motor tract. 
 s t. s t. s t. Sensory tract, the posterior third of the antero- 
 lateral column, s c. Sensory root of the fifth pair of 
 nerves. 
 
SENSORY TRACT. 
 
 201 
 
 fig. 93.* In the medulla oblongata, the cerebral sensory tracts lie in 
 contact with each other in the mesial line. In the fourth ventricle, or 
 calamus scriptorius, they are covered by the auditory ganglia, or pos- 
 terior pyramidal bodies. From this part they ascend behind the pons 
 Varolii, where they form the floor of the iter a tertio a quarto ventriculo. 
 In this situation they decussate with their corresponding fibres on the 
 opposite side (see fig. 94). 
 
 Fig. 94. 
 
 
 This figure I sketched from a dissection made on the same brain as that from which fig. 91 had been 
 taken, and the two may be advantageously compared. The whole of the pyramidal and olivary bodies, 
 and their respective tracts, have been removed, and the posterior part of the cord left. D P. Decussation 
 of the pj'ramidal bodies. D s. Decussation of the cerebral sensory tract, or posterior third of the antero- 
 lateral column, i & c. Inter-cerebral commissure divided. K. Posterior extremity of the thalamus nervi 
 optici. K it. Divided end of the same. g. Corpus geniculatum externum. u. Crus cerebri. v u. Divided 
 end of the same, w w. Corpora restiformia. c. Third pair of nerves, c a. Corpora albicantia. e s. 
 Sensory root of the fifth pair. I n Locus niger. s t. Cerebral sensory tract, p v. Dotted lines marking 
 the situation and width of the pons Varolii, behind which the decussation takes place. 
 
 The presence of such a decussation for the sensory tract has long been 
 suspected, as it was proved to exist for the motor tract. 
 
 Sir Charles Bell believed that he had discovered it, but he placed it 
 too low down, and, as I have stated elsewhere, in all probability mistook 
 the posterior surface of the pyramidal decussation for a distinct decussa- 
 tion. The best mode of demonstrating this interlacement, is, first, to 
 separate the medulla oblongSta, with the pons Varolii, crura cerebri, and 
 optic thalami, from the rest of the brain. Secondly, divide the pons 
 Varolii anteriorly, in a longitudinal direction, through the centre to the 
 depth of half an inch; divide the pyramidal decussation; then take the 
 
 * I am delighted to find that Stilling, in his new work on the Pons Varolii, has accurately 
 figured all these fibres. 
 
202 HUMAN BRAIN. 
 
 two lateral halves of the cord and split them upwards, tearing through 
 the floor of the fourth ventricle. When the rent passes the roots of the 
 auditory nerve, fibres, the size of ordinary ligature silk, may be seen 
 running obliquely across the mesial fissure, from one side to the other, 
 decussating with their fellows. This decussation may also be demon- 
 strated anteriorly, as represented in fig. 94, though it requires more care 
 and some dissection. This decussation may be seen in the sheep as 
 distinctly as in the human brain. I have not looked for it in any other 
 animal.* 
 
 After this decussation, on their emergence from behind the pons Varolii, 
 the fibres of the sensory tract form the upper part of the cms cerebri, 
 separated in that body from the motor tract by that deposit of cineritious 
 neurine called the locus niger, as previously mentioned : the sensory 
 tract, where forming the upper layer of the constituent fibres of the crus 
 cerebri, is covered superiorly by the optic tubercles and the inter-cere- 
 bral commissure. 
 
 These structures must be raised, in order to expose its course in this 
 situation. From this point they plunge into their appropriate ganglion, 
 the posterior cerebral ganglion, better known, as before stated, by the 
 name of the thalamus nervi oplici. 
 
 The course of the fibres through the posterior cerebral ganglion is not 
 so distinctly marked as that of the motor tract through the anterior; for 
 here the medullary fibres are not so decidedly separated from the cine- 
 ritious; the two appear more intimately mingled. From the outer side 
 of the posterior cerebral ganglion, the medullary fibres issue forth, spread- 
 ing in every direction until, meeting with the convoluted surface of the 
 brain or the cineritious neurine of the hemispherical ganglia, their pro- 
 gress is arrested and their course terminated. 
 
 A side view of the course of this tract through the posterior cerebral 
 ganglion, or thalamus nervi optici, and its expansion in the hemispheres, is 
 well shown in Gall's large work. 
 
 The relation of the motor and sensory columns of the cord, as forming 
 part of the cerebrum, with their appropriate ganglia, is thus described 
 by Sir Charles Bell in his paper in the Philosophical Transactions above 
 referred to: "The thalamus forms a nucleus round which the corpus 
 striatum bends, and when their respective layers of striaB make their exit 
 beyond these bodies to form the great fan, or solar-like expansion, into 
 the hemisphere of the cerebrum, their rays mingle together. A rude 
 representation of these two parts of the cerebrum, as we have traced them, 
 may be made with the hands. If I place my wrists together, parallel, 
 and closing one hand, embrace it with the other, I represent the two 
 
 * Foville does not describe any decussation of the posterior columns, but he figures this 
 decussation, though, as it appears to me, in an exaggerated manner. " Pi. 2 (Foville), fig. 
 4. F. Point of the calamus : from this point, up to c', may be observed the entre rroissement 
 of the two halves of the medulla oblongata." Longet (vol. i. p. 382) says, " We have long 
 known that all the fibres of the antero-lateral columns of the spinal marrow are far from 
 intercrossing at the place designated for the decussation of the pyramids. But in separating 
 the posterior median fissure of the bulb and protuberance just below the tubercula quadri- 
 gemina, M. Foville has pointed out a superior interlacement, which, without doubt, effects in 
 part a union between those fibres of the antero-lateral columns which Rolando described, 
 and Cruveiihier designated the fasciculus of reinforcement of the bulb, or faisceau mnome'. 1 ' 
 
SENSORY TRACT. 203 
 
 portions of one crus. The closed fist is the thalamus, and the other is 
 the corpus striatum. If I then extend my fingers, interlacing their points, 
 I represent the final distribution of the portions of the nervous matter 
 which are dedicated to sensation and volition." 
 
 The best mode of dissecting these parts, for the purpose of tracing the 
 sensory columns, as just described, and which perhaps will give the most 
 correct ideas of their relative position to the parts with which they are 
 connected, is to lay the brain upon its under surface, and then to make 
 a perpendicular section through the mesial line, from before to behind, 
 of the whole cerebral mass. This section will divide, it is true, all the 
 transverse commissures ; all those structures, in fact, which connect 
 together corresponding parts placed on opposite sides of the mesial line ; 
 consequently, these apparatuses of union must be studied in another 
 brain, should they not have been previously traced as suggested above. 
 The similarity of the parts exposed by this section to those composing 
 the cerebral mass of the turtle, cannot fail to arrest the attention of the 
 student. 
 
 Let me remark, that though most of the parts to be observed in the 
 following view, have been already described under a different aspect, I 
 speak of them again without reference to the previous notice. Com- 
 mencing from behind, and proceeding forwards, may be observed (fig. 
 100): 
 
 1. The medulla oblongata, divided in the mesial line. Anterior to 
 this, and rather superior to it, is, 
 
 2. The pons Varolii, or commissure of the cerebellum. Above and 
 behind the pons is, 
 
 3. The cerebellum, presenting that curious and beautiful appearance 
 resulting from the disposition of cineritious and medullary neurine, called 
 the arbor vitce. If the student carry his eye along that portion of the 
 medullary neurine which corresponds to the stalk of the tree, he will find 
 it emerging from the cerebellum, and turning up to a little rounded body 
 about the size of a small pea; immediately anterior to which is another 
 of rather larger size : the two together are, 
 
 4. The optic tubercles, or corpora quadrigemina, the posterior being 
 the testes, the anterior the nates. 
 
 The structure which has been likened to the stalk of the tree, will be 
 recognized as the commissure connecting the greater cerebral mass to 
 the lesser, in other words, the cerebrum to the cerebellum ; this is, 
 
 5. The inter- cerebral commissure. 
 
 Beneath the optic tubercles we observe, rising up, as it were, from 
 the pons Varolii, a structure previously mentioned, namely, 
 
 6. The crus cerebri. A section of this part shows it to consist of 
 medullary neurine above and below, with cineritious interposed between 
 the two. The medullary neurine, which is above the cineritious, is the 
 sensory tract, that below, the motor tract. The cineritious neurine has 
 been long known to anatomists by the name of locus niger. Immediately 
 in front of the crus and optic tubercles is a rounded nodule of considera- 
 ble size, being about the same dimensions as the jpons Varolii, called 
 
 7. The thalamus nervi optici by anatomists of the old school, the j90s- 
 terior cerebral ganglion of the cord by more modern teachers. 
 
204 
 
 HUMAN BRAIN. 
 
 Anterior to this ganglion, and partly overlapping it, will be observed 
 some fibres, which, appearing to spring from the under part of the brain, 
 run backwards and upwards ; these fibres form a portion of a longitudi- 
 nal commissure or fornix. 
 
 If these fibres be removed, another rounded nodule of neurine will 
 be exposed, which has been already observed upon its under surface ; 
 this is, 
 
 8. The corpus striatum, or anterior cerebral ganglion, in front of and 
 behind which, are 
 
 9. The hemispheres, formed of the fibres of the cord, commissural 
 fibres, and hemispherical ganglia. 
 
 The structure of the hemispherical ganglia, or cortical substance of the 
 brain, may next be examined. Their enormous size in the human being, 
 as compared with those in the lower animals, has been already adverted 
 to. The extent of the convoluted surface is well seen in both an hori- 
 zontal section (figs. 77 and 78), and perpendicular section (fig. 95). 
 
 These ganglia do not consist of one single layer of cineritious neurine, 
 but of three layers alternating with three layers of medullary neurine. 
 The distinction between some of these layers may often be seen with the 
 naked eye in the posterior convolutions in a state of health. But this 
 stratification is still more evident after disease. When the cortical sub- 
 stance has been long the subject of chronic inflammation, as in old cases 
 of insanity, it is peculiarly distinct. In the section on pathology, some 
 cases will be detailed. The white fibres may be traced through these 
 layers, as we have traced them through the corpus striatum. 
 
 Fig. 95. 
 
 This drawing having been taken from a preparation which had been some time in spirit, the uppe 
 surface is unnaturally flattened. It exhibits a transverse section of the brain taken a little posterior to r 
 its centre, measured from before to behind. It partly shows the enormous extent of, B, the hemispherical 
 ganglion. M. Anterior cerebral or corpus striatum ; the broad white line just below the letter, dividing 
 it into two portions, is the motorJract. p. Great transverse commissure x. Pons Varolii. The great 
 depth of the fissura Sylvii may Be seen on both sides of the brain. It is most distinct on the right side ot 
 the figure between the two B B. 
 
 -': . . 
 
HEMISPHERICAL GANGLIA. 205 
 
 To the superficial observer this ganglion appears to consist of a single 
 layer of cineritious neurine, A little care is sufficient to enable us to see 
 with the naked eye that there are at least two layers of gray matter separated 
 by a white layer. This is often most distinctly seen in a brain that has 
 been in a state of chronic inflammation. It is also more distinct in the 
 posterior than in the anterior convolutions. Vicq d'Azyr first pointed 
 this out in the posterior portion of the brain, and Casanvielh demon- 
 strated its existence throughout the whole.* M. Baillarger, in 1840, 
 stated that, under the microscope, this ganglion will be found to consist 
 of six layers, three of gray alternating with three of white. 
 
 The first going from within to without, is gray ; the second, white ; 
 the third, gray ; the fourth, white; the fifth, gray ; and the sixth, white 
 (see fig. 96, left half of the drawing). 
 
 Fig. 96. Fig. 97. Fig. 98. 
 
 Fig. 96. Magnified representation of the cortical substance of the brain of the sheep. (Baillarger.) 
 The left half is seen as an opaque object; the right as a transparent one. Left half. B. Tubular neurine 
 of the hemispheres. 1, 2. 3, 4, 5, 6. The six alternate layers of gray and white neurine. Right half. 
 The white substance fooks dark, and the gray neurine light. The numbers the same. 
 
 Fig. 97. Convolution from the human brain, single aspect ; six alternate layers. 
 
 Fig. 98. This figure shows the passage of the fibres through the layers of the hemispherical ganglion. 
 The left half is from the human brain ; the right from the brain of the pig. 
 
 These six layers can be distinctly made out with the microscope. 
 Under the glass, the appearance is reversed, the gray being transparent, 
 and the white opaque (see the right side of fig. 96). 
 
 This author states that he has examined the gray substance of the 
 hippocampus, and that he has found it striatified like that of the convolu- 
 tions, which he considers a proof that this is an internal convolution, as I 
 have stated elsewhere. 
 
 The tubular fibres from the hemispheres pass through these three layers 
 of vesicular neurine (see fig. 98). 
 
 These fibres, which are very long and numerous at the summit of the 
 convolutions, become shorter and more scanty at their base. At the 
 bottom of the anfractuosities, these fibres are so short that in some brains 
 we can separate them from the cortical substance without rupturing them. 
 
 Baillarger asserts positively that the external layer of the brain is white, 
 and not gray, as has been usually supposed. This color is most evi- 
 dent in the brain of infants, old people, the insane, and of some animals. 
 
 Mr. Grainger informs me that his own observations by the microscope 
 on the cortical substance, quite accord with M. Baillarger. 
 
 Regarding the structure of the cortical substance in the lower animals, 
 
 * M6m. de 1'Acad. de M6d.,tom. viii. 1840. 
 
206 HUMAN BRAIN. 
 
 M. Baillarger states, that in the fish he observes no stratification of this 
 ganglion. In the class Amphibia he has only examined the frog, and 
 that he has not been able to observe any stratification in this ganglion. 
 In the brain of the bird there is only one white line. He found six in 
 the brain of all the Mammalia he examined. 
 
 Commissures. In commencing this new inquiry, the student must 
 remember that the commissures or apparatuses of union can only be 
 thoroughly understood, and their exact connections and relations appre- 
 ciated, after a diligent consideration of the exact relative position of the 
 different ganglia which it is the office of these commissures to connect 
 together. 
 
 Spurzheim confines the word commissure to designate structures which 
 connect corresponding parts, and applies the term instruments of com- 
 munication to those which connect different parts on the same side; a 
 distinction which, as it does not appear to me to be attended with any 
 advantage, I have taken the liberty of rejecting. 
 
 Let the brain be now laid upon its under surface, when of course the 
 upper surface of the hemispheres will meet the eye.* Let the membranes 
 be removed from these, and the depth of the fissures separating the con- 
 volutions, as well as the general exact correspondence or symmetry of 
 the hemispheres of the brain, be remarked. The great fissure separating 
 them longitudinally is deep ; at the bottom of it a broad band of fibrous 
 or medullary neurine will be observed ; this is the great transverse com- 
 missure^ or corpus callosum (figs. 77, 92, 95, 99, 100, p, the same let- 
 ter in all). Before entering on the description of this part, let me 
 remind the student of the simple form in which a commissure was first 
 presented to his notice in the nervous system of the star-fish, where it 
 appeared as a slender cord of neurine connecting one ganglion with 
 another. 
 
 In this description of the human brain I shall consider under the head 
 of commissures all those collections of medullary neurine which are so 
 arranged as to connect either corresponding parts which are placed on 
 each side of the mesial line, as, for instance, the right and left hemi- 
 spheres ; or different organs on the same side, as the various convolutions 
 of each hemisphere ; or two distinct structures, as the two grand divi- 
 sions of the encephalon, the cerebrum and cerebellum ; thus following 
 out to its fullest extent the principles which have been laid down else- 
 where, that a ganglion is a collection of neurine of any size and of any 
 form, and that the cerebro-spinal axis, of which the brain is a part, is no 
 more than a collection of ganglia of immense size connected together 
 by commissures of corresponding dimensions. 
 
 Transverse Commissure. The great transverse commissure^ or corpus 
 
 * Supposing the student only to have one brain at his disposal, he must replace the por- 
 tion of the right hemisphere which he removed when directed to make the section exposing 
 the centrum ovale. 
 
 f Vicq d'Azyr was the first anatomist who described the corpus callosum as a commissure, 
 while, on the other hand, Rolando denies that it is entitled to the name of a commissure; 
 for, says he, " laying together the observations of Wenzel and Tiedemann upon the formation 
 of the corpus callosum, and my own observations on the union of the cerebral vesicles, the 
 point of union constituting the future corpus callosum, this is obviously, in the first instance, 
 no more than a contraction of the superior and inferior margins of the vesicles ; the part 
 cannot, at any rate, be justly described as a commissure." Op. ctt., p. 72. 
 
COMMISSURES. 
 
 207 
 
 callosum, is a body consisting of fibres of medullary neurine, the ex- 
 tremities of which are everywhere in contact with the internal or central 
 surface of the cineritious layer which forms the convolutions of the 
 hemispheres the hemispherical gnnglia. These fibres consequently 
 establish a communication between the cineritious neurine of the whole 
 convoluted surface of both sides of the cerebrum. 
 
 Fig. 99. 
 
 This figure I sketched from a dissection which I made in company with my friend Mr. Grainger, whpse 
 testimony ot its accuracy I am glad to quote, though it is opposed to the views and dissections of M. 
 Foville. It is intended to show the course and connection of the fibres of the great transverse commis- 
 sure of the hemispheres or corpus callosum. The dissection has only been carried into the right hemi- 
 sphere. It will be seen that these fibres ascend to the convolutions above the mesial line, p v p. Fibres 
 of the corpus callosum radiating into the hemispherical ganglion. B. Left hemispherical ganglion undis- 
 sected. E. Cerebellum. Near the centre of the drawing, and a little to the right of the mesial line, is 
 the representation of a broken fasciculus of fibres the part tori} off was traced most carefully into the 
 convoluted surface of the brain. 
 
 Strictly speaking, the fibres of the great transverse commissure do not 
 commence on one side more than another ; but with the hope of assist- 
 ing the mental eye in following their course from hemisphere to hemi- 
 sphere, these fibres shall be described as originating on the right side 
 and crossing over to the left. The fibres from the front, sides and supe- 
 rior part of the ^anterior lobe, then, pass backwards and inwards to the 
 distance of an inch and a half from the anterior extremity of the cere- 
 brum, where they cross the fissure which divides the two hemispheres. 
 The anterior edge of the commissure consequently forms the posterior 
 boundary of the anterior part of the fissure. In this situation the fibres 
 are folded one upon another; so that on a transverse section of the com- 
 missure the anterior edge appears thicker than the centre, though it is 
 not so thick as the posterior edge (see fig. 100). 
 
208 HUMAN BRAIN. 
 
 The fibres from the convolutions of the upper part and sides of the 
 middle lobes run downwards and inwards, being joined by those from 
 the convolutions at the base of the brain. 
 
 Those again, from the upper, under, and posterior surface of the pos- 
 terior lobe, run forwards and inwards to cross the fissure at the distance 
 of nearly three inches from the posterior extremity of the cerebrum. 
 The fibres from such extensive surfaces are necessarily numerous, and 
 give a considerable thickness to the posterior edge of the commissure.* 
 
 All these fibres may be easily demonstrated in a brain that has been 
 immersed for some time in spirits, and they may also be shown, though 
 not so readily, in the fresh brain. The best method of exposing them 
 is gradually, by tearing, to remove the upper part of the hemispheres, 
 the handle of the knife being pushed into the horizontal fissure through 
 which the commissure creeps, as it were, under the convolutions on both 
 sides of the hemispheres. The dissection here had better be confined 
 to the right side, in order to reserve the left entire for other observations, 
 as in the preparation from which fig. 99 has been drawn. 
 
 Let me again repeat that I consider these connecting fibres of the great 
 commissure as performing the same office, and that they ought to be 
 considered as perfectly analogous structures to the single commissural 
 cord which we met with in the star-fish. Their vast number, which is 
 only in proportion to the great extent of surface from which they origi- 
 nate or which they connect, ought not to deceive us as to their similarity, 
 and thus withdraw attention from the illustration of their real character 
 afforded in the simple type of the nervous system as it exists in that 
 animal. 
 
 The mode of tracing the fibres of the transverse commissure recom- 
 mended will open the lateral ventricle, as previously described. But 
 let me again remind the student, that this space must not, however, be 
 viewed in the light of a cell or cavity situated in the interior of the brain, 
 the walls of which are formed by the cerebral mass ; but that he must 
 consider it as resulting merely from the contact of the different surfaces 
 of the brain. The external surface of the anterior and posterior cerebral 
 ganglia, or the figurate surface, is here in contact with the internal smooth 
 surface of the superficial cerebral convolutions or hemispherical ganglia. 
 
 The next commissure to which our attention should be directed is a 
 longitudinal commissure. I have designated it the superior longitudinal 
 commissure (see fig. 100), in distinction to the fornix, which I have 
 called the inferior longitudinal commissure; the former being situated 
 above the great transverse commissure, the latter below it. In most 
 
 * M. Foville, op. cit., gives a very different account of the nature of the corpus callosum, 
 and the origin of its component fibres. He considers that they commence from the corpus 
 striatum and thalamus, and says they have nothing to do with the hemispheres, but in reality 
 form a commissure between the two crura cerebri of a vaulted form. Mayo, in his Outlines 
 of Physiology, has very clearly proved the manner in which that mistake has occurred, and 
 shown that Foville, in producing the appearance which induced him to adopt the opinion 
 stated above, breaks through the point where the fibres from the columns intersect the com- 
 missural fibres, and then follows the columnal fibres in their course to the striated bodies. 
 Rolando advances the same opinion regarding the composition of this commissure as Foville, 
 quoting the opinions of Tiedemann in support of his own. Notwithstanding such weighty 
 testimony, I am convinced from repeated dissections that they have been deceived, most 
 probably as explained by Mayo in his Physiology. 
 
COMMISSURES. 
 
 209 
 
 systematic works we do not find any mention whatever made of these 
 fibres. Mayo, with his usual accuracy of observation, has delineated 
 them in his Plates of the Brain, showing on their external aspect, what 
 I have exhibited on their internal, in fig. 100, where they are repre- 
 sented as they run above the transverse commissure on the edge of 
 the longitudinal fissure. Mayo did not give them any distinctive or 
 generic appellation. These fibres may be easily seen by removing the 
 surface of the convolutions where they form the lower part of the 
 outer wall of the above fissure. 
 
 Fig. 100. 
 
 This figure represents longitudinal fibres placed above the great transverse commissure corresponding 
 with those which we have just observed below it tfie superior longitudinal commissure. The relations 
 being more simple than those of the inferior commissure, are simply designated by the letters s L. s L. 
 They are traced, ascending forwards, from the locus quadratus, which is anterior to the fissura Sylvii, 
 and then, curving backwards and winding round the front of the great transverse commissure (P), receiv- 
 ing fibres from all the convolutions at the upper and sides of the hemispheres, winding round the posterior 
 extremity of the same commissure, and terminating after crossing the fissura Sylvii, where it commenced 
 in the locus quadratus at the base of the brain. H. Spinal cord. J. Pituitary gland, just above which is 
 the divided optic nerve. N. Letter placed on the crus cerebri, and behind that root of the fornix which 
 springs from the interior of the thalamus. p. Great transverse commissure, s. Olivary ganglion, a, 
 Olfactory ganglion, c D. Optic ganglia, c a. Corpus manimillare, formed by the twist of the tbrnix. 
 cm. Commissura mollis in the third ventricle, k. Optic thalamus. o. Peduncle of the pineal gland: if 
 this line is traced backwards it will be found connected with a dark rounded body, the pineal gland, 
 which is lying on the anterior optic tubercle nates; if this line is traced forwards it will be seen joining 
 the anterior pillar of the fornix, which has been turned down to show this connection. The divided end 
 of the fornix is turned towards us. p c. Posterior commissure, s. Ta3in'a semicircularis joining the for- 
 nix at the same point. This letter is placed in the anterior cornu of the lateral ventricle on the corpus 
 striatum. This junction is very distinct in both the recent and hardened brain, though the connecting 
 fibres are too delicate to be done justice to in a woodcut. 4. Fourth ventricle, v. Iter a tertio ad quartum 
 ventriculum. u. Posterior commissure. 
 
 The convolution which is opened to show this commissure is the 
 " convolution de Vourlet" and from the centre of it these fibres may be 
 traced either backwards or forwards. In tracing them forwards, we find 
 them turning over the anterior edge of the transverse commissure, and 
 running down to those convolutions at the base, which, forming the under 
 
210 HUMAN BRAIN. 
 
 and back part of the anterior lobe, are placed close to the locus quadratus 
 in front of thefasura Sylvii : these fibres do not, however, form merely 
 a narrow band, but an extended plane, the exact width of which cannot 
 be defined, as its constituent fibres are in contact with the internal surface 
 of all that part of the hemispherical ganglion which is to the outer side 
 of the longitudinal fissure. The posterior fibres run backwards in the 
 same manner in which the anterior run forwards, terminating in like 
 manner in the convolutions at the under part of the hemispheres, running 
 across the fissura Sylvii to the locus quadratus, where we traced the an- 
 terior. No one, I think, can trace this longitudinal commissure without 
 acknowledging the justice of Spurzheim's observation, when after de- 
 scribing and reasoning on the composition of the fornix, and the appara- 
 tuses of communication in the brains of the lower animals, he says, 
 " Thus, the especial pains which nature has taken to establish communi- 
 cations between cerebral parts cannot be overlooked, and it is this 
 arrangement which enables us to understand the mutual influence. of their 
 functions respectively." Nevertheless, it is rather extraordinary that he 
 should make no mention of the fibres above described as constituting 
 the superior longitudinal commissure. 
 
 The lateral ventricle must next be opened, as directed at page 165. 
 The student will again observe a structure, already briefly noticed, namely, 
 the fornix. In pursuing the dissection of this commissure, where we 
 have not more than one brain at our command, a difficulty arises from its 
 lying over and concealing from view the transverse commissures which 
 remain to be studied. This obliges us to divide it and turn it back, in 
 order that the others may be seen ; as this proceeding interferes with 
 that perfect and minute dissection of the inferior longitudinal commis- 
 sure, which can only be accomplished on a brain almost entirely devoted 
 to it, a drawing of the fornix has been introduced in fig. 101, with the 
 view of assisting the student to a knowledge of its complicated relations. 
 The longitudinal commissure must now be divided in the middle, just 
 opposite the divided end of the transverse commissure, but not removed, 
 as we must return to the study of it ; this being done, the posterior por- 
 tion must be turned back, when the optic thalami on both sides may be 
 distinctly brought into view with a fissure of some depth between them 
 (third ventricle). See fig. 78. 
 
 Commissura Mollis. Crossing the centre of this median fissure, the 
 so called third ventricle, is the commissura mollis, consisting almost en- 
 tirely of cineritious neurine. It connects the two thalami' together. 
 This corresponds with the gray matter, which, crossing the mesial line in 
 the spinal cord, connects the two sides of the spinal cord together (see 
 fig. 100, c m). 
 
 Pineal Commissure. Running from before backwards along the inner 
 edge of the thalami a white line may be seen formed by a collection of 
 medullary fibres, which are connected to the pineal gland in the mesial 
 line ; these, through the intervention of that body, form the pineal com- 
 missure before mentioned (see figs. 78, 100). 
 
 Posterior Commissure. The pineal commissure may now be divided ; 
 beneath it, and just anterior to the optic tubercles, a narrow band of 
 
COMMISSURES. 211 
 
 medullary neurine will be perceived ; this is the posterior commissure; 
 its fibres may be traced in the thalami on each side (fig. 100, pc). 
 
 interior Commissure. The whole extent of this commissure cannot 
 be perfectly seen in this stage of the dissection ; but if the student direct 
 his attention to the anterior boundary of the fissure called the third ven- 
 tricle, he will see two rounded cords, which are called the anterior pillars 
 of the fornix, the nature of which will be explained hereafter. Between 
 these two cords a transverse commissure may be observed : this is the 
 anterior commissure ; and the only portion of it brought into view is that 
 which runs across the small fissure left between the anterior pillars of the 
 longitudinal commissure; its dissection will be most conveniently con- 
 ducted at the base of the brain, where it will be found (having been 
 already exposed in the dissection of the passage of the motory tract 
 through the anterior cerebral ganglion of the cord, see fig. 91,) to be 
 about three lines in width, and commencing in the middle of the hemi- 
 spheres to pass through the substance of the corpus striatum or anterior 
 cerebral ganglion, apparently receiving additional fibres from the cineri- 
 tious neurine of the most external portion of this ganglion ; near to the 
 internal edge of the ganglion, however, the anterior commissure becomes 
 quite distinct from it, and crosses over to the corresponding ganglion of 
 the opposite side, in front of the anterior pillars of the longitudinal com- 
 missure. From the outer part of this commissure some fibres may be 
 traced to the olfactoy nerves; these were first discovered by Spurzheim, 
 in 1821, and are mentioned in his thesis entitled "Encephalotomie." 
 The portion running to the olfactory nerve forms an arc the convexity of 
 which is turned backwards, the concavity forwards.* 
 
 Pons Varolii Transverse Commissure of the Cerebellum. This is the 
 last of the transverse commissures to be dissected ; the appearance 
 which it presents will be already familiar to the student, as he has traced 
 the fibres of the spinal cord through its centre. The fibres of which it 
 consists running from one lateral lobe of the cerebellum to the other, 
 can be seen on the surface without dissection, and these are sufficient to 
 establish its commissural character. But if we make a section through 
 it we find, in addition to medullary fibres, there is a large quantity 
 of the vesicular or cineritious neurine. The presence of this neurine 
 gives to it a ganglionic character. This gray matter is not found in the 
 anterior portion of the commissure, but in the posterior division, where 
 the fibres of the cord traverse it. Burdach saw immediately the import- 
 ance of this fact, and concludes that its presence has some relation to 
 the formation of the longitudinal fibres. The connection of the commis- 
 sural fibres to the cerebellum will be given in the description of this 
 organ. 
 
 Inferior Longitudinal Commissure, or Fornix.] The commissure to 
 
 * Chausssier and Tiedemann both regard the anterior commissure as a continuation of 
 the cerebral crura; but with all due respect to such high authorities, I cannot agree with 
 them ; for in pursuing the dissection which has been already described, tracing the course of 
 the anterior fibres through the corpus striatum, and giving the utmost attention to the rela- 
 tions of the anterior commissure, it will be found that there is no continuity of fibre between 
 the peduncles of the brain and the anterior commissure. 
 
 t Cruveilhier, when speaking of the fornix, p. 720, says, u Shall it be considered as *n 
 anterior posterior commissure ?" As a circumstance favorable to this view, I recall to mind 
 
212 
 
 HUMAN BRAIN. 
 
 which we must next direct our attention is the inferior longitudinal commis- 
 sure or fornix (see fig. 101), which having been divided in its centre in the 
 course of the preceding dissection, must be replaced in its normal position. 
 
 Fig. 101. 
 
 This figure has been introduced with the view of assisting the student in his study of the relations of 
 Ihe inferior longitudinal commissure or fornix, which may be described as commencing in the centre of 
 the thalamus nervi optici (L), proceeding from thence to the base of the brain, where it suddenly bends 
 upwards and forwards, forming by this turn the knuckle (B). which is called corpus albicans or mammillare. 
 This body receives a few fibres (A) from the locus niger (6) in the crus cerebri (5), running forward from 
 thence towards the anterior commissure, receiving fibres from the convolutions at the base of the brain, 
 crossing and as it were kneeling upon the anterior commissure (s), and, ascending towards the great 
 transverse commissure, forms the anterior pillar of the fornix (c), receiving fibres in its course from the 
 under and front part of the anterior lobes, and thus forming the (septum lucidum (D) : running back from 
 thence, passing in its course backwards over the thalamus nervi optici (L). it spreads laterally, constitut- 
 ing that portion which is called the body of the fornix (E) ; descending again at the back part of the brain 
 it forms the descending or posterior pillar of the fornix teenia hippocampi (F), some of its fibres running 
 back to be connected with the posterior lobes (i); others crossing the projection called hippocampus ma- 
 jor (G), to be connected with the middle lobe, and others again passing over the pes hippocampi (H) to be 
 connected with the anterior portion of the middle lobe. Thus does this commissure connect different 
 portions of the convoluted surface of the brain together, which are inferior to the great transverse com- 
 missure, and on the same side of the mesial line. A. Fibres of the inferior longitudinal commissure, or 
 fornix, from the locus niger. B. Corpus mammillare. c. Anterior pillars of inferior longitudinal commis- 
 sure, or fornix. D. Septum lucidum. E. Body of the fornix, or centre of the commissure. F. Tsenia 
 hippocampi, or descending fibres of the inferior longitudinal commissure. G. Fibres covering the hip- 
 pocampus major. H. Fibres covering the pes hippocampi, i. Fibres covering the hippocampus minor. 
 K. Great transverse commissure divided in the mesial line. s. Posterior cerebral ganglion, or thalamus. 
 L Anterior commissure. 5. Section of the crus cerebri. 6. Locus niger. 7. Anterior cerebral gan- 
 glion, or corpus striatum, partially scraped away. 
 
 This part has not been generally described in the light of a commissure. 
 By Vieussens it was considered simply as the under surface of the cor- 
 pus callosum ; but the direction of its fibres being so entirely different, 
 that is, being longitudinal instead of transverse, it is impossible to agree 
 with that celebrated author in this view of the relations of the fornix. 
 The name of Fornix is derived simply from its vaulted figure, for it forms 
 in the centre of the cerebral mass a surface which is convex superiorly 
 and concave inferioriy, bearing, therefore, some resemblance to an arched 
 or vaulted roof. By the German anatomists it is called the twain band. 
 If the student will here refer to fig. 101, he will find the following de- 
 scription considerably elucidated. 
 
 The general form of the fornix may be described as that of a vaulted 
 roof supported upon four pillars, which, unlike pillars in general, are 
 bent nearly double, the anterior pair presenting their concavity forwards, 
 
 that I have seen the right half of this vault atrophied in a case of destruction of those cere- 
 bral convolutions which lie on the tentorium cord. 
 
COMMISSURES. 213 
 
 the posterior pair theirs backwards. Its real character, and the direction 
 of the fibres composing it, will be ascertained by making a section of 
 the brain, so as to obtain a side view of it ; and in order to effect this, 
 the crus cerebri on the right side should be divided by an incision just 
 between the optic tubercles and the posterior cerebral ganglion ; and the 
 scalpel being kept quite close to the inner side of that ganglion, the in- 
 cision may be carried forward, running also on the inner side of the 
 motory ganglion, and then cutting through the anterior lobe into the 
 anterior fissure, as has been done in the dissection from which fig. 101 
 is taken. This commissure, like every other commissure, cannot, strictly 
 speaking, be described as commencing in one part more than another; 
 in describing it, therefore, as commencing in the crus cerebri, it must be 
 remembered that it would be equally correct to describe it as terminating 
 there ; but being obliged to suppose it to commence at some point, we 
 shall speak of it as arising from the cineritious neurine, or locus niger, 
 in the centre of the crus cerebri. 
 
 From the centre of the crus cerebri the fibres of the longitudinal 
 commissure may be traced to the corpora mammillaria, at which point 
 they are joined by a band from the interior of the thalamus, which can 
 be most easily dissected when the brain rests on its upper surface and 
 the base is exposed (fig. 101, B; fig. IjJO, c a), when it will be found 
 that this little body is produced by a turn of the band coming from the 
 interior of the thalamus; for this band, after emerging from the thala- 
 mus, first runs directly inwards, then turns suddenly forwards and forms 
 a sort of knot, such as we can imitate exactly by means of our handker- 
 chief or soft cloth. This arrangement is very well delineated in Langen- 
 beck's Plates of the Brain ; it has been described and designed by Vicq 
 d'Azyr. Reil was also aware of its existence. Cruveilhier states that 
 he has traced it to a connection with the taenia semicircularis. Prof. 
 Erie considers that he has traced fibres from the optic nerve through the 
 thalamus into this band, and continuous with the fornix in the course 
 now described. 
 
 From the corpora mammillaria the fibres are collected, so as to form 
 two rounded cords ; the course of these is first forwards, then upwards, 
 and afterwards backwards, thus forming a semicircle, the concavity of 
 which facing backwards used to be called the anterior pillars of the for- 
 nix, and is free and unattached, whilst the anterior or convex edge re- 
 ceives fibres from the anterior lobes and beneath the great transverse 
 commissure,* by which means a thin delicate septum is formed, called 
 the septum lucidum.^ 
 
 These pillars also receive two sets of fibres anteriorly ; first, from a 
 white band which has already been under the notice of the student 
 the tania semicircularis running in a groove between the thalamus and 
 corpus striatum ; the tcenia semicircularis commences (see fig. 100, s) 
 
 * I believe that I was the first to describe the septum lucidum as consisting of longitudinal 
 fibres, and thus forming a portion of the longitudinal commissure. 
 
 f Rolando describes the septum lucidum as a folding in of the fibres of the hemispheres 
 from the corpus callosum. The direction of its component fibres convinces me, however, 
 that such cannot be a true view of its construction, and the fornix as a whole he views as 
 merely a portion of the corpus callosum. 
 
214 HUMAN BRAIN. 
 
 from the middle lobe in the descending cornu of the lateral ventricle, 
 and is continued through the body of the lateral ventricle into the an- 
 terior columns of the fornix: secondly, a set which are described further 
 on as the peduncles of the pineal gland or the pineal commissure, 
 beneath the last (fig. 100, o). The longitudinal commissure in its pass- 
 age backwards under the great commissure (corpus callosum), to which 
 it is attached, spreads laterally, and at first is nearly of the width of 
 half an inch ; while tracing its fibres in this portion of its course, two 
 projections are observed, which have received the names of hippocam- 
 pus major, and hippocampus minor ; they are situated in the descending 
 and posterior cornua of the lateral ventricles. 
 
 " The hippocampus," says Wenzel, (p. 134, op. cit.,) " from the time of 
 Arantius, who first described them (Observations Anatomicae, Venetiis 
 1587, 4 Observat. 3, page 45), to that of Haller, was considered as a 
 continuation of the fornix, or, in the words of Haller, u pro fornicis 
 ipsius cruribus." Haller referred them to the corpus callosum, consider- 
 ing them as continuous with its structure, saying (Commentaria ad pra3- 
 lectiones academicas, H. Boerhaave, tome ii., Taurino 1743,-4, p. 509), 
 " Nobis imprimis ta3nis continua? videntur fornici tubera fornix ad tan- 
 turn horum corporum molem, neque posteriores pedes hippocampi facere 
 possit." 
 
 Gunz (Prolusio, Observationes anatomicas de cerebri continens altera. 
 Leipsiae 1750, 4) points out very decidedly that the corpus fimbriatum, 
 as it is usually called, is the true pillar of the fornix. 
 
 In this division of our subject it will, I think, be advisable to inquire 
 into the real character of these hippocampi, and the relation they bear 
 to other parts of the brain. 
 
 If the hippocampus major be examined carefully in a brain that has 
 been thoroughly hardened in spirits of wine, it will be found to consist 
 of cineritious neurine covered by a thin layer of medullary fibres. The 
 cineritious neurine is on the same plane, and continuous with the con- 
 volutions at the base of the brain, and is in reality a true convolution; 
 the medullary fibres come from the under part of the cerebrum in various 
 directions, and being collected at the inner edge of this body, form what 
 have usually been called the posterior pillars of the fornix, or the tsenia 
 hippocampi, but which we must regard as the posterior descending ex- 
 tremity of the inferior longitudinal commissure. 
 
 The cineritious neurine over which these fibres of the longitudinal 
 commissure run from before backwards, and from below upwards, is, in 
 fact, nothing more than a continuation of that neurine which constitutes 
 a portion of the convoluted surface of the brain, neither more nor less, 
 therefore, than a part of the hemispherical ganglion, but in this situation 
 covered by the inferior fibres of the longitudinal commissure. Its large 
 size in some of the lower animals, especially those in whom the olfactory 
 ganglia are much developed, has gained for it by some anatomists the 
 title of hippocampal lobe; and though clearly a continuous portion of 
 the cortical substance of the brain, in all probability it has its peculiar 
 and individual office to perform in relation to the sense of smell. 
 
 Wenzel was aware of its real character, justly observing, (p. 141,) 
 "Hippocampus ergo, manifest! nihil aliud est, nisi continuatio superficii 
 
COMMISSURES. 215 
 
 cerebri intro flexa, sive in unam lateralium ventriculorum partem ; sive 
 hippocampus nil est nisi unius gyrorum in superficii cerebri sitorum in 
 interius cerebri prolongatio." 
 
 The hippocampus minor is in some respects analogous to the hippo- 
 campus major; for it is formed by the projection of one of the fissures 
 dividing the convolutions at the inner side of the posterior lobe, where 
 it is covered by the posterior fibres of the longitudinal commissure. It 
 differs from the hippocampus major in this respect, that the projection is 
 caused by the central surface of the convolutions, and not by the peri- 
 pheral surface, as is the case in the hippocampus major. 
 
 This account of the fibres which enter into the composition of the 
 inferior longitudinal commissure will prove to the student that this struc- 
 ture connects the cineritious neurine or locus niger of the crura cerebri 
 and the thalami nervorum opticorum with the convolutions of the hemi- 
 spheres, as well as most of the convolutions of the same hemisphere, 
 together, and is in this respect distinguished from the great transverse 
 commissure, whose office is to connect the two opposite hemispheres 
 together. It must be regarded, therefore, as an apparatus of union be- 
 tween different points of the same hemispherical ganglia. The presence 
 of these two longitudinal commissures connecting together different parts 
 of this extensive layer of vesicular neurine may be regarded as offering 
 presumptive evidence in favor of the opinion, that this ganglion, though 
 anatomically but one centre, physiologically consists of many, which is 
 the fundamental principle of phrenology. 
 
 There is another portion of cineritious neurine which I am compelled 
 to mention in consequence of its being uniformly described in all descrip- 
 tions of the brain under the silly name of corpus denticulatum ; I say 
 silly name, because it would have been equally wise to have given a 
 particular appellation to every square inch of the convoluted surface as 
 to this portion, which is partly covered by the posterior pillar of the 
 longitudinal commissure. The corpus denticulatum is neither more nor 
 less than a portion of the hemispherical ganglion, which, being brought 
 into view according to the old method of dissecting the brain by cutting 
 through the posterior pillar of the fornix, appeared to be a distinct part 
 deserving an appropriate title. 
 
 Inter- cerebral Commissure, or Cerebral- cerebello Commissure. The re- 
 maining commissure which demands our attention consists of medullary 
 fibres connecting the two great cerebral masses, the cerebrum and the 
 cerebellum, together, as well also as the optic tubercles and the cere- 
 bellum ; these fibres have been briefly noticed before under the name of 
 the inter-cerebral commissure, consisting of fibres thick and strong on 
 each side, but extremely thin and delicate in the centre ; the fibres are 
 arranged longitudinally in both situations (fig. 77, fig. 102, i & c). 
 
 The constituent fibres of this commissure are not so simply arranged 
 as we might in the first instance be inclined to suspect. To me they 
 appear to be divisible into three sets ; and as they are all collected to- 
 gether at the point where they enter the cerebellum, we shall describe 
 them from that point forwards. 
 
 1st. The most superior, those in fact which form the surface of the 
 
216 
 
 HUMAN BRAIN. 
 
 processuse cerebello ad testes, and the valve of Vieussens, may be traced 
 distinctly to the optic tubercles. 
 
 2dly. The external; these form the external surface of the processus 
 e cerebello ad testes, and may be traced to the side of the optic tuber- 
 cles, and thence to the optic thalami, and as far as I can discover, though 
 I cannot speak decidedly, through that ganglion to the hemispheres. 
 
 3dly. The third and last set are the deep or descending fibres: these 
 may be seen by first dividing the cerebellum into two halves, then divi- 
 ding close to the cerebellum that portion of the pons Varolii called the 
 crus cerebelli, and the corpus restiforme. If the cerebellum be now 
 raised, tearing up the inter-cerebral commissure, it will be found that 
 some of its fibres descend, and in so doing interlace with the ascending 
 fibres of the sensory tract : these descending fibres may be traced through 
 the locus niger of the crus cerebri till they become continuous with the 
 motor tract, and also with the portion of the longitudinal commissure 
 or fornix which takes its origin at that point. See fig. 107, i & c, re- 
 presenting the relation of the fifth pair of nerves to this commissure. 
 
 A perpendicular incision having been made through the centre of the 
 cerebellum, the course of this commissure into its interior may be next 
 demonstrated, and at the same time that beautiful appearance, which 
 from its resemblance to the branches of a tree is called the arbor vita, 
 observed distinctly exposed. 
 
 Fig. 102. 
 
 c. Anterior optic tubercle. D. Posterior ditto. E. Cerebellum divided, showing the arbor vitro. F. The 
 descending fibres of the inter-cerebral commissure, i & c. Another portion of the same commissure, 
 ir. Crus cerebri. x. Commissure of the cerebellum divided, z. Portion of the olivary tract and resti- 
 form body, divided from the cerebellum, and raised so us to show the motor origin of the fifth pair of 
 nerves (e). c. Third pair of nerves, d. Fourth pair of nerves, e. Motor origin of the fifth. 
 
 On reviewing what has been said on the commissures it will be found 
 that they may be arranged under two heads; the transverse and longi- 
 tudinal. " 
 
 The transverse commissures, six in number. 
 
 1. The great transverse commissure of the hemispheres, or the cor- 
 
 pus callosum. 
 
 2. The pineal commissure. 
 
CEREBELLUM. 217 
 
 3. The posterior commissure, or commissure of the posterior cere- 
 
 bral ganglia, or thalami nervorum opticorum. 
 
 4. The soft commissure, or commissure also of the posterior cere- 
 
 bral ganglia. 
 
 5. The anterior commissure, or commissure of the anterior cerebral 
 
 ganglia or corpora slriata. 
 
 6. The commissure of the cerebellum, or pons Varolii. 
 The longitudinal commissures, four in number. 
 
 1. The superior longitudinal commissure. 
 
 2. The inferior longitudinal commissure, or fornix. 
 
 3. The inter-cerebral commissure, or processus e cerebello ad testes, 
 
 with the valve of Vieussens. 
 
 4. The olivary commissure. 
 
 The Cerebellum. This portion of the encephalon is situated in the 
 posterior division of the skull beneath the cerebrum. In the human 
 subject it is more completely overlapped by the cerebrum than in any 
 other animal. 
 
 The portion of the skull in which it is contained is bounded superiorly 
 by the tentorium, by which it is separated from the posterior lobes of the 
 cerebrum, posteriorly and inferiorly by the occipital bones, laterally and 
 anteriorly by the temporal and parietal bones. 
 
 The superior surface of the cerebellum is almost flat, but is not placed 
 quite horizontally, rising anteriorly where it comes in contact with the 
 optic tubercles (fig. 105). 
 
 The relative position of the cerebellum to the cerebrum and the occi- 
 pital bone, and thus to its position in the neck, is very clearly exhibited 
 in fig. 71, E, and should be reflected upon by the student before he re- 
 moves the cerebellum from the cerebrum, in order to study its external 
 configuration and dissect the course of its fibres. For he cannot clearly 
 observe each surface of the cerebellum unless it is removed with the 
 medulla oblongata from the cerebrum by cutting through the crura 
 cerebri.' 
 
 The pia mater and arachnoid must next be carefully and entirely dis- 
 sected from every portion of it, as well as from the pons Varolii and 
 medulla oblongata.* This having been done, and its superior face ob- 
 
 * The following directions are given by Reil, for the preparation of the cerebellum. " The 
 cerebellum of a male should be selected, and of one who may have died in early manhood 
 of some chronic disease; it should be in as fresh a state as possible ; the brains of those who 
 have died of typhus lose their consistence too soon for this purpose, and where inflamma- 
 tion of the brain has existed, the membranes are not easily separable. The cerebellum 
 may be detached by dividing the crura cerebri above, and the medulla oblongata below ; it 
 should then be placed in a basin under water, and the membranes removed with the forceps ; 
 the membranes are prevented from drying, and the blood exudes more freely, when the part 
 is thus immersed in water. The denuded cerebrum is now to be placed in a vessel, and 
 to be twice washed by the effusion of brandy, which may be suffered to remain on it some 
 minutes ; afterwards alcohol is to be substituted, in which it should stand twelve hours ; 
 when, in this way, the surface appears somewhat hardened, the membrane is to be removed 
 from the deeper furrows, in order that the spirit may everywhere penetrate the mass; spirit 
 is then again to be poured over the preparation, which may stand a day or two: finally the 
 alcohol is to be renewed, and the vessel closed and set by for two or three months, till the 
 part has acquired a grayish color, and is thoroughly hardened. It is right, during this time, 
 to turn the preparation occasionally, and to contrive that every surface is freely bathed in 
 the spirit." 
 
218 HUMAN BRAIN. 
 
 served, it will be found to consist of innumerable laminae, separated by 
 furrows which take a curved direction, the concavity forwards, and con- 
 vexity backwards. These fissures between them vary in depth from a 
 line to half an inch, increasing from before backwards. 
 
 Fig. 103. 
 
 Superior surface of the cerebellum, a a. Lateral lobes, b. Lobulus quadratus, or square lobe. c. 
 Superior semilunar lobe. d. Internal part of the inferior semilunar lobe, e Sff. Superior vermiform 
 process, g. Commencement of the valley, h. Pons Varolii. i. Superior fossa of the cerebellum. 
 
 The deeper furrows form the boundaries of the lobes, the shallower 
 ones of the lobules: this arrangement is best seen by a vertical section 
 (fig. 102). The central portion of this surface being elevated, has been 
 described by some authors as a distinct process, the superior vermiform 
 process (103, e). This portion of the cerebellum has been described by 
 Reil as a commissure, but it does not appear to me to be an apparatus 
 of union, but rather a centre of power placed in the mesial line, and 
 connected laterally with the two hemispheres, perfectly analogous to the 
 cerebellum of all animals below the Mammalia. Reil, himself, states 
 that in the brain of the hare there is little more than a vermiform pro- 
 cess. Indeed a mere section of it ought to be sufficient to convince us 
 that it is no true commissure. Comparative anatomy has shown us that 
 this, the central lobe, is the fundamental portion of the cerebellum. The 
 lamina? of it curve forwards, while those of the lateral lobes on each 
 side curve backwards. 
 
 Viewing the superior surface of the cerebellum, we observe the lateral 
 lobes are again subdivided (103) by a deep fissure, into a lobe of a 
 square shape (6), situated anteriorly; and a semicircular-shaped lobe (c) 
 on the posterior margin. The lobulus quadratus is bounded by the fis- 
 sure of the anterior margin, the semilunar fissure of Reil, in which is 
 situated the pons Varolii. 
 
 At the posterior extremity of the superior surface a deep and wide 
 notch also occupying the mesial line may be observed. This notch, 
 called by Reil the purse-like fissure, divides the cerebellum into two 
 lateral lobes or hemispheres, as they are sometimes called, as will be 
 more distinctly seen by reversing the position of the cerebellum. Sepa- 
 rating the under from the upper surface, there is a very deep horizontal 
 fissure (fig. 104, c). Looking at the under surface of the cerebellum 
 
CEREBELLUM. 219 
 
 and medulla oblongata when they are removed together from the rest of 
 the brain, we observe first the medulla oblongata lying in this mesial 
 furrow, the valley. Raising the medulla and turning it forwards, we 
 next observe another worm-like process, the processus vermiformis info- 
 
 Fig. 104. 
 
 Inferior surface of the cerebellum. The medulla oblongata is cut away close to the pons Varolii. a a. 
 Lateral lobes, b. Anterior and external part of the semilunar and square lobes, c. Great horizontal fis- 
 sure, d. Inferior semilunar lobe. e. Slender lobe. /. Biyentral lobe g. Tonsilla lobes, or amygdala. 
 h. Flocculus, i. Its white substance, k. The spigot, or inferior vermiform process, almost covered by 
 the tonsils, or amygdala. 1. Nodules, m. Pyramid, n. Pons Varolii, or commissure of the cerebel- 
 lum, o o. Crura cerebelli. 
 
 rior, connecting the two lateral lobes, and partly filling up the valley. 
 This vermiform process is laminated in the same manner as the lateral 
 lobes ; it is divided by Reil into three portions ; the posterior he calls 
 the pyramid (fig. 104, m), the middle, the spigot ; and the anterior, the 
 nodule (fig. 104, /). The fissures in this, the under surface, are much 
 deeper than in the upper. Their direction at the anterior part, instead 
 of being from side to side, is from before backwards, cutting so deeply 
 into its substance that Reil has described the intermediate portions as 
 distinct lobes. Each lateral lobe or hemisphere of the cerebellum has 
 five lobes; the most anterior and inferior of these portions is the small- 
 est ; it is more separated than the rest, and stands out from the inferior 
 edge of the pons Varolii close to the corpus restiforme, like a cauliflower 
 on a stalk. This first lobe is called, by Reil, the flock (fig. 104, A), and 
 stated to be absent in the lower animals. Immediately behind the flock, 
 lying in contact with the restiform bodies of the medulla oblongata, is 
 the tonsil-shaped lobe, or amygdala of Reil (g 1 ); the next division in 
 succession as we pass backwards is, Thirdly. The biventral lobes 
 (fig. 104, e), which lie between the slender lobes and the amygdala. 
 Fourthly. The slender lobes (e). Fifthly. The under and posterior semi- 
 lunar lobes (d). 
 
 A view of the posterior surface is also very instructive, as exhibiting 
 the above-mentioned lobes from a different point of sight (fig. 105). 
 From this general view of its configuration the student must proceed to 
 the more difficult and important question of its internal structure. First, 
 the arrangement of its gray neurine which forms its ganglionic portion. 
 
220 HUMAN BRAIN. 
 
 The arrangement of the gray neurine in the cerebellum is beautifully 
 simple, for, with one exception, it is entirely on the surface. This layer, 
 like the hemispherical ganglia, or the cortical substance of the hemi- 
 spheres, is of immense extent, requiring in the same manner to be folded 
 up in order to pack it into the small space devoted to its reception. 
 The term laminated ganglion of the cerebellum might be advantageously 
 employed to designate it. 
 
 Fig. 105. 
 
 Posterior surface of the cerebellum and spinal cord. a. Spinal cord. . Amygdala, f. Biventral 
 lobe. g. Slender lobe. h. Inferior semilunar lobe. i. Superior semilunar lobe. k. Square lobe. / 4* m - 
 Superior vermiform process, n. Inferior ditto, o. Pyramid, ii. Posterior roots of the cervical nerves. 
 
 Its extent and relation to the fibrous neurine is best seen by perpen- 
 dicular and horizontal sections, as directed further on. 
 
 The only gray neurine in the interior of the cerebellum is deposited a 
 little on each side of the mesial line, very near to the centre. It is a 
 curious waving surface, presenting both in a perpendicular and hori- 
 zontal section a denticulated appearance, very like that in the interior 
 of the corpus olivare, only rather more than twice its extent (fig. 92). 
 
 This body, long known as corpus rhomboidum, corpus dentatum, ker- 
 nel of the cerebellum, &c., was denominated by Spurzheim the ganglion 
 of the cerebellum. 
 
 "Vicq d'Azyr," says this author (see p. 121), , " believed that the 
 ganglion of the cerebellum was only to be found in the human kind. 
 But in 1808, conjointly with Dr. Gall, I showed that it exists in the 
 Mammalia generally ; and I now add, that it is very distinct in birds. 
 Whenever the cerebellum is somewhat considerable, it may always be 
 demonstrated ; its small size and pale color were probably the causes of 
 its existence being overlooked. But it is matter of prime importance 
 not to confound the forms assumed, and the lighter or deeper shades of 
 color possessed by the pulpy substance, with its necessary existence." 
 
 I think that the better title, one more in accordance with the principle 
 of nomenclature already advocated, would be Ganglion dentiforme. 
 
 Reil (p. 33, Mayo's Physiol. Com.) compares the laminated arrange- 
 ment of the medullary and cineritious matter of the cerebellum to the 
 
CEREBELLUM. 221 
 
 u plates of a voltaic pile." I do not see the correctness of this simile. 
 Indeed, this arrangement seems rather a necessary part of that admira- 
 ble contrivance which we observed carried out in the hemispheres of 
 the cerebrum, for obtaining an extensive surface of gray neurine placed 
 upon and in close connection with a corresponding amount of white 
 fibres ; inasmuch as the gray neurine being supposed to generate power, 
 requires an adequate supply of conducting instruments in the white 
 fibres for the exportation of its power, or the importation of a stimulus 
 to its production. 
 
 The student may first study the white fibres of the cerebellum merely 
 anatomically, reserving for future consideration the physiological ques- 
 tion, which of them belong to the motor, sensory, or commissural tracts. 
 Speaking metaphorically, and without reference to their offices or the 
 course of nervous power, they are derived from six sources, three on 
 each side. 
 
 The collected bundles from which we are supposing them to emanate 
 external to the cerebellum, are described as the peduncles of the cere- 
 bellum, and named from their position, superior, inferior, and middle 
 peduncles. These terms, though unphysiological, it is, perhaps, con- 
 venient to retain. 
 
 The great transverse commissure of the cerebellum, or pons Varolii, 
 had better first engage the student's attention. In his previous dissec- 
 tions he has observed how the anterior and posterior columns of the 
 cord traverse its central portion. Now he must follow out the lateral 
 portions, crura cerebelli of old authors, which plunge into the substance 
 of the cerebellum. Let him reverse its position and place the pons Va- 
 rolii upon its under surface, and raise with the fingers all those laminaB 
 of the cerebellum which overlap it as it enters this ganglion. And by 
 taking a pinch, if I may so say, of these laminaB, and tearing them up- 
 wards and inwards, the course of the fibres of this the middle peduncle 
 of the cerebellum will be seen spreading in all directions, and running 
 into each separate lamina both of the superior and inferior vermiform 
 process and the lateral lobes. The same mode of dissection pursued at 
 the under surface will expose them, running equally to all parts of the 
 cerebellum, including the inferior vermiform process (fig. 104). 
 
 Indeed, if there is one point in the anatomy of the cerebellum on 
 which I feel more certain than another, it is the fact that the fibres of 
 the pons Varolii are in connection with the whole of the laminated gan- 
 glion or cineritious surface of the cerebellum. 
 
 They do not appear so intimately connected with the dentiform gan- 
 glion as those of the superior peduncle, but I am not able to say that 
 they do not pass through it. 
 
 The inferior peduncles are the corpora restiformia, or processus e 
 cerebello ad medullam oblongatarn, consisting, as before stated, of motor 
 and sensory fibres. The best mode of following them to their destina- 
 tion is to raise the auditory nerve (fig. 108) just at the lower edge of the 
 pons Varolii, and by turning it down carefully with a probe its iwo roots 
 which embrace the restiform body will be seen, and that body distinctly 
 exposed just as it plunges into the cerebellum, where it will be found 
 to pass upwards, beneath, and to the inner side of the crus cerebelli or 
 
222 HUMAN BRAIN. 
 
 lateral portion of the pons Varolii, from which it may easily be separated 
 by a probe. 
 
 I prefer a probe, or any narrow blunt instrument, for dissecting the 
 brain, as less liable to deceive you with regard to the existence and di- 
 rection of fibres. 
 
 The student should next divide the whole of the transverse commis- 
 sure or crus cerebelli, carefully avoiding the inferior peduncle, or resti- 
 form body ; and tearing this commissure in the same direction as before, 
 upwards and inwards, the fibres of the restiform body will be seen run- 
 ning to both the inferior and superior vermiform process and the posterior 
 laminae of the lateral lobes. But here, as in the case of the superior 
 peduncle, I cannot state positively the extent of the connections of the 
 fibres of the restiform bodies ; but my belief is that they do not pass 
 laterally, or reach the surface of the lateral lobes. 
 
 And it is most probable that such is the arrangement, considering the 
 fact that the lateral lobes of the cerebellum are deficient in those ani- 
 mals in whom the pons Varolii is wanting, and extremely small in all 
 animals except in man, in whom alone the pons Varolii attains any size 
 at all. 
 
 The superior peduncle of the cerebellum has been already referred to 
 as the inter-cerebral commissure, or processus e cerebello ad testes. Its 
 component fibres are, however, twofold, as before stated : one portion 
 of them truly commissural, connecting the cerebrum and cerebellum 
 together; the other is derived from the motor tract. The fibres of 
 this, the superior peduncle, may be traced into the substance of the 
 cerebellum by first raising those laminaB of its superior vermiform pro- 
 cess, which, overlapping this body, are in apposition to the optic 
 tubercles. Next tearing up carefully one lamina after another, the fibres 
 of this peduncle will be seen to pass in the leaflets of this vermiform 
 process. 
 
 To the outer side of this process they are found running through the 
 ganglion dentiform of the cerebellum to the posterior laminaB, and I have 
 not yet been able, by the most careful dissections, to satisfy myself that 
 these fibres spread into the lateral lobes so as to reach the lateral lamina. 
 In this portion of their course they are overlaid by that thick layer of 
 fibres from the pons Varolii which sweep round from the outer side of 
 the cerebellum to the superior vermiform process. The remaining fibres 
 of this peduncle pass to the inferior vermiform process; these may be 
 easily traced after making a perpendicular section through the centre of 
 the cerebellum. 
 
 Those fibres of this peduncle, which are apparently derived from the 
 motor tract, will be most clearly demonstrated by dividing the cerebel- 
 lum into two halves, then dividing close to the cerebellum that portion 
 of the pons Varolii called the crus cerebelli, and the corpus restiforme. 
 If the cerebellum be now raised, tearing up the inter-cerebral commis- 
 sure, it will be found that some of its fibres descend, and in so doing 
 interlace with the ascending fibres of the sensory tract; these descending 
 fibres may be traced through the locus niger of the crus cerebri till they 
 become continuous with the motor tract. 
 
 The physiological analysis of the cerebellar fibres is simple : First, 
 
CEREBELLUM. 223 
 
 there are transverse commissural fibres in the shape of the pons Varolii, or 
 great transverse commissure, connecting the whole corresponding sur- 
 face of the ganglion of the cerebellic hemispheres. Secondly, longitu- 
 dinal coramissural fibres, the inter-cerebral commissure connecting the 
 cerebrum and cerebellum. Thirdly, motor fibres passing from the 
 cerebrum in common with the rest of the motor tract through the cor- 
 pus striatum, or crus cerebri, entering into the composition of the 
 superior peduncle and terminating in the superior and inferior vermi- 
 form processes. Fourthly, motor fibres emanating from the superior 
 and inferior vermiform processes, entering into the composition of the 
 restiform bodies, and joining the anterior portion of the cord, as the 
 cerebellic fibres of the anterior columns. Fifthly, and lastly, sensory 
 fibres from the posterior columns of the cord, forming likewise a por- 
 tion of the restiform bodies, and terminating in the two vermiform pro- 
 cesses. 
 
 Let the student now call to mind the simple form in which the cere- 
 bellum was first presented to his notice. In the carp, he saw it as a 
 mere rounded point; in the whiting, a narrow leaflet or tongue; in the 
 skate, advanced so as to form two larger or more distinct leaflets ; in the 
 tortoise, much larger, and hollowed out internally; and in the bird, so 
 much further advanced as to assume a true laminated character. 
 
 "The cerebellum of the bird," (says Reil, p. 205, whose account of 
 the development of this organ I have followed almost literally, and 
 which will be found peculiarly interesting to the student after he has 
 thoroughly mastered its anatomy in the human subject,) " represents in- 
 deed a vermiform process alone, and wants the lateral parts, which are 
 superadded in animals more nearly allied to human beings in their 
 anatomical construction, possessing in their place little germs or shoots 
 scarcely discernible. 
 
 "The successive additions, which may be traced to this simple form 
 of a cerebellum, are of a similar structure with the elementary part: and 
 those additions which adhere with the primitive portion by medullary 
 substance alone, being otherwise separate and distinct, are termed offsets 
 (Ansatze) ; those which are connected both by medullary and cortical 
 substance are termed wings (Flugeln) of the vermiform process. Among 
 the lower animals, there are but few and simple offsets ; higher in the 
 scale, these become more numerous; the vermiform process extends 
 itself laterally and receives wings, and in proportion as the wings are 
 developed, the offsets diminish. The first improvement in the cere- 
 bellum takes place at its anterior and upper surface; while on its under 
 surface the parts remain contracted and sunken. The vermiform pro- 
 cesses predominate even in quadrupeds, in length, breadth, and depth; 
 the fore part only of the cerebellum possesses distinct wings ; laterally 
 and behind, there are only offsets. In proportion as the fabric improves, 
 the offsets are changed into wings, till at length in human beings the 
 hemispheres are completed ; and with the exception of the flocks, the 
 offsets have wholly disappeared. All the parts are now brought together 
 in compact order: the vermiform processes, with their wings, constitute 
 one whole, between the parts of which the freest communication seems 
 to exist, which the employment of offsets would interrupt. 
 
224 HUMAN BRAIN. 
 
 " In the brain of the hare there is little more than a vermiform pro- 
 cess: there are but few wings, and these slight and short: the lateral 
 offsets are small. In the brain of the sheep the central lobe is large, 
 firm and broad, but has neither wings nor offsets: the anterior velum is 
 somewhat depressed upon the fourth ventricle. The next lobe in order 
 is broad, of some length and depth, but has laterally short projections, 
 not equal in their breadth to half the length of the vermiform process; 
 these, however, may be viewed as wings. In the third lobe the organ 
 is contracted, and has longer and larger wings ; there follow, upon the 
 under surface, a pyramid, spigot, and nodule, which have no wings, but 
 a large bundle of lateral offsets ; between the wings and offsets the 
 peduncles of the annular protuberance emerge, and mark the place of 
 the horizontal fissure. The whole cerebellum has a globular form, which 
 results from the projection of the vermiform processes. The latter stand 
 more or less vertically over the medulla oblongata, and have an anterior 
 and a posterior surface, which correspond with the superior and inferior 
 surfaces of the same parts in the human brain. The lateral offsets in 
 the higher animals are more and more driven from the fore to the back 
 part of the cerebellum, until at length, in the human brain, they are ex- 
 changed for the lobes of the inferior surface, which unite with the inferior 
 vermiform process. The whole cerebellum seems, indeed, pressed back- 
 wards, as its parts become more complex ; so that the central lobe con- 
 tinually emerges more and more from between the peduncles of the 
 tubercula quadrigemina, and in the human brain lies fairly behind these 
 bodies, the common anterior stem being directed upwards, and the 
 posterior horizontally. In the brain of the ox the central lobe is large, 
 and without wings; the remaining lobes of the anterior surface are of 
 inconsiderable dimensions: on the posterior surface, the pyramid, spigot, 
 and nodule are barely separable; they are without wings, and have 
 scarcely offsets. Lastly, in the brain of the horse the central lobe is 
 large, and without wings, but of less size than in the ox, and more com- 
 pressed from above downwards. The next lobes of the vermiform pro- 
 cess have anteriorly larger and longer wings, which are bent forwards, 
 contracted in their middle, and at their ends have a club-like thickening. 
 The upper and posterior lobe is distinct; but the under and posterior, 
 the slender, the biventral, and almond-like lobes, are wanting, and in 
 their stead a large bundle of irregular offsets is found on either side of 
 the pyramid, the spigot, and the nodule. 
 
 "Thus the enlargement of the cerebellum proceeds from the central 
 primary portion ; to which new processes, as wings or offsets, are con- 
 tinually added, in proportion as the scale of its improvement rises. In 
 quadrupeds, and even in the human brain, traces of the simplest type 
 of a cerebellum are to be seen in the central lobe, illustrating further the 
 principle on which its improvement proceeds. The furrow between this 
 lobe and the lateral processes connected with it is so deep, as to leave 
 it doubtful whether the latter are properly wings or offsets. 
 
 " In the human brain the wings form the principal part of the cerebel- 
 lum, viz. the hemispheres. On the upper surface these are immediately 
 prolonged from the vermiform process; on the under surface they seem 
 incomplete, being separated by a deep furrow from the inferior vermi- 
 
CEREBELLUM. 225 
 
 form process on either side. It is remarkable that the human cerebel- 
 lum, the most complex in its structure of any, should yet exhibit a 
 resemblance of the clearest kind to the primitive and elementary form. 
 When the human cerebellum is placed with its usually horizontal axis 
 in a vertical direction, it may be rigorously compared with the cerebel- 
 lum of birds: what in the latter case is a single lamina, is here subdi- 
 vided, and has become arborescent ; in the one case single leaves, in the 
 other, lobes, lobules, and finally leaves, are raised around the nucleus, 
 forming a dense investment to it, from under which the peduncles pro- 
 ject on each side, like the fin-like feet from under the shell of the turtle. 
 
 " In proportion as the lateral parts increase in the shape of offsets or 
 wings, the vermiform processes become smaller, as if compressed to- 
 wards the centre. This circumstance is most apparent in the human 
 brain : the vermiform processes are there comparatively diminutive in 
 every dimension, in length, breadth, and depth: before them spring out 
 the horns of the semilunar fissure, behind them the projecting margin 
 of the purse-like fissure : within the latter, and at the place of the spigot 
 and nodule, the inferior vermiform process is scarcely a few lines in 
 breadth. In animals the vermiform processes overtop the lateral por- 
 tions; in man the upper surface of the general commissure is only on a 
 level with the hemispheres, while below it is contracted and shrunken 
 to the bottom of the valley. This compression of the general commis- 
 sure on all sides in the human brain, accounts for the difference observ- 
 able in its structure as compared with that of the hemispheres ; a differ- 
 ence which is not found in the brains of quadrupeds. In its texture this 
 part in the human brain is softer, and its membrane firmer and more 
 vascular than is the case in the hemispheres. The medullary matter is 
 here again in thinner layers than in the hemispheres ; thinly spread out 
 in the anterior velum, it forms a thicker mass at the meeting of the ver- 
 tical and horizontal process, where the nucleus of the general commis- 
 sure begins : in the former process it exists in greater quantity than in 
 the latter, and finally it forms an extremely thin layer in the posterior 
 velum. In the anterior fissure the general commissure has its greatest 
 breadth, becoming narrower as it passes towards the purse-like fissure: 
 in the single commissure, where it has shrunk to a single lamina, and in 
 the short commissure, it continues still narrow ; it becomes broader 
 again at the pyramid, and finally tapers to a point in the spigot and nodule. 
 On either side of the superior vermiform process there are furrows of 
 greater or less depth, at which the laminae are thinner, and indented, 
 and their direction altered ; so that whereas the convex margin of the 
 laminae of the hemispheres is Directed backwards, that of the lamin 
 of the superior vermiform process loot.? forward. In these furrows, by 
 which the lateral limits of the superior vermiform process are defined, 
 blood-vessels are lodged ; these fuwms are continued along the valley, 
 where they become deeper. 
 
 " Looking generally at the vermiform processes, we observe that 
 they are composed of corresponding portions on either side of the me- 
 dian plane, that there is no material difference in the structure of the 
 upper and under portions, and thus that the whole is one homogeneous 
 organ. We may observe further, that whereas in birds these parts con- 
 15 
 
226 HUMAN BRAIN. 
 
 stitute the whole of the cerebellum, and in quadrupeds the principal 
 portion, in human beings, where their relative bulk is trifling, compared 
 with that of the hemispheres, they are, on the one hand, parts of the 
 same composition and nature with the latter, and on the other may be 
 considered as the general commissure, by which the lateral portions are 
 intimately united." 
 
 Tuber Cinereum, Infundibulum, and Pituitary Gland. The only parts 
 of the brain which now remain to be noticed, are situated at its base, 
 namely, the tuber cinereum, infundibulura, and pituitary gland. The 
 tuber cinereum derives its names from the cineritious neurine of which 
 it consists, and which entitles it to be classed among the ganglia. From 
 the circumstance of the optic nerve sending some filaments into its sub- 
 stance, and the longitudinal commissure deriving several from it, I am 
 inclined to view it as an instrument of power connected in some way or 
 other with the phenomena of vision. Its general form has been already 
 noticed in the description of the base of the brain. The infundibulum, 
 or pituitary process, is a funnel-shaped tube, deriving its name from its 
 shape ; it passes down from the tuber cinereum to the pituitary body. 
 It is hollow, and consists principally of cineritious neurine, but internally 
 some white fibres may be seen descending in a striated manner from the 
 mesial surfaces of the thalami. They are best seen by means of a glass, 
 magnifying about ten diameters. I am inclined to regard this process 
 as a medium of nervous communication or commissure between the 
 pituitary body and the thalami. The pituitary body, or gland, is sjtu- 
 ated,like the semilunar ganglion of the fifth pair of nerves, external to 
 the dura mater. It occupies the whole of the sella turcica of the sphe- 
 noid bone. It weighs, with the infundibulum, about eight grains. It 
 consists of two lobes, an anterior and posterior. The anterior, which is 
 about twice the size of the posterior, lodges the latter in a hollow on its 
 posterior edge. 
 
 The structure of this body is similar to the cineritious neurine of the 
 brain ; it is vesicular, made up of large nucleated cells, surrounded by 
 a granular matter imbedded in a white fibrous tissue. This fibrous tis- 
 sue accompanies the blood-vessels, which are found in it in great num- 
 bers. Its substance is soft, but not so soft as the cerebral matter, and 
 when pressed between the fingers, is reduced to a grayish pulp, like the 
 substance of an absorbent gland in an early stage of suppuration. 
 
 It is larger in the infant than in the adult, and more developed in some 
 of the Vertebrata than in man. We have already observed its great size 
 in fish. Some anatomists have supposed that the pituitary body is the 
 cerebral ganglion of the sympathetic nerve ; and to me this appears a 
 very probable hypothesis. 
 
 Dr. Todd does not consider it a ganglion, but says, " It may with 
 more propriety be classed with the glands without efferent ducts ; and 
 from its numerous vessels and close relation to part of the venous sys- 
 tem within the cranium, it may be connected with the process of absorp- 
 tion or removal of the effete particles of the brain." 
 
 Recapitulation. The description of the course and termination of the 
 various tracts of medullary neurine which, with their ganglia, constitute 
 the brain or encephalon, being now concluded, it will, I think, be useful 
 
RECAPITULATION. 227 
 
 to take a general review of the subject, by a recapitulation of what has 
 been stated in detail separately ; and we will reverse the order of our 
 observations, proceeding from above downwards instead of from below 
 upwards. 
 
 In the first place, we have an extensive surface of cineritious neurine, 
 the hemispherical ganglion, (speaking merely of one side of the brain,) 
 which, in the higher orders of animals, is convoluted or folded in a 
 peculiar manner. 
 
 In apposition to the whole of the vesicular neurine of this ganglion, 
 there are tubular fibres which radiate through it, and are encrusted by 
 its nucleated cells. 
 
 These fibres are disposed of in four different ways; 1st, some of them, 
 commencing from the convolutions of the anterior, middle, and posterior 
 lobes, pass through the corpora striata, and, forming the inferior layer of 
 the crus cerebri, pass through the pons Varolii, so as to form the ante- 
 rior columns of the cord, as previously described the motor tract : 2d, 
 others commencing in the nerves of sensation, and after passing through 
 the pons Varolii, and emerging from the substance of the thalamus, 
 terminate in the same neurine that gave origin to the last ; this is the 
 sensory tract : 3d, others, passing from one side of the brain to the other, 
 and in apposition to the internal surface of all the convolutions, are 
 those fibres which, collected into a mass, form between the hemispheres 
 that wide bridge, if I may so call it, the great transver&e commissure, or 
 corpus callosum: 4thly and lastly, in contact with all the convolutions 
 are the fibres of the superior and inferior longitudinal commissures, 
 which, connecting together those convolutions which are situated on the 
 same side of the mesial line, or different portions of the same hemi- 
 spherical ganglion, so far differ from the transverse commissure, which 
 connects those situated on opposite sides, or the two distinct but corre- 
 sponding ganglia. 
 
 The first and second set of fibres, which radiate from the external 
 surface of the two large ganglia of the anterior and posterior columns, 
 as from a common centre, forming, however, in their radiation, only half 
 a circle, were designated by Gall and Spurzheim the diverging fibres. 
 The third set of fibres, which converge towards the centre of the brain, 
 the transverse commissural, were distinguished as the converging fibres 
 by the same authors. 
 
 The above descriptions demonstrate that the encephalon or brain in 
 the human subject is not a large solid mass of matter, in the interior of 
 which are cavities scooped, as it were, out of its substance, to be appro- 
 priately denominated ventricles, but that it really consists of ganglia or 
 collections of cineritious neurine, placed on each side of the mesial line. 
 Some of them being the appropriate ganglia of the nerves of sensation ; 
 as, for instance, the olfactory ganglia, the optic ganglia or tubercula 
 quadrigemina, the auditory ganglia or posterior pyramidal bodies, the 
 pneumogastric ganglia or restiform ganglia, the olivary bodies or lingual 
 ganglia ; the others being the motory and sensory ganglia, as the corpora 
 striata and thalami nervorum opticorum. The hemispherical ganglia, 
 again, that they might present the greatest possible extent of surface, are 
 folded up into innumerable plaits, and thus cover or surround every other 
 
228 HUMAN BRAIN. 
 
 ganglion within the cranium, so that on first removing the skull-cap, no- 
 thing can be seen but the convoluted surface of these extensive ganglia. 
 
 And here let me insist upon this important principle in the study of 
 the brain, which is also one of the first ideas that the student should 
 acquire regarding its composition, namely, that it consists of correspond- 
 ing or symmetrical parts on each side of the mesial plane, and that in- 
 stead of regarding the fissures of separation between its different portions 
 as forming ventricles or cavities, he must direct his attention to the 
 ganglia which bound the fissure, and the structures called commissures, 
 which, connecting them together, cross the fissure, and necessarily alter 
 its character in different points, masking it, it is true, but not at any place 
 changing the fissure into a true bag or circumscribed cavity. The third, 
 the iter a tertio ad quartum ventriculum, the fourth and fifth ventricles, 
 we have already seen, are in truth no more than the successive dilata- 
 tions from below upwards of the posterior fissure of the cord ; difficult 
 enough to be understood when these are viewed in different situations 
 and unconnected one with the other, as in the ordinary mode of dissect- 
 ing the brain, but which seem necessary and obvious where its parts are 
 traced in connection with one another. 
 
 In conclusion, let me express the hope that these views or analyses, if 
 I may be allowed so to call them, of the component parts of the ence- 
 phalon, will really simplify the whole of its anatomy, and materially assist 
 the student in acquiring a knowledge of its true character. I wish that 
 custom did not require the student to burden his memory with fanciful 
 and unmeaning names, and that, instead of learning a long catalogue of 
 the contents of the lateral ventricles, as they are erroneously designated, 
 and puzzling himself with the absurd titles of hippocampus major and 
 minor, pes hippocampi, tcenia hippocampi, cornu Ammonis,&c., he should 
 be required simply to observe how the spinal columns appear to terminate 
 superiorly in two large tubercles, the corpora striata and thalami^ from 
 the sides and under parts of which the hemispheres spring out, being 
 afterwards reflected so as completely to envelop this bulbous extremity 
 of the spinal cord. In the same way the third ventricle should be de- 
 scribed as a fissure separating the two halves of the brain, his particular 
 attention being directed to the commissures which pass across it to con- 
 nect the different cerebral ganglia with one another. The description 
 of the relative position of these ganglia, the commissures connecting 
 them, and their relation to the ganglia and columns of the spinal cord, 
 comprehend all the information which is either interesting or useful to 
 the student. 
 
229 
 
 PART VII. 
 
 CEREBRAL NERVES, 
 
 HAVING thus considered both individually and collectively the various 
 centres of power which constitute the encephalon in man, we shall next 
 direct our attention to the connections of the cerebral nerves, organs 
 which conduct the mandates of the will outwards, and the different per- 
 ceptions inwards. 
 
 Connected with the encephalic ganglia, and that portion of the motory 
 and sensory tract which is contained within the skull, there are, accord- 
 ing to some authors, eleven pairs of nerves ; in the opinion of others, 
 no more than nine. Each nerve is distinguished by an appropriate 
 name in addition to its title derived from its numerical position. This 
 difference in the number of nerves reckoned by different anatomists, 
 arises from the fact that some describe the 7th pair or facial, and the 
 8th pair or auditory, as if they were merely portions of the same nerve, 
 whose office was analogous although their distribution might be differ- 
 ent; whereas the fact is that they are as distinct instruments of two dis- 
 similar kinds of nervous power as the optic nerve and the olfactory 
 nerve, and are therefore equally well entitled to appropriate and dis- 
 tinguishing appellations. If it is found convenient to employ numerical 
 names in speaking of the cerebral nerves, it is still very important that 
 no single number should be given to two nerves physiologically distinct, 
 however closely they may be connected. The glosso-pharyngeal and 
 pneumogastric nerves have, also, 'like the auditory and facial, been till 
 lately described as forming the 8th pair of cerebral nerves. In this in- 
 stance we are not perhaps authorized to separate these two nerves from 
 any decided proofs of their having distinct functions ; on the contrary, 
 we are rather led to regard the two as mere portions of the conducting 
 instrument of one and the same nervous power. Nevertheless, as one 
 division or root of the old 8th pair is now invariably described under 
 the title of the pneumogastric , and the second division is constantly 
 spoken of by the name of the glosso-pharyngeal when they have passed 
 out of the cranium, it seems important that the two should still be dis- 
 tinguished by distinct numerical designations when within the skull. 
 Upon these grounds I shall follow the arrangement of Soemmerring, who 
 describes eleven pairs of cerebral nerves: not, indeed, that I am alto- 
 gether satisfied of the correctness', in a strictly physiological point of 
 view, of this procedure, for if it be proper to separate the seventh and 
 eighth pairs into two nerves each, it would be strictly correct to consider 
 the third pair and the sixth as merely separate roots of the same nerve, 
 
230 HUMAN BRAIN. 
 
 and to describe the two together by the name of the common oculo-mus- 
 cular: for the circumstance of the commissure of the cerebellum separat- 
 ing their roots is merely accidental to their arrangement in a physiolo- 
 gical point of view; but the fact of their being described as if they were 
 distinct nerves has frequently led the student to believe that they must 
 be endowed with distinct offices, and wonder why the abductor muscle 
 of the eye should be supplied by a peculiar nerve, while the other mus- 
 cles, with the exception of the superior oblique, receive their supply 
 from the same source. 
 
 Most authors, with the exception of Spurzheim, who fell into the 
 opposite mistake, have erroneously described all the cerebral nerves as 
 originating in the brain. The fallacy of this idea, and the vicious 
 method of description that resulted from it, have been pointed out in 
 the section on Comparative Anatomy, where it has been remarked that 
 the nerves of sensation should be described as terminating in their ap- 
 propriate ganglia, as has actually been done by Spurzheim, whilst the 
 nerves of motion, on the contrary, should be described as originating 
 there, an extension of the legitimate mode of proceeding which Spurz- 
 heim neglected to enforce. 
 
 If, after this statement regarding the most correct method, in a physio- 
 logical point of view, of describing the connection of the cerebral nerves 
 with the encephalon, the student is still desirous of information upon 
 each of these individually, he will find it useful to make out a table for 
 himself, in which he must carefully distinguish between the apparent 
 origin more properly point of emergence from, or of entrance of the 
 nerve between the fibres of the cerebral mass, and the actual point of 
 union between the neurine of the nerve and that of the cerebral mass 
 itself. 
 
 First Pair of Nerves, Olfactory. The first pair of nerves (the numera- 
 tion commencing at the anterior part of the brain) encountered are the 
 olfactory or nerves of smell ; they originate on the lining membrane of 
 the nose, and, entering the skull through the cribriform plate of the 
 ethmoid bone, terminate in the olfactory tubercles or ganglia, which are 
 situated in the cribriform fossa? of the same bone.* In man these gan- 
 glia, whose minuteness as compared with those of the horse, sheep, cat, 
 dog, indeed most of the Mammalia, is interesting in a physiological 
 point of view, are entirely concealed by the enormously developed hemi- 
 spheres.! Each ganglion is connected to the hemispheres by a long 
 narrow commissure, frequently designated a peduncle, which, lodged in 
 a triangular-shaped groove, passes backwards till opposite the fissura 
 Sylvii, where it splits into three divisions. The most external of these, 
 which is also the longest, and distinctly medullary, runs down the fissura 
 Sylvii to be connected with the anterior extremity of the middle lobe : 
 
 * MM. de Blainville and Rolando are almost the only modern authors who seem to be 
 aware of the absurdity of retaining the ordinary mode of describing these portions of the 
 olfactory apparatus as a nerve ; in fact, as Rolando remarks, we have in this particular re- 
 trograded from the knowledge of the ancients, who never described them by the title of 
 nerves. Willis appears to have been the first to speak of them in connection with the cere- 
 bral nerves. 
 
 f In describing each pair of nerves, the description will generally be confined to one side 
 only, as being simpler for the student to follow. 
 
CEREBRAL NERVES. 231 
 
 this portion of the olfactory peduncle is connected with the anterior 
 commissure, as described by Malacarne in his Encephalotomie et Micro- 
 cephalotomie, by Rolando, and by Gall and Spurzheim. The internal 
 is connected to the posterior internal surface of the under part of the 
 anterior lobe. The middle, which is the shortest, and, strictly speaking, 
 no more than the internal portion of the external, is connected with the 
 posterior edge of the anterior lobe (see fig. 72). 
 
 Thus we see the olfactory ganglion in the human brain connected by 
 a commissure with the cineritious neurine of the hemispheres, as in the 
 lowest animals, where we have invariably observed each individual 
 ganglion in succession connected with the others. 
 
 The canal which Gall and Spurzheim believed they had discovered 
 in the interior of the olfactory commissure in man was in all probability 
 formed under the blowpipe by the breaking down of the cineritious 
 neurine in its interior, in the same manner as a canal was formed in the 
 spinal cord by the action of the blowpipe in the hands of these anato- 
 mists. Tiedemann observed the existence of a canal in the brain of 
 two idiots, an appearance which, I think, must be considered merely as 
 an arrest of development at a period corresponding to the permanent 
 organization of the part in some fishes. 
 
 Second Pair. Optic Nerves, The optic nerves commence in the 
 globe of the eye, from a nervous expansion called the retina. After pe- 
 netrating the choroid and sclerotic coats of the eye, they enter the skull, 
 through the foramina optica of the sphenoid bone, on the processus 
 olivaris of which they form a commissure, consisting of fibres arranged 
 in the following manner. The optic nerve on reaching this spot 
 divides into two sets of fibres. One passes over to the opposite side, 
 and after decussating with the corresponding fibres of its fellow, reaches 
 its cerebral connections (as described further on), on the different side 
 of the brain to the eye from which it emanates. The other set of fibres 
 do not decussate, but pass to the same side of the brain as the eye from 
 which they are derived. This structure is represented in fig. 107, which 
 is taken from a dissection similar to that figured by Mayo, who was, I 
 believe, the first who demonstrated by dissection this peculiar arrange- 
 ment. 
 
 The object of this contrivance is explicable on the following prin- 
 ciples.* The rays of light from any object, placed laterally, impinging 
 upon the retina of both eyes, will strike the outer side of one eye and 
 the inner side of the other. 
 
 Now, supposing the arrangement just depicted to be correct, (and 
 there is no reason for supposing it to be otherwise,) it follows as a ne- 
 cessary consequence, that the outer and inner side of each opposite 
 retina is formed by one and the same nerve, a peculiarity of structure 
 
 * Dr. Wollaston (Phil. Trans, for 1824), in a paper entitled, "On SemidecussaTion of the 
 Optic Nerve," suggests the probability of such an anatomical arrangement as affording an 
 explanation of the phenomena of single vision. His words are: "Without pretending to 
 detect by manual dexterity as an anatomist, the very delicate conformation of the nerves of 
 vision, 1 have been led, by the casual observation of a few instances of diseased vision, to 
 draw some inferences respecting the texture of that part which has been called the decus- 
 sation of the optic nerves, upon which I feel myself warranted to speak with some con- 
 fidence." 
 
232 HUMAN BRAIN. 
 
 that goes far to account for the circumstance so often reasoned upon, 
 viz., that a single impression is conveyed to the sensorium, though each 
 eye receives the impression. Whether this mode 
 Fig. 106. O f acc ounting for it be satisfactory or not, the fol- 
 
 lowing facts are extremely interesting, and not 
 sufficiently known, viz., that in those fishes whose 
 eyes are placed so completely on the side of the 
 head that the rays of light from any given object 
 cannot impinge on both retina?, as, for instance, 
 in the cod and haddock, the optic nerves, instead 
 of forming any union or commissure, cross each 
 
 ^^^^^ other completely, having a membrane interposed 
 
 This figure represents that between them i in those fishes, again, whose eyes 
 33^toS$S3R are situated so that even a small portion of their 
 winThaTbet $&3E% retin8B . correspond, as in the carp, we find a few 
 dwelt upon in the body of the commissural fibres ; and in those whose retinae 
 
 work ; it is taken, as well as , . . , . r \ 
 
 every other drawing of my correspond in every point, as in the skate, we find 
 pTsseSkJn r?t P wni to noVhoX tne commissure as complete as in the human being, 
 ever, be the less valuable While engaged in the investigation of this inte- 
 
 from its corresponding, in the . ) p. o . o . , 
 
 representation of the fibres, resting subject, by the dissection of those animals 
 
 to that of Mr. Mayo's in his i , T ,, , ' i i i i i ., T 
 
 folio work. i. other fibres which I thought would best elucidate it, I was 
 ^&-SStSSiS^Si^ informed by Mr. Wheatstone, Professor of Natural 
 running from one side of the Philosophy at King's College, that Prof. Miiller, 
 
 brain to the other, and wholly /rvii . 
 
 unconnected with the retina, or berlin, had given great attention to the same 
 
 crossing oveTut th^commis- subject, and had carried his observations much 
 
 P U ositeVide n th se nthe P ~ further than I have had any opportunity of doing, 
 
 but uniformly confirming the opinions stated above. 
 
 The commissure of the optic nerves is not alone formed of fibres de- 
 rived from the retina of the eye ; for, in addition to these, we find a set 
 of fibres highly interesting to the physiologist, and wholly unconnected 
 with the organ of vision. These are strictly commissural, and were 
 first pointed out to me by Mr. Mayo ; they run from one side of the brain 
 to the other, forming in their course a curve convex anteriorly and con- 
 cave posteriorly; they may easily be seen in a human brain that has 
 been hardened in spirits. In the mole, in which the optic nerves are 
 so extremely minute that they have often escaped detection, and by 
 many authors described as entirely wanting, these commissural fibres are 
 found distinctly crossing the base of the brain, opposite the usual situa- 
 tion of the optic commissure ; while the small black speck, evidently 
 the rudiment of the eye, is supplied by a minute branch from the fifth 
 pair. 
 
 Wenzel, who enters very fully into the question regarding the compo- 
 sition of the optic commissure, sums up in the following words (p. 126) : 
 " Parlialis ergo nervorum opticorum decussatio, et evidens antopsia 
 patens non ex solis nervorum opticorum, sed et existorum loci unionis 
 ipsorum, et ex collicorurn nervorum opticorum, ex simul sumptorum 
 morbosis afTectionibus colligitur : quamquam sileant hac de re Scemmer- 
 ring, Ackermann et Michealis. Conclusio ista unica et sola ex tarn 
 multis observationibus quas attulimus extra omne dubium esse, nobis 
 videtur." 
 
CEREBRAL NERVES. 
 
 233 
 
 In the paper already referred to by Dr. Wollaston, I find that he sup- 
 ports his theory by the reference to the complete decussation of the 
 nerves in the sturgeon, cod,&c., where the eyes are on each side of the 
 head. 
 
 Fig. 107. 
 
 The drawing exhibits the cerebral connection of all the cerebral nerves except the 1st. It is from a 
 sketch of my own taken from two dissections of this part. i>. Posterior optic tubercle. The generative 
 bodies of the thalamus are just above it. E. Cerebellum. H. Spinal cord. i. Tuber cinereum. K. Optic 
 thalamus divided perpendicularly, w. Corpus restiforme. x. Pons Varolii. bb. Optic nerves: this 
 nerve is traced on the left side back beneath the optic thalamus and round the crus cerebri. It divides 
 into four roots; the first (g g) plunges into the substance of the thalamus, the next runs over the external 
 geniculate body and surface of the thalamus, the third goes to the anterior optic tubercle, the fourth runs 
 to D, the testis or posterior optic tubercle, c. Third pair common oculo-rnuscular, arising by two roots 
 like the spinal roots of the spinal nerves, the upper from the gray neurine of the locus niger, the lower 
 from the continuation of the pyramidal columns in the crus cerebri and pons Varolii. p t. d. Fourth 
 pair, apparently arising from the inter-cerebral commissure (i e). but really plunging down to the olivary 
 tract (o t) as it ascends to the optic tubercles, e in. Motor or non-ganglionic root of the fifth pair, arising- 
 frorn the posterior edge of the olirary tract, e. Sensory root of the fifth pair running down between the 
 olivary tract and restiform body to the sensory tract (for its exact connection, see fig. 108). /. Sixth pair, 
 or abducens, arising from the pyramidal tract, g. Seventh pair, facial nerve, or portio dura, arising by 
 an anterior portion from the olivary tract and by a posterior portion from the cerebellic fibres of the ante- 
 rior columns as they ascend on the corpus restiforme, w. h. Eighth pair, portio mollis, or auditory nerve, 
 with its two roots embracing the restifonn body. i. Ninth pair, or glosso-pharyngeal, and.;. Tenth pair, 
 or par vagum, plunging into the restifonn ganglion, j J. Fibres of the optic nerve plunging into the thala- 
 mus : immediately below these letters is the corpus geniculatum externum. Ic. Eleventh pair, or lingual 
 nerve ; the olivary body has been nearly sliced off and turned out of its natural position: some ofthe 
 filaments ofthe lingual nerve are traced into the deeper portion of the ganglion, which is left in its situa- 
 tion; others which are the highest are evidently connected with the pyramidal tract. 
 
 . 
 
 M. P. G. Pelletan, " Memoire surla specialite des nerves des senses," 
 1837, after describing this band, says, p. 32, " After their interlacement 
 these optic nerves undergo such an atrophy that they are not more than 
 one-twentieth of a millimetre, the band or chiasma being about six times 
 as large." 
 
 The same author recommends the dissection of either fetal moles or 
 very young ones, in whom the optic foramen is still distinct. "When 
 
234 HUMAN BRAIN. 
 
 the optic nerve has been well prepared, it is to be seen leaving the 
 cranium, and passing between the fasciculi of the ophthalmic nerve of 
 Willis, which it accompanies to the eye." 
 
 " The mole," says Miiller, (Elements of Physiology, translated by 
 Dr. Baly, p. 767,) " has an uncommonly small optic nerve, and a very 
 delicate chiasma, as Dr. Henle has shown me." 
 
 Tracing the fibres of the optic nerve in man from its commissure, we 
 find it a flattened band, which has been designated the tractus opticus. 
 The tractus opticus passes backwards and outwards, running along the 
 external margin of the gray matter (tuber cinereum, figs. 72 and 107, i) 
 which surrounds the infundibulum. The optic nerve either transmits or 
 receives a few fibres from this cineritious neurine, and traveling back- 
 wards, becomes still more flattened as it passes beneath (the brain being 
 supposed to be in its natural position in the skull) the crus cerebri (fig. 
 72, u), just at the point where that body plunges into the hemispheres. 
 The internal margin of the nerve is connected to the crus cerebri by 
 membrane; the external margin is not so well defined in consequence 
 of its giving some fibres to the under part of the middle lobe of the 
 cerebrum. The tractus opticus in this curved portion of its course lies 
 parallel, and almost in contact, with the inferior pillar of the fornix, being 
 overlapped, as the student dissects from the base of the brain, by that 
 convolution of the middle lobe of the cerebrum which is called the hip- 
 pocampus major, which it runs over in the natural position of the brain. 
 The tractus opticus in this part of its course has above it the optic thala- 
 mus (fig. 107, K). On reaching the posterior part of the crus cerebri, 
 the internal margin of this band diminishes, and great care is required 
 in tracing it to its ultimate cerebral connections. The external surface 
 of the optic nerve now becomes much widened ; some of its filaments, 
 viz., those forming the internal margin, run inwards and become con- 
 nected with those little nodules of the optic thalami called the corpora 
 geniculata ; other fibres pass still further inwards, ultimately terminating 
 in the tubercula quadrigemina (D). 
 
 The more superficial portion of the nerve, when traced backwards, is 
 found winding round the posterior extremity of the thalamus nervi 
 optici, and spreading on the superior surface of that ganglion, becomes 
 intimately connected with it. The internal portion of this layer is 
 attached to the peduncles of the pineal gland. This connection of the 
 optic nerve with the surface of the posterior cerebral ganglion or optic 
 thalamus may be distinctly and easily demonstrated on the brain of the 
 sheep, in which animal the deeper portion is not so large as in man. I 
 have not been able to trace this superficial portion of the nerve into the 
 hemispheres beyond the external border of the thalamus. The remain- 
 ing portion of the nerve continues its course backwards, and, spreading 
 as it runs, passes also a little outwards. It now splits into two portions, 
 the division of which cannot, however, be seen on the surface; for one 
 portion is placed beneath the other, and plunges into the substance of the 
 thalamus (fig. 107, gg), where it terminates. I first described these 
 fibres in a letter published in the Medical Gazette, vol. xxi. They may 
 easily be shown even in a brain which has not been hardened in alcohol, 
 
CEREBRAL NERVES. 235 
 
 by making a section longitudinally through the tractus opticus and 
 thalamus nervorum opticorura (fig. 107). 
 
 It must be evident from this description, that, notwithstanding the 
 assertion of Spurzheim that u it was a great error to consider the eminences 
 called optic thalami as the sources of the optic nerves," these nerves 
 are intimately connected with them. Nevertheless, it is very certain that 
 the optic thalami have a more immediate relation to the hemispheres of 
 the brain than to the organs of vision. They are always in proportion 
 to the size of the hemispheres, and, consequently, are found of greater 
 size in man than in any other animal. 
 
 S. W. Stein, in a thesis on the origin of the optic nerve,* considers 
 it as decided " that the optic nerves are connected to the thalamus, and 
 that this organ connects the optic nerves to the whole brain." Rolando 
 denies that the optic nerves arise from, or terminate in, the tubercula 
 quadrigemina, asserting that they take their origin from the thalamus 
 alone. f This statement is altogether untenable with the parts before us. 
 
 Third Pair, or common Oculo-muscularJVerve. The third pair of nerves, 
 the common oculo-muscular, emerges from the cerebral mass at the inner 
 side of the crus cerebri, the medullary fibres of which, as already ex- 
 plained, are continuous with the motory tract of the spinal cord. This 
 is not, however, the real origin of this nerve ; for if it be traced care- 
 fully, it will be found not merely to be connected with the surface of the 
 crus cerebri, but dipping beneath it, and there dividing into two por- 
 tions : one of these ascends through the pons Varolii to be connected 
 with the motor tract in its passage through that commissure ; the other 
 passes through the locus niger, and splits in five or six white threads, 
 which, separated by the gray neurine, present a beautiful appearance in 
 a fresh brain (see fig. 107, c). Mr. Grainger first demonstrated this 
 arrangement to me. These filaments, after traversing this deposit of 
 cineritious matter, reach those fibres which the motor tract sends through 
 at this point to the inter-cerebral commissure or processus e cerebello 
 (fig. 102). From this origin the third nerve passes forwards on the outer 
 side of the posterior clinoid process, and penetrates the dura mater mid- 
 w 7 ay between the anterior and posterior clinoid processes, where it enters 
 a space left between the under surface of the dura mater and the side of 
 the sella turcica, which, we have seen, constitutes the cavernous sinus. 
 It runs along the upper part of this sinus, quitting the cavity of the 
 skull at the foramen lacerum orbitale, and thus entering the orbit, within 
 which it is distributed to the levator palpebra, and to the levator, ab- 
 ductor, and depressor oculi. The more particular distribution of these 
 nerves will be found described in most of the elementary anatomical 
 works, to one or other of which I shall therefore refer my readers for 
 further information.^: 
 
 Fourth Pair, or inner Oculo-muscular. Theybwr^ pair of nerves, also 
 called the pathetic, and the smallest of the cerebral nerves, emerges from 
 the surface of the inter-cerebral commissure, close to the optic tubercles. 
 
 * De Thalamo et origine nervi optici, &c. Haunise, 1833. 
 t Page 92, op. cit. 
 
 * Let me here particularly recommend the excellent practical manual of my friend and 
 colleague Mr. F. Le Gros Clark. 
 
236 HUMAN BRAIN. 
 
 It arises much deeper from the olivary portion of the pyramidal or motor 
 tract (107, D). The fourth pair of nerves, at their origin, are connected 
 together by a distinct commissure, more evident in some brains than in 
 others. From this origin they take their course, between the cerebrum 
 and cerebellum, along the edge of the tentorium, by which membrane 
 they appear to be conducted to the posterior clinoid processes, where, 
 entering the cavernous sinus, they take their course, in the posterior 
 part of that cavity, just below the third ; but as they approach the fora- 
 men lacerum orbitale, they cross above the third pair, and, on their 
 entrance into the orbit, are situated to the inner side of the third pair : 
 they supply the superior oblique muscle of the eye. 
 
 Fifth Pair, or Trigeminal. The fifth or trigeminal consists of two 
 portions, the one for sensation and the other for motion. The sensory 
 portion commences by numerous filaments from the surface of the mu- 
 cous membrane of the nose, of the palate, from the pulpy structure of 
 the teeth in both jaws, from the papillae of the tongue, from many parts 
 contained within the orbit, the lachrymal apparatus, the conjunctiva, 
 &c., and from the skin covering the face. The numerous filaments 
 from all these sources are collected into separate portions, which pass 
 individually into the skull. The first division passes through the fora- 
 men lacerum orbitale; the second through the foramen rotundum; and 
 the third, through the foramen ovale. Under the dura mater in the 
 temporo-sphenoidal fossa, they enter the lower edge of the cineritious 
 matter of the semilunar ganglion of the fifth nerve. From the concave 
 edge of the semilunar ganglion other fibres arise, which, passing over 
 the anterior surface of the petrous portion of the temporal bone, pene- 
 trate the dura mater on the outer side, and below the posterior clinoid 
 processes. They then run direct to the upper edge of the pons Varolii, 
 and, passing between the fibres of this commissure, descend completely 
 through its substance, maintaining their individuality down through the 
 medulla oblongata, till they terminate in the posterior portion of the 
 antero-lateral columns of the spinal cord, about an inch and a half be- 
 low the pons Varolii, as represented in fig. 107, e\ and fig. 108. 
 
 This termination of the sensory root of the fifth is so close to that of 
 the motor division, that Dr. Alcock considers that they arise from the 
 same tract. This is not the case, as the olivary tract to which the 
 motor root is attached, is on the outer side of the sensory tract, and dis- 
 tinct from it (see figs. 94, 107). 
 
 The motory portion of the fifth nerve, again, does not arise, as usually 
 described, from the continuation of the anterior columns or motory tract 
 while passing through the pons Varolii or commissure of the cerebel- 
 lum, but passing beneath the inter-cerebral commissure, very close to 
 the cerebellum, as designated in fig. 107, runs from this point down- 
 wards to the olivary portion of the motor tract, as it ascends to the optic 
 tubercles. This root of the fifth pair of nerves is described by Dr. Al- 
 cock, in his admirable article " on the Fifth Pair of Nerves," in the 
 Encyclopaedia of Anatomy, parts xi. and xii., as arising from the anterior 
 columns of the spinal cord, where they form part of the medulla oblon- 
 gata. I have not yet succeeded in tracing it so low down as that point. 
 The motor root emerges from the pons Varolii, almost close to the spot 
 
CEREBRAL NERVES. 237 
 
 where the sensory division enters it, after which it is applied to the sen- 
 sory portion of the nerve. As it then passes through the same foramen 
 in the dura mater, and enters the temporo-sphenoida! fossa, it slides 
 behind the semilunar ganglion, to which it is connected by membrane, 
 but not by neurine. It quits the skull at the foramen ovale, and is then 
 distributed to the muscles concerned in the motions of mastication, viz., 
 the masseter, temporal, pterygoid, and buccinator. 
 
 To recapitulate : the motory portion of the fifth nerve emerges from 
 between the fibres of the pons Varolii, very close to the spot where the 
 sensory portion enters: but in all cases in which I have dissected it, 
 the motory is separated from the sensory portion by a bundle of fibres 
 of the pons Varolii, of variable thickness. If the nerve be traced with 
 great care which is necessary, for it is very thin and easily torn it 
 will be found running backwards and upwards, towards the inter-cere- 
 bral commissure or processus e cerebello ad testes, behind the fibres of 
 which it descends, until it reaches the medulla oblongata. 
 
 Sixth Pair, or .ftbducentes. The sixth pair arises from the motor tract, 
 at the inferior edge of the commissure of the cerebellum, just as it is 
 about to pass through that structure, proceeding immediately from the 
 portion of the anterior columns known as the pyramidal bodies ; the 
 nerve directs its course forward towards the upper edge of the basilary 
 process of the os occipitis, at which point, or at the distance of about 
 half an inch below the posterior clinoid processes, it penetrates the dura 
 mater. It then advances upwards, and, crossing the superior angle of 
 the petrous portion of the temporal bone, it enters the cavernous sinus, 
 where it crosses the carotid artery at nearly a right angle, being joined 
 at the anterior edge of the vessel by some filaments from the sympa- 
 thetic nerve or cyclo-gangliated system, which accompany the sixth 
 nerve into the orbit, and are connected with the lenticular ganglion. 
 
 The sixth nerve, in its course through the cavernous sinus, is situated 
 the most internally ; but under the transverse spinous process of the 
 sphenoid bone, and just previous to its passage through the foramen 
 lacerum orbitale, it is crossed by the ophthalmic division of the fifth 
 pair in its course from the orbit to the semilunar ganglion. The sixth 
 nerve is finally distributed to the abductor muscle of the eye. This 
 nerve, let it be remembered, in a physiological point of view, is merely 
 a portion of the third, its separation from which by the pons Varolii is 
 perfectly analogous to the separation of the roots of the spinal nerves by 
 a blood-vessel running between them, and of no greater physiological 
 importance. 
 
 Seventh Pair, Facial, or Portio Dura. The facial nerve, which emerges 
 from the groove between the corpus pyramidale and olivary, just below 
 the pons Varolii, may be traced backwards through the substance of that 
 commissure in which it runs immediately to the inner side of, and in 
 contact with, the sensory root of the fifth pair of nerves (see fig. 108). 
 On arriving even with the posterior and superior surface of this portion 
 of the fifth pair of nerves, the seventh appears to split into two parts, 
 the one running inwards to be connected with the olivary portion of the 
 motor tract of the spinal cord in its passage through the pons Varolii, 
 the other division proceeding outwards to be connected with that por- 
 
238 HUMAN BRAIN. 
 
 tion of the corpus restiforme which I have described as being derived 
 from the motor tract of the cord (see figs. 89 and 90). 
 
 From this origin the seventh nerve passes forward to the foramen 
 auditivum internum, passing through which, and entering the stylo- 
 raastoid canal, it quits the skull at the inferior orifice of this canal, where, 
 becoming external, it is finally distributed to several of the muscles 
 taking their rise from the styloid process of the temporal bone, to the 
 platysma myoides, and to all the muscles of the face. 
 
 Eighth Pair, Auditory, or Portio Mollis. The eighth or auditory nerve 
 commences from the pulp which lines the labyrinth of the ear. Its 
 fibres gradually unite so as to form a single cord, which quits the tempo- 
 ral bone at the foramen auditivum internum, and directs its course to the 
 posterior part of the medulla oblongata, being connected to the facial 
 nerve by cellular membrane. On reaching the medulla oblongata oppo- 
 site the inferior edge of the pons Varolii, where the facial nerve emerges, 
 the auditory splits into two portions (fig. 108). One of these passes 
 through the substance of the medulla oblongata anterior to the corpus 
 restiforme, and plunges into its appropriate ganglion,* the posterior pyra- 
 
 Fig. 108. 
 
 This figure exhibits the origin of the facial, not as it is usually described, but as I found it on three pre- 
 parations which I dissected in succession. The origin of the auditory, split by the restiform body (w) by 
 two roots, the inner from the olivary tract as it passes through the pons, the other from those fibres of the 
 anterior columns which cover the corpus restiforme (w), as shown in this figure, has been known for 
 some time to a few anatomists, but is not usually described so in most systematic writers. 
 
 * Foville gives the following strange doctrine, as it appears to me (p. 507, op cit.) : " The 
 enlargement known under the name of the Gasserian ganglion, and assimilated to the true 
 spinal ganglia of the posterior roots of the nerves, seems to us to differ essentially from 
 them, and that the ruban gris, or the gray matter on the posterior fasciculus, and united to 
 the auditory nerve, might quite as legitimately be assimilated, to a spinal ganglion. We 
 consider the ruban gris as a part of the gray substance of the posterior fasciculus spread 
 upon the surface of the cerebellar ventricle, and concurring to form the roots of the auditory 
 nerve. The true ganglia of the auditory and trigeminal are to us the cerebellar hemispheres 
 and the vermiform eminences." 
 
CEREBRAL NERVES. 239 
 
 midal body (fig. 78). The other, which is the posterior division of the 
 nerve, winds round the restiform body, which is thus hid between the 
 two portions of the nerve as in a fossa, and then crossing the posterior 
 fissure of the cord or fourth rentricle, forms by its separation three or 
 four white lines, which are usually rery distinct (fig. 78). Meckel* 
 states that he has sometimes found the whole of these lines deficient, 
 sometimes on one side and sometimes on both, and that Prochaska and 
 Wenzel have observed them to differ on the two sides of the brain. 
 Meckel views these striaB as not merely the roots of the auditory nerve, 
 but as connected both with the trigeminal and pneumogastric nerves. 
 
 Ninth Pair, or Glosso-pharyngeal Nerve. The ninth pair, called also 
 the glosso-pharyngeal nerve, arises from the pneumogastric or restiform 
 ganglion and cerebellic fibres of the anterior columns, immediately above 
 the pneumogastric nerve, by one or two roots (fig. 107, i). It runs for- 
 wards to the foramen lacerum posterius, passing through which it quits 
 the skull, separated from the jugular vein by a process of dura mater 
 and a spiculum of bone; arid passing down the stylo-pharyngeal muscle, 
 is finally distributed to the muscles of the pharynx and tongue. 
 
 Tenth Pair, or Pneumogastric. The tenth pair, the pneumogastric 
 nerve or par vagum, is a compound nerve, like most of the spinal nerves ; 
 that is to say, it consists of two tracts of neurine bound up together, the 
 one for sensation, the other for motion. The motor filaments of the 
 nerve are not entirely conductors of volition, for most of the muscular 
 fibres that are brought into action by this nerve are independent of the 
 will; the only exception being the muscles of the larynx concerned in 
 the production of vocal sounds: and as one portion of the tract of volition 
 runs close upon the posterior edge of the corpus olivare, from which 
 these filaments probably arise, we have no difficulty in reconciling the 
 fact of one portion of the nerve being destined for voluntary and the 
 remainder for involuntary motion and sensation, as the constitution of 
 this nerve is proved to be by the most accurate experiments and observa- 
 tions. This nerve has two origins or central attachments, one to the 
 cerebellic fibres of the anterior columns as they form part of the resti- 
 form body; the other may be traced through the fibres of the restiform 
 body into some gray matter at the posterior surface of the cord, the resti- 
 form ganglion (fig. 107). This deposit of cineritious neurine is both 
 physiologically and anatomically distinct from that in which the auditory 
 nerve terminates, as I have shown by repeated dissections of this part 
 in the human subject, and in the calf, horse, and other animals, as before 
 stated in the section on comparative anatomy (see figs. 52 56). Stil- 
 ling describes this gray matter as the ganglion of the pneumogastric 
 nerve. Accompanying these nerves in their passage from the skull is a 
 spinal nerve, which, instead of quitting the vertebral canal like the 
 spinal nerves in general, enters the cavity of the skull by the foramen 
 magnum, and adding itself, as it were, to the glosso-pharyngeal and 
 pneuraogastric, is from this circumstance called the ppinal accessory.^ 
 
 * Anatomie, tome ii. p. 614, n. 
 
 f "In the medulla oblongata," says Forille (p. 500), the nerves of the posterior fasciculus 
 are grouped into two distinct cords of great importance the pneumogastric and glosso- 
 pharyngeal." His description of their origin is most meagre and unsatisfactory. He states 
 
240 HUMAN BRAIN. 
 
 Eleventh Pair, or Lingual Nerve. The last of the cerebral nerves is the 
 lingual, or the eleventh pair. This nerve arises in a groove between that 
 portion of the anterior columns of the medulla oblongata usually desig- 
 nated the pyramidal bodies, and the corpora olivaria. I believe that its 
 origin, like all the spinal nerves, is double, one set of fibres being con- 
 nected with the brain through anterior columns of the cord, and the other 
 with the gray matter ; the olivary body being to this nerve what the 
 anterior peaks of gray matter are to the other spinal nerves. Mayo 
 states* that some of the "fasciculi of the lingual nerve penetrate to the 
 gray capsule in the olivary body." It commences by several filaments, 
 which being collected together, the nerve they compose quits the skull 
 at the foramen condyloideum anterius. It is distributed to the muscles 
 of the tongue and also to those of the os hyoides, viz., the omohyoideus 
 and sterno-hyoideus, which fix the bone inferiorly. 
 
 Regarding the origin of this nerve, Foville states really nothing. 
 He saysf it is detached from the medulla oblongata between the corpus 
 pyramidale and olivary body, but not one word regarding its connection 
 with the interior of the medulla. StillingJ traces it to the posterior sur- 
 face of the cord into what I have described as the auditory ganglion ; 
 but I think he is mistaken. 
 
 that the arciform fibres of Rolando unite with the pneumogastric and glosso-pharyngeal 
 nerves, and then goes on to say, " There are certainly some difficulties which have not yet 
 been resolved in a satisfactory manner relative to the roots of the pneumogastric and glosso- 
 pharyngeal nerves." 
 
 * Plates of the Brain, VII. fig. 2. f P - 527 
 
 J P. 21, op. cit. 
 
 rf) 
 
241 
 
 PART VIII. 
 
 
 
 VESSELS EMPLOYED IN THE CEREBRAL CIRCULATION. 
 
 As the brain receives one-fifth of the whole amount of blood circu- 
 lating in the body, the student will not be surprised to find it supplied 
 with this fluid by four large arteries, the internal carotids and the verte- 
 brals. 
 
 The internal carotid arteries are derived from the common carotids 
 opposite the os hyoides: ascending from their point of origin, they reach 
 the base of the skull, and enter its cavity by the foramen caroticum and 
 carotid canal. The course of the vessel in this canal is worthy of ob- 
 servation. Changing the nearly vertical course they held at the external 
 orifice for one almost horizontal in its direction, they advance forwards 
 and inwards through the space of about an inch ; they then form a curve, 
 resume their nearly vertical course, and quit the carotid canal by the 
 foramen caroticum internum. At this point the vessels bend forwards 
 horizontally again, passing through the cavernous sinuses, groove the 
 outer surface of the sella turcica, and at the inner side of the anterior 
 clinoid processes, they pierce the dura mater and enter the proper cere- 
 bral cavity. It is impossible to follow the two carotid arteries in this 
 way without the peculiarity of their course forcing itself upon the atten- 
 tion. The changes from a perpendicular to a horizontal direction cannot 
 have been ordained without some peculiar purpose to be fulfilled, and 
 the end most probably has been to protect the delicate structure of the 
 brain from any ill effects which the suddenly increased or hurried action 
 of the heart would have been liable to produce had the tube been per- 
 fectly straight and the wave of circulating fluid been suffered to arrive 
 directly, and with its force unbroken, within the cavity of the skull. 
 
 This view of the subject is corroborated by the existence of that com- 
 plicated plexus of vessels, called the rete mirabile, emanating from the 
 internal carotid artery, and situated at the base of the brain. This beau- 
 tiful arrangement of the carotid arteries is to be remembered in connec- 
 tion with the protective apparatus of the brain. 
 
 The branches of the internal carotid artery, as regards the brain, are 
 three in number; two supplying the brain immediately, and one simply 
 forming a communication or anastomosis with the branches of the verte- 
 bral artery. The two first are the anterior and middle cerebral arteries. 
 
 The student will meet with very accurate delineations of these arteries 
 in Professor Richard Quain's folio work on this subject ; the most valu- 
 able work which for years has issued from the press of this country, 
 i ? >xMtimfc t* ^m tomi^t v ,-*>->*i.-. 
 
242 HUMAN BRAIN. 
 
 estimated either for the practical importance of its facts, or for its beauty 
 as a work of art. 
 
 The anterior first runs inwards towards the great median fissure, where 
 approaching very close to its fellow on the opposite side, the two are 
 united by a short transverse branch, called the transverse artery of the 
 cerebrum. The anterior cerebral artery continues its course in the an- 
 terior part of the median fissure between the two lateral hemispheres, 
 giving off numerous branches in its course, winding round the great 
 transverse commissure, and running backwards on its upper surface, 
 where it receives the name of artery of the corpus callosum. 
 
 The middle cerebral runs deeply within the fissura Sylvii, through which 
 it continues its course, arid ultimately reaches the upper surface of the 
 hemispheres. 
 
 The third branch of the carotid, called the communicating artery, is 
 small but interesting ; for running backwards, and joining with the pos- 
 terior artery of the cerebrum, a branch of the basilary artery to be de- 
 scribed further on, it connects these large arterial channels together, and 
 lessens the danger of accident to the brain from obstruction to the cir- 
 culation in one channel, and from an irregular supply of the vital fluid. 
 When tracing the connection of the two communicating arteries with 
 the basilary branches, a perfect arterial circle will be observed to be 
 formed, the sides being constituted by the communicating artery, the 
 posterior part by the basilary, the front by the anterior arteries of the 
 cerebrum and the transverse artery. This curious circle is celebrated 
 under the title of the circle of Willis, who first described it. This free 
 anastomosis is of the greatest importance to such an organ as the brain, 
 for if by any accidental circumstance the flow of blood is arrested in 
 one channel, there is another immediately ready for it. 
 
 The vertebral arteries arise from the subclavian at the lower part of 
 the neck, immediately anterior to the passage of that artery between the 
 scaleni muscles. 
 
 The vertebral has a long course from this point to the cavity of the 
 skull, and nature has beautifully provided for its protection by sending 
 it through a bony and ligaraentous canal, bored, as it were, for it in the 
 transverse processes of the cervical vertebrae. This vessd, though much 
 smaller than the internal carotid artery, does not run in a direct course 
 from the heart to the skull, nor begin to distribute its blood to the brain, 
 till it has undergone a succession of curves by which the impetus of the 
 contained blood must be materially diminished. On quitting the fora- 
 men in the transverse process oif the first cervical vertebra, the artery 
 courses round the articulating process of that bone, and, like the carotid, 
 taking a horizontal direction, it enters the skull through the foramen 
 magnum. Within the cranial cavity the two vertebral arteries approach 
 each other, and on the basilary process of the occipital bone, they inos- 
 culate at an acute angle and form a single trunk. The single artery thus 
 produced is designated from its relation to the occipital bone, the basilary 
 artery. 
 
 The branches of the vertebral are three in number; two to the spinal 
 cord and one to the cerebellum. The two arteries to the cord called the 
 anterior and posterior spinal arteries^ though of small size at their origin, 
 
CEREBRAL CIRCULATION. 243 
 
 run the whole length of the vertebral canal to the os coccygis, giving 
 off numerous branches in their course. Their calibre, however, is almost 
 undiminished even to their termination, in consequence of their being 
 reinforced by frequent anastomoses with the branches of the deep cervi- 
 cal, intercostal, and lumbar in particular. 
 
 The branch to the cerebellum is called the inferior artery of the cere- 
 bellum, and supplies, as its name indicates, the under surface of that 
 portion of the brain. 
 
 The branches of the basilary artery are three in number on each side. 
 One of these is not, however, distributed to the brain, but to the inter- 
 nal ear. Of the other two, one supplies the cerebellum, called, in dis- 
 tinction to the last mentioned cerebellic artery, the superior artery of the 
 cerebellum; the other is distributed to the cerebrum supplying the pos- 
 terior surface of the hemisphere, and is called the posterior artery of the 
 cerebrum. 
 
 In relation to cerebral circulation we must refer to the thyroid gland ; 
 for there is now but little doubt that this sanguineous gland acts as a 
 diverticulum to the brain. I have long thought so, and for years was in 
 the habit of mentioning to my class the facts which supported such an 
 hypothesis. The recent accurate and extended researches of Mr. Si- 
 mon,* have, I think, fully established this view of its office. The fol- 
 lowing are Mr. Simon's conclusions. 
 
 1. The thyroid gland, or an organ representing its place and office, 
 may be found in all vertebrate animals. 
 
 2. It does not appear (as is the case with some organs) to belong to 
 these animals merely in behoof of the.great general completeness of their 
 organization, but seems to have a particular reference to that specific 
 character which binds them together as a natural section of the animal 
 kingdom namely, the aggregation and more perfect development of 
 their nervous centres ; for 
 
 3. The gland, shifting its position most variously, yet always main- 
 tains an intimate relation to the vascular supply of the brain, always is so 
 nourished that it can alternate a greater or lessnutrition, according to the 
 activity or repose of that nervous centre. 
 
 4. The organ which in certain fishes represents a rudimental form of 
 the thyroid, is plainly a mere diverticulum to the cerebral circulation ; in 
 the remaining fishes (where a more perfect thyroid exists), as likewise 
 in the ascending scale of vertebrate animals, there is no essential change 
 from the vascular organization of the branchiola there is simply the 
 superaddition of a glandular structure. The thyroid is but a higher de- 
 velopment of the branohiola. What was a mere capillary plexus now 
 has gland-cells intermingled with its texture. 
 
 Probably, then, the use of the secretory actions occurring in the thy- 
 roid gland is to be found in harmony with the obvious intention of its 
 vascular supply; as the latter is diverticular, so we may expect the 
 former to be vicarious or alternative. 
 
 * Phil. Trans., Part II, 1844. 
 
244 
 
 PAST IX. 
 
 DEVELOPMENT OF THE BRAIN. 
 
 THE development of the human brain is a subject which every philo- 
 sophical inquirer into the laws of organization will find invested with 
 peculiar interest. The vast mass of facts which have been accumulated 
 for its elucidation are amongst the most satisfactory and conclusive in 
 proof of the existence of general laws instituted by an Almighty power, 
 and in conformity with which every organ in the animal series is found 
 to be framed on one beautifully simple and harmonious plan ; and as it 
 is only by the discovery of the general laws which regulate the pheno- 
 mena of vitality that we can ever expect to raise the study of physiology 
 to hs legitimate rank among the natural sciences, we ought to recognize 
 with especial gratitude the well-digested store of interesting facts con- 
 tained in the works of Tiedemann, Serres, the Wenzels, and Doellinger, 
 on the evolution of the brain. Newton, whose vast discoveries in ano- 
 ther of the realms of nature have raised him so far above his fellow 
 mortals that we almost reverence his name, showed us that true philo- 
 sophy simply consists in the discovery of the universality of a fact. 
 How abundant, since Newton's day, has been the harvest, to those whose 
 researches have been guided by this simple principle, to which alone 
 we are indebted for any knowledge we possess of the laws by which 
 the Creator governs the universe; for" we perceive, as Dr. Paley finely 
 expresses it, that u God has been pleased to prescribe limits to his own 
 power, and to work his ends within those limits. The general laws of 
 matter have, perhaps, the nature of these limits: its inertia, its reaction, 
 the laws which govern the communication of motion, of light, of heat, 
 of magnetism, electricity, and probably of others yet undiscovered. 
 These are general laws, and when a particular purpose is to be effected, 
 it is not by making them wind and bend and yield to the occasion, (for 
 Nature with great steadiness adheres to and supports them,) but it is, as 
 we observe in the structure of the eye, by the interposition of an appa- 
 ratus corresponding with those laws, and suited to the inquiry which 
 results from them, that the purpose is at length effected."* 
 
 This simple view of the existence of fixed laws, established by the 
 Almighty, is not, however, confined to mere matter and its properties ; 
 the scientific physiologist has reason to believe that there are similar 
 laws which regulate vital phenomena, and produce results, without the 
 constant and immediate agency of the Supreme Being. 
 
 * Natural Theology, chap. iii. 
 
DEVELOPMENT. 245 
 
 It is told of Newton, that one day \vhen meditating on the simplicity 
 and harmony of the laws which regulate the universe, and struck par- 
 ticularly with the relations and uniformity of the masses of the planetary 
 system, his thoughts reverting thence to the animal kingdom, whose 
 wonderful organization attests in no less degree the supreme wisdom, 
 and power of a creating Providence, he exclaimed, "I doubt not that 
 animals are subjected to the same uniformity." The only true philoso- 
 phical plan upon which any branch of physiology can be studied, is to 
 follow out this idea of Newton, and strive to discover such an harmo- 
 nious arrangement among its objects; for example, to attain a knowledge 
 of the great principle which is in operation during the life, or which 
 presides over and regulates the development of the individual beings 
 composing the animal kingdom. And here we must carefully guard 
 against being seduced by the vain attempt to gain a knowledge of the 
 ultimate cause of vital phenomena; we must strictly content ourselves 
 with observing those phenomena so as to ascertain their relations, their 
 harmony one to another, and their effects. It is, indeed, only by study- 
 ing physiology on these principles that it can ever truly deserve the 
 name of a science, or afford us that clear and steady light which will 
 guide us philosophically amid the intricate paths of pathology and the- 
 rapeutics. 
 
 Physiologists in general have too much neglected to conduct their 
 studies in accordance with this idea of Newton ; they have too constantly 
 amused themselves with creating theories on one or two isolated facts, 
 or in vainly searching after the ultimate cause of vital phenomena : it is 
 but of late that they have begun to content themselves with observing 
 their uniform relations and with scrutinizing their effects, and that they 
 have ceased from being the laughing-stocks of true philosophy. 
 
 If, indeed, we required proof of the present imperfect state of physi- 
 ology, and the mean rank which it holds in comparison with the other 
 branches of natural philosophy, we have only to refer to cotemporary 
 writers, where we still find such passages as the following, in which the 
 writer, after stating how ignorant we are of the nature of the intellectual 
 faculties in man, goes on to say: "Nay, the springs and wheelworks of 
 animal and vegetable vitality are concealed from our view by an im- 
 penetrable veil, and the pride of philosophy is humbled by the specta- 
 cle of the physiologist bending in fruitless, ardor over the dissection of 
 the human brain, and peering in equally unproductive inquiry over the 
 gambols of an animalcule." Surely we ought, after this, to see how 
 absolutely necessary it has become to cast aside crude and ill-digested 
 hypotheses, and to study physiology under the guidance of the general 
 laws of nature deduced from an unprejudiced observation of fact and 
 circumstance. Such a sweeping assertion of the fruitlessness of the 
 labors of the physiologist as we have above, is by no means applicable 
 to the nature of his studies, though it is to the mode in which they have 
 usually been conducted ; for the physiologist is just as competent to in- 
 quire into the causes of vital phenomena, as the natural philosopher is into 
 those of physical phenomena: neither the one nor the other can ever 
 ascertain the ultimate cause of anything. All that can be done in either 
 natural philosophy or physiology is to study the mutual relations in which 
 
246 HUMAN BRAIN. 
 
 phenomena stand to one another, and thus to trace their connection and 
 possible dependence. 
 
 The mature human frame, which, in its perfect adaptation to fulfil the 
 ends of its existence, strikes the philosophical anatomist with admiration, 
 does not result from the gradual increase of an exact though minute 
 representation of its perfect form; but during the course of its develop- 
 ment, and while gradually progressing towards its ultimate perfection, 
 its constitution temporarily assumes many forms which are permanently 
 retained by one or other of the members among the lower orders of 
 creation. 
 
 The facts which prove the existence of this law of progressive deve- 
 lopment are derived from observation of the different organs at different 
 periods of the foetal existence ; and in no set of organs is its truth more 
 clearly shown than in the various component parts of the nervous sys- 
 tem, as the reader will discover by giving his attention to the observa- 
 tions on its development which follow. The same thing may also be 
 said in regard to the law which governs the development of the vascu- 
 lar system ; and as the circumstances are here peculiarly interesting, and 
 may be made introductory to those of the subject we have especially in 
 hand, I shall make no apology for presenting a few of them in this 
 place. 
 
 For instance, the first appearance of the heart in the human embryo is 
 that of a mere pulsating vessel without any division into cavities, or 
 thickening of its walls; an arrangement which in all its simplicity is 
 met with as the sufficient instrument for effecting the circulation in (he 
 perfect insect. 
 
 The next step consists in the gradual dilatation of this tube into a sac, 
 previously to its division into four cavities: and this corresponds with 
 the single heart of the fish, consisting merely of an auricle for the recep- 
 tion of the blood, and a ventricle for its propulsion. 
 
 As the development advances, a second ventricle is added to the first 
 on the right side of it, separated from the left by a septum, which is so 
 imperfect that the aorta communicates with both cavities; and the very 
 same arrangement is found to exist in the adult crocodile. 
 
 While the septum is being formed in the interior, a notch appears on 
 the exterior, which, extending from the apex to the base, divides the 
 heart in exactly the same manner as it is met with in the dugong. 
 
 In the respiratory system, again, we find some most extraordinary 
 changes ; those we have remarked in the vascular we could explain on 
 the supposition that they were the necessary and unavoidable steps to- 
 wards perfection ; but when we find the human embryo assuming forms 
 which are afterwards entirely discarded, we can only account for it on 
 the supposition that one general law governs the developments of the 
 whole animal creation. The lungs in the first instance are placed on 
 each side of the vertebral column, like the air-bladders of fishes, without 
 any appearance of trachea or branchial tubes; an arrangement which, 
 though interesting, as being analogous to the permanent state in fishes, 
 has nothing peculiarly extraordinary in it; but finding, in addition to 
 this, and in perfect correspondence with it, branchial apertures on the 
 sides of the neck, the aorta giving off a regular set of branchial arteries 
 
DEVELOPMENT OF THE NERVOUS SYSTEM. 247 
 
 which take their course to the edges of the openings, some of which 
 are afterwards entirely obliterated, while the others are converted into 
 vessels corresponding with the regular distribution of the adult. As the 
 organism of the human foetus cannot be supposed to be formed with the 
 idea of providing for aquatic respiration like the embryos of fishes, we 
 can no longer doubt that the whole series of phenomena which are taking 
 place during the development of the foetus, do not result from any special 
 interference of Divine agency for each individual occasion, but from the 
 action of fixed and general laws. 
 
 In the development of the nervous system, to which we must next 
 direct our attention, we shall find even more decided proofs of this 
 general harmony throughout the animal kingdom. 
 
 For a clear, simple, and accurate account of the phenomena attending 
 the development of the ovum, the reader should consult Dr. Carpenter's 
 excellent work on physiology. 
 
 In order to understand the development of the brain, we must briefly 
 trace the very earliest changes which take place in the germinal vesicle, 
 or ovum. A portion of this vesicle becomes opake ; the opacity is 
 called the germinal space area germinativa. The nucleated cells of 
 this spot, at first uniformly arranged, so that the whole is obscure, soon 
 begin to accumulate on the circumference, leaving a clear space in the 
 centte. The transparent spot assumes an oval lunar form, transversely 
 to the ovum. If we examine closely the material of the germinal spot 
 at thi^time, we find that it consists of two layers. The superior is the 
 animal or serous layer; from it all the organs of animal life are formed. 
 The inferior is the vegetative or mucous layer; from it are formed all the 
 organs of vegetative life. The transparent line is confined to the animal 
 layer; the vegetative layer is opake throughout. 
 
 We may next observe that this transparent tract assumes a pyriform 
 shape, and the edges becoming elevated, a groove or gutter is formed. 
 The edges of this gutter gradually approximate, at first in the centre, 
 and then gradually above and below, so as to form a canal ; but the 
 edges do not join continuously at their two extremities. At the superior, 
 anterior, or cephalic extremity, they are separated, so as to form dilata- 
 tions placed consecutively to one another, the dimensions of which in- 
 crease from behind forwards. At the inferior, posterior, or caudal 
 extremity, they are equally separated, but in such a way as to produce 
 a laminated figure, which is gradually effaced. The clear edges of this 
 groove seem dotted with square spots, which are the bodies of the future 
 vertebrae. 
 
 At very early periods of foetal existence there is no appearance of any 
 neurine ; the parts .corresponding to the head and vertebral column are 
 transparent, and contain a limpid fluid; about the fifth or sixth week the 
 pia mater is distinctly perceptible, forming the walls of the canal in 
 which the fluid is contained, arranged in the head so as to form three 
 vesicles. Tiedemann, to whom we are indebted for almost all we know 
 regarding the development of the human foetal brain, considered that in 
 the first division into cells they are five in number. But Bischoff* has 
 
 * Trait6 du D6veloppement del'Homme et des Mammiferes parT. L. G, Bischoff, traduit 
 de 1'Allemand par A. J. L. Jourdan. 1843, p. 182. . - 
 
248 HUMAN BRAIN. 
 
 proved that the brain consists first of three cells, which are afterwards 
 divided into five. This tertiary division of the encephalic portion of the 
 cerebro-spinal axis accords with the tertiary division of the skull. The 
 skull, as mentioned elsewhere, consists of vertebra, just like the cervi- 
 cal, dorsal, and lumbar portions of the vertebral column. The number 
 of cranial or encephalic vertebras is three in number, and hence the 
 same number of primary cerebral cells. The anterior cell appears first, 
 and is shortly afterwards followed by two others ; soon afterwards, a fis- 
 sure appears on the anterior and posterior cell, which thus divide the three 
 cells into five. The anterior and superior wall of the anterior cell in- 
 creases on both sides of the mesial line with more rapidity than the 
 posterior ; so that when we look at it from above it represents first a 
 double vesicle, with a feeble median depression, dividing it into two 
 lateral halves. The two anterior represent the olfactory ganglia and 
 hemispheres; the two middle, the optic ganglia; and the posterior, the 
 cerebellum : the spinal marrow is represented by a long canal communi- 
 cating with the cerebral vesicles, which in reality are but swellings of a 
 single sac. The description which I have already given of the pia 
 mater, and the mode in which it first forms a continuous canal, may 
 here be again referred to. 
 
 The brain of all Mammalia has this vesicular form in the first in- 
 stance ; the embryos of the rabbit or cat are, perhaps, the best that the 
 student can select for his own observation. Rolando gives a very ac- 
 curate account of the vesicular form of the fetal bfcin in 
 Fig. 109. Mammalia and in birds. 
 
 The peculiar form and general appearance of the foetus 
 at the seventh week will be easily comprehended by re- 
 ferring to fig. 109, taken from Tiedemann, who represents 
 it as an oblongated mass slightly curved upon itself, ge- 
 latinous, and semitransparent. 
 
 In this embryo, which was about seven lines in length, 
 Fcetus of seven and about seven weeks old, Tiedemann was enabled dis- 
 tTon of the^elk 6 " tinctly to observe the structure and disposition of the brain 
 
 and spinal cord. 
 
 The cavity provided for the cord was situated immediately beneath 
 the integuments, the muscles and vertebral arches not being yet formed. 
 On opening this cavity by means of a fine pair of scissors, he perceived 
 the dura mater nearly dividing the cranium into two equal portions ; the 
 pia mater beneath it adhered so intimately to the substance of brain and 
 spinal cord, that it was difficult to detach it without destroying the in- 
 closed pulp, the general form of which may be clearly understood by 
 referring to figs. 110 and 111. 
 
 On the posterior part of the cord a longitudinal fissure existed, into 
 which the pia mater entered, which has received the name of the spinal 
 canal ; at the upper part, where in the adult it forms the fourth ventri- 
 cle, a thin narrow plate or flattened fasciculus of neurine arose from 
 either side, and inclining inwards, touched, without uniting with, its 
 fellow ; thus forming a sort of arch over the fourth ventricle, and con- 
 stituting the rudiment of the cerebellum (c, figs. 110 and 111), about one 
 line and two-thirds in breadth. 
 
DEVELOPMENT OF THE NERVOUS SYSTEM. 249 
 
 In front of the cerebellum were two membraniform productions, the 
 first appearance of the optic tubercles or cor- 
 pora quadrigemina, taken together about a 
 line in breadth and one in length (d). The 
 rudiments of the thalami (e), in the shape of 
 two rounded protuberances, were next in 
 order, the space between them being that 
 which corresponds to the third ventricle. In 
 front of these eminences were two others, in 
 apposition to them, about a line in length, and 
 apparently the rounded extremities of the an- 
 tenor part of the crura cerebri; these were the c. cerebellum, a. Optic tubercles, 
 
 . / < i -i r\ \ or quadngeminal bodies, e. Optic 
 
 Corpora Striata (fig. 110, g). thalami. /. Membraniform hemi- 
 
 From the corpora striata arose two thin Jj^fi&^tifc 3^ 
 membraniform productions of neurine curving str ^ m i L _p osteT . ior view of the 
 backwards and inwards; these are the first same brain, s P m and open in all 
 
 P .. i i f .1 t its length, a a. Spinal marrow. 
 
 commencement of the hemispheres of the brain &. orifice of the canal of the spmai 
 
 ffirr 11Q\ marrow, c. Swelling of the spinal 
 
 1B* */ marrow, dd. The cerebellum split 
 
 At this early period there are no traces of in the median line, and laid like a 
 
 J " , bridge over the fourth ventricle. 
 
 the COmmiSSUre Of the Cerebellum Or Of the e e. The quaclrigeminal bodies se- 
 
 *fif]2rt3& 
 
 cerebrum, or of the thalami, or of the longitu- ne another " 
 
 dinal commissure, called the fornix. 
 
 The substance of the brain and cord examined with a glass, presented 
 no fibrous appearance ; it seemed to be composed of extremely minute 
 globules. It does not assume a fibrous appearance until the commence- 
 ment of the fourth month. Tiedemann states that he could not per- 
 ceive any appearance of the cerebral nerves, which he accounts for on 
 the supposition that they were so delicate as to escape detection ; but 
 such a supposition appears to me unnecessary, when we recall to mind 
 the facts which I mentioned in the early part of this work, regarding the 
 development of the nerves in the first instance in all the different tis- 
 sues, and their subsequent union with the brain and spinal cord. 
 
 In the following details I have adhered generally to the plan of de- 
 scribing the gradual development of individual parts connectedly, as 
 bringing the whole more simply before the eye of the student than of 
 particularly detailing each change as it takes place from one month to 
 another, which has been faithfully done by Tiedemann and Serres, to 
 whom I must refer the reader for greater minuteness. 
 
 It may be laid down as a rule that the spinal cord is formed previously 
 to the brain, not merely in man, but in all the orders of vertebrated ani- 
 mals. At first it consists of two cords, not united posteriorly, by which 
 a deep furrow is formed, which is soon converted into a canal by the 
 union of the opposite halves. 
 
 This canal of the spinal cord, which is so distinct in the human foetus 
 until the fifth month, and in that of the horse and the calf until the sixth, 
 exists permanently of a certain width in fishes, reptiles, and birds. In 
 the fcetal state of the human embryo it is obliterated by the deposition 
 of successive layers of gray matter secreted by the pia mater. But what 
 is, perhaps, more extraordinary is, that the cord in the human foatus ex- 
 tends to the extremity of the coccyx until the third month, when it ap- 
 
250 HUMAN BRAIN. 
 
 pears, according to the statement of M. Serres, to rise suddenly to the 
 point where it is met with after birth, namely, opposite the second lum- 
 bar vertebra. The os coccygis, which, previous to this period, consisted 
 of seven pieces, suddenly becomes reduced to its permanent number, 
 four. 
 
 The spinal marrow is of equal calibre, in its whole extent in the young 
 embryos of all classes ; it is without enlargement either anteriorly or 
 posteriorly, as in those reptiles which do not possess extremities, as 
 snakes, &c. This appearance corresponds with the absence of extremi- 
 ties at this period of existence ; for as soon as they are developed, the 
 cord enlarges at those points with which their large nerves are connected. 
 
 The corpora olivaria are not formed until the end of the sixth, or be- 
 ginning of the seventh month. The interlacement of the pyramidal 
 fasciculi is visible in the human embryo from the eighth week. In rep- 
 tiles and fishes there is no interlacement at all. 
 
 In the second month of fetal existence the fasciculi of the spinal 
 cord, which are prolonged into the brain, are curved downwards beneath 
 the optic tubercles : tlys curve remains distinct until the third month. 
 The bundles may be distinctly traced into the optic thalami, and having 
 become more voluminous they then pass into the corpora striata, from 
 the anterior surface of which they may be seen emerging, and spreading 
 like a fan to form the hemispheres. From the internal and inferior side 
 of the thalami, or from the continuation of each crus, a fasciculus of fibres 
 is detached, which descends into the mamillary eminences. These re- 
 flected on themselves, and thus directing their course backwards, form 
 the anterior pillars of the fornix, or, more properly speaking, the infe- 
 rior longitudinal commissure. 
 
 All the other fibres of the crura, which are very numerous, are directed 
 forwards and outwards, passing under the corpora striata, forming the 
 hemispheres ; and at the posterior part they join, or more strictly speak- 
 ing form, the posterior pillar of the fornix. In doing so they form a fold, 
 which, projecting on the internal surface of the ventricle, gives rise to 
 that appearance which is called the cornu Ammonis. 
 
 The corpus callosum or commissura magna does not exist in the brain 
 of the fetus in the second month, nor even in the early part of the third. 
 Towards the end of the third, however, it makes its appearance ; at 
 first it is very narrow and nearly perpendicular. In its growth it passes 
 from before backwards. By the seventh month its fibres may be traced 
 in connection with those of the spinal cord through the medium of the 
 crura cerebri. 
 
 From the description already given of the brains of fishes, reptiles, 
 and birds, the reader is aware that this commissure does not exist in 
 them. 
 
 The pituitary gland is not in existence in the second month, nor even 
 at the commencement of the third ; but it appears towards the end of 
 it, forming a rather large soft mass. 
 
 The very gradual manner in which the cerebellum attains its ultimate 
 complexity, is in perfect harmony with the gradation which it pursues 
 in the animal kingdom. 
 
 About the third month the cerebellic fasciculi, which we formerly ob- 
 
DEVELOPMENT OF THE NERVOUS SYSTEM. 251 
 
 served just touching each other, are now united so as to form a concave 
 mass internally, smooth and convex externally, but without any appear- 
 ance of grooves or leaflets, thus accurately corresponding with the cere- 
 bellum in osseous fishes, such as the carp, cod, &c. 
 
 In the fourth month the commissure of the cerebellum is perceptible, 
 and is about a line in width. About the fifth month the cerebellum, 
 itself about seven lines in breadth, begins to assume the same appear- 
 ance as that of the skate ; for grooves appear upon the surface, which 
 gradually increase in depth and number, till at the sixth month the stems 
 and branches of the arbor vita become apparent, and the part then puts 
 on the exact appearance of that of birds. 
 
 In conclusion, let it be remembered that the cerebellum proceeds, in 
 the first instance, from the spinal marrow in fact, from the two fasci- 
 culi which are earliest apparent, and which constitute the corpora resti- 
 formia. 
 
 The masses of neurine which correspond with the tubercula quadri- 
 gemina or optic tubercles in the adult, are in the embryo of the second 
 month merely two plates bending upwards and inwards, but not yet 
 covered by the hemispheres, and in apposition only in the mesial line, 
 their union not being complete until the end of the third month, when, 
 becoming convex externally, they gradually increase in size and become 
 united. 
 
 At this period they correspond in appearance with the optic tubercles 
 in fishes and in birds ; and it is not until the seventh month that we can 
 perceive any division into nates and testes, or into four bodies instead 
 of two ; and even at this period they are scarcely covered by the hemi- 
 spheres, so that they now resemble those of the Rodentia. 
 
 The anterior ganglions of the cord or corpora striata, at the end of the 
 second month, not being yet covered by the hemispheres, are clearly to 
 be seen (fig. 112). Towards the end of the third month, however, 
 when they measure two lines and a half in length (figs. 113, 114, 115, 
 116), the membranous hemispheres' are partially extended over them. 
 These protuberances, which are solid throughout, are united by a trans- 
 verse band representing the posterior commissure, and their increase 
 from this period is in exact correspondence with the progressive deve- 
 lopment of the hemispheres. The commissura mollis was not observed 
 by Tiedernann until the ninth month. The Wenzels are said to have 
 met with this commissure in the fifth, and again in the seventh month. 
 
 The pineal gland is not to be seen previous to the fourth month, when 
 it appears in the form of a small flattened round body, the peduncles of 
 which, extremely thin, are seen arising from the inner edge of the supe- 
 rior surface of the optic thalami. 
 
 This body is not met with in fishes, though it is in many reptiles, as 
 the hawk-bill tortoise, wall lizard, and ringed snake, as also in birds, 
 and invariably in the brains of the Mammalia, varying in size, figure, 
 and structure. 
 
 In volume it is much. larger in proportion to the size of the brain in 
 the ruminating animals than in man. 
 
 The thalami nervorum opticorum or posterior ganglions of the cord, 
 are just perceptible at the second month. In the commence'ment of the 
 
252 
 
 
 HUMAN BRAIN. 
 
 third they become more voluminous, and are partly covered by the 
 hemispheres, which structures, being in the first instance mere layers of 
 neurine shooting out from the hinder part of the corpora striata and 
 thalami, give to the corpora striata an appearance of greater size and 
 prominence than they seem to possess afterwards, when the hemispheres 
 have become nearly as thick as themselves. At the period of birth they 
 appear sunk amid the substance of the hemispheres, which then bound 
 the anterior part of the space left between them and the corpora striata 
 and thalarni, and which has been so incorrectly designated a ventricle 
 or bag. 
 
 Fig. 112. Fig. 113. Fig. 114. Fig. 115. Fig. 116. 
 
 Fig. 112. Brain of an embryo of nine weeks, a a. The two principal columns of the spinal marrow, 
 separated from one another by a longitudinal fissure, b b. Cerebellum, c. Parts which give rise to the 
 quadrigeminal bodies, d. Thalami optici. e. Membranous hemispheres, turned backwards and inwards. 
 
 Fig. 113. Brain of an embryo of twelve weeks, seen in the cranium, a a. Fragments removed from 
 the cranium, which has been opened, b. Spinal marrow, c. Swelling of the spinal marrow, which is 
 bent inwards, d. Cerebellum, f. Elevation which gives rise to the quadrigeminal bodies, g. Crus 
 cerebri, or a cord of the spinal marrow which comes down again, and is directed forwards h. Mem- 
 branous hemisphere of the cerebrum, broken down behind and before ; .it does not yet cover the emi- 
 nences destined to form the quadrigeminal bodies. 
 
 Fig. 114. Brain and spinal marrow of the same fetus seen posteriorly, a a. Spinal marrow, with its 
 posterior longitudinal fissure, b. Cerebellum, and beneath it the fourth ventricle, c.c. Hemispheres of 
 the cerebrum, d. Eminences which are to become the quadrigeminal tubercle, with the fissure which 
 they present. 
 
 Fig. 115. Inferior surface of the brain of the same fetus, a a. Spinal marrow, with the anterior longi- 
 tudinal fissure, b b. Swelling of the spinal marrow, bent forward, c c. Peduncles of the cerebellum, 
 which arise from the cerebellum, d d. Cerebellum e e. Peduncles of the cerebrum. /. Mamillary 
 eminences, g. Pituitary gland, h h. Anterior lobes of the cerebrum, i i. The posterior and round ap- 
 pendices which represent the middle and posterior lobes. 
 
 Fig. 116. View of the superior surface of the brain of the same fetus : the membranous hemispheres 
 are separated from one another and laid aside, a a. The two principal cords of the spinal marrow, b. 
 Posterior longitudinal fissure, c c. Cerebellum d d. Masses which are to form the quadrigeminal bodies. 
 ee. Thalami optici. ff,gggg. Membranous hemispheres separated from one another and laid on the 
 sides, h h. The two corpora striata. which are a little, wider anteriorly, and divided into two parts by a 
 slight fissure, i. Commissure of the two hemispheres and commencement of the corpus callosum. k k. 
 Lateral ventricles, with the radiated folds of the under-surface of the hemispheres. 
 
 The anterior commissure does not exist in the second month ; but in 
 the third it appears like a thin delicate thread, and its development 
 proceeds in accordance with that of the corpora striata and thalami. 
 
 Although in the preceding descriptions of the corpora striata and 
 thalami we have had frequent occasion to speak generally of those 
 layers of neurine which ultimately form the hemispheres, it may be desira- 
 ble to give a more detailed account of them. This is particularly im- 
 portant as calculated to do away with the false notions that have been 
 entertained on the subject of the ventricles, as well as to convey clearer 
 impressions on the difference between the figurate and convoluted sur- 
 faces of the brain. .These ends, indeed, can in no better way be ac- 
 complished than by following out the development of the hemispheres 
 
DEVELOPMENT OF THE NERVOUS SYSTEM. 253 
 
 of the brain. At any rate I think that if the reader will attentively 
 .compare the description which I have given on the subject of the adult 
 brain, of the relations of the hemispheres to the ganglia of the cord, or 
 corpora striata and thalami, no doubt will remain in his mind as to the 
 correctness of the statement made at the commencement of this work, 
 namely, that the ventricles are no more entitled to the name of bags 
 than the space left between any two convolutions of the surface of the 
 hemispheres. 
 
 In the foetus of the second month we perceive springing out from the 
 under part of the corpora striata on each side, a thin delicate membrane, 
 consisting of medullary neurine, which is reflected backwards and in- 
 wards, scarcely covering them, invested with pia mater: this is the 
 rudiment of the hemispheres (fig. 112). In the commencement of the 
 third month these membraniform hemispheres completely cover the 
 corpora striata, and towards the end of the month, they have extended 
 over the thalami, not having yet reached the optic tubercles (figs 113, 114, 
 115 and 116). 
 
 Fig. 117. / , Fig. 118. 
 
 Fig. 117. Superior surface of the brain of a fetus of fourteen or fifteen weeks, a a. Spinal marrow. 
 b. Peduncles of the cerebellum separated from one another, from above downwards, which brings the 
 fourth ventricle into view. e. The cerebellum, which has not yet any fissures, d d. The right hemi- 
 sphere of the cerebrum, which does not yet cover the quadrigeminal mass. 
 
 Fig 118. Side view of the brain of a fcetus of twenty-seven weeks. B. Cerebrum. E. Cerebellum, 
 ii. Spinal marrow, s. Corpus olivare. T. Corpus pyramidale, \v Corpus restiforrne. . Annular pro- 
 tuberance. The fissura Sylyii are very deep, and extend to a great distance on the sides ; they lodge the 
 middle cerebral arteries, which distribute almost all their branches to the deep*seated parts of the ence- 
 phaloii, namely, to the corpora striata. The olfactory nerve descends from the fissura Sylvii. 
 
 During the fourth month (fig. 117) they have advanced as far as the 
 anterior edge of the optic tubercles, but they do not cover them entirely 
 until the sixth, when they have extended as far as the cerebellum (fig. 
 118). At this period we may perceive on the surface corresponding to 
 the falx major, some grooves or furrows which are the first steps to- 
 wards the formation of the convolutions. The upper and lateral surfaces 
 still remain perfectly smooth. At the seventh month the convolutions 
 are very imperfectly developed, though the hemispheres now cover the 
 cerebellum entirely, and upon this division of the cerebral mass, depres- 
 sions appear here and there, the rudiments of the convolutions and fossa, 
 into which the pia mater dips. The fissure Sylvii are distinct, lodging 
 
254 HUMAN BRAIN. 
 
 the middle arteries of the brain, which send numerous branches into the 
 interior. 
 
 In the eighth month the hemispheres which cover the cerebellum, and 
 are prolonged even beyond its posterior border, are two inches eleven 
 lines in length, two inches one line in breadth, and one inch ten lines 
 deep. On examining their inferior surface, the anterior, middle, and 
 posterior lobes may be distinctly seen, the boundaries of each being well 
 marked. 
 
 At nine months the hemispheres are three inches and four lines in 
 length, and two lines in breadth ; they have now exactly the same form 
 as in the adult, and are covered w r ith convolutions and anfractuosities. 
 
 After these details, it must be evident trwt the hemispheres are formed 
 from before backwards, and from without inwards ; that at first they 
 consist only of a thin membranous layer of neurine, reflected upon itself 
 from behind forwards, and from without inwards ; that they increase in 
 thickness and volume very gradually ; and that as they are developed 
 they extend themselves, first over the corpora striata, and afterwards 
 over the thalami, optic tubercles, and cerebellum, so that in the end 
 they entirely cover all these parts. 
 
 We observe precisely the same plan adopted in the formation of the 
 hemispheres of the brain throughout the Vertebrata, except that they are 
 arrested at different stages of the development in different species, which 
 the human embryo merely assumes for a short period, and passes on to a 
 more elevated type. 
 
 Professor Retzius, of Stockholm, has given the following account of 
 the development of the hemispheres, which is more minute than that of 
 Tiedemann. I am unable to say whether it is more accurate:* 
 
 " In the first period, which corresponds with the second and third 
 months, only the anterior lobes form; in the second period, which is 
 comprised in the end of the third month, in the fourth, and in a small 
 portion of the fifth, the two middle lobes appear: and after this time the 
 posterior lobes. During the first period the descending horns of the 
 lateral ventricles, and the pedes hippocampi, are wanting; these are 
 added in the second period. During a great portion of the first period, 
 the hemispheres do not cover the thalami nervorum opticorum; in the 
 second period they completely overlap these parts, approach the large 
 corpora quadrigemina, cover their anterior part, and then descend by 
 the side of the cerebral nucleus, (cone or stem,) and, as it were, fold 
 round it. If we examine a brain at this period of development, we 
 might, from its external appearance, imagine that, the posterior margin 
 of the hemispheres corresponds to their persistent posterior ends and 
 margins, i. e., to those which are their posterior margins in their per- 
 fectly developed state. But it is not so. If we open the brain we come 
 at once to the descending horns of the lateral ventricles, in which are 
 the rudiments of thp great pedes hippocampi. At a later period, in the 
 fourth month, a small superficial notch is formed at the posterior margins 
 of the hemispheres; and that part of this margin which is above the 
 notch is the first rudiment of the posterior lobes of the hemispheres. 
 
 * British and Foreign Quarterly Medical Review, vol. xxii. p. 503. 
 
 . 
 
, I 
 
 DEVELOPMENT OF THE NERVOUS SYSTEM. 255 
 
 These, which are thus for a long time only rudimental, begin above the 
 middle lobes, gradually take in their posterior margin, follow it down, as 
 development advances, by the sides of the cerebral nucleus, and terminate 
 at that part of the middle lobes which meet the pedes hippocampi. Even 
 in the brain of the mature foetus, as well as in the fully developed brains 
 of older persons, the posterior lobes are very clearly separated from the 
 middle lobes by a branching furrow, which is especially distinct on the 
 vertical side of the hemisphere which lies next to the falx." 
 
 Having entered generally into the composition of the cerebral mass 
 in fishes, reptiles, birds, and the mammalia, I consider it unnecessary to 
 dwell more fully upon the subject at present than to point out a few of 
 the analogies between them and the human foetus. 
 
 The skate presents one of the most decided specimens of a structure 
 analogous to the foetal or rudimentary hemisphere of the higher classes, 
 in the two tubercular enlargements which are placed immediately in 
 front of the optic tubercles, and with which the peduncles of the olfac- 
 tory nerves are connected as in the human subject. 
 
 These bodies are hollow, and the walls of the cavity are formed by a 
 membranous layer of neurine reflected backwards and inwards, into 
 which the fibres of the crura cerebri expand as in the human embryo. 
 
 In the carp we have also observed rudimentary hemispheres. 
 
 The rudimentary hemispheres of the reptiles are equally interesting 
 when viewed in relation to this subject. In the crocodile, each hemi- 
 sphere represents a membranous sac containing within it the optic 
 thalami, the pineal gland, and the corpora striata, from which ganglia 
 the hemispheres appear to 'arise, thus corresponding accurately with the 
 same part in its state of evolution at the third month of foetal existence 
 in the human being, presenting the reflection of neurine which consti- 
 tutes the hemispheres, extending to the same point behind, and covering 
 the corpora striata and thalami, but leaving the optic tubercles exposed. 
 And so we might in the same manner go on multiplying examples of the 
 truth of the law of progressive development of the hemispherical gan- 
 glia: more than has been said seems unnecessary. 
 
 The corpora marnraillaria do not appear until the end of the third 
 month, and then not divided as they are after birth, but simple and homo- 
 geneous. 
 
 The above facts which I have laid before my readers on the authority 
 of Tiedemann, Serres, BischofF, and others, will, I think, thoroughly 
 convince them of the truth of the law which I stated at the commence- 
 ment of this section regarding the gradual development of the brain and 
 spinal cord on one simple and uniform type: and that the complicated 
 structure which we meet with in the human adult, is at an early period 
 of foetal existence, as simple in its general arrangement as many of the 
 permanent forms of the lower vertebrated animals, and that in its develop- 
 ment Nature appears to have pursued' the same plan which she has 
 adopted in thet>rganization of each individual in her vast family, gradu- 
 ally adding one part after another, and at the same time concentrating the 
 whole, each fresh addition changing the appearance of the several parts, 
 so that unless the chain be observed from its very commencement, all 
 
256 HUMAN BRAIN. 
 
 the analogies which are so palpable when we proceed step by step are 
 obscured, and even made altogether incapable of demonstration. 
 
 Let me not, however, be misunderstood, when speaking of the addi- 
 tion of fresh parts, for the brain of man even in its state of perfect 
 development consists of the same number of ganglia as that of the Ver- 
 tebrata in general, though the amazing size of the hemispherical ganglia 
 and the cerebellum, with the addition of fresh commissures, give to the 
 human brain an appearance wholly unlike that of the reptile and the 
 fish. 
 
257 
 
 PART X. 
 
 PHYSIOLOGY OF THE CEREBRO-SPINAL AXIS. 
 
 THIS is a subject which every candid physiologist approache/with 
 great diffidence, for though much has been done in the last ten years, 
 still much remains in doubtful obscurity. 
 
 In the anatomical sections of this work I have purposely introduced 
 much physiology, in order to give more interest to the anatomy than is 
 usually attached to mere details of structure, without reference to func- 
 tion, so that in this section it will only be necessary to give a summary 
 of what has been more or less touched upon previously. 
 
 The sources of our information on the functions of the nervous sys- 
 tem are fourfold. 
 
 First. Observation of the parts composing it in the lower animals, 
 and the relation which they bear to those of man, considered in connec- 
 tion with the development of their organs of sense and muscular actions. 
 This source we have already availed ourselves of in the section on com- 
 parative anatomy, and observed how clearly the development of the 
 nervous centre keeps pace with the increase of the animal powers ; and 
 I need only advert to the important discoveries of Mr. Newport, among 
 others, to remind my readers that this is one of our most unerring sources 
 of information. 
 
 Secondly. Experiments on living animals. 
 
 Thirdly. Pathological facts. 
 
 Fourthly. Observations between the relations of the size of the 
 human cranium in individuals, and their manifestations of intellect. Also 
 observations on the relation between the external configuration of the 
 cranium in individuals, and their manifestations of particular degrees of 
 intellectual power, propensities, and sentiments. 
 
 Though the deductions which are made from experiments on living 
 animals are so liable to error that reliance must not be placed upon them 
 as unerring sources of knowledge, ihey have afforded very important 
 and valuable information on this subject. I do not agree with the ob- 
 jections which Mr. Combe has urged against the experiments on the 
 brain as useless in the elucidation of its functions, for it appears true 
 that, notwithstanding the various sources of error to which experiments 
 on living animals are exposed, some very important facts have been 
 elicited, which, taken in conjunction with those derived from compara- 
 tive anatomy, pathology, and observation during life, have afforded col- 
 lateral evidence of the separate offices of different portions of the brain 
 and nervous system. As regards our knowledge of the functions of the 
 17 
 
258 HUMAN BRAIN. 
 
 nerves and the spinal cord, experiments have been invaluable ; and in 
 reference to the encephalon, when taken in connection with the facts 
 of comparative anatomy, they have shed much light on the subject, 
 particularly those of MM. Flourens and Bouillaud. In so far as this 
 mode of investigation is admissible, the results obtained by these 
 authors are perhaps the best authenticated and the most satisfactory of 
 any. 
 
 If we were not bound to receive with the greatest caution the conclu- 
 sions of every experimental physiologist, knowing how liable even the 
 strictly honest, (among whom both the above-mentioned authors may be 
 classed,) are to see results as they expect them to be, and not as they 
 really occur, we might be induced to believe, after reading their works, 
 that fr great deal more of the functions of the nervous system must be 
 known than is actually the case. 
 
 We must guard against extending the mischief which has been done 
 by several recent authors, who have referred to the whole of the results 
 and inferences as if they were so many firmly-established facts in the 
 science of physiology. 
 
 From pathology we might naturally expect surer evidence; but even 
 here the physiologist who carefully examines its records is doomed to 
 disappointment. 
 
 It is clear that if, in uniform accordance with the derangement or ob- 
 literation of individual functions during life, morbid alterations of indi- 
 vidual portions of the nervous system were met with after death, no surer 
 evidence could be procured of the connection between function and 
 organic structure. But no certain light has yet shone on physiology 
 from this source. 
 
 The last, or fourth source mentioned as affording us knowledge of 
 the functions of the brain, can only yield us instruction as to the office 
 of its surface. But, as we shall see hereafter, the mass of evidence in 
 favor of the belief that the great hemispherical ganglion or cortical sub- 
 stance of the brain is the immediate agent in all mental operations, is, in 
 my own opinion, so conclusive, that it becomes next a most interesting 
 question whether different portions of this ganglion play different parts 
 in the production of mental phenomena. Now I candidly avow that 
 the more I have examined the facts adduced by the supporters of this 
 theory, the more I am inclined to believe that its general principles are 
 correct and philosophical. I entirely agree with that talented observer, 
 Mr. G. Combe, that " Phrenology, in its evidence, rests on the same 
 foundation as the practice of medicine. The existence of disease can- 
 not in general be determined by weight or measure, and the characters 
 of diseases can be judged of only by their appearances, or the symptoms 
 which they present. The organs affected the degree to which they 
 are affected and the extent to which medicines act on them are all 
 estimated by the exercise of observation and reflection on mere symp- 
 toms. In the practice of medicine, anatomy, physiology and pathology 
 shed their light to help the judgment in its estimates, but they do not 
 reveal the theory of medicine a priori, nor do they render it a demonstra- 
 tive science." 
 - "The same general laws of evidence must necessarily apply to the 
 
PHYSIOLOGY. 259 
 
 study of phrenology. The mental manifestations are not ponderable nor 
 measurable any more than the capacity for pain or pleasure, or the powers 
 of hearing or sight, are so. We estimate the degree in which these 
 susceptibilities and capacities are possessed by different individuals, and 
 regard our knowledge as substantial, and we must of necessity learn to 
 estimate the force of the mental manifestations by a similar exercise of 
 observation and reflection, or remain forever ignorant of mental science." 
 (See Phren. Journ., vol. x. p. 556. On the nature of the evidence by 
 which the functions of different parts of the brain may be established, by 
 Geo. Combe.) 
 
 In the course of our observations of the composition and properties of 
 neurine, and on the essential elements of a nervous system, the follow- 
 ing fundamental principles have been established, and need only be 
 adverted to in the present section. 
 
 1. That vesicular neurine is the source of power. 
 
 2. That medullary neurine is the conductor of it. 
 
 3. That medullary neurine is also the conductor of those impressions 
 which call forth the power of the vesicular neurine. 
 
 4. That the vesicular neurine is collected in masses of variable form 
 and size the ganglia. 
 
 5. That the medullary neurine is moulded into cords and bands the 
 nerves and commissures. 
 
 In an inquiry like the present, the surest path to sound opinions must 
 be first to investigate the office and mode of action of such organs as the 
 nerves, which are sufficiently isolated to enable us to experiment on them 
 without being in danger of injuring adjoining organs of the same kind, 
 and performing separate offices, and thus interfering with the result of 
 the experiments; and afterwards to prove the physiology of the central 
 portions, where the problem is more difficult to solve. 
 
 Indeed, the facility of exposing the nerves, and the striking results 
 which follow their injury, show the important part which they play as 
 conductors of stimuli. And even Herophilus, Erasistratus, and Galen, 
 perceived that there was a flow of power from the centres of the nervous 
 system and the muscles, which produced their contractions, and from 
 the organs in general to the centres of power which produced the sensa- 
 tions. Further researches have only confirmed the fact that they are 
 mere conductors, not originating the power of contraction in muscles, or 
 perceiving sensations in themselves, but in the first place conducting a 
 stimulus which calls the resident power of muscles, that of shortening 
 themselves, into action, and in the second conducting a something to a 
 certain point, where it is converted into a sensation and perceived; the 
 course of these influences, namely, the one, that of the stimulus to mus- 
 cular contractions, proceeding from the centre to the circumference, the 
 other, the producer of sensations, from the circumference to the centre. 
 
 And though the fact that we can produce contraction in a muscle by 
 pinching a nerve cut off from its connection with the brain, but still in 
 connection with the muscle, might seem to prove that the stimulus to 
 contraction actually resides in the nerve, and is merely called forth by 
 the brain, yet the experiments of Miiller (see Muller, op. cit. y p. 7917) 
 show that the divided nerves lose this power after they have remained 
 
260 HUMAN BRAIN. 
 
 . 
 
 unconnected for a short time, so that the previous power of exciting 
 contractions must have been derived from the nervous centres, and not 
 generated by the nerves themselves. The experiments of Sir C. Bell, 
 Magendie, and Mayo, have proved that there are nerves subservient to 
 sensation sensiferous or sensory nerves, and nerves of voluntary motion. 
 The physiological researches of Whytte, Prochaska, and, more perfectly, 
 Marshall Hall, confirmed by the anatomical observations of Grainger, 
 Carpenter, and Newport, have established another system of nerves for 
 the involuntary the conservative movements of the body, under the title 
 of the excito-motory system of nerves. All sound research and careful 
 experiment prove that a nerve in the whole extent of its course, whether 
 that course is between the fibres of a muscle, in the canal of a. bone, in 
 the substance of the spinal cord, in the crura of the brain, or in the 
 masses of the hemispheres, always performs one and the same office, 
 conducting always in one and the same direction. 
 
 The spinal nerves are connected with the spinal cord by anterior and 
 posterior roots. Each root consists of two sets of nerves, making, there- 
 fore, four sets of spinal nerves functionally distinct. The two anterior 
 are the conductors of volition from the brain to the voluntary muscles, 
 and the conductors of a stimulus to muscular action independent of voli- 
 tion from the ganglia of the spinal cord the efferent nerves of spinal 
 power. The posterior roots are also binary in their functional power 
 nerves of sensation, conducting impressions to the brain, and recognized 
 by the conscious being: and conductors of impressions to the spinal 
 ganglia from parts requiring the protective action of muscles too import- 
 ant to be left to the control of mind the incident nerves of spinal im- 
 pressibility. 
 
 The spinal cord is a series of ganglionic centres, structurally homo- 
 logous and functionally analogous to the jointed ganglionic cord of the 
 articulata, and although we are unable to point out any corresponding 
 anatomical lines of demarkation between them, they are as functionally 
 distinct as the auditory, optic, and olfactory ganglia of the brain. For 
 instance, those cervical centres which give origin, with such undeviating 
 regularity in the Mammal, to the phrenic nerve, endowing that nerve as 
 a conductor with power that keeps the diaphragm in unremitting and 
 unwearied action during the whole of life, must possess the power of 
 acting independently of those lumbar centres from which the nerves of 
 the generative system arise, and by which various muscles are brought 
 into numerous and convulsive actions during the act of copulation. In 
 the latter instance unrestrained action, so injurious to our moral natures, 
 in its excess brings its own punishment disease and softening of the 
 .cord ; in the former, constant action is essential to life, and the power is 
 only exhausted by death itself. 
 
 Wherever there are distinct centres of power, there are also connect- 
 ing commissures. The transverse commissures of the spinal cord, con- 
 necting corresponding ganglia on opposite sides of the mesial line, are 
 easily demonstrated. Longitudinal commissures connecting them toge- 
 ther from below upwards must also exist, though it is not so easy to dis- 
 tinguish them from the longitudinal fibres of the volitional and sensiferous 
 
PHYSIOLOGY. 261 
 
 nerves. It is quite possible that the posterior columns are the longi- 
 tudinal commissures which connect these ganglia together, and with the 
 cerebrum and cerebellum,^as the fibres of these columns terminate in 
 both the grand divisions of the encephalon, though principally in the 
 cerebellum. 
 
 The spinal cord consists, then, of ganglia, nerves, transverse and 
 longitudinal commissures, perfectly similar to the longitudinal commis- 
 sures which connect the jointed cord of the articulata. 
 
 The medulla oblongata consists of three ganglia on each side of the 
 mesial line six, therefore, in all. The olivary bodies, most probably 
 the lingual ganglia, the restiform or pneumogastric ganglia, the posterior 
 pyramidal bodies or auditory ganglia. The olivary ganglia are connected 
 with the rest of the cerebral ganglia by means of the olivary commissures, 
 and the important office of those ganglia, if my hypothesis is correct, 
 that they preside over the consensual movements of the tongue, as an 
 organ of speech, explains the reason of such a perfect communication 
 with the rest of the encephalon. Between the pneumogastric ganglia 
 and the brain the commissural communication is not so distinct, and 
 there does not appear to be the same physiological reason to expect it. 
 
 The auditory ganglia are imbedded in the sensory tract; but un- 
 doubtedly some of these fibres which we have heretofore considered as 
 belonging solely to this system of nerves, must be regarded as belong- 
 ing to that system of longitudinal commissures which we have seen so 
 distinctly carried out in the brain. 
 
 The next anatomical division we come to is the pons Varolii. This, 
 though evidently a great transverse commissure, must also be an instru- 
 ment of power through the medium of its vesicular neurine ; and though 
 we are unprepared to define the nature of its power, it must hold some 
 relation to transmission of motor and sensory impressions by the tracts 
 which in the spinal cord conduct them. 
 
 Cerebellum. The extensive surface of vesicular neurine which con- 
 stitutes the ganglionic portion of this encephalic centre, shows that it 
 must perform some very important office in the animal economy ; that it 
 must, in fact, be a ganglion, or series of ganglia, of great power. Its 
 extensive nervous and commissural connections also support this opin- 
 ion. The motor and sensory tracts, as they form the restiform bodies 
 and plunge through the substance of its great transverse commissure, 
 have a connection with its nucleated dynanaic vesicle. By the inter- 
 cerebral commissure the cerebellum is intimately associated with the 
 optic, the anterior and posterior cerebral, and the hemispherical ganglia. 
 
 From what has been already said in the sections on comparative and 
 human anatomy regarding the function of this organ, the reader will be 
 prepared for my opinion on this subject. 
 
 There can, I think, be little doubt but it is a regulator and co-ordi- 
 nator of muscular action on the one part, most probably by means of 
 the central portion of the cerebellum, viz., the superior and inferior 
 vermiform processes. On the second part, it certainly would appear 
 to hold some relation to the generative function. The pathological and 
 other facts adduced by Drs. Gall, Vimont, and Broussais, on this subject, 
 
262 HUMAN BRAIN. 
 
 are very striking, and almost as conclusive as all other physiological 
 evidence.* 
 
 The locus niger in the cms cerebri is the next ganglion for our con- 
 sideration; it is the serial homologue and analogue of the anterior peaks 
 of gray matter of the spinal cord. It is, I suppose, the seat of the ex- 
 cito-motor power of the third pair of nerves, the importance of which in 
 relation to the instinctive and conservative movements of the eyeball 
 need not be insisted on here. 
 
 The tubercula quadrigemina or optic tubercles, we may fairly con- 
 clude, are the instruments by which the physical impressions of light 
 received by the retina are converted into sensations of light, color, 
 form, &c. 
 
 The optic thalami and corpora striata, or anterior and posterior cere- 
 bral ganglia, are the next in rotation. With regard to the office of these 
 nervous centres, we have already had occasion to consider the thalamus 
 as the essential ganglion of the sensory tract, as the corpus striatum is 
 of that of the motor tract. And I am quite disposed to adopt the inge- 
 nious and philosophical theory of my friend, Dr. Carpenter, as enunciated 
 in his review of Mr. Noble's work in the October number of the British 
 and Foreign Quarterly Medical Review for 1846. 
 
 The anterior and posterior cerebral ganglia are regarded by Dr. C. as 
 forming part of the series of sensorial centres, of which we have seen 
 other members in the olfactory, optic, and auditory ganglia. That they 
 are independent centres of action, not mere appendages to the hemi- 
 spheric ganglia, appears from the large quantity of vesicular neurine which 
 they contain ; and that the corpora striata are so, further appears from 
 the absence of any correspondence in size between them and the hemi- 
 spheric ganglia. Thus in fishes, we find that the corpora striata make 
 up the principal bulk of the second pair of masses ; in reptiles, birds, 
 and the lower Mammalia, they still form a very large portion of that 
 which is commonly termed the cerebrum ; and their subordinate aspect 
 in man and the higher Mammalia is solely due to the large relative de- 
 velopment of the hemispheric ganglia. On the other hand, there is 
 scarcely any rudiment of the thalami optici to be discovered in fishes; 
 their proportional size increases in reptiles, birds, and the lower Mam- 
 malia ; but it is only in man that their dimensions approach those of the 
 corpora striata. The peculiar connection of the thalami optici with the 
 posterior columns of the spinal cord, and their great development in man, 
 suggest the idea that they are the ganglia of tactual sensation ; whilst 
 the connection of the corpora striata with the anterior columns indicates 
 their relation with the motor function. The very close relation between 
 the thalami optici and the corpora striata corresponding, as Messrs. 
 Todd and Bowman have suggested, with that which exists between the 
 posterior and anterior peaks of gray matter in the spinal cord harmonizes 
 \vell with the fact that the greater number of muscular movements are 
 directed by common sensation; whilst the special connection established 
 
 * On the Functions of the Cerebellum, by Drs. Gtvll, Vinxont,. and Bcoussajp, translated 
 from the French by George Cornb,e, 1837. 
 
PHYSIOLOGY. 263 
 
 by the inter-cerebral commissure between the corpora striata and the 
 optic ganglia (tuberculaquadrigemina) explains the peculiar influence of 
 the sense of light in directing certain classes of muscular actions. The 
 communication which is formed by the medullary substance of the cere- 
 brum between these ganglia and the hemispheric ganglia seems to be the 
 medium by which sensations are transmitted to the latter, to become the 
 stimulus of intellectual operations, and by which the influence of volition 
 is transmitted downwards to excite muscular motions through the cor- 
 pora striata. 
 
 The whole chain of sensory ganglia is regarded by Dr. C. as not only 
 the instrument by which sensations are received, but also as the centre 
 of those automatic muscular movements which differ from those of a 
 simply reflex character, in being dependent upon sensation. To this 
 head, he refers the purely instinctive actions of the lower animals, as 
 well as a variety of actions performed by the human being, both in 
 health and disease ; such as the consensual movements of the eyes, the 
 regulation of the laryngeal muscles in the production of vocal sounds, 
 the convulsive movements in hydrophobia, brought on by the sight or 
 sound of water, &c. &c. And he considers the actions which become 
 automatic by habit, as executed through the same channel; each move- 
 ment being directly prompted by the sensation with which it has become 
 associated. 
 
 We come lastly to those important ganglia which crown and cover 
 in the rest the hemispherical. If there is one point in the physiology 
 of the brain more unequivocally demonstrated than another, it is that 
 these ganglia are the instruments of the mind the portion of the brain 
 in which sensations are converted into perceptions, and give rise to 
 ideas. Comparative anatomy ; developmental anatomy ; experiments 
 on living animals ; observations on its size and form, as indicated by 
 the size and form of the skull ; and last, but not least, pathology, ail 
 afford a mass of overwhelming evidence that this portion of the brain, 
 and this only, is the cerebral organ of intellectual power. 
 
 Miiller, whose authority on all physiological subjects is interesting, 
 after speaking of the general evidence in favor of a belief that the intel- 
 lectual faculties reside in the cerebral hemispheres, says,* " It has, 
 however, been proved by direct experiment that such is their seat. 
 The experiments of Flourens are here also especially instructive, and 
 Hertwig has in the essential points done no more than confirm them. 
 The hemispheres are insensible both to puncture and incisions. That 
 part of the brain in which the sensations are converted into ideas, and 
 the ideas hoarded up, to appear again, as it were, as shadows of the 
 sensations, is itself devoid of sensibility." 
 
 Further on, he says, " The experiments of Hertwig confirm M. 
 Flourens' observations. Wounds of the hemispheres (in a dog) excited 
 no pain, unless they extended to the base of the brain, when signs of 
 pain were exhibited. M. Hertwig removed both hemispheres in a dog: 
 the animal did not move from the spot voluntarily, but was thrown into 
 a state of complete stupor; if irritated, it moved a few steps, and then 
 
 * P. 834, op. cit. 
 
264 HUMAN BRAIN. 
 
 fell again to the ground in a sleepy state. It did not hear even the 
 report of a pistol. M. Hertwig removed the upper part of the hemi- 
 spheres in a pigeon ; sight and hearing were abolished, and the animal 
 sat in one spot, as if asleep. He fed it: peas, if placed merely within 
 the beak, were not swallowed ; but they were, if laid upon the tongue, 
 owing to reflex action; the muscles were but slightly enfeebled ; the 
 bird stood firmly, and flew when thrown into the air. This state en- 
 dured for a fortnight, when the hearing and sensibility in a great mea- 
 sure returned ; this pigeon lived three months. A hen, in which Hert- 
 wig had cut away both hemispheres nearly to the base of the brain, was 
 found to be deprived of sight, hearing, taste, and smell. It sat constantly 
 in one spot, and was as if dead, until strongly roused, when it moved a 
 few steps. The animal lived in this state of stupor, without its senses 
 being restored, for three months. M. Schoeps has instituted similar 
 experiments." 
 
 It is evident from these experiments, and from the effects of pressure 
 on the cerebral hemispheres in man, that they are the seat of the mental 
 functions; that in them the sensorial impressions are not merely per- 
 ceived, but are converted into ideas ; and that in them resides the power 
 of directing the mind to particular sensorial impressions, the faculty of 
 attention. 
 
 In considering the question, is the brain the organ of the mind ? I 
 must say, with Mr. Combe, that the physiologist u regards man as he 
 exists in this world, and desires to investigate the laws which regulate 
 the connection between the mind and its organs, but without attempting 
 to discover the essence of either, or the manner in which they are united." 
 
 And, in connection with this subject, let us ever bear in mind that 
 we are not conscious of the existence and functions of the organs by 
 which the mind operates in this life, and, in consequence, many acts ap- 
 pear to us to be purely mental, which experiment and observation prove 
 incontestably to depend on corporeal organs. 
 
 " For example, in stretching out or withdrawing the arm, we are 
 conscious of an act of the will, and of the consequent movement of the 
 arm, but not of the existence of the apparatus by means of which our 
 volition is carried into execution." 
 
 " Experiment and observation, however, demonstrate the existence of 
 bones of the arm, curiously articulated and adapted to motion ; of mus- 
 cles endowed with power of contraction ; and of three sets of nerves, at 
 least, &c." 
 
 " All that a person uninstructed in anatomy knows is, that he wills 
 the motion, and it takes place : the whole act appears to him to be pure- 
 ly mental, and only the arm or thing moved is conceived to be corpo- 
 real. Nevertheless, it is positively established by anatomical and phy- 
 siological researches that this conclusion is erroneous that the act is 
 not purely mental, but accomplished by the instrumentality of the vari- 
 ous organs now enumerated. In like manner every act of vision in- 
 volves a certain state of the optic nerve, and every act of hearing, a 
 certain state of the internal ear; yet of the existence and functions of 
 these organs, we obtain by means of consciousness no knowledge what- 
 
 ever/' 
 
PHYSIOLOGY. 265 
 
 Now the phrenologist, says Dr. Combe, goes " one step further in the 
 same path, and states, that every act of the will, every flight of imagi- 
 nation, every glow of affection, and every effort of the understanding, 
 in this life, is performed by means of cerebral organs unknown to us 
 through consciousness, but the existence of which is capable of being 
 demonstrated by experiment and observation ; in other words, that the 
 brain is the organ of the mind the material condition, without which no 
 mental act is possible in the present world." 
 
 "The mind sees through the medium of the eye, just as it thinks or 
 feels through the medium of the brain ; and as changes in the condition 
 of the eye deteriorate or destroy the power of vision without any affec- 
 tion of the principle of mind, the obvious inference follows, that in like 
 manner may changes in the condition of the brain destroy the power of 
 feeling or of thinking, and yet the mind itself, or soul y remain essentially 
 the same." 
 
 The most decisive facts in proof that it is the surface qf the brain or 
 the hemispherical ganglion which directly ministers to intellect, are de- 
 rived from pathology, and especially the consequence of inflammation of 
 the membranes, as we shall see when we consider the diseases of the 
 brain. The varying effects of apoplexy afford also strong evidence in 
 favor of this opinion. I will very briefly state the argument now. If 
 the effusion of blood take place on the surface of the brain, the mind is 
 more or less disturbed, and if the effusion is extensive, the intellect is 
 buried for ever; but if the effusion is limited to the medullary substance, 
 the mind, having recovered the first effect of the general shock, remains 
 perfect, though its conducting instruments are paralyzed. 
 
 The first philosopher who attempted to prove that the brain does not 
 minister to the intellect as a single organ, but as a combination of or- 
 gans, was Gall ; and I think he deserves the gratitude of mankind for 
 his labors, though all his views may not ultimately prove correct. 
 
 The science which Gall advocated is now well known under the title 
 of phrenology. Those who have not given their serious attention to this 
 subject have a sort of indefinite idea that phrenology is some occult sci- 
 ence, by means of which its professors pretend to be able to judge of a 
 man's character by an examination of the bumps upon his head. This 
 is the phrenology of the superficial and the idle, who, not having indus- 
 try enough to investigate for themselves, set up a baseless shadow, and 
 then take credit for the facility with which they overthrow it. This is 
 not the science of phrenology, but the phantom of their own imagina- 
 tion. In the first place, the term bump, in reference to the surface of 
 the skull, has no place in the vocabulary of the phrenologist. The prac- 
 tical phrenologist judges of character by space rather than by mere ele- 
 vation or depression. 
 
 It must always be borne in mind that the physiological principles upon 
 which phrenology is founded, may be perfectly correct, and nevertheless 
 its professors may make great mistakes in their application. 
 
 Spurzheim himself says, " The true principles of a science may be 
 established, but those who apply them may err." 
 
 " The art of surgery is positive, yet there cannot be a doubt but that 
 legs have been amputated which might have been saved, and in the 
 
266 HUMAN BRAIN. 
 
 practice of their art all surgeons have not the same dexterity. Every 
 physician has not equal facility in distinguishing disease ; the healing 
 art nevertheless exists." 
 
 u I do not conceive that phrenology has reached perfection now 
 [1826], nor do I expect that its application, even when perfect, will 
 always be without error. I have been frequently obliged to rectify my 
 judgment, but I always endeavor to profit by my mistakes." 
 
 Those who really wish to understand phrenology, and judge of its 
 correctness, ought to read the works of Gall, Spurzheim, Combe, and, 
 lastly, the admirable treatise of Mr. Noble ; for arguments on the other 
 hand they should also peruse a critique of the last-mentioned work in 
 the British and Foreign Quarterly Medical Review, vol. 22 ; in which 
 the writer most ably advocates the necessity of employing comparative 
 anatomy in the study of cerebral physiology. 
 
 My reasons for believing that there must be a great deal of truth in 
 phrenology are fourfold. First, I have received from practical phreno- 
 logists, and especially the late worthy Mr. Deville, such accurate cha- 
 racters of individuals known to me, but unknown to them, that I cannot 
 believe the accounts I received could be the result of accident and 
 conjecture, which must have been the case if phrenology is untrue. 
 
 Secondly. Phrenology alone as it appears to me can account for 
 all the varieties of insanity, especially monomania. 
 
 Thirdly. The facts which have been collected by the late Mr. Deville, 
 showing that the brain will alter its form at any period of life. 
 Fourthly. The existence of longitudinal commissures. 
 In Mr. Deville's collection there are above twenty casts which prove 
 an alteration in form ; as far as I am able to judge, they correspond with 
 the mental and moral exercise which the brain experienced in the period 
 during which the changes were taking place. Few medical men are 
 aware of the immense number, and the importance, of the facts esta- 
 blished by that collection ; and whether phrenology is true or false, such 
 a collection should not be lost to the nation. The government has 
 been most liberal in granting sums for the purchase of antique marbles 
 and specimens of natural history for the British Museum all important 
 objects for the improvement of the people ; and they would confer a 
 lasting benefit to science, and, through it, to the nation at large, were 
 they to add this to our national treasures. 
 
 If phrenology is true, insanity on its first ingress is frequently not a 
 disease of the whole brain, but of only a part of it. The first effect of 
 inflammation is to excite to an unnatural degree the natural function of 
 an organ. The function of the organ thus exalted obtains a mastery 
 over the rest. For instance, a man, from defective education, combined 
 \vith hereditary tendency, allows his love of approbation, his vanity, in 
 other words, to grow with his growth, and strengthen with his strength, 
 gradually becoming the sole ruling principle of life : at last it, instead 
 of reason, so completely guides and regulates all his actions, that they 
 are contrary to reason, and justly called the acts of a lunatic. Yet all 
 this may go on with reasoning faculties so acute, that he conceals the 
 dominant feeling of his breast, the mainspring of all his actions, and in 
 a court of law defies any one to prove him insane. 
 
PHYSIOLOGY. 267 
 
 The great amelioration which has been effected in the condition of 
 the lunatic has been founded on this principle, that none are so mad as 
 to be incapable of appreciating kindness. Throughout all the admirable 
 and interesting reports of Dr. Conolly, it will be seen that this has been 
 the guiding principle of his boldly humane treatment. The first thing, 
 says this admirable man, is to gain the confidence of your patient ; and 
 that once obtained, you may do anything with him. 
 
 Now if this is true, (and no one who has treated the insane on these 
 principles doubts it,) so is it equally true that they may be awed by 
 punishment and even acknowledge its justice. Only the last time I 
 had the pleasure of visiting that noble asylum, Hanwell, I listened with 
 much interest to a lunatic whom we met in the grounds. He began by 
 requesting Dr. Conolly to procure his release from the Asylum, and then 
 went on in a rambling manner, reasoning on things and circumstances 
 which had no existence, showing his mental aberration ; but he finished 
 by saying, as an argument for his being allowed his liberty, that he had 
 always conducted himself with propriety while there, which was perfectly 
 true. This sense of right and wrong was as perfect as ever, and this 
 sense enabled him to conduct himself properly. But if we had supposed 
 that the circumstance of his being lunatic gave him a license for any 
 conduct, and freed him from all responsibility, would he have been so 
 anxious to conduct himself properly ? And if he were told that the law 
 of the land would not take notice of an improper act, even if that act 
 amounted to the murder of a fellow-creature, he would not feel the same 
 reason for self-control. 
 
 Mental philosophers have always admitted that if a man through im- 
 perfect education has never had his reasoning faculties called forth, the 
 instrument of that power becomes more or less atrophied, and the power 
 is more or less lost. For instance, take two boys born of the same 
 parents, and with the same or nearly the same original capacity; sup- 
 pose them differently educated, the one brought up in the fields, and all 
 mental culture neglected, the other trained for a learned profession. 
 When these two have arrived at maturity, oblige them to change places, 
 and the incapacity of the brain of the peasant would only be surpassed 
 by incapacity of the muscular system of the student. The same applies 
 to moral as to intellectual culture. And hence the same importance of 
 early education for the formation of moral strength as for the formation 
 of intellectual or muscular strength. But phrenology goes further than 
 merely to insist on the importance of educating the child. It goes fur- 
 ther also in tracing moral insanity to its real cause. It teaches'us that 
 the child inherits more or less of the mental or moral capacity of the 
 parent, just as much as he inherits the form of the face and physical 
 constitution. And as personal beauty may be more or less spoiled and 
 effaced by evil education, (and I refer to the moral and mental educa- 
 tion of circumstances and example,) so may the brain, with its mental 
 and moral faculties, be deteriorated and debased by the same causes. 
 But phrenology also inculcates that, although it has pleased the Almighty, 
 for some good and wise purpose, to ordain that not merely the bodily 
 diseases of parents, but even their mental and moral imperfections, shall 
 more or less descend to their children, such hereditary imperfections. 
 
268 HUMAN BRAIN. 
 
 whether of the intellectual, the muscular, or the mental organs, may be 
 corrected by careful attention. 
 
 It has not been my object so much to prove the truth of phrenology, 
 as to show that, if true, the following must also be so that though the 
 form of the brain is not alike in all children at birth, any more than their 
 dispositions or intellectual capacities are alike, the form of their brain 
 may be altered and improved, as the disposition and the intellect may 
 be, at any period of life, by education and restraint. 
 
 Lastly, with regard to the office of the commissures, this is implied in 
 the name by which they are known. The structure of these parts, their 
 comparative anatomy, analogy, and the few pathological facts that have 
 been recorded, bear us out in the view I have taken of their office as 
 conductors of nervous power, as the media of establishing communica- 
 tion between one portion of the encephalic mass and another, and, in 
 this way, intimately connected with the faculty, possessed by man espe- 
 cially, of comparing and reasoning upon the various impressions received 
 by the different portions of the hemispheres. 
 
269 
 
 PART XI. 
 
 DISEASES OF THE BRAIN. 
 
 IN undertaking this division of my subject, I am afraid that by some 
 I shall be considered as stepping beyond the proper boundaries of sur- 
 gical practice. To such I must observe that every surgical disease re- 
 quires more or less of medical treatment ; that no surgeon is competent 
 to treat an injury of the head affecting the brain, who is ignorant of 
 cerebral pathology ; that the distinction between medicine and surgery 
 is artificial; and that a distinction between diseases arising from external 
 violence and from internal disease is false and mischievous. One of the 
 first principles instilled into my medical mind by my respected master, 
 Mr. Travers, was the necessity of studying medicine at the hospital with 
 the same diligence and attention as surgery. The interest I have felt 
 from the time I first heard Spurzheim demonstrate the brain in 1826 has 
 induced me to attend to the pathology of this subject more than perhaps 
 I should otherwise have done. These observations are made, not to 
 prove fitness for the task I have undertaken, but simply to explain that 
 I do not allow that the fact of my practising as a surgeon is any excuse 
 of incompetency. 
 
 For many years I have thought much upon the functions of the brain, 
 and endeavored to observe the phenomena which attend the disturbance 
 of those functions. In detailing the information I have obtained by ob- 
 servations and reading, I must rely on the same kind indulgence for the 
 imperfect execution of my task, which has been so liberally accorded to 
 my former labors. 
 
 In this outline of the diseases of the brain, the following arrangement 
 will be adopted : 
 
 1. Anaemic affections. 
 
 2. Hyperaemic. 
 
 3. Convulsive. ^ >. 
 
 4. Organic. 
 
 This arrangement, like every other that has been adopted, is of 
 course liable to objections. Each of these affections will occasionally 
 run one into the other, so that the lines of distinction are lost; neverthe- 
 less, in a practical point of view, I hope it will on the whole be found 
 advantageous. 
 
 I have not divided the history, diagnosis, and treatment of these dis- 
 eases so strictly as some authors have done. My reason for which is, 
 that it is impossible to maintain these divisions, if the subject is much 
 
270 HUMAN BRAIN. 
 
 illustrated by cases; and I believe that the interest of the reader is more 
 continuously kept up by mingling them together. 
 
 Before we consider these different affections separately, it will be ad- 
 visable to determine, as far as possible, whether the quantity of blood 
 within the cranium ever varies, and whether the cerebral substance can 
 be compressed. The student who has seen something of disease prac- 
 tically, and is conversant with the expressions which the practical phy- 
 sician employs, but who is not well acquainted with the literature of 
 medicine, will be astonished that these points should have been ever 
 questioned. It has, however, been questioned, and the result is, that 
 for some years it was admitted, as an established doctrine of physiology, 
 that the quantity of blood in the cranium never varies, and that the brain 
 is incompressible. It will be necessary to show here the grounds upon 
 which they are now abandoned. The theory has had a mischievous 
 tendency in a practical point of view ; for instance^Dr. Clutterbuck, in 
 his article on cerebral apoplexy in the Cyclopa?dia of Practical Medicine, 
 says, that "no additional quantity of blood can be admitted into the 
 vessels situated in the brain, the cavity of the skull being already com- 
 pletely filled by its contents. A plethoric state, or over-fullness of the 
 cerebral vessels altogether, though often talked of, can have no real ex- 
 istence; nor, on the other hand, can the quantity of blood within the 
 vessels of the brain be diminished : no abstraction of blood, therefore, 
 whether it be from the arm or other part of the general system, or from 
 the jugular veins (and still less from the temporal arteries), can have any 
 effect on the blood-vessels of the brain so as to lessen the absolute quan- 
 tity of blood contained within them." 
 
 I cannot conceive a more dangerous doctrine in the practice of medi- 
 cine, particularly coming from such an authority as Dr. Clutterbuck, and 
 one who is generally so fond of bleeding. The profession is indebted to 
 Dr. George Burrows for dispelling these illusions. 
 
 Monro Secundus, of Edinburgh, is generally believed to have been 
 the first who propounded this doctrine. He observes,* "As the sub- 
 stance of the brain, like that of the other solids of our body, is nearly 
 incompressible, the quantity of blood within the head must be the same 
 at all times, whether in health or disease, in life or after death, those 
 cases excepted in which water or other matter is effused or secreted 
 from the blood-vessels: for in these cases a quantity of blood, equal in 
 bulk to the effused matter, will be pressed out of the cranium." 
 
 Monro regarded the skull as if it were a perfect air-tight sphere, unin- 
 fluenced by the pressure of the atmosphere ; and he used to illustrate 
 his theory by showing to his class a glass ball filled with water, which 
 he inverted to show them that not a drop of water would escape through 
 the aperture. 
 
 Abercrombie, who supported this view, does not appear to have insti- 
 tuted any positive experiments, but to have founded his opinion on the 
 experiments of Dr. Kellie, published in vol. i. of the Transactions of 
 the Med. Chir. Society of Edinburgh. 
 
 Dr. Burrows first promulgated his valuable and conclusive researches 
 
 * Observations on the Nervous System, Alex. Monro, M. D.', 1793. 
 
PATHOLOGY. 271 
 
 on this subject in his Lumlean Lectures, delivered at the College of Phy- 
 sicians, March, 1843, published in the thirty-second volume of the 
 Medical Gazette, p. 146, and to them I must refer my readers for a full 
 exposition of the opinions of preceding observers, their experiments, 
 and the conclusions they draw from them. Dr. Burrows has since en- 
 tered more fully into the subject in his admirable work entitled " On 
 Disorders of the Cerebral Circulation," &c., 1846. The following ex- 
 periments which he first made are so decisive of the question that I can- 
 not help quoting them in full: 
 
 " On the llth of January, 1843,1 killed two full-grown rabbits. The 
 one (A.) by opening the jugular vein and carotid artery on one side of 
 the throat ; the other (B) was strangled. Each animal died violently 
 convulsed. A ligature was drawn tightly round the throat of the rabbit (A) 
 immediately it expired, to prevent any further escape of blood from 
 the vessels of the head. The rabbits were allowed to remain twenty- 
 four hours on a table resting on their sides. While the blood was flow- 
 ing from the rabbit (A), the conjunctiva was observed to become pallid, 
 and the eyeballs to shrink within the sockets. Upon the examination 
 of the head of the rabbit, the integuments and muscles appeared blanched 
 and exsanguine. Upon removing the upper portions of the cranium, the 
 membranes of the brain were found pallid, and scarcely the trace of a 
 blood-vessel was to be detected on the surface of the brain. The longi- 
 tudinal and lateral sinuses were nearly empty of blood, and their course 
 was not denoted by any color of blood. Upon making sections of the 
 brain, the interior appeared equally exsanguine. 
 
 u Soon after the cord was drawn tight round the throat of the rabbit (B), 
 the conjunctiva became congested, the eyeballs turgid, prominent, 
 and even projecting beyond the margin of their sockets. The integu- 
 ments and muscles of the head were found full of blood. Upon opening 
 the cranium, the superficial vessels of the membranes, as well as the 
 sinuses, were full of dark liquid blood. The whole substance of the 
 brain and its membranes appeared of a dark reddish hue, as if stained 
 by extravasated blood. 
 
 u The contrast between the two brains on the point of vascularity, 
 both on the surface and in the interior, was most striking. In the one, 
 scarcely a trace of blood-vessel was to be seen ; in the other, every ves- 
 sel was turgid with blood. It seems hardly necessary to bring forward 
 further evidence to prove that death by hemorrhage has a most decided 
 effect in depleting the vessels and reducing the quantity of blood within 
 as well as upon the outside of the cranium. 
 
 u I have, however, repeated the experiments with similar results. In 
 fairness to Dr. Kellie, I should state that I have attended at the slaugh- 
 tering of sheep by butchers, and find the brains of those animals much 
 less depleted than the brains of rabbits which have died by haemorrhage. 
 But the sheep did not die from simple loss of blood, but partly from the 
 division of the pneumogastric nerves and cervical portion of the spinal 
 cord. These lesions no doubt influenced the appearances. 
 
 *' Hence it is not a fallacy, as some suppose, that bleeding diminishes 
 the actual quantity of blood in the cerebral vessels. By abstraction of 
 blood we not only diminish the momentum, of blood in the cerebral 
 
272 HUMAN BRAIN. 
 
 arteries and the quantity supplied to the brain in a given time, but we 
 actually diminish the quantity of blood in those vessels. Whether the 
 vacated place is replaced by serum or resiliency of the cerebral sub- 
 stance under diminished pressure, is another question, into which I do 
 not now enter." 
 
 Dr. Burrows also made experiments to decide whether position could 
 affect the condition of the vessels within the skull ; for Dr. Kellie had 
 asserted that the quantity of blood in the cerebral substance is not affected 
 by posture, and details experiments in order to prove it. 
 
 Dr. Burrows says, " On the 28th of December, 1842, two full-grown 
 rabbits were killed by prussic acid, and, while their hearts were still 
 pulsating, the one (c) was suspended by the ears, the other (D) by the 
 hind legs. They were left suspended for twenty-four hours ; and, before 
 they were taken down for examination, a tight ligature was placed round 
 the throat of each rabbit, to prevent, as effectually as was possible, any 
 further flow of blood to or from the head, after they were removed from 
 their respective positions. 
 
 " In the rabbit (c) the whole of the external parts of the head, the 
 ears, the eyeballs, &c., were pallid and flaccid ; the muscles of the scalp 
 and bones of the cranium were also remarkably exsanguined. Upon 
 opening the cranium, the membranes and substance of the brain were 
 pallid, the sinuses and other vessels were exsanguined ; anaemic beyond 
 my expectation. 
 
 "In the rabbit (D) the external parts of the head, the ears, eyeballs, 
 &c., were turgid, livid, and congested. The muscles and bones of the 
 cranium were of a dark hue, and gorged with blood, which at some 
 parts appeared extravasated. Upon opening the cranium, the mem- 
 branes and vessels were dark and turgid with fluid blood ; the super- 
 ficial veins were prominent, the longitudinal and lateral sinuses were 
 gorged with dark blood ; there was staining of the tissues, if not extra- 
 vasation of blood into the membranes. The substance of the brain was 
 uniformly dark, and congested to a remarkable extent." 
 
 " Dr. Kellie asserts, but I think his experiments do not support him, 
 that the contrast in the appearances within the heads of the two animals 
 was but trifling. In my analogous experiments the contrast was most 
 striking. In the one was to be seen a most complete state of anemia 
 of the internal as well as external parts of the cranium ; in the other a 
 most intense hyperaBtnia or congestion of the same parts ; and these 
 opposite conditions in the vascularity of the brain induced solely by 
 posture and the gravitation of the blood." 
 
 " If the cranium were the perfect sphere, as taught by Monro, and 
 as s subsequently maintained by Abercrombie and other distinguished 
 writers on the pathology of the brain, these effects on its circulation 
 (which I have now exhibited) ought not to have resulted from the force 
 of gravity on the blood in the cerebral vessels." 
 
 When Dr. Burrows first promulgated his opinions on this subject, he 
 was obliged to combat the authority of Dr. Watson, among other men 
 of note. It is, therefore, satisfactory to find this excellent physician now 
 giving in his allegiance to these views. Indeed, it may be asserted 
 
ANEMIC AFFECTIONS. 273 
 
 that they are now admitted by nearly all men as established principles 
 in physiology. 
 
 Jincemic Affections. During the last twenty years, much has been done 
 in cerebral pathology, but in no section of it has so much progress been 
 made as in the anaemic affections. At one time, coma was considered 
 an unerring sign of pressure on the brain, and delirium an equally cer- 
 tain indication of inflammatory mischief; but it is now well known that 
 both may arise from anaemia, either local or general. 
 
 The occurrence of serious symptoms from a diminished supply of 
 blood to the brain is not universally admitted, but it is still a matter of 
 dispute with some, whether these symptoms are occasioned by diminished 
 pressure on the brain, or by a smaller quantity of blood within the cere- 
 bral capillary system. 
 
 Dr. Burrows, in the lectures already referred to, says that he is inclined 
 to the opinion that some of the most remarkable symptoms arise rather 
 from insufficient vascular pressure than from an insufficient quantity of 
 blood in the substance of the brain. With all due deference to this ad- 
 mirable observer, I am inclined to an opposite opinion. We know that 
 the function of all other organs, uninfluenced by pressure, may be 
 excited by a flow of blood into them, or their function may be arrested 
 by any stoppage in their supplies. Take the salivary glands or the testi- 
 cles, as an illustration: mental emotions will both excite and arrest their 
 secretions; and I believe that the brain would be similarly affected, and 
 to the same extent as now, even if that organ were not enclosed in a 
 spherical box, and supported on all sides by the cerebro-spinal fluid. 
 
 The effect upon the sensoriurn, of suddenly cutting off' the supply of 
 blood to the brain, is strikingly exhibited in the familiar instance of 
 syncope, whether induced by loss of blood or mental emotion. Now it 
 appears to me contrary to all analogy that the function of an organ like 
 the brain (clearly as dependent as any other organ in the body on the 
 blood for its power, or why should it receive so very large a proportion 
 of the whole circulating quantity ?) should be arrested by a mere change 
 in its physical condition. The maintenance of such a doctrine appears 
 to me to partake of the old leaven, which Dr. Burrows has so admirably 
 upset. 
 
 Sir Astley Cooper, by his experiments with ligatures on the carotid 
 and vertebral arteries of dogs, showed the dependence of the brain on 
 its supply of blood for the performance of its functions. The first effect 
 of pressure on the carotid arteries was to produce a state of partial in- 
 sensibility: if the pressure was continued, then the animal lost apparently 
 all consciousness. By pressing on the vertebrals as well as the carotids, 
 life was very soon extinguished ; the respiratory centres receiving their 
 supply of blood from the vertebral arteries. 
 
 In the human being, the surgeon has occasionally an opportunity of 
 observing the effect upon the brain of cutting off a portion of its supply 
 of blood by a ligature on the carotid artery. It is true that sometimes 
 a ligature is thus applied, and no sensible impression produced upon the 
 sensorium, but more frequently there is an immediate, though it may 
 be a temporary, effect produced. In other cases, the remote conse- 
 quences are serious. Dr. Norman Chevers has published, in the Medical 
 18 
 
274 HUMAN BRAIN. 
 
 Gazette, vol. xxxvi. p. 1140, October 31, 1846, an admirable summary 
 of the cases in which these vessels have been tied, and he has exposed 
 the danger to which the brain is subjected by this proceeding, showing 
 that the danger of the operation is not confined to its performance. The 
 whole paper is worthy of perusal but I must confine myself to some 
 of his deductions. He says, that though by far the larger proportion of 
 those in whom the primitive carotid artery on one side is obliterated, 
 recover, a considerable number become hemiplegic, and perish from 
 disease of that hemisphere of the brain. The conclusion that oblitera- 
 tion of one carotid artery is never liable to be followed by impairment 
 of the cerebral functions, must therefore be discarded. 
 
 "(1.) The form of disease found in the brain after death in several 
 cases related above," says Dr. Chevers, "was of a kind which is gene- 
 rally considered to depend upon local anaemia, not upon congestion. 
 
 44 In some of these instances, signs of deficient supply of blood in the 
 side of the brain to which the obstructed artery passed, were strikingly 
 apparent. 
 
 41 The parts of the cerebral substance which were principally involved 
 in disease, were those supplied by the chief branches of the obstructed 
 vessel. 
 
 44 Obliteration of the internal jugular vein was not observed. 
 
 44 (2.) There were not remarked any morbid appearances to indicate 
 that inflammation had been conveyed backwards along the nerve to the 
 brain. The part from which the par vagum arises is not shown to have 
 been involved in the disease. That cerebral disease may be established 
 in these cases quite independently of implication of either the vein or 
 the nerve, is further proved by the facts that the paralysis has been known 
 to occur almost immediately after the artery has become obliterated, 
 before inflammation could be possibly established in the surrounding 
 parts: and that organic lesions of the brain present themselves in cases 
 where the vessel has become gradually obliterated by processes which 
 are confined to its interior, and do not at all involve adjacent structures; 
 that although persons in whom the carotid is tied may suffer from slight 
 cerebral symptoms, and yet perfectly recover, those who become com- 
 pletely hemiplegic have barely a chance of surviving." 
 
 Dr. Chevers sums up with this excellent practical observation: 
 44 The facts adduced in this paper, it is submitted, prove that the danger 
 of cerebral disorganization should have its weight in the consideration 
 of cases where it is proposed to secure the common carotid artery, not 
 indeed as rendering at all doubtful the propriety of the operation in the 
 majority of the cases in which it is at present had recourse to, but as 
 strongly discountenancing it in nearly all instances where the disease 
 for which it is employed does not positively threaten the patient's exist- 
 ence, and in every case where other means of treatment can be em- 
 ployed." 
 
 Dr. Burrows, whose opinion on all practical subjects is of the high- 
 est value, suggests the application of a ligature to the carotid artery in 
 some cerebral affections. He says,* "In violent and hopeless cases of 
 
 * P. 78, op. cit. 
 
DELIRIUM TREMENS. 275 
 
 epilepsy, and some kindred maladies which are characterized by extreme 
 cerebral congestion, it appears to me that, other remedies failing, this 
 operation may be fairly resorted to. I am aware of the responsibility of 
 advocating a remedy attended with risk to life; but are not all our best 
 remedies most violent poisons in the hands of the unskillful?" I quite 
 concur with Dr. Burrows in this opinion, and more particularly as the 
 operation has been successfully performed for epilepsy as related fur- 
 ther on. x 
 
 Surgical operations and accidents are not the only agents which pro- 
 duce an anaemia of the brain, local or general. 
 
 The balance of the circulation may be disturbed by various causes, 
 but there is none so frequently observed as that arising from the intem- 
 perate use of stimulating drinks. 
 
 Their primary effect is to excite the heart's action to unnatural exer- 
 tion ; all the organs feel this, but the brain more than the rest: after a 
 storm comes a calm. The intervals between the use of these stimuli 
 are the calms; but unlike the calms of Nature's hand, they are states 
 of fearful depression. When these intervals are long continued, they 
 are not merely states of depression, but states of delirium ; and this 
 leads us to the consideration of that frightful, and, if it were not for the 
 feelings of pity which arise from the contemplation of a human being 
 degraded below the level of the brute, we might add, disgusting and 
 horrible malady, delirium tremens. Delirium ebriosorum I regard as a 
 distinct disease, an hypersemic affection, as will be explained a little fur- 
 ther on. 
 
 Delirium Tremens. I believe that we are justified in classing delirium 
 tremens tinder the head of anaemic affections of the brain. It is true, 
 that our pathological records of this disease are very scanty; but in all 
 the cases which I have had the opportunity of examining after death, I 
 have invariably found the hemispherical ganglion, or cortical substance, 
 pale and bloodless; the venous canals were generally full; and occa- 
 sionally the arachnoid thickened, as if it had been the subject of chronic 
 inflammation. It is curious that so well as the treatment of delirium 
 tremens is now understood, it is comparatively only a few years since 
 it was first described in print. The late Dr. Thomas Sutton, of Green- 
 wich, first gave it its present title, and distinguished it from phrenitis. 
 He says,* "Delirium tremens, and likewise the treatment, which will 
 be pointed out as we proceed, are known to some professional men to a 
 certain extent; but to many they are wholly unknown: and the disease 
 has not yet taken a station in medical writings. Dr. Wm. Saunders, late 
 physician to Guy's Hospital, and for many years lecturer on medicine 
 at that hospital, whose opinion I had the advantage of obtaining on this 
 tract, considered the assertions in this paragraph to be perfectly correct; 
 but stated to me, that he had mentioned the disease alluded to in his 
 lectures for many years, and had been in the habit of noticing and dis- 
 tinguishing it from phrenitis during forty years of his practice. So far 
 as my observations and inquiries have gone on this point, its treatment 
 
 * Tract on Delirium Tremens, by Thomas Sutton, M.I)., of the Royal College of Physi- 
 cians, late Physician to the Forces, and Consulting Physician to the Kent General Dispensary. 
 1813, p. 3. 
 
276 HUMAN BRAIN, 
 
 is acknowledged by only a few, who have not collected any very arr.ple 
 information on the subject." The Dr. does not add to our knowledge 
 of the pathology of the disease. 
 
 Dr. Copland, whose article on this subject, like all contained in his 
 admirable Encyclopaedia, is copious and erudite, merely says, " The 
 appearances on dissection have furnished only negative information as 
 to the nature of the disease." He speaks of " slight opacity of the 
 arachnoid, especially at the base, a little injection of the pia mater, a 
 little fluid in the ventricles," but not one word about the condition of 
 the cortical substance of the brain. 
 
 Dr. Blake* says, " When this disease terminates fatally, it does not 
 seem to me to be owing to venous congestion, as the late much-to-be- 
 lamented Dr. Armstrong asserted in his valuable work, or to inflamma- 
 tion of the brain, as Dr. Clutterbuck mentions in his lectures in the 
 Lancet, vol. ii. p. 376. I would ascribe it to serous effusion within 
 the cranium every post-mortem that I have since witnessed in cases of 
 pure delirium tremens, tended to confirm me in these sentiments." 
 
 This author makes an excellent practical observation, to the correct- 
 ness of which T can add my testimony, and which bears out my view 
 of the anaemic character of this disease. The stimulus of light, or in- 
 deed of any excitant, seems of advantage in delirium tremens; but not 
 so in the commencement of mania: its symptoms are invariably exas- 
 perated by such influence. 
 
 Many authors have divided delirium tremens into two kinds, but, as 
 I have long thought and taught, erroneously. They have, in fact, con- 
 founded that delirium, delirium ebriosorum, which may be excited in 
 any individual by the use of stimulants, with the true delirium tremens, 
 which is alone produced by the sudden withdrawal of a long-continued 
 use of them. The one depends on a congested state, the other on an 
 anaemic condition, of the hemispherical ganglion. Entertaining these 
 opinions, I was much pleased to find it thus treated by Dr. Blake. f 
 Correct views on this subject are essential to a right understanding for 
 practical purposes, of many other diseases of the nervous system. I 
 suspect many forms of Hysteria are dependent on a similar anaemic con- 
 dition of the brain, though the cause producing it is so widely different. 
 
 Dr. Blake regards them as distinct and opposite diseases, the one 
 being the immediate consequence of intemperance, the other arising 
 from the sudden cessation of accustomed intemperate stimulation the 
 one requiring the cautious use of depletion, the other the administration 
 of stimuli the one belonging to the class phlegmasiee, the other to that 
 of neuroses. In illustration of the distinction of the delirium which im- 
 mediately follows indulgence to excess in spirituous liquors, and that 
 which does not come on until after a cessation of intemperate habits, 
 he relates a case of a man who was an habitual tippler, and whenever 
 he exceeded his usual allowance, which was tolerably often, he was 
 attacked with furious delirium, and which, if not cautiously treated, 
 
 * A practical Essay on the disease generally known under the denomination of Delirium 
 Tremens, &c., by Andrew Blake, M. D., M. R.C. S., &c., 18-10, p. 58. 
 f P. 04. op. cit. 
 
DELIRIUM TREMENS. 277 
 
 was followed by a consequent stage of exhaustion, and, in due time, by 
 all the stages of delirium tremens. 
 
 This peculiar idiosyncrasy of constitution, by presenting both diseases 
 successively in the one subject, serves to point out clearly the difference 
 which exists between the delirium consequent upon the immediate 
 effects of spirits, or other diffusible stimuli, and that which succeeds in 
 one, two, three, or more days, as the consequence of suddenly desisting 
 from the habitual abuse of any stimuli. 
 
 In the cases of delirium tremens which we have in the surgical wards 
 of the hospital, the disease generally comes on in patients who have met 
 with some severe injury, such as fracture of one or more of the extre- 
 mities, injuries of the head, &c., and whose habits are extremely intem- 
 perate. Many of these miserable drunkards are in the habit of swal- 
 lowing more than a gallon of beer in the day, with a certain amount of 
 gin to carry it off by the kidneys. On their admission into the hospital, 
 of course the enormous supplies are cut off', though we generally ascer- 
 tain what are the usual habits of our patients, and give them a little 
 extra to the ordinary house allowance. But a pint of beer extra is a 
 mere drop in the ocean compared to their usual quantity, and in a few 
 days we often observe a slight tremor of the tongue when protruded. 
 There is a wildness about the eye, an unnatural quickness of manner 
 when answering our questions. The sister of the ward tells us that 
 during our absence he is very busy pulling the bed clothes, perhaps 
 rolling up his upper sheet. The tongue is not unusually dry or furred, 
 as in phrenitis ; the skin is bathed in sweat ; the pulse is quick and 
 irregular, both in force and frequency. Now if we do not take the hint 
 of the storm which is threatened by these premonitory symptoms, we 
 find our patient in a state of raving delirium in the course of a very 
 few hours, and woe to the fracture. 
 
 Dr. Watson, whose description of all disease is so graphic and so 
 correct, and who has seen it more frequently than I have had the oppor- 
 tunity of doing, unconnected with a confinement to bed by local injuries, 
 says, " The delirium you will generally find to be, not a fierce or mis- 
 chievous delirium, but a busy delirium ; he does whatever you desire 
 him to do, but he does it in a hurried manner, with a sort of anxiety to 
 perform it properly. During the approach of the malady, while he is 
 yet able to go about, he manifests great impatience of any interference, 
 or advice, or assistance in his ordinary duties, which he sets about in a 
 bustling and blundering manner. His loquacity is extreme, and he re- 
 fers to matters that are not present before him ; he is not altogether in- 
 attentive to the objects and proceedings that are going on around him, 
 but his mind wanders away to other subjects. There is an odd mixture 
 of the real and the ideal in his thoughts and language. Sometimes he 
 is very suspicious that those who are about him intend him some injury ; 
 or that he is surrounded by enemies. You will find also that he does 
 not sleep, that he has not slept perhaps for several nights, but been rest- 
 less and rambling; and you will generally learn that he has been habi- 
 tually intemperate, or subject to some great source of care, or anxiety, 
 or excitement: and in many cases he has been recently, somehow or 
 other, debarred from his customary stimulus. In addition to these points 
 
278 HUMAN BRAIN. 
 
 in his history, you will frequently be told that having been unwell, first 
 he has been kept upon low diet, and then, as the delirium came on, he 
 has been freely bled, and that he has been none the better, but com- 
 monly the worse for the bleeding. When you gather such particulars 
 as these from his friends (for upon his own statements you cannot place 
 any reliance), and when you find the delirium to have the character I 
 have been attempting to describe, and especially when there has been 
 obstinate watchfulness, and the tongue is moist, and the skin is sweating, 
 you may be pretty certain that your paiient is affected, not with inflam- 
 mation of the brain, but with delirium tremens ; and Jhat if you bleed 
 him further you will make him worse." Sometimes the pathological 
 condition which excites delirium ebriosorum is an inflammatory action 
 of a low character occurring in a constitution much shattered by long- 
 continued debauchery. In these cases it is necessary to support the 
 system with the accustomed fermented liquors, and employ local coun- 
 ter-irritants to the head, with diuretics, to prevent serous effusion. The 
 following history illustrates this class of cases : 
 
 Case 1. Conl?on Johnson, aet. 47, waterman on cab-stand, countenance bloated, admitted 
 into Georges Ward, under my care, January 12th, 1847, with simple fracture of the thigh, 
 about the middle third. It was very loose, and he complained of much pain. He appeared 
 as if he had been drinking, and his face was flushed and skin moist. Pupils dilated. Ap- 
 peared inclined to sleep, and does not answer questions readily. His breath was very foul. 
 When in bed his teeth chattered from cold, and so he continued for some time. 
 
 Was put up in splints for the night. 
 
 Jan. 13th. Has passed a restless night, and complains of much pain. Pulse quick and 
 full. Skin moist, but he says he is very cold. Tongue and breath foul. Restless. Put up 
 in the straight splints great difficulty in doing so, owing to his drawing the limb up. Says 
 he has been used to drink freely. Mr. Green saw him, and ordered Opii gr. j. statim. To? 
 wards night he was quiet for a time after the opium, but at 8 P.M. wanted to get out of bed, 
 and was noisy but not violent. Vespere. Mr. Whitfield ordered him, Sol. Morph. Mur. 
 Tt^xx. Ammon. Carb. gr. v. ex. Mist. Camph. 6''" Gin ^iv. Pulv. Rhei. c. Hydr. ^j- stfit - 
 
 14th. Is no better. Passed evacuations and urine in bed this morning. Dozes off occa- 
 sionally, awakes, and is restless, and then dozes again for a time. Answers questions when 
 roused. He removed all the apparatus from his thigh. 
 
 15th. Much the same. Removes his apparatus, and the handcuffs were put on him. 
 I saw him lor the first time to-day. The symptoms were very obscure; there was more 
 coma and less tremor than we generally meet with in delirium tremens. But the cold sur- 
 face, sleeplessness, contracted pupils, and weak pulse, determined me to give him porter; at 
 the same time I thought it safe to add some tinctura Lyttre to his medicine, in order to 
 excite the action of the kidneys and avert serous cerebral effusion, of which there was 
 some threatening. Porter, 2 pints; Tinct. LytUe Tt^xv. e. Mist. Pupils contracted. Gets 
 no continued rest. 
 
 16th. No better; 4 pints of porter. 
 
 17th. Is decidedly belter for the extra porter; but as he has diarrhoea, and passes motions 
 in bed, I feel obliged to omit the porter, and order Trse. Opii TT^x. Mist. Creue Co. ^j. G tis - 
 Brandy ^iv. daily. 
 
 18th. A little better. Has not passed evacuations since. Is restless towards night. Pulse 
 slower. 
 
 20th. His hands having been unfastened, he undid all the apparatus during the night. 
 
 22d. Sol. Morph. Mur Tt^xl. e. Mist. b lis - Continues in much the same state. 
 
 26th. No better; but with rather more tendency to coma. Hyd. c. Cretae gr. ij o.n. Trse. 
 Opii (>'' horis Empl. Lyttoe pone aures. 
 
 27th. Apparatus put up once more. 
 
 28th. Is better lor the blister. Has been quiet since yesterday, and answers questions 
 more rationally. 
 
 30th. Still better. Answers questions perfectly remembers the circumstances of the 
 accident but not his pulling the splints off. Does not pass evacuations in bed. Porter ilbfs. 
 
 Feb. 1st. As bad as ever. Removed all the splints again, but answers questions, and de- 
 clares lie does not meddle with the apparatus, but that the other patieats do. In this state 
 
DELIRIUM TREMENS. 279 
 
 he continued until February 10th; his hands muffled night and day. Takes his drink and 
 asks for more. He was tried for a day without the gin, but soon became worse for that. 
 Empl. Lyttae p. aur. 
 
 16th. Rather better. One hand let loose, when he immediately removed the splints ; 
 talks rationally except at night, when he calls out on people whom he has seen in the day, 
 and sometimes is very noisy. Pulse natural. Evacuations not passed in bed. 
 
 20th. Put up in pasteboard splints to-day. The stimulants were continued, and he gra- 
 dually recovered, but with weakened intellects. 
 
 Judging from the cases of delirium ebriosorum, which are even now 
 occasionally published in the medical periodicals as cases of delirium 
 tremens, I am afraid that this distinction is not sufficiently attended to. 
 The diagnosis is often very difficult, but I have almost always found that 
 when large doses of opium fail in producing sleep, we ought to con- 
 sider that the case is one of hyperaBmia, and not anaemia, and if we 
 change the treatment, relieving the congestion of the brain, sleep soon 
 follows. It is better to avoid the use of all blood-letting if possible, and 
 never to abstract it except locally. Leeches and the cupping-glass are 
 the best agents. A warrn-bath for the whole body, and cold to the head, 
 either by means of a stream of cold water or pounded ice, prove much 
 better narcotics than all the varied forms of opium, in delirium ebriosorum. 
 If these means do succeed, their success establishes the nature of the 
 case, and ought to guide our future treatment, as explained further on 
 in the section on chronic meningitis. These cases are often very obsti- 
 nate, and require great patience on the part of both patient and surgeon. 
 They often ultimately terminate with more or less mental debility. The 
 last case of this kind which I had under my care was a retired naval 
 surgeon ; he nearly recovered from the corporeal disorder, but I fear 
 that his mental energy is so weakened, that he will return again to the 
 fatal source of his disease. 
 
 It is impossible to give in words, all that distinguishes these two dis- 
 eases ; they must be seen frequently to be appreciated. But the follow- 
 ing will assist in their diagnosis. The head and skin generally is cool 
 and moist in delirium tremens, dry and hot in delirium ebriosorum. The 
 pupil varies in both according to the stage : in the early stage of both 
 it is generally contracted, in the latter stage dilated. The conjunctiva 
 injected and red in delirium ebriosorum ; the reverse in delirium tremens. 
 The mental derangement in the former is more allied to an exalted, ex- 
 cited state of intellect ; in the latter it approaches fatuity and depression. 
 The tongue is generally pale and furred in delirium tremens, sometimes 
 unnaturally clean and red ; in delirium ebriosorum is usually dry, and 
 sometimes brown, but this is no certain guide. The pulse is most un- 
 certain, for as all inflammatory affections of the brain are depressing in 
 their effects on the heart's action, so do we find that the pulse is not hard 
 and wiry in the hyperaeraic affection, which, however, never amounts 
 to one acutely inflammatory. Still, on the whole, there is less power in 
 the beat of the artery, and that more varied in delirium tremens than in 
 delirium ebriosorum. 
 
 The danger attending an error in diagnosis in such cases is evident, 
 for if we omit to recognize the inflammation of delirium ebriosorum, 
 only a few days need elapse to render such inflammation fatal ; and even 
 in those cases in which all the signs of delirium tremens are so clearly 
 
280 HUMAN BRAIN. 
 
 present that we cannot mistake them, we have to bear in mind that 
 though delirium tremens is not an inflammatory disease, that the exces- 
 sive and constant use of stimulating liquors does predispose the mem- 
 branes of the brain to inflammation, and that the two diseases frequently 
 run one ijito the other. 
 
 The plan of treatment which I have found on the whole most success- 
 ful in true delirium tremens, is to give the stimulus which the patient 
 prefers from being most accustomed to: this is usually porter and gin, 
 in the hospitals ; brandy or wine, or both together in private practice. 
 And revolting as it is to our feelings as moral bein'gs to pour in the very 
 poisons which, by their habitual use, have reduced the man to the level 
 of the brute, still, as medical men, it is our duty to preserve life by those 
 means which we know are capable of doing so. 
 
 Often have I been obliged to go on increasing the quantity of porter 
 from one pint up to four or even five ; and gin up to twelve and sixteen 
 ounces. I always combine with it opium and ammonia. I much prefer 
 the tincture of opium to any other preparation, as being more certain 
 and more rapid in its action. I give thirty drops with a drachm of the 
 spiritus. am. aromat. in camphor mixture every four hours, and a drachm 
 of the tincture at night, to be repeated if it does not produce sleep in 
 two hours. 
 
 If there is much irritability of stomach, I then give it in a state of 
 effervescence. 
 
 I have had no experience of anodyne enemata, as recommended by 
 Dupuytren, but I should not hesitate to employ them, if the oral exhibi- 
 tion of opium failed. 
 
 As soon as the stomach will retain any food, it must be given. Patients 
 ^will often take soups and broths before solids ; but whatever is given 
 should be highly nutritive. 
 
 Generally speaking, I find this plan successful. Where it has failed, 
 it has generally done so because it has not been adopted early enough, 
 and the stimulus has not been given in sufficiently large quantities, or 
 the patient has been an old man, whose constitution had been worn out 
 by long-continued intemperance and repeated attacks of this awful com- 
 plaint. 
 
 Dr. Blake says,* and I agree with him, "The state of the pulse, 
 though not always an infallible guide in disease, has been to me a com- 
 paratively sure one in this complaint, as when its frequency did not ex- 
 ceed one hundred strokes in the minute, I looked on the patient, generally 
 speaking, as safe; but on the contrary, when, from its rapidity, and the 
 tremor of the hands, it could scarcely be counted, I considered him in 
 imminent danger." 
 
 The cases of delirium tremens which are the most difficult to diagnose 
 and prescribe for, are those which accompany injuries of the skull oc- 
 curring to persons of intemperate habits, such as brewers' servants, many 
 of whom we have admitted into St. Thomas's Hospital. 
 
 The late Mr. Tyrrell, from whose practical skill I derived much valu- 
 able knowledge, used to recommend the use of diffusible stimulus, such 
 
 * Op. cit 
 
ANEMIC COMA. 281 
 
 as ammonia, in the first instance, as a feeler in doubtful cases, as the 
 effect was evanescent, even if it should prove injurious. The pulse is 
 often an uncertain criterion, but it will be generally found that a pulse 
 which alters much, either in rapidity or in power, is not one that indicates 
 inflammatory action. It is generally a sign of weakness. Mr. Tyrrell 
 used to relate a case which occurred in his practice in illustration of this 
 view, and the danger attending an erroneous diagnosis. 
 
 Case 2. A patient was admitted having received a severe blow on the head which ren- 
 dered him quite insensible. Reaction took place very slowly; Mr. T. first gave him am- 
 monia, and afterwards a small quantity of porter : he improved slightly. Tn the evening he 
 was seen by another surgeon, who took a different view of the case, arid ordered him to be 
 bled from the arm. He died the following morning, with serous effusion on the brain, but 
 no signs whatever of inflammation or congestion. 
 
 An&mic Coma. We have seen that delirium may arise from an ane- 
 mic condition of the brain, and we shall next observe that a state of in- 
 sensibility may be produced by similar causes. 
 
 I believe that if cerebral anaemia be allowed to continue for a long 
 period, it will occasionally terminate in hydrocephalus, and also in the 
 white form of ramollissement. 
 
 We will first consider anaemic hydrocephalus, with its effect, anaemic 
 coma, for I believe that there are tw r o forms of hydrocephalus, the one 
 anaemic, the other inflammatory, as well as two forms of ramollisse- 
 ment. 
 
 Dr. Marshall Hall was one of the first to point out the resemblance 
 which exists between a comatose condition arising from exhaustion, and 
 that which is occasioned by inflammation and effusion. The affection 
 which Dr. Hall described, arises principally in infants, but it is not 
 confined to them. He calls it " an hydrencephaloid affection of infants 
 arising from exhaustion." 
 
 Dr. Hall has observed this affection generally as a consequence of con- 
 tinued diarrhosa, produced either by bad diet or long-continued use of 
 purgative medicines, or as a consequence of blood-letting. He divides 
 the affection into two stages, "the first that of irritability, the second 
 that of torpor ; in the former there appears to be a feeble attempt at re- 
 action, in the latter the nervous powers appear to be more prostrate." 
 He thus describes the signs of complaint: "The infant becomes irrita- 
 ble, restless and feverish, the face flushed, the surface hot, and the 
 pulse frequent; there is an undue sensitiveness of the nerves, and the 
 little patient starts on being touched, or from any sudden noise; there 
 are sighing, moaning, during sleep, and screaming; the bowels are fla- 
 tulent and loose, and the evacuations are mucous and disordered. If, 
 through an erroneous notion as to the nature of this affection, nourish- 
 ment and cordials be not given ; or, if the diarrhea continue, either 
 spontaneously or from the administration of medicine, the exhaustion 
 which ensues is apt to lead to a very different train of symptoms. The 
 countenance becomes pale, and the cheeks cool or cold ; the eyelids are 
 half closed, the eyes are fixed, and unattracted by any object placed 
 before them, the pupils unmoved on the approach of light; the breath- 
 ing, from being quick, becomes irregular and affected by sighs; the yoice 
 becomes husky; and there is sometimes a husky, teazing cough; and 
 
282 HUMAN BRAIN. 
 
 eventually the strength of the little patient has been subdued, and the 
 vascular system exhausted, by abstraction of blood." 
 
 Dr. Hall considers that this affection is to be distinguished from true 
 hydrocephalus principally " by observing the condition of the counte- 
 nance, and by tracing the history and causes of the affection." 
 
 Dr. Abercrombie observes,* "In the last stages of diseases of exhaus- 
 tion, patients frequently fall into a state resembling coma, a considerable 
 time before death, and while the pulse can still be felt distinctly; I have 
 many times seen children lie for a day or two in this kind of stupor, and 
 recover under the use of wine and nourishment. It is often scarcely 
 to be distinguished from the coma which accompanies diseases of the 
 brain. It attacks them after some continuance of exhausting diseases, 
 such as tedious or neglected diarrhea, and the patients lie in a state of 
 insensibility, the pupils dilated, the eyes open and insensible, the face 
 pale, and the pulse feeble. It may continue for a day or two, and ter- 
 minate favorably, or it may prove fatal. This affection seems to corre- 
 spond with the apoplexia ex inanitione of the older writers. It differs 
 from syncope by coming on gradually, and in continuing a considerable 
 time, perhaps a day or two; and it is not, like syncope, induced by sud- 
 den and temporary causes, but by causes of gradual exhaustion going 
 on for a considerable time. It differs from mere exhaustion, in the 
 complete abolition of sense and motion, while the pulse can be felt dis- 
 tinctly, and is, in some cases, of considerable strength. I have seen in 
 adults the same affection, though perhaps it is more uncommon than in 
 children." In a letter which Dr. Hall received from Dr. Abercrombie, 
 that gentleman observes, " The state of infants which I have referred 
 to, is a state of pure coma, scarcely distinguishable, at first sight, from 
 the perfect stupor of the very last stage of hydrocephalus, the child lying 
 with the eyes open, or half open, the pupils dilated, the face pale. It 
 is difficult to describe distinctly the appearance, but it is one which con- 
 veys the expression of coma, rather than of sinking ; and I remember 
 the first time I met with the affection, the circumstance which arrested 
 my attention, and led me to suppose the disease was not hydrocephalus, 
 the state somewhat different from coma, was finding on further inquiry, 
 that it came on after diarrhoaa, and not with any symptom indicating an 
 affection of the head. The child recovered under the use of wine and 
 nourishment." 
 
 u The remedies for this affection," says Dr. Hall, u are such as will 
 check this diarrhoea, and afterwards regulate the bowels and restore and 
 sustain the strength of the little patient. With the first object, it may be 
 necessary to give the tinctura opii and chalk, and afterwards the pilula 
 hydrargyri, rhubarb and magnesia; with the second, sal volatile, but 
 especially brandy, and proper nourishment are to be given according to 
 circumstances. But in this, as in so many cases of infantile disorders, 
 the young milk of a young ami healthy nurse is the best remedy of all ; 
 in the absence of which, asses' milk may be tried, but certainly not with 
 the same confident hope of benefit." 
 
 " Five or ten drops of the sal volatile may be given every three or 
 
 * P. 72, 76. 
 
ANEMIC COMA. 283 
 
 four hours, and twice or thrice in the interval five or ten drops of brandy 
 may be given in arrow-root done in water. As the diarrhoea and appear- 
 ances of exhaustion subside, these remedies are to be subtracted, the 
 bowels are to be watched and regulated, and the strength is to be con- 
 tinually sustained by the nurse's or asses' milk. The brandy has some- 
 times appeared to induce pain sal volatile is then to be substituted for 
 it ; a dose of magnesia has also appeared to do good. For the state of 
 irritability, the warm-bath is a remedy of great efficacy. For the coma, 
 a small blister or sinapism should be applied to the nape of the neck. 
 A state of exhaustion of the general system, as I have observed else- 
 where, by no means precludes the possibility of real congestion of the 
 brain. It rather implies it. In extreme cases these are not only the 
 symptoms of cerebral congestion during life, but effusion of serum into 
 the ventricles of the brain is found on examination after death. In every 
 case the extremities are to be kept warm by flannel, and the circulation 
 should be promoted in them by assiduous frictions. It is of the utmost 
 importance carefully to avoid putting the little patient into the erect 
 posture. A free current of air is also a restorative of the greatest effi- 
 cacy." 
 
 Dr. M. Hall follows up this account with some excellent cases very 
 illustrative of his views ; he also quotes the following observations of 
 Dr. Gooch, which, like all that this excellent practitioner ever penned, 
 are worthy of attention : 
 
 " Case 3. A little girl, about two years old, small of her age, very delicate, was taken ill 
 with the symptoms which I have above described. She lay dozing, languid, with a cold, 
 skin, and a pulse rather weak, but not much quicker than natural. She had no disposition 
 to take nourishment. Her sister having died only a week before of an illness which began 
 exactly in the same way, and some doubts having been entertained by the medical attendant 
 of the propriety of the treatment, leeches were withheld, but the child not being better at 
 the end of two days, the parents, naturally anxious about their only surviving child, consulted 
 another practitioner. The case was immediately decided to be one of cerebral congestion, 
 and three leeches were ordered to be applied to the head. 
 
 "As the nurse was going to apply them, and during the absence of the medical attendants, 
 a friend called in who had been educated for physic, and who had great influence with the 
 family; he saw the child, said that the doctors were not sufficiently active, and advised the 
 number of leeches to be doubled. Six, therefore, were applied; they bled copiously: but 
 when the medical attendants assembled in the evening, they found the aspect of the case 
 totally altered, and that for the worse ; the child was deadly pale, it had scarcely any pulse, 
 its skin was cold, the pupils were dilated and motionless when light was allowed to fall on 
 them, and when a watch was held to its eyes it seemed not to see; there was no squinting. 
 Did this state of vision depend on the pressure of a fluid effused into the brain since the 
 bleeding, and during this exhausted and feeble state of circulation, or did it depend on the 
 circulation of the brain being too languid to support the sensibility of the retina? It is well 
 known that large losses of blood enfeeble vision. I saw a striking instance of this in a lady 
 who flooded to death. When I entered the chamber she had no pulse, and she was tossing 
 about in that restless state which is so fatal a sign in these terrific cases. She could still 
 speak, asked whether I was come (she knew I had been sent for), and said, 'Am I in any 
 danger? how dark the room is! I can't see.' The shutters were open, the blind up, and the 
 light from the window, facing the bed, fell strong on her face. I had the curiosity to lift the 
 lid and observe the state of the eye; the pupil was completely dilated, and perfectly motion- 
 less, though the light fell strong on it. Who can doubt that here the insensibility of the re- 
 tina depended on the deficiency of its circulation ? But to return to the little patient. The 
 next day she had vomited her food several times; it was, therefore, directed that she should 
 take no other nutriment than a dessertspoonful of asses' milk every hour, and this was 
 strictly obeyed, and continued for several days. The child wasted, her features grew sharp, 
 and every now and then she looked fretful, and uttered a faint squeaking cry; the eyeballs 
 became sunk in the socket, like those of a corpse that had been dead a month ; the skin 
 continued cool, and often cold, and the pulse weak, tremulous, and sometimes scarcely to be 
 
HUMAN BRAIN. 
 
 felt. Under this regimen, and in this way, she continued to go on for several days. At 
 times she revived a little, so as to induce those who prescribed this treatment to believe con- 
 fidently that she would recover ; and she clearly regained her sight, for if a watch was held 
 up to her she would follow it with her eyes. She lived longer than I expected a full 
 week, and then died with the symptoms of exhaustion, not with those of oppressed brain. 
 The head was opened by a surgeon accustomed to anatomical examinations, and nothing 
 was found but a little more serum than is usual in the ventricles. 
 
 " If the reader has perused the foregoing case attentively, and has re- 
 flected on it, he will, of course, draw his own inferences. I can draw 
 no other than these: that the heaviness of head and drowsiness which 
 were attributed to congestion in the brain, really depended on a defi- 
 ciency of nervous energy; that the bleeding and scanty diet aggravated 
 this state, and insured the death of the child ; also that the state of the 
 eye which so speedily followed the loss of blood, and which resembled 
 that occasioned by effusion, did, in reality, depend on a deficiency in 
 the circulation of the brain a fact of considerable curiosity and import- 
 ance. 
 
 " I will now relate a case similar in the symptoms, but very different 
 in the treatment and result. 
 
 " Case 4. I was going out of town one afternoon, last summer, when a gentleman drove 
 up to my door in a coach, and entreated me to go and see bis child, which he said had some- 
 thing the matter with its head, and that the medical gentleman of the family was in the 
 house, just going to apply leeches. I went with him immediately; and when I entered the 
 nursery, I found a child ten months old lying on its nurse's lap, exactly in the state which I 
 have already described; the same unwillingness to hold its head up, the same drowsiness, 
 languor, absence of heat, and all symptoms of fever. The child was not small of its age, and 
 had not been weak, but it had been weaned about two months, since which it had never 
 thriven. The leeches had not been put on. I took the medical gentleman into another 
 room, related to him the foregoing case, and several similar to it, which had been treated in 
 the same way. Then I related to him a similar case, which I had seen in the neighboring 
 square, which had been treated with ammonia in decoction of bark, and good diet, which 
 had recovered ; not slowly, so as to make it doubtful whether the treatment was the cause 
 of the recovery, but so speedily, that at the third visit I took my leave. He consented to 
 postpone the leeches, and to pursue the plan which I recommended. We directed the gruel 
 diet to be left ofl^ and no other to be given than asses' milk, of which the child was to take 
 at least a pint and a half, and at most a quart, in the twenty-four hours. Its medicine was 
 10 minims of the aromatic spirit of ammonia in a small draught every four hours. When 
 we met the next day, the appearance of the child proved that our measures had been right; 
 the nurse was walking about the nursery with it upright in her arms. It looked happy and 
 laughing; the same plan was continued another day; the next day it was so well that I took 
 my leave, merely directing the ammonia to be given at longer intervals, and thus gradually 
 withdrawn ; the asses' milk to be continued, which kept the bowels sufficiently open, with- 
 out aperient medicine. 
 
 " So inveterate is the disposition to attribute drowsiness in children 
 to congestion of the brain, and to treat it so, that I have seen an infant, 
 four months old, half dead from the diarrhoea produced by artificial food, 
 and capable of being saved only by cordials, aromatics, and a breast of 
 milk ; but because it lay dozing on its nurse's lap, two leeches had been 
 put on the temples, and this by a practitioner of more than average 
 sense and knowledge. I took off the leeches, stopped the bleeding of 
 the bites, and attempted nothing but to restrain the diarrhoea, and get in 
 plenty of nature's nutriment, and as I succeeded in this the drowsiness 
 went off and the child revived. If it could have reasoned and spoken, 
 it would have told this practitioner how wrong he was; any one,, who 
 from long defect in the organs of nutrition is reduced so that he has neither 
 flesh on his body, nor blood in his veins, well knows what it is to lay 
 
ANEMIC COMA. 285 
 
 down his head and doze away half the day without any congestion or in- 
 flammation of the brain. This error, although I have specified it only in a 
 particular complaint of children, may be observed in our notions and treat- 
 ment of other diseases, and at other periods of life. If a woman has a pro- 
 fuse hemorrhage after delivery, she will probably have a distressing head- 
 ache, with throbbing in the head, noises in the ears, a colorless complexion, 
 and a quick, weak, often thrilling pulse, all which symptoms are greatly 
 increased by any exertion. I have seen this state treated in various ways, 
 by small opiates, gentle aperients, and unstimulating nourishment, with 
 no relief. I have seen blood taken away from the head, and it has 
 afforded relief for a few hours, but then the headache, throbbing, and 
 noises, have returned worse than ever; the truth is, that this is the 
 acute state of what in a, minor degree, and in a more chronic form, oc- 
 curs in chlorosis, by which I mean pale-faced amenorrhoea, whether at 
 puberty or in after-life. It may be called acute chlorosis, and, like that 
 disease, is best cured by steel, given at first in small doses, gradually in- 
 creased, merely obviating constipation by aloetic aperients." 
 
 My esteemed friend and colleague, Dr. Risdon Bennett, in his admira- 
 ble work on Hydrocephalus, advocates the doctrine, that this disease 
 assumes very distinct forms ; and that though it undoubtedly does arise 
 in some instances from inflammation, in others it arises from an opposite 
 condition. He says,* u There can be no difficulty in admitting that the 
 physical alterations of softening and serous effusion may be induced by 
 functional and organic changes, very different from inflammation or any 
 allied morbid action." He considers that in by far the largest class of 
 cases, the disease is essentially the result of scrofulous action, and may 
 or may not be attended by the signs of inflammation. 
 
 The comatose condition which we see occasionally following a severe 
 attack of erysipelas of the head in a debilitated constitution, comes into 
 this category of anaBinic affections of the brain. It is difficult to say 
 whether this condition of the brain is the result of that general depres- 
 sion which is both cause and effect in the erysipelas of London, or 
 whether it can be attributed to a derivation of blood to the surface. We 
 all know that in hypersemia of the brain we can relieve our patients by 
 determining the blood to the surface. It is therefore possible, that this 
 morbid cutaneous determination of blood has the effect of diminishing 
 the supply to the capillaries of the brain as effectually as our artificial 
 measures. In a practical point of view there is nothing more important 
 to the surgeon than a knowledge of the fact that a rambling, incoherent 
 manner in the day, with a restless delirium at night, is no proof of the 
 existence of inflammatory action in the brain. The following case may 
 be selected from many in illustration of this view of the subject: 
 
 Case 5. In the month of January, 1846, 1 removed a small tumor from over the parotid 
 gland in a gentleman aged 25. 
 
 He imprudently exposed himself to cold after the operation, notwithstanding my strong 
 injunctions to keep his room, for fear of erysipelas being excited. My fears were realized, 
 and a severe attack was the result. My friend Dr. Munk attended the case with me. The 
 erysipelatous inflammation attacked the wound on the fifth day but I will give the case in 
 his words : 
 
 The Cause?, Nature, Diagnosis, and Treatment of Acute Hydrocephalus, 1848, p. 147. 
 
286 HUMAN BRAIN. 
 
 "The patient went on satisfactorily for some days; but on Saturday, January 31st, he felt 
 unwell, and erysipelas attacked the wound, which, at that time, however, had nearly healed. 
 The redness and swelling extended somewhat over the cheek, and along the neck, and an 
 incision was made through the swollen parts. Port wine, decoction of bark, and small 
 quantities of infusion of senna, were given at intervals. 
 
 " I saw the case in consultation with Mr. Solly, on Tuesday, February 3d. The inflam- 
 mation had then extended over the whole of one side of the face, and the rUht eye was 
 completely closed. The affected parts were of a dusky red hue; the pulse 120; the bowels 
 purged; and there was some griping. The patient was manifestly anxious about himself, 
 and wandered slightly at times, although answering every question with perfect accuracy. 
 He was ordered eight ounces of port wine, and seven drachms of decoction of bark; one 
 drachm of the compound tincture of bark, and four grains of the sesqui carbonate of am- 
 monia, every four hours. 
 
 "The following day (Wednesday, February 4th), he appeared much the same; the erysi- 
 pelas, however, extending, now implicated the forehead, though not encroaching upon the 
 hairy scalp. 
 
 ' On Thursday, February 5th, he was, in every respect, decidedly worse ; the left side of 
 the face and ear had now become affected, the disease, however, subsiding in the parts first 
 attacked. The forehead was much swollen, tense, and of a dusky-red; the pulse still 120, 
 but decidedly weaker. He wandered considerably, but still replied to questions with tolera- 
 ble accuracy, though rambling off again immediately. During the night he had been vio- 
 lently delirious; had got out of bed in spite of his attendants; and was with difficulty re- 
 strained. His forehead was punctured by Mr. Solly in several places with the point of a 
 lancet, and a large bread and-water poultice applied. A few drops of blood only exuded. 
 He was ordered to have two ounces of port wine every two hours, and to continue his mix- 
 ture as before. This was at mid-day. About midnight we found him slightly improved, 
 quiet, rational, and his pulse, if anything, stronger an 1 less frequent. The wine and bark 
 had been given regularly, and he had taken considerable quantities of jelly and strong beef- 
 tea. 
 
 " On the ensuing day (Friday, Feb. 6th), at half past four o'clock P.M., we found him 
 again very decidedly changed, for the worse. The erysipelatous inflammation had not ex- 
 tended, but his tongue had become dry, dark -brown, and fissured; his pulse 130, and much 
 weaker: the whole surface was below the natural temperature, and the extremities were 
 decidedly cold. He laid in a heavy, semi-comatose condition, and was altogether incapable 
 of replying to our inquiries. His breathing was becoming difficult and infrequent. Two 
 ounces of port wine were ordered every hour, and to each dose of the mixture, which was 
 now to be given at intervals of two hours, there was added one drachm of the compound 
 spirit of sulphuric ether. A turpentine enema was also employed, at the suggestion of our 
 patient's friend, Mr. Bristowe, of Camberwell. who, throughout, watched the case with much 
 anxiety, and favored us with his assistance and advice during the most alarming stages of 
 the disease. At six o'clock P.M., our patient was seen by his neighbor, Mr. Henry, of the 
 Commercial-Road. He was then sinking rapidly. The pulse had risen to 150, or upwards, 
 find had become weak and thready: the respirations took place at longer interval*, and were 
 more laborious: his legs were icy cold. Mr. Henry poured a full glass of brandy down the 
 throat, and repeated it at intervals of half an hour or an hour; beef-tea and jelly were also 
 given freely. By these means the symptoms of sinking were for the time arrested. At half 
 past ten o'clock P.M., I found him perfectly rational, his tongue moist, and the dark brown 
 coating gone; the pulse reduced in frequency, from 150 to 1 12 or 1 18, and having, in great 
 measure, recovered its strength and volume; his breathing was now natural and easy, and 
 the body and extremities were warm. The brandy was ordered to be continued every hour. 
 
 " Feb. 7th. Our patient went on well during the early portion of the night, but at four 
 o'clock A.M. symptoms of sinking again appeared; his pulse became rapid and weak; the 
 surface cold, and the respirations labored. Drachm-doses of sulphuric ether were now given 
 with the brandy, and under their joint influence he again rallied. Since this, he has been 
 progressing favorably. His pulse is now (ten o'clock P.M.) under 100; skin warm and moist; 
 tongue clean amb moist. He is now perfectly rational, arid has slept quietly and comfort- 
 ably at intervals; the inflammation has not extended, and desquamation has commenced; 
 the bowels have not been relieved since last evening; but he feels an inclination to go to 
 stool. He has up to this time continued, and is still to continue, the brandy, beef-tea, &c., at 
 short intervals. 
 
 "8th. Noon: the swelling of the face has now much diminished, and desquamation is 
 taking place over the whole of the affected parts; pulse below ninety, with more power, 
 but unequal, and with a long intermission from time to time. This intermission, however, 
 is less marked at the heart than in the radial artery; tongue moist; feet comfortably warm ; 
 owing to the diminution of the swelling he can now open both eyes ; he has passed one 
 
ANAEMIC COMA. 287 
 
 healthy evacuation. About four o'clock this morning symptoms of sinking again returned; 
 he breathed with much effort, and the feet and legs became cold, a state which shortly, 
 however, disappeared under the freer use of stimuli. He was now ordered to take the 
 brandy in smaller quantities, and to have two grains of quinine in decoction of bark every 
 four hours. 
 
 "On Monday, Feb. 9th, I found him in every respect improved: he was quite collected 
 and comfortable; had slept well during the night ; his pulse had more power, and was under 
 ninety in the minute : the skin was warm and moist. Convalescence was from this period 
 steadily progressive. Suppuration of both eyelids took place, and the pus was evacuated 
 by the lancet. He left town on the 26th of February, and returned about the end of March 
 perfectly well. 
 
 '' Here is an instance of erysipelas treated by what some would perhaps characterize as an 
 undue and lavish administration of stimulants; but I feel fully convinced (arid I believe the 
 conviction is equally strong in the minds of those who watched the case) that nothing short of 
 the quantities given would have been competent to bring about a favorable issue. I am no 
 advocate for large doses of medicines in ordinary cases. On the contrary, I am inclined to 
 believe that the tendency of medical opinion and practice is. at the present time, in favor of 
 larger doses than the absolute requirements of disease render necessary; and I am quite 
 sure that benefit would accrue to the patient, in most cases, by a diminution in this respect. 
 It must, however, be remembered, that cases do every now and then occur of such extreme 
 severity as to render ordinary plans of treatment inefficient. In these we must step out of 
 the beaten track, and administer our remedies to an amount which, in more ordinary cases, 
 would be injurious and culpable. The case above related is one in point. I know of no 
 instance of erysipelas in which so large a quantity of stimulants has been necessary: and I 
 certainly have never met with one in which their effects were so strikingly and unequivo- 
 cally beneficial. 
 
 " On Thursday, Feb. 5th, about mid-day, the freer use of wine was commenced. He took 
 two ounces every two hours, and continued it till half past four P.M. of the following day. 
 In the four-and twenty hours he had thus taken twenty-four ounces of wine, besides jelly, 
 beef tea, and the bark-and-ammonia mixture. At half past four o'clock, when Mr. fcolly, 
 Mr. Bristowe, Mr. Henry and 1 saw him, he was sinking, and now two ounces of wine were 
 given every hour, and a drachm of Hoffman's anodyne every alternate hour. Even this 
 quantity did not suffice, and at six o'clock Mr. Henry, with a promptitude and decision to 
 which our patient, I believe, owes his life, commenced the administration of brandy. A 
 wineglassful was given every hour, and continued in the same quantity, and at similar in- 
 tervals, till Feb. 8th, at noon. During this period of forty-two hours, he took, at the very 
 lowest computation, upwards of sixty ounces of brandy. Notwithstanding the quantity ad- 
 ministered, neither the patient's pulse nor his nervous system was at any time unduly ex- 
 cited. On the contrary, the larger the quantity of brandy given, the stronger but less frequent 
 became the pulse, the stupor was diminished, and the delirious wandering quieted. The 
 tongue likewise became clean and moist. The latter circumstance was strikingly illustrated 
 on Friday, Feb. 6th. At half past four o'clock, the tongue was dry, dark-brown, and fis- 
 sured ; at six o'clock he appeared to be dying, and now commenced the administration of 
 brandy. A wineglassful was given at intervals of less than an hour At ten o'clock 
 the tongue had become moist, and the dark-brown coating was gone. ! ' 
 
 This case requires little comment; it speaks for itself; and it is not a 
 rare one ; many such might be brought forward. Our patient was on the 
 brink of the grave ; his brain was so disturbed that his intellect had fled. 
 Brandy in quantities which, in a state of health, would have produced 
 complete intoxication and insensibility, restored his senses, removed his 
 fever, and saved his life. It is indeed an interesting question to us, 
 what is the positive state of brain which accompanies this disorder of 
 the intellect. I believe that it is a state of local anaemia. It is not 
 often that we have the opportunity of examining it in its simple, uncom- 
 plicated condition, as it so frequently follows an inflammatory state, 
 though the inflammation may have been one of a low or sub-acute cha- 
 racter. With the view of ascertaining the condition of the brain, I 
 have always anxiously sought for every opportunity of examining the 
 brain of patients who have died in this state, and I have generally found 
 it free from all signs of inflammation. Nevertheless, though it is true 
 
288 HUMAN BRAIN. 
 
 that in London, as a general rule, erysipelas is a disease of debility, re- 
 quiring wine, brandy, &c., we must remember that acute inflammation 
 of the scalp will sometimes travel by continuity of tissue to the mem- 
 branes of the brain, and then prove rapidly fatal, either by serous 
 effusion or by acute inflammation of the hemispherical ganglion. We 
 should therefore endeavor, in our constitutional treatment, to steer a 
 middle course on the onset, keeping, as sailors say, your weather eye 
 open for a storm from very opposite points of the compass. A scruple 
 of rhubarb and calomel, that is, five grains of calomel to fifteen of rhu- 
 barb, followed by a senna draught in the morning, clears the prima via and 
 fits the system for either course, as subsequent events may direct. la 
 wounds of the scalp it may be well to remark that often when the peri- 
 cranium has been extensively separated from the bone, and the edges 
 of the wound heal quickly, there is always danger of subsequent suppu- 
 ration, and the surgeon must be on the alert to make a free opening, as 
 matter cannot be put up between the tendon of the occipito frontalis 
 and the bone without the brain sympathizing. 
 
 I remember inspecting the body of a very fine young woman who 
 died with erysipelas of the scalp, and in whom there was a large col- 
 lection of pus under the back part of the pericranium, which the medical 
 man failed to detect during life, but which most assuredly must have 
 been instrumental in producing the fatal result, for there was a corre- 
 sponding inflammation of the membranes of the brain, though not of an 
 active character or great extent ; there was also some serous effusion. 
 
 A morbid condition of the brain of an anaBmic character is often in- 
 duced in London by long-continued dyspepsia, with confinement in an 
 impure atmosphere. One of the worst cases of this kind I ever saw was 
 the following: 
 
 Case G. A watch and clock maker, who lived in the neighborhood of Shoreditch, con- 
 sulted me in January. 1840. He was a cripple, and therefore unable to take much ex- 
 ercise, 38 years of age, unmarried, spare habit, and lax fibre. He stated that he had been 
 suffering for the last eight months with a disorder in his head. He described his symptoms 
 in the following words: Loss of appetite, confusion, giddiness in the head, violent sickness, 
 sleepless nights, horrid dreams, waking suddenly in a fright, noises in the head and ears, 
 sometimes like the singing of a tea-kettle, sometimes like a wineglass or a large rummer 
 struck close to the ear, sometimes like water thrown on a hot iron, or running from a tap, 
 sometimes like a muffled drum at a distance; occasionally on falling off to sleep, he would 
 be awakened by a feeling as if a sky-rocket were shot through his head ; sometimes he 
 would be very deaf. 
 
 He suffered occasionally from violent headaches, and black and bright spots dancing before 
 his eyes ; and to sum up his mental miseries, he had a constant dread of his memory failing 
 him. His bowels were generally relaxed, and he suffered frequently from pain in his 
 stomach. 
 
 After carefully balancing all the above symptoms, formidable by themselves, with the 
 following a languid, weak, irritable pulse, cold skin, pale, flabby tongue I came to the 
 conclusion, that all his symptoms arose from anaemia, occasioned by inadequate assimilation 
 of his food. I treated him on this view of his case. All his sufferings were relieved, and 
 he was quite restored to health in about two months, by giving him in the first instance 
 small doses of blue pill at night and a mild aperient in the morning, and afterwards light 
 bitters with rhubarb and soda, and strict attention to diet. 
 
 I have frequently been consulted by professional men, and others en- 
 gaged in business in London, who, suffering from London cachexia, 
 have supposed that they have some disease of the brain. In one in- 
 stance my patient stated that he had lost his memory, that he frequently 
 
CEREBRAL ANAEMIA. 289 
 
 would ring the bell and forget before his servant answered it what he 
 had rung it for; he complained, also, of having a sort of muzzy feeling 
 in his head, that he could not read or apply himself to anything; horse 
 exercise was dreadful to him. He was a long while in getting well, 
 but it was ultimately effected, entirely by means of very mild tonics. 
 
 Bakers are very liable to these affections, owing, I suppose, to their 
 irregular habits, sudden alternations of temperature, and disturbance of 
 the natural hours of rest, &c. I do not refer to the decidedly intemperate. 
 The following brief abstract illustrates my meaning : 
 
 Case 7. Charles Chadwick, aet. 23, biscuit baker, pale complexion, weak and irritable 
 pulse, states, he awakes in the middle of the night with .a start, and is afterwards seized 
 with giddiness in the head, but that he is very much relieved by getting out of bed and walk- 
 ing about his room; this returns two or three times in the same night. He says that it has 
 lately come on in the day. His general health is not very good; has had gonorrhoea for the 
 last twelve months, which is getting a little better. He is now much depressed in spirits. 
 
 This case was treated entirely upon a tonic system, principally with quina ; he took it for 
 some time, and though the improvement was not rapid, he ultimately recovered. 
 
 When these symptoms have lasted some time, they are subdued with 
 difficulty, and require care. It is very necessary that the practitioner 
 should inform the sufferer of their obstinacy, otherwise he will become 
 impatient and dissatisfied. In the treatment of them, stimulants are 
 prejudicial, and the tonics must be very mild. Steel and quinine seldom 
 answer at first, and afterwards only in small doses. Strict diet, pure air, 
 and exercise without fatigue, are more important than medicine. I make 
 it an almost invariable rule to give an active purgative calomel, &c., 
 at night, haustus senna in the morning; and I examine the evacuation 
 before prescribing any other medicine. If the liver is at fault, taraxa- 
 cum, with small doses of sulphate of magnesia, and sulphuric acid, will 
 be found more beneficial generally than mercury. This diseased con- 
 dition cannot be removed by a coup de main, and it is not advisable to 
 say much to your patients regarding its nature, for if you convince them 
 that it arises from debility, they think that they have nothing to do but 
 to eat, drink, and sleep, and thus get strong, and then they will be well. 
 On the other hand, you must relieve their minds of the impression, that 
 it is allied to apoplexy, and depends on fullness of the head or inflam- 
 mation of the brain, which is generally their feeling, or, otherwise, they 
 will be anxious to be cupped, leeched, &c. If you have sensible per- 
 sons to deal with, you may explain the real rationale of your treatment; 
 if not, you must keep them in ignorance ; but especially guard against 
 dropping one word about weakness, for all prefer eating and drinking to 
 taking physic; and they will think they understand all about it, and, 
 throwing physic to the dogs, feed themselves. Finding this fail, they 
 immediately conclude that you have mistaken the nature of their case, 
 go to somebody else, who perhaps orders a few leeches to the head, 
 which sometimes relieve for a day or two, from the reaction which takes 
 place, and this confirms their opinion, until they again get worse. 
 
 The state of the nervous functions in a chlorotic female forms another 
 good illustration of the effect of anaemia on the brain. It is not neces- 
 sary to detail symptoms which are familiar to all. 
 
 How instructive it is to watch the gradual disappearance of the head- 
 aches, often most violent, under a judiciously managed course of steel 
 19 
 
290 HUMAN BRAIN. 
 
 medicine. After the bowels have been freely opened and the tongue 
 clean, there is nothing equal to the old steel mixture with the compound 
 decoction of aloes and aromatip confection, with a drachm of the spiritus 
 inyristici ; but the practitioner must not expect the headaches to be re- 
 moved immediately. 
 
 I believe that if cerebral anaBmia continues for a long while, it will 
 produce white softening, or one form of ramollissement, sometimes in 
 connection with hydrocephalus, as we have seen, sometimes independent 
 of it. This form of disorganization does not often occur in the middle 
 period of life ; it sometimes occurs in the infant and the child, as a se- 
 quence to hydrocephalus, and in the old man, from disease of the arteries, 
 or other impediments to the circulation ; sometimes in the chlorotic female. 
 But we must distinguish the two kinds of softening; there is some dif- 
 ference of opinion as to their nature and origin ; I will therefore give a 
 short detail of the opinions of the best pathologists on its real nature. 
 
 The term made use of to distinguish this peculiar disorganization of 
 the brain, implies the appearance which it presents to the observer: it 
 is, in fact, softening of the substance of the brain, generally isolated in its 
 seat. By this the observer distinguishes it from the firmer portions of 
 the brain which surround it, though, as it sometimes happens that the 
 whole brain is softened and broken down into a pulpy mass, he has 
 more difficulty in deciding whether it is truly a morbid appearance, or 
 simply the effect of decomposition. The portion thus broken down does 
 not necessarily lose its natural color, though frequently it becomes 
 darker ; however, it never resembles pus either in color or in its disa- 
 greeable odor, so that it ought never to be confounded with suppu- 
 ration. 
 
 The earliest observations on this peculiar lesion of the brain are to be 
 met with -in the fifth Letter of Morgagni, De Sedibus, &c.,* u which 
 treats of the apoplexy as arising neither from a sanguineous nor a serous 
 cause;" 
 
 Case 8. The patient whose case he relates was in her 59th year, and was seized with an 
 apoplexy, followed by loss of speech and paralysis, with loss of sensation of the right side. 
 She was not insensible, for "she gave of her own accord the sound arm to the physicians to 
 have her pulse/elt," and " she had no difficulty in swallowing fluids,' ; but did not live many 
 days after her admission to the hospital. 
 
 Of the post-mortem appearances I shall merely detail those which illustrate the lesion in 
 question; and, these I shall give from Dr. Alexander's translation, in the author's own 
 words : 
 
 "But let us now goon to the head, for the sake of which, principally, this dissection was 
 performed. While the skull was sawed through, a quantity of serum came forth ; and the 
 upper part of it being taken off, and the brain being dissected in its natural situation, we first 
 observed that the dura mater was thickened. And the vessels that ran through the pia 
 mater were all distended with blood, as if they had been filled by injection. This blood 
 was such as that of the whole body, black, and not very fluid. And under the same mem- 
 brane, in the convolutions of the brain, was seen a transparent water, of the same kind with 
 that which was found in the lateral ventricles afterwards ; yet the choroid plexuses were 
 not at all discolored, although they had vesicles upon them turgid with water, and one of 
 these vesicles was equal even to the bigness of a grape. This was in the left plexus, which 
 being taken off, the thalamus nervi optici appeared not of the same color as the right thala- 
 mus, but brown. As I cut the brain into small pieces, I observed that every other part of it 
 was natural and sound; but that the medullary substance, which was on the external side 
 of the left thalamus, spoken of above, was very soft, and liquefied, and was found to be mixed 
 
 * Translated by Dr. Alexander, 1769, p. 98, article 6. 
 
RAMOLLISSEMENT. 291 
 
 with a certain bloody fluid, of a color almost effete: so that nothing but a disagreeable smell 
 was wanting to make us pronounce it absolutely rotten. The space of the brain which this 
 disorder occupied was larger than that which the largest walnut would have taken up ; and 
 that color of the bloody fluid was most manifest in the middle thereof. It was more na- 
 tural to take notice of this difference, because the cerebrum in general, as I said, was of its 
 natural color, and not only more hard than the cerebellum, but even endowed with a won- 
 derful hardness everywhere, especially in the whole right hemisphere, and had only, in that 
 place I have mentioned, a kind of bloody color, and a loose ill-compacted substance. 
 
 " I believe that this was an apostema sui generis, which is agreeable to the opinion even of 
 Avicenna, that an apoplexy might have its origin ' from an apostem formed by repletion ;' 
 the violence of which was increased in the patient in question by the water being extrava- 
 sated, and by the vessels being distended. But this apostem happened about the very place 
 in which, as I have already said, organical injuries most frequently happen according to my 
 observations." 
 
 The accurate account which Morgagni has given of the post-mortem 
 appearances in this case can leave no doubt as to the real character of the 
 lesion; and it is extraordinary that it should have escaped observation 
 for so long a period after the celebrated author of the work " On the 
 Causes and Seats of Diseases" wrote ; for until Rostan published his 
 "Recherches sur le Ramollissement du Cerveau," the second edition of 
 which appeared in 1823, softening of the substance of the brain seems 
 to have been entirely overlooked by the pathologists of Europe. 
 
 In the present day, however, no one ought to have any difficulty in 
 distinguishing, after death, the morbid appearances designated ramol- 
 lissement by the French writers, and softening by the English. But 
 whether this lesion is the result of inflammation, or whether it is a dis- 
 ease sui generis, has not been so clearly decided. Lallernand believes 
 that ramollissement is invariably the result of an inflammatory process, 
 while Andral does not allow that this matter is yet decided. But we 
 will quote AndraPs own words ; after pointing out the different appear- 
 ances, he says:* " Do these different appearances which may be pre- 
 sented by softening of the brain, refer to lesions of a different nature ? 
 Are they but degrees more or less advanced of one and the same dis- 
 ease ? It is easy to prove that in a considerable number of cases the 
 substance of the brain is first injected, then softened, then secretes pus. 
 This has been excellently well established by M. Lallemand. The soft- 
 ening is then one of the anatomical characters of inflammation of the 
 brain, as it may be of all other organs. But if, in other cases, we do not 
 find within the softening any trace either of sanguineous injection, or 
 purulent infiltration ; if we find there, in a word, no other alteration than 
 softening itself, will it not be an abuse of analogy to conclude that in 
 these cases also, the cause which has deprived the brain of its consist- 
 ence is inflammation ? Ji fortiori, will not one be induced to admit it 
 in those other cases where the softened part has become at the same 
 time the seat of an anaemia? Observe, besides, that among those cases 
 of white softening, there are some which have formed very rapidly, after 
 the manner of acute diseases, and in such cases it cannot be supposed 
 that the softening has commenced by a sanguineous congestion, which 
 would disappear, according as the affection would assume a chronic 
 course. No doubt those who refer the proximate cause of every disease 
 to a defect of the normal stimulation, must necessarily make cerebral 
 
 * P .cit,p.l60. 
 
292 HUMAN BRAIN. 
 
 softening enter into one or other of these states, and not finding in this 
 alteration the characters of an asthenic disease, must regard it as an in- 
 flammation." 
 
 " In thinking so, they but follow their theories ; but for us, who think 
 that in a crowd of morbid states there is no more hypersthenia than 
 asthenia, but mere perversion of the vital actions, we are no more obliged 
 to consider the cerebral softening or any other softening as an inflamma- 
 tion than tuberculous pneumonia. It is a specific alteration of nutrition, 
 which may supervene under the influence of morbid conditions widely 
 differing from each other. To endeavor to determine these different 
 conditions is the task to be performed a task, difficult, no doubt, but 
 of quite another importance from that on which medical men have occu- 
 pied themselves in latter times, when they have wished to reduce every 
 cerebral softening to one of the forms or one of the degrees of inflamma- 
 tion of the nervous centres. We are convinced that by proceeding thus, 
 men have entered on a course diametrically opposite to that which should 
 lead to the truth. We, too, might collect groups of facts to demonstrate 
 that softening is capable of being produced by different causes of inflam- 
 mation. Thus we might find some group from which it would result that 
 commencing obliteration of the arteries which enter the brain, is one of 
 the conditions which concur in the production of a certain number of 
 softenings. We might cite other facts which would show us a remark- 
 able coincidence between the impoverishment of the blood, or any other 
 alteration whatever of this liquid, and the softening of a great number 
 of our tissues. Are there really so many causes of softening? The 
 future will decide, and will discover, no doubt, many other causes which, 
 in the present state of our knowledge, we cannot even suspect. All 
 that we affirm is, that it is necessary to seek elsewhere than in inflam- 
 mation for the cause of all softenings. It does not even seem to us that 
 the presence of an unusual quantity of blood in the midst of a softened 
 tissue is a sufficient proof that irritation is the cause of its softening. 
 May it not be that this superabundant blood has flowed into these softened 
 parts but consecutively ? See the case where, after a limb has remained 
 for a long time merely paralyzed, it suddenly became rigid, convulsed 
 and contracted; on opening the body we often find, in such cases, one 
 part of the brain softened, and at the same time reddened with blood : 
 reasoning may then lead us to admit that the sanguineous congestion 
 occurred but as a mere complication of softening, and that it is this 
 which caused the phenomena of excitement to succeed the simple loss 
 of motion. In order to explain a cause which simultaneously softened 
 and reddened a tissue, shall we never see anything beyond the mere fact 
 of an irritation which has acted on this tissue ? Is it then in the gums 
 of a scorbutic subject that the cause resides which has brought them at 
 the same time to a state of hyperaBmia, and deprived them of their con- 
 sistence ?" 
 
 "Here, no doubt, are very many questions raised which wait till facts 
 rigorously observed shall come to solve them. But it is enough, we 
 think, that such questions can be put, and that in the future progress 
 of science their solution is possible, to make one distrust very much 
 Jhe opinion which refers every softening to an inflammation. Because 
 
ANAEMIC RAMOLLISSEMENT. 293 
 
 the brain is softened after a blow on the cranium, is that a reason for 
 saying that every time it shall have lost its consistence it must have been 
 previously irritated ?" 
 
 " If science Tefuse to admit inflammation as the sole cause of soften- 
 ing the brain, if it see in this softening several other causes, for the proof 
 of which it waits for new researches, it is quite clear that the term en- 
 cephalitis cannot be used as synonymous with the word softening. 
 Neither do we think it correct to call this alteration capillary apoplexy, 
 as M. Cruveilhier has done. In a certain number of cases, to be sure, 
 the softening is accompanied, or, rather, complicated with sanguineous 
 infiltration, or effusions of blood more or less multiplied ; but certainly 
 it is not in the presence of this blood that the essence of the disease 
 consists, and there are at least many cases in which we do not find the 
 least trace of it. The softening may then be either a capillary apoplexy 
 or an encephalitis ; but it is not necessarily either the one or the other." 
 
 Dr. Abercrombie,* in speaking of ramollissement, says, " When I 
 formerly endeavored to contribute something to the pathology of this 
 remarkable affection, I had no hesitation in considering it as one of the 
 results of inflammation of the cerebral substance ; since that time it has 
 been investigated with much attention by M. Rostan and other French 
 pathologists, and a different view of the nature of the affection has been 
 strongly contended for by these eminent individuals. They consider it 
 as an affection of the brain entirely sui generis, and M. Rostan, in par- 
 ticular, seems to look upon it as a peculiar and primary disease of the 
 brain, though he admits it is sometimes the result of inflammation. 
 From all the facts which are now before us in regard to this interesting 
 affection, I think we are enabled to arrive at the conclusion that it occurs 
 under two modifications which differ essentially from each other. In the 
 cases of M. Rostan the disorganization was observed chiefly in the exter- 
 nal parts of the brain : it occurred almost entirely in very old people, many 
 of them seventy, seventy-five, and eighty. It was found in connection 
 with attacks of a paralytic or apoplectic kind, many of them protracted, 
 and was often found combined with extravasation of blood, or surround- 
 ing old apoplectic cysts. On the contrary, the affection which I had 
 been anxious to investigate, was found chiefly in the dense central parts 
 of the brain, the fornix, septum lucidum, and corpus callosum, or in the 
 cerebral matter immediately surrounding the ventricles ; and occurred in 
 persons of various ages, but chiefly in young people and in children. 
 It took place in connection with attacks of an acute character, chiefly 
 the character of acute hydrocephalus ; and it was in many cases dis- 
 tinctly combined with appearances of an inflammatory kind, such as 
 deep redness of the cerebral matter surrounding it, suppuration border- 
 ing upon it, and deposition of false membrane in the membranous parts 
 most nearly connected with it. We may even observe, in different parts 
 of the same diseased mass, one part in the state of ramollissement, an- 
 other forming an abscess, while a third retains the characters of active 
 inflammation, and probably exhibits, as we trace it from one extremity 
 to the other, the inflamed state passing gradually into the state of soften^ 
 
 * Op. cjt, p. 24. 
 
 > JiiuttUi* ; *jiia 
 
294 HUMAN BRAIN. 
 
 ing. Remarkable examples of this will be given in the sequel, and an- 
 other of a different nature, in which an opening in the septum lucidum 
 produced by the ramollissement was entirely surrounded by a ring of 
 inflammation. This is the affection which I have endeavored to inves- 
 tigate, and which I consider as one of primary importance in the patho- 
 logy of acute affections of the brain, and upon the grounds now shortly 
 referred to, I cannot hesitate to consider it as a result of inflammation." 
 
 u When we compare the facts now alluded to with the observations of 
 M. Rostan and his friends, I think we may arrive at a principle by which 
 the apparent difference may be reconciled. The principle to which I 
 refer is, that this peculiar softening of the cerebral matter is analogous 
 to gangrene in other parts of the body ; and that, like gangrene, it may 
 arise from two different causes, inflammation, and failure of the circula- 
 tion from disease of the arteries. The former I conceive to be the origin 
 of the affection which I have described, and the latter to be the source 
 of the appearances described by M. Rostan. If this doctrine be ad- 
 mitted, the difficulty is removed; and I do not see any good objection 
 to it." 
 
 " Gangrene from inflammation is familiar to every one ; and equally 
 familiar, though very different in its origin and concomitant symptoms, 
 is gangrene from disease of the arteries of any particular part of the 
 body. Ossification of the arteries of the brain to a very great extent is 
 a common appearance in elderly people, and seems to be a very frequent 
 source of apoplexy, with extravasation of blood, at advanced periods 
 of life. It appears extremely probable that it may be the source of that 
 particular condition of a part of the brain which terminates in the ramol- 
 lissement of M. Rostan, and indeed he distinctly points at this explana- 
 tion of it. On the other hand I am still disposed to contend that the 
 ramollissement of young persons occurring in acute affections, and 
 seated chiefly in the central parts, is one of the terminations of inflam- 
 mation in that particular structure. I conceive it to be an affection of 
 primary importance in the pathology of acute affections of the brain, 
 and to mark a peculiar seat of the inflammation of very frequent occur- 
 rence. It is often combined with suppuration in other parts of the brain, 
 and very often with effusion in the ventricles ; but the peculiar interest 
 of it is observed in those cases in which it is only the morbid appear- 
 ance, and in which it is sometimes of small extent. Of this some re- 
 markable examples will be given in the sequel, in which the perforation 
 of the septum lucidum, by softening of a part of its substance, and 
 similar softening of the fornix, were the only morbid appearances in 
 cases which were fatal, with all the usual symptoms of acute hydroce- 
 phalus." 
 
 On reconsidering all these different opinions, and more particularly 
 the simple but clear-sighted views of Dr. Abercrombie, we are war- 
 ranted in concluding that the morbid appearance called ramollissement 
 is usually the result of acute inflammatory action, but that in old people 
 it frequently follows a total failure of the circulation, corresponding, 
 both in its consequence and in the cause producing it, to asthenic senile 
 gangrene in other parts, and also that it may be the consequence of local 
 and general anaemia even in joung subjects. The question regarding 
 
ANAEMIC RAMOLLISSEMENT. 295 
 
 its inflammatory character is peculiarly interesting to the physiologist, 
 from deductions he may draw from the effects which its first stage pro- 
 duces on the functions of the brain, a$ distinguished from those exhi- 
 bited after the disease has pursued its course to the actual destruction 
 of its texture. 
 
 Gluge,* Henle,f Valentin, J Wagner, and Dr. Hughes Bennett, of 
 Edinburgh, have made some most important and interesting observations 
 on ramollissement of the brain. To the papers|| of this last-mentioned 
 excellent pathologist I am indebted for the following information on this 
 subject. Gluge was the first to point out, not only in softening of the 
 brain, but that, in certain stages of inflammation generally, corpuscles 
 are produced, which he has denominated compound inflammation glob- 
 ules. The blood in the capillary vessels stands still. The blood cor- 
 puscles lose their coverings and color, only their nuclei remaining. 
 These become agglomerated by means of a white connecting mass, and 
 form thick opaque round bodies, which consist on an average of from 
 twenty to thirty small granules, which, when examined singly, are per- 
 fectly clear and transparent. Henle has shown that these granules are 
 contained in a true cell-wall with a nucleus. Valentin, Vogel, and 
 Dr. H. Bennett concur in this view of their structure. 
 
 Dr. H. BennettH thus describes the mode in which these exudation 
 corpuscles are developed : u The blood-plasma or liquor sanguinis, 
 which exudes through the walls of the blood-vessels, after a time, which 
 may be shorter or longer, according to circumstances, coagulates in the 
 form of minute granules. These may be seen coating the vessels, and 
 filling up the spaces between them in masses more or less dense. If a 
 small quantity only be exuded, the granules occur in small patches at 
 irregular intervals. (Plate I. fig. 5.) This appears to arise from a com- 
 paratively slight degree of congestion, which, however, may produce 
 very intense symptoms from its diffusion over a large surface, as in cases 
 of fever, delirium tremens, &c. When, on the other hand, the conges- 
 tion is more intense in certain places, the exudation is more abundant, 
 and the granules accumulate in a dense mass outside the vessels, or in 
 the interstices of the elementary structures of the organ. (Plate I. fig. 
 4.) This exudation serves as a blastema for the production and nourish- 
 ment of nucleated cells. These may either be formed directly from the 
 fluid liquor sanguinis or subsequent to its coagulation. In the former 
 case these may be seen coating the blood-vessels (see Journal, No. 153, 
 Plate V. fig. 6). In the latter imbedded in the granular solid mass (fig. 
 7, 8). In parenchymatous tissues, where the whole exudation passes 
 into solid coagulation, it is the growth and development of these cor- 
 puscles which cause it to break up, and gradually become more and 
 more soft. Thus we have uniformly seen that when the softening is 
 diffluent, perfect corpuscles are few, and that the granules are numerous 
 
 * Anat. Mikroscopische Untersuchungen, pp. 12, 13. 
 
 t Mftller's Archives, 1839, p. 24. 
 
 J Vogel uber die Erwachung des Gehirns. 
 
 Wagner, Handworterbuch der Physiologic. 
 
 1! Ed. Med. & Surg. Journal, vpl. Iviii. pp, 58 and 60. 
 
 V Ibid., vol. lix. p. 344, 
 
296 HUMAN BRAIN. 
 
 and loose. When it is pultaceous, only the corpuscles are numerous, 
 and the granules less so ; and when the diseased part retains to a con- 
 siderable degree its resistance, or is unchanged, the corpuscles are few, 
 whilst the granules, instead of floating loose, are attached to and coat 
 the blood-vessels. During the progress of disintegration, it frequently 
 happens that portions of the solid exudation are broken up into masses 
 of greater or less size, which are frequently seen of irregular shapes, 
 both attached to the vascular walls, and floating loose in the field of the 
 microscope." 
 
 "The exudation corpuscle is formed like all other primary cells a 
 nucleus is produced, from which a cell-wall arises. During, or subse- 
 quent to its full growth, granules are formed between the nucleus and 
 cell-wall. These become more and more numerous, until at length the 
 nucleus is obscured, and the whole cell appears full of, and distended 
 with granules. It presents different appearances at different periods 
 of its growth. At an early period it is very delicate and transparent; 
 the "nucleus is very distinct, like a white spot, and the granules exceed- 
 ingly minute, and few in number. As the development proceeds, the 
 granules become larger and more numerous, the corpuscle assumes a 
 brownish color and becomes more or less opaque. Sometimes it en- 
 tirely obstructs the rays of light, and looks black. In the observation 
 where the softening resembled chalky milk, the whole cell was full of 
 granules of a large size, each of which was perfectly round and trans- 
 parent." 
 
 "When the exudation corpuscle is distended with granules, it appears 
 to have reached its furthest stage of development: the cell-wall now 
 bursts, and its contents escape. This occurring in numerous corpuscles, 
 causes the coagulated exudation to become soft, pultaceous, or even 
 diffluent. When, by the process of organization thus described, the ex- 
 uded mass is broken down, it appears probable that the minute granules 
 or molecules, of which it now principally consists, may be re-absorbed, 
 the structures of the organ set free from the pressure the exudation pro- 
 duced, and thus the part return to a healthy state. Gruly tells us, that 
 he has seen the molecules thus produced by the breaking down of pus 
 cells, permeate the coats of the intermediary and capillary vessels, and 
 mix with the blood. This is the process by which it seems probable 
 that hepatization of the lungs is removed. It is impossible, however, 
 Jo know with certainty whether a similar process takes place in the brain, 
 because the symptoms of exudation into that organ are by no means so 
 unequivocal, but it is highly probable. More generally, however, ab- 
 sorption either does not take place, or is not in proportion to the amount 
 of exudation poured out, and the ultimate structure of the organ is also 
 at length broken up and disorganized. Thus, when inflammatory soft- 
 ening of the brain is diffluent, not only is the exudation mass reduced 
 to granules, but the cylindrical and varicose nervous tubes are broken 
 up into fragments more or less long." 
 
 " Dr. Henderson, in an interesting paper on pneumonia, was the 
 first to point out a distinction between the different granular bodies 
 resulting from exudation, as he has observed them in inflamed lungs. 
 He says, l They do not always present in their agglomerated form the 
 
RAMOLLISSEMENT. 297 
 
 figure described by Gluge, but are variously shaped, according to the 
 state of perfection in which they may happen to be; while some are 
 globular and exhibit a circular outline, others appear deeply indented 
 and defective, as if a portion of their substance had been removed ; and 
 others have nothing of their original round figure remaining.' I think 
 it will appear that these differences do not arise from the stages of de- 
 velopment of the exudation corpuscle, as Dr. Henderson supposes, but 
 are caused by the coagulated blood-plasma breaking up into different- 
 sized masses. I have frequently, by means of friction, caused such por- 
 tions of coagulated exudation to separate, to peel off, as it were, from 
 the exterior of the vessels, and float loose amongst the granules and cor- 
 puscles. These bodies I have distinguished by the term exudation 
 masses." 
 
 Dr. Hughes Bennett has shown that the most important changes may 
 take place in the cerebral substance, inappreciable to the naked eye, 
 but clearly discernible with the microscope. He also distinguished 
 more decidedly than had been done previously, the inflammatory and 
 non-inflammatory softening. 
 
 The following case illustrates very strikingly the value of the micro- 
 scope in the examination of the brain. It quite confirms the opinion I 
 have always expressed, that every decided deviation from the normal 
 action of the brain would be always found to correspond to some altera- 
 tion of structure, and that it was only owing to the imperfect manner in 
 which we have hitherto examined the brain that we failed to detect these 
 alterations. 
 
 Case 9. Acute hydrocephalus; death ten days after the commencement of the disease; 
 nothing abnormal in the brain. Vessels of the convolutions abundantly coated with exuda- 
 tion granules. John Smith, aged 3 years, admitted into the Royal Infirmary, under Dr. 
 Traill, February 12th, 1842. 
 
 According to the mother's account, he awoke during the night of the 3d instant with a 
 ]oud scream, and, by pointing to his head, seemed to indicate that he felt pain there. On 
 the following day he vomited repeatedly, and he has since refused all food. On admission 
 there was constant rolling of the head ; pupils contracted on the approach of light ; pulse 
 quick and sharp ; bowels regular. Two leeches to the head 5 powders of calomel and sugar 
 
 Feb. 13th. Vomited powder ; passed a restless night; some tremor observed in the limbs. 
 Blister to the head; clyster; became restless, and died during the night. 
 
 Sectio. Feb. 15. The membranes covering the brain displayed no unusual vascularity. 
 The ventricles contained no fluid, nor was the consistence of the cerebral substance in any 
 way altered. 
 
 Microscopic examination. The vessels of the convolutions were in many places slightly 
 coated with exudation granules. The fornix and central medullary parts of the brain pre- 
 sented a similar appearance. The coating of granules here, however, was frequently two 
 and even three times thicker than the vessel to which it was attached, and contained here 
 and there clear, round white spots, similar to the nuclei of the exudation corpuscles. 
 
 Remarks. This case presented the usual symptoms of acute hydrocephalus in children, 
 yet after death no morbid lesion of any consequence was to be discovered. This is a cir- 
 cumstance of by no means unusual occurrence. A more minute examination, however, 
 determined that the capillaries of the central substance of the brain were coated with exu- 
 dation granules to a very great extent, and that these granules contained among them nume- 
 rous bodies similar to the corpuscular nuclei. That the exudation in this case should have 
 presented this condition, notwithstanding the violent symptoms, is very curious, and in a 
 histological point of view, exceedingly interesting. It furnishes us with an intermediate 
 stage in the development of the exudation corpuscle, as seen in many of the preceding cases, 
 on the one hand, and those which are to follow on the other. 
 
 Dr. Bennett thus sums up his conclusions regarding the two kinds of 
 softening :* 
 
 * Vol. lx. p. 398. 
 
298 HUMAN BRAIN. 
 
 1. That two kinds of cerebral and spinal softening exist, an inflam- 
 matory and a non-inflammatory, which may always be distinguished 
 from each other by means of the microscope. 
 
 2. That inflammatory softening is characterized by the presence of 
 exudation corpuscles and granules, whilst in non-inflammatory softening 
 these bodies are never found. 
 
 3. That the nature of inflammatory softening consists in the forma- 
 tion and development of nucleated cells in exuded blood-plasma: whilst 
 the nature of non-inflammatory softening consists in the mechanical de- 
 struction or maceration of the nervous tissue in serum, or is the result 
 of putrefaction. 
 
 4. That non-inflammatory softening, unaccompanied by hemorrhage, 
 is usually post-mortem^ and causes no symptoms; whilst uncomplicated 
 inflammatory softening always causes marked symptoms, which, how- 
 ever, vary according to the seat of the lesion. 
 
 5. That the inflammatory and non-inflammatory softenings have fre- 
 quently been confounded together by morbid anatomists, it being impos- 
 sible* to distinguish one from the other with any certainty by the naked 
 eye. 
 
 6. That inflammation in the nervous centres has, in several instances, 
 been demonstrated by means of the microscope, after it has escaped the 
 search of good morbid anatomists, and been indicated by most unequi- 
 vocal symptoms. 
 
 7. That every different colored softening has, at various times, been 
 found to be connected with inflammation, but that yellow and white 
 softenings are most frequently non-inflammatory, whilst the fawn-colored 
 softening is non-inflammatory. 
 
 8. That red softenings usually depend on congestion^ or the direct 
 extravasation of blood ; yellow softenings on the imbibition of the co- 
 loring-matter of the blood ; fawn and gray-colored softenings on the 
 presence of gray exudation corpuscles; and white softenings, in the 
 great majority of cases, -are post-mortem, and the result of maceration in 
 serum. 
 
 9. In no single instance has softening of the nervous centres been 
 traced to the presence or infiltration of pus. 
 
 10. That inflammation of the central parts of the brain generally pro- 
 duce well-marked lesions of sensation and motion ; whilst in inflamma- 
 tion of the peripheral portions, lesions of intelligence are commonly well 
 pronounced. 
 
 11. That in idiopathic inflammatory softening of the brain, contraction 
 in one or more limbs is a common symptom. 
 
 12. That the fawn-colored spots, described by Dr. Sims, are no evi- 
 dence of the cure of inflammatory softening. 
 
 13. That inflammation accompanying haemorrhages is usually conse- 
 cutive. 
 
 14. The softening surrounding apoplectic clots, or sanguineous infil- 
 tration, is no proof of inflammatory action. 
 
 The following highly important communication on this subject, I have 
 received from my esteemed colleague, Dr. Peacock. Knowing his ac- 
 curacy, I have no hesitation in publishing it in full. 
 
RAMOLLISSEMENT. 299 
 
 " From the opportunity which I had in Edinburgh of observing Dr. Bennett's researches into 
 the microscopic structure of softened portions of the brain, and from a considerable number of 
 cases of cerebral disease which I have since dissected and minutely examined, the following 
 points may, 1 think, be regarded as established : 
 
 "1st. That in all cases where characteristic symptoms of softening of the brain are pre- 
 sent during life, evidences will be found, on microscopic examination, of the extravasation 
 of lymph into the cerebral substance under one or other of the several forms of the so-called 
 exudation granules, corpuscles, or masses: 
 
 a 2dly. That the appearance of portions of the brain softened after death, either arti- 
 ficially, by manipulation, or from post-mortem change, often, to the naked eye, so closely re- 
 sembles the genuine results of disease as to render it extremely difficult, if not impossible, 
 for practised morbid anatomists to decide between them : 
 
 " 3dly. And consequently that portions of brain, presenting every appearance of soften- 
 ing to the naked eye, but in which the microscope does not reveal the presence of some 
 form of exudation, intermixed with the broken-up cerebral substance, cannot, in the present 
 state of our knowledge, be regarded as having resulted from any diseased process during 
 life. 
 
 "In support of these propositions, I have selected the two following cases from a number 
 of unpublished observations of my own; they will be observed to confirm several of Dr. 
 Bennett's conclusions, and show, 1st, that softening of the brain may prove fatal at a period 
 when the local changes are so little apparent, as to be scarcely detectable to the unaided 
 sight, yet that, in this stage, their nature may be rendered conclusive on microscopic exami- 
 nation; 2dly, that in the same brain there may exist softenings essentially resulting from 
 morbid processes during life, and others dependent simply on changes after death ; and that 
 the respective nature of these, not certainly capable of solution by ordinary vision, become 
 apparent when recourse is had to the use of the lens. 
 
 " Case I. Vourdelot, a female, 69 years of age, was admitted into the Salle St. Madeline, 
 at La Charite, under the care of M. Bouillaud, on the 23d of February, 1844. 
 
 "She stated that she had been seized on awaking the morning before with entire loss of 
 motion and general numbness in the left arm and leg, in consequence of which she was 
 incapable of leaving the bed. The morning of her admission she had some pain in the 
 head, and felt giddy when sitting up ; she had not had any feeling of sickness or vomiting. 
 When admitted she looked sallow and feeble, but had no particular expression of suffering. 
 The angle of the mouth was slightly drawn to the right side. The tongue did not present 
 any material deviation, and was freely movable ; it was moist and somewhat red. The 
 pupils were of natural size, and sensible to light; the hearing was entire. She had some 
 difficulty of speaking and swallowing. The leg and arm were entirely paralyzed ; and the 
 forearm was flexed upon the arm, and rigid. She had experienced some difficulty of mak- 
 ing water, but the bowels had been naturally relieved. The pulse was 88, and sufficiently 
 strong. There was no increased dullness in the region of the heart, and the sounds, though 
 flat, were far from morbid murmur. The respiration was natural. She referred the pain 
 in the head to the upper and middle part of the right side ; she had no giddiness except 
 when sitting up ; the intelligence was scarcely impaired. She was directed to be bled to 3 
 palettes. 
 
 " On the 24th, the paralysis continued much as before, and was combined with semiflexion 
 of the joints, which ceased on extension. The mouth was slightly drawn to the right side. 
 The lips had their natural movement when she attempted to blow ; the motions of the eye- 
 lids were natural. The pulse was 88, and firm; the heat of skin moderate. The blood 
 drawn the night before was moderately contracted, and without any buffy coat. M. Bouil- 
 laud gave as his diagnosis Cerebral hemorrhage in the optic lobes, or corpus striatum, of 
 the right side, or in their immediate neighborhood, with softening of the cerebral substance 
 around, probably ossification of the central arteries. The symptoms underwent little change 
 after this date. The power of speech, which had never been greatly affected, was much 
 improved after the bleeding, and the intelligence continued perfect. The contraction and 
 rigidity of the left arm were very irregular ; though decided on the evening of her admission, 
 it was nearly absent at the time of M. Bouillaud's visit the following morning ; and again in 
 the evening it existed, though not to a great degree. The left leg was throughout in a state 
 of complete resolution, and the sensibility was unaffected in both limbs. 
 
 "On the 25th, the bowels not having been relieved, she was directed to take one grain of 
 the potassio-tartrate of antimony in a basin of broth ; portions being drank at intervals. This 
 did not produce vomiting, but acted moderately on the bowels. Towards the evening she 
 became delirious and restless, then sank into a state of coma, and died at 5 A.M. on the 26th. 
 
 " The body was examined at 9 A.M. on the 27th. The heart was of large size, the walls 
 of the left ventricle being unusually thick, and its avity small. The aorta and bicuspid 
 valves were somewhat thickened and opaque. The lungs and organs in the abdomen were 
 healthy. 
 
300 HUMAN BRAIN. 
 
 "In the brain there existed considerable sub-arachnoid effusion, and fluid was found in 
 large quantities at the base ; and the basilar and central arteries, and their divisions, were 
 extensively ossified. The cerebral substance was of natural firmness; the sections were 
 abundantly sprinkled with red dots. Divided into small sections, and examined with the 
 greatest care, the brain displayed no trace of haemorrhage or softening, unless, perhaps, the 
 optic thalamus and corpus striatum of the right side were slightly less firm than the same 
 parts of the opposite side. There was observed nothing unnatural in the ventricles, pons 
 Varolii, medulla oblongata, or spinal marrow ; all these parts retained their natural firm- 
 ness, and the only striking peculiarity was the altered condition of the coats of the various 
 cerebral arteries. 
 
 " In this report I have purposely retained the words dictated by M. Bouillaud to his extern 
 in the Post-mortem Theatre, to show that every care was taken to ascertain the state of the 
 brain and spinal cord; and that, with the attention specially directed to the central portions 
 of the right hemisphere, they afforded no satisfactory, or even probable, evidences of soften- 
 ing. Having taken portions of the thalamus and corpus striatum, I subjected them to a 
 careful microscopic examination, and obtained very characteristic proofs that morbid changes 
 had been proceeding in these parts sufficient to account for the symptoms present during 
 life. The scarcely softened portions of the right thalamus and corpus striatum, though 
 scarcely more tinged with blood than natural, as viewed by the naked eye, were found, on 
 microscopic examination, to contain numerous blood globules, and the tubes were much 
 broken up; along the sides of the capillary vessels the small exudation granules were found 
 extensively extravasated, and occasionally there existed in the adjacent cerebral tissue the 
 large round clusters of granules, to which the terms exudation corpuscles, and masses, have 
 been applied. The exudation was, however, chiefly in the granular form, and confined to 
 the sides of the vessels, and thus corresponded with the very slight amount of softening pro- 
 duced. The granules were found in portions of the corpus striatum and thalamus opticus, 
 which were far from any appearance of softening. 
 
 " The report of the microscopic appearances in this case, and which so fully confirmed the 
 correctness of the diagnosis formed during life, I had the pleasure of communicating to M. 
 Bouillaud, through his Chef de Clinique, M. Lemaire. 
 
 "The second case occurred in my own practice more recently ; it is as follows: 
 
 " Case II. John Fletcher, set. 62, a porter, admitted into the Royal Free Hospital, August 
 the 15th, 1846. He stated that he had lived very freely for the last 14 years, but enjoyed 
 good health till about a month before his admission. He then began to suffer from breath- 
 lessness, cough, and swelling of the extremities, more particularly of the legs, and latterly of 
 the abdomen. When admitted, he complained of difficulty of breathing, but had no pain in 
 the chest; he had a severe cough, and expectorated some frothy mucus. The body was 
 generally anasarcous, and the abdomen tumid, and fluctuated on percussion. The tongue 
 was covered with a brown fur ; the pulse was 88, and tolerably resistent ; the respirations 
 28, short and labored. The urine acid, very albuminous, and of a deep brownish red color; 
 in quantity it amounted to three pints during the twenty-four hours. The chest sounded 
 generally dull on percussion, both before and behind ; but it was relatively less resonant in 
 the right side, towards the lower part. The respiration was throughout feeble, and attended 
 by a prolongation of the expiratory sound. It was weaker on the right side, and absent at 
 its lower part. The respiration was generally attended with sonorous and sibilant rales, 
 and a moist, and somewhat small, crepitation was heard over the lower part of the back, at 
 each side. The extent of the cardiac dullness was not materially increased. The action of 
 the heart was regular, the sounds nearly inaudible, from the loud pulmonary sounds ; but, 
 on the breath being held, a rough and grating murmur was heard, with the impulse of the 
 heart, over the whole praecordia. This murmur was loudest at a point one inch below the 
 nipple, but it was also distinct between that body and the sternum, and was audible over the 
 upper third of the sternum. The second sound was heard both at the base and apex, and 
 was grating and rough in its character, but was unattended by murmur. On the 22d he 
 complained of much pain in the region of the heart, and there was increased difficulty of 
 breathing; deep brown-colored expectoration, occasionally bloody ; great lividity of face, and 
 very scanty secretion of urine : during the whole period he was in the hospital he had been 
 in a state of great mental torpor, with muttering delirium, though rational when aroused ; the 
 tendency to coma now increased, he breathed stertorously, became entirely insensible, and 
 died on the morning of the 26th of August. 
 
 "The body was examined at 4 P.M. the same day. 
 
 "The right side of the chest and the cavity of the abdomen contained much deep amber- 
 colored serum. Both lungs were very sparingly crepitant, and exuded much serurn on com- 
 pression, especially the right, which was much compressed. The bronchi were dilated; the 
 tubes filled with glairy mucus, and the mucous membrane reddened. The heart was very 
 large, weighing one pound (avoirdupois) ; it was much overlapped by the left lung. The 
 
RAMOLLISSEMENT. 301 
 
 serous coverings were coated by a thin and very soft layer of lymph. The right ventricle 
 was hypertrophied and much dilated. The left ventricle very large, and its walls greatly 
 increased in thickness. The aorta orifice was small, and the valves much ossified at their 
 attachments, and a mass of atheroma projected between the angles of the right and posterior 
 crescents. The valves, though probably competent, had evidently formed an obstruction to 
 the passage of the blood from the ventricle. The mitral valve was also thickened, and its 
 aperture somewhat contracted. It had a hard atheromatous mass projecting from the right 
 extremity of its folds. The auricles, especially the right, were large. The aorta displayed 
 much atheromatous thickening, and the orifices of the coronary arteries were surrounded by 
 deposit, but not materially strictured. The chylopoietic organs were congested; the kidneys 
 were somewhat granular; the proper coat adherent. 
 
 "The brain weighed 39f oz. (avoirdupois). 
 
 " There existed much fluid in the sub-arachnoidal cellular membrane, in the cavity of the 
 ventricles, and at the base. The convolutions on the superior surface of the hemispheres 
 were very narrow, convex, and widely separated from each other; the pia mater was very 
 readily removed from them. This atrophy of the convolutions was most marked at the upper 
 surface of the anterior lobes, and here there existed patches of softening of the surface, as 
 also at the under surface of the anterior and middle lobes. The softened portions were of a 
 deep amber color, and occupied chiefly the convexities of the convolutions. The softening 
 seemed to have commenced on the free surface of the gray matter, so that, on removing 
 the pia mater, a portion of the altered tissue adhered to it, and a furrow was exposed, filled 
 by a diffluent pulp. In some places the surfaces of the convolutions were only slightly 
 abraded: in others the softening involved the whole thickness of the cortical substance; but 
 in none did the change appear to implicate the subjacent medullary matter. The gray matter 
 of the brain for some distance around the patches of softening was of a hard and almost 
 horny consistence, had a peculiar semi-transparent appearance, and was of a leaden hue. 
 The softened matter, when more minutely examined, was found to consist of a diffluent or 
 fluid portion, readily miscible with water, and a more solid material of a deep amber color, 
 of the consistence of firm gelatine, and only admitting of being broken down with difficulty. 
 The former, examined by the microscope, consisted of broken down cerebral substance, with 
 capillary vessels having exudation granules on their sids, and. a few exudation corpuscles 
 mixed with the cerebral substance. The latter was composed of little else than dense masses 
 of aggregated granules of exudation. Both materials were intermixed with free oil globules, 
 and contained tabular crystals, apparently of cholesterine. 
 
 " On the free surfaces of the corpora striata, in each ventricle, there existed patches of 
 softening. The cerebral substance was in these almost diffluent, but retained its natural hue, 
 and, when subjected to the microscope, was found to present no other peculiarity than being 
 mixed with an unusual proportion of fluid, and the tubes broken up and separated. There 
 was no evidence of exudation. 
 
 " The various cerebral arteries were covered with atheromatous matter, but to a less ex- 
 tent than is frequently seen in elderly persons. 
 
 " In this instance the brain presented two very different forms of softening the one, in- 
 volving very extensively the gray matter of the convolutions, was evidently inflammatory in 
 its origin; the other, affecting the surfaces of the corpora striata, was most probably the result 
 of postmortem changes. These inferences accord, it will be observed, with the symptoms 
 present during life. The previous history of the patient was not ascertained : he was brought 
 into the hospital in a state of destitution, and presented at that time, as well as afterwards, 
 great mental hebetude, with partial delirium, gradually lapsing into complete coma; the dis- 
 turbance of the intellectual functions which chronic disease of the gray matter of the brain 
 would be expected to induce. On the other hand, he had, throughout his illness, no convuls- 
 ive attack or paralysis ; which would have existed had the central softening resulted in a 
 morbid process; and which, we have seen, was present in the first case, though the change 
 in the corpus striatum was, to the naked eye, much less obvious. 
 
 "The inflammatory softening of the gray matter of the brain was, in this case, probably 
 of considerable duration. The deep amber color of the softened portions, the darkness and 
 induration of the surrounding cineritious matter, and the dense, opaque, and irregular masses 
 of exudation, found on microscopic examination, correspond with what I have observed in 
 several other cases of chronic softening of the surface of the brain, and exist to a less degree 
 in cases of chronic softening of the medullary substance. The dark color of the softened 
 portions and the density and large size of the exudation masses, are, I believe, characteristic 
 of the slower forms of cerebral softening-. 
 
 " The changes undergone by the surfaces of the corpora striata in this case are also charac- 
 teristic of the most frequent form of what is believed to be post-mortem softening; and the 
 case affords an example of the circumstances under which this change most frequently occurs. 
 The softening appears to be dependent on infiltration of the serum, effused into the ventricles 
 
302 HUMAN BRAIN. 
 
 and the adjacent cerebral substance; and the appearances presented on microscopic exami- 
 nation are such as would thus result. I have many times observed this state, and have no- 
 ticed its various stages, from a degree of infiltration producing only a sudden appearance of 
 portions of the boundaries of the ventricles, to the complete destruction of extensive portions 
 of the corpora striata, thalamus, fornix and septum, forming a thick milky pulp, floating in 
 the ventricular cavity. This extensive softening I have seen unattended by any symptoms 
 of paralysis or contraction during life, as, were it produced before death, could certainly not 
 be the case. It is generally, however, if not always, found in cases of very copious effusion 
 from acute inflammation, and is especially common after the arachnitis of children. The 
 production of the softening is, therefore, probably aided by a slight extension of disease from 
 the inflamed serous membrane to the parts beneath, analogous to the slight change, which , 
 in cases of pleurisy or pericarditis, affects the portions of the substance of the lungs and 
 heart contiguous to the serous membrane. 
 
 "In cases of extensive chronic effusion into the ventricular cavities, the parts around are 
 most frequently indurated, as we find in the cases of serous effusion after chronic insanity, 
 after death from diseases attended with great emaciation, and in persons who die at an ad- 
 vanced period of life. 
 
 " There is another remark which suggests itself in reference to these cases : both were, it 
 will be observed, elderly persons, the one originally of feeble constitution, and debilitated; 
 the other exhausted by organic disease in two other organs : in both, the arteries of the brain 
 were diseased, and in the last the softening involved extremely different portions of the sur- 
 face of the brain. They were, therefore, both persons in whom the form of softening, re- 
 garded by Rostan and Recamin as non inflammatory, might have been expected to be found ; 
 yet, in each case, microscopic examination of the diseased portions afforded conclusive evi- 
 dences of the presence of inflammation. The inference which thus suggests itself is sup- 
 ported by several other cases I have had the opportunity of observing, and I cannot but 
 regard the views of these pathologists as doubtful. 
 
 " The importance of the color of softened portions of the brain, as affording the means of 
 distinguishing the* nature of the change, has, I believe, been overrated; and while it is pro- 
 bable, that all cases of softening of some duration will be found to present decided changes 
 of color, referable either to the engorgement of the part with blood, to slight sanguineous 
 extravasation, or to the color of the exuded material, we have evidenced, in the first case, that 
 inflammatory softening may prove fatal without the tissue having undergone any alteration 
 of color. The difference between the processes of cerebral softening in persons at early and 
 advanced periods of life I regard as perfectly analogous to those which, under similar cir- 
 cumstances, affect other forms of diseased action." 
 
 Atrophy of the Brain. There is no doubt that the brain, either as a 
 whole or in part, becomes atrophied, though more frequently the latter. 
 It may arise from arrest of development in the foetal state. The anen- 
 cephalous foetus is the most complete illustration of this form of atrophy. 
 Sometimes the arrest of development is confined to the hemispherical 
 ganglion, and then the brain retains the same condition permanently, 
 which, in a normal state, would be merely one of its stages of growth. 
 There is an excellent account of this disorder, with illustrations, in 
 Cruveilhier's Morbid Anatomy. 
 
 Cruveilhier describes another form of atrophy as resulting from the 
 pressure of serous effusion into the ventricles in childhood ; but this I 
 consider does not deserve to be considered as a true case of atrophy ; 
 it is in reality simply a case of chronic hydrocephalus in childhood, 
 which, causing a dilatation of the left lateral ventricle at the expense of 
 the tubular portion of the hemispheres, has been partially absorbed, and 
 hence the paralysis. The hemispherical ganglion or cortical substance 
 was neither atrophied nor absorbed, but in normal quantity, as demon- 
 strated by the section, and the rugae on the surface were much more 
 numerous on that side, and hence the preservation of the intellect. 
 
 A third form is that which follows chronic inflammation of the hemi- 
 spherical ganglion; we often meet with it in the brain of old standing 
 cases of insanity, where the patient has sunk into a complete state of 
 
HYPER.EMIC AFFECTIONS OF THE BRAIN. 303 
 
 fatuity. The convolutions are then narrow and pinched, almost sharp, 
 instead of being flat and rounded, full and plump. In some cases the 
 ganglion is actually thinner, as may be seen on section. A fourth is 
 simple senile atrophy. In very old age the brain, like other organs, is 
 less perfectly nourished, and like other organs, shrinks in bulk. The 
 wide fossaB between the two convolutions are filled with that beautiful 
 protector, the cerebro-spinal fluid : for in these cases the excess of this 
 fluid is not to be regarded as morbid ; it is the cushion which nature has 
 kindly provided to supply the deficiency of brain. Still it must, I think, 
 be allowed that the brain of old people is more exposed to injury from 
 external violence than the adult. This I conceive arises from its being 
 more easily shaken in its case. It is only upon such a supposition that 
 we can account for those instances of laceration of the brain from a 
 blow on the skull unaccompanied with fracture, an accident which is 
 comparatively rare in the younger subject. The following case I have 
 selected from among others as a good illustration of the accident: 
 
 Case 10. Elizabeth Swannell, set, 69, a cook, was admitted, under the care of Mr. Green, 
 into Elizabeth's ward, St. Thomas's Hospital, on the 24th of February, 1841, at half-past four, 
 P.M., having received a large contused wound which exposed the bone over the right eye- 
 brow. No fracture or further external injury could be detected. Symptoms on admission :' 
 Perfectly insensible and motionless; left pupil very much contracted and fixed, the swelling 
 of the surrounding part preventing the state of the right from being ascertained; breathing 
 labored, with a stertorous noise; pulse 96, full, and not easily compressed; extremities mo- 
 derately warm ; faeces and urine involuntarily passed ; great rigidity of the muscles, especially 
 of the right arm and left leg; frothy saliva issuing from the mouth; no spirituous odor could 
 be detected in the breath. 
 
 History. Shortly after two o'clock, while going down stairs, she suddenly fell, and was 
 picked up exactly in the same state in which she was brought to the hospital. Was not 
 subject to fits. Nobody saw the accident. 
 
 Treatment, A surgeon had bled her in the left arm previous to admission. Soon after she 
 was brought in, she was cupped to ijix from the nape of the neck, a large blister was applied 
 to the back part of the head, which was shaved, and hot water applied to her feet. Breath- 
 ing slightly relieved by cupping; pulse continues full, and at 92. At nine o'clock, I saw her, 
 with Mr. B. Travers, apparently exactly in the same state, except that her pulse varied in 
 frequency from 76 to 92; it was very full, but did not indicate sufficient strength to bear 
 further loss of blood ; the breathing was not quite so labored. At 1 1 o'clock I gave her 
 grs. viij. of calomel. 
 
 Feb. 25th, 9 A.M. No improvement in respect of sensation or motion : pupil contracted 
 and fixed : pulse 90, and full, breathing a little impeded by mucus, much frothy saliva issu- 
 ing from the mouth. She remained exactly in the same state, her pulse continuing full, and 
 about 90, till within two or three minutes of her death, which took place at 10 minutes 
 past 4 P.M. 
 
 Post-mortem. The brain did not seem to fill the skull completely. No morbid appear- 
 ance on the surface of the brain. Tentorium smeared with blood. Interior. Extensive 
 effusion of blood into the left ventricle ; some into the right : this effusion appears to have 
 resulted from laceration of the left corpus striatum and thalamus, also those fibres of the 
 great commissure which form the anterior part of the roof of the left ventricle. The lace- 
 rated corpus striatum and thalamus were forced into the right ventricle under the fornix, 
 and, when first observed, looked almost like a medullary tumor with an ulcerated surface. 
 
 In this case the brain appears to have been lacerated by the " centre coup," to which it 
 was especially exposed from its diminished size, in relation to its containing cavity, the 
 result of senile atrophy. 
 
 Hypertemic Affections of the Brain. From the an&mic affections let 
 us now direct our attention to the hypersemic. First, the inflammatory. 
 
 These may be divided, for the sake of convenience, into the following 
 heads : 
 
 Inflammation of the Brain from without: 
 
 1. Inflammation of the brain from concussion. 2. Inflammation of 
 
304 HUMAN BRAIN. 
 
 the brain consequent upon and continuous with inflammation of its pro- 
 tective apparatus, viz., the pericranium, the cranium, and the cerebral 
 membranes, whether caused by injuries, local diseases, or constitutional 
 diseases. 
 
 Inflammation of the brain consequent on metastasis, such as the re- 
 trocession of an eruption, &c. 
 
 Inflammation of the Brain from within : 
 
 Inflammation of the brain from over action, mental emotions, sudden 
 fright, &c. 
 
 Inflammation of the brain is a wide subject, for the brain, unlike the 
 liver, lungs, kidneys, &c., is not, as we have seen, a single instrument 
 performing one office. It is made up of many instruments, each having 
 its individual function to perform. The symptoms of the disease will 
 therefore vary according to the portion which is diseased. It is true, 
 that all the ganglia within the skull are so closely united that any single 
 ganglion can scarcely be affected without the rest sympathizing. Still 
 inflammation is sometimes restricted and the symptoms peculiar. 
 
 I believe, 1st. That inflammation of the hemispherical ganglion may 
 be distinguished from inflammation of the rest of the encephalon. 2dly. 
 That inflammation of the upper portion of this ganglion may be distin- 
 guished from that inflammation which is at the base of the brain. 3dly. 
 That inflammation of the medullary or tubular substance, though seldom 
 occurring alone, may be distinguished from that of the ganglia. 4thly. 
 That inflammation of the cerebellum has its characteristics. 
 
 The most important portion of the brain, as regards our relation to 
 the external world, is the hemispherical ganglion or cortical substance. 
 From its exposed position this ganglion is that portion of the brain which 
 is most frequently disordered and diseased. It will be well to consider, 
 first, what morbid changes it is liable to, their consequences and termi- 
 nations, and afterwards review the various circumstances which may 
 give rise to them, such as disease and injuries of the skull and mem- 
 branes, &c. &c. Inflammation of the hemispherical ganglion is usually 
 described by authors as inflammation of the membranes of the brain 
 meningitis overlooking entirely the more important organ affected. 
 This will be adverted to again. 
 
 I am afraid that in many cases the post-mortem appearances of menin- 
 gitis are not always detected. There is no doubt that it is often difficult 
 in many cases to decide after death whether there has been any undue 
 vascularity of the pia mater during life. The position in which the 
 head has been placed after death in relation to the body, should always 
 be attended to, for if the examination is shortly after death, the blood 
 still fluid, and the head hanging down, the cerebral vessels are sure to 
 be full. On the other hand, if the head has been raised, and the chest 
 opened before the head, and the great vessels of the heart divided, so 
 that a large quantity of the blood escapes, the meningeal vessels which, 
 during life, had been over-filled with blood, may be unloaded and empty. 
 Still it will be found that these accidental circumstances affect the larger 
 vessels rather than the capillaries. The morbid appearances of the arach- 
 noid which indicate the existence of inflammation, cannot be so easily 
 affected. These are First, Opacity. It is true that this is a very com- 
 
HYPER-EMIC AFFECTIONS OF THE BRAIN. 305 
 
 mon appearance, but still it is one which I believe all pathologists agree 
 in considering the result of chronic inflammation. Secondly. Dryness 
 of the arachnoid. This is by no means common, but I quite agree with 
 Dr. Bright in saying, "In many cases of high cerebral irritation, and 
 where we have reason to suspect actual inflammation, this app?arance 
 occurs ; and there is no reason to doubt that in this membrane, as in 
 others, a defective secretion is amongst the well-marked signs of inflam" 
 mation." Thirdly. Effusion of lymph and fibrine are proofs of inflam- 
 matory action. 
 
 The effect of inflammation on the hemispherical ganglion, in producing 
 morbid alterations of structure, depends much on the intensity of the 
 inflammation, and its duration. 
 
 The appearance which it presents after death, will vary according to 
 the time at which death occurs in relation to the occurrence of the at- 
 tack. These alterations may be divided into alterations in consistency 
 and alterations in color. >,Jj 
 
 Thus there are softening and hardening. In regard to color, the changes 
 are very striking. In health, the color varies a little, but the variation 
 is slight. The natural color may be closely imitated in water colors, by 
 mixing light red and Indian red ; it is difficult to describe it in words. 
 Dr. Bright has called it " a light fawn-colored brown." 
 
 In disease the color varies from a pale tint, scarcely darker than the 
 medullary substance, up to an intense purple ; occasionally it assumes a 
 bright scarlet ; but we seldom have the opportunity of seeing it in this 
 state, for it is the result of active inflammation, and patients seldom die 
 during this stage of the disease. 
 
 For some time, I took every opportunity of making a colored drawing 
 of the cortical substance, or hemispherical ganglion, of all patients in*- 
 discriminately that I could examine after death ; at this time I went a 
 great deal to Hanwell, and, through the kindness of that noble bene- 
 factor of his fellow creatures, Dr. Conolly, I had many opportunities of 
 examining the brains of the insane. 
 
 The general result of my observations was, that a pale condition of 
 this ganglion was almost invariably found in patients who had sunk into 
 a state of mental imbecility, and was generally associated with some 
 serous effusion and thickening of the arachnoid and pia mater. 
 
 In patients who had been long inmates of the asylum, and in whom 
 the disease had ebbed and flowed, sometimes producing high excitement, 
 and sometimes depression, I often found a mottled appearance. 
 
 The following abstract, from the details of a case noted at the time, 
 will explain what I mean : 
 
 Case 11. Mania, Hanwell, April 23d, 1842. Thomas Griffiths was admitted on the 16th 
 March, 1842; he was violent and refractory, but not showing any disposition to injure any 
 one; very sleepless, opiates having very little effect upon him; never slept for more than 
 two hours at a time; pulse always low, arid general indications of debility, suppuration 
 taking place from slight causes. The skin sloughing from the smallest injuries. 
 
 The day before his death, he was quite tranquil, not rational, but simply quiet and ex 
 hausted. These particulars I obtained from Dr. Begley. 
 
 Post-mortem. Skull. Sero-sanguineous etlusion into the sac of arachnoid. Arachnoid 
 white, thick, and opaque. Pia mater rather more than normally vascular. Hemispherical 
 ganglion decidedly more vascular than in health, but not much darker. This increased, 
 
 20 
 
306 HUMAN BRAIN. 
 
 vascularity was so irregular, that the patches gave the ganglion a mottled appearance of purple 
 red color. Serum in the ventricles clear, but quantity increased. 
 
 A bright rose-colored tint is sometimes met with, and always indicates 
 that there had been increased vascular action during life. This color 
 may be seen both on section, and on the surface after the removal of the 
 arachnoid and pia mater. The different layers which compose this 
 ganglion are sometimes unusually distinct ; but I have not been able to 
 associate this appearance with any peculiar symptoms during life. 
 
 Dr. Bright says* that " a rose tint is sometimes peculiarly distinct on the 
 inner layer, sometimes confined by a distinct line of separation from the 
 outer part of the cineritious substance, at other times imperceptibly 
 shading into it. The one division between the layers is sometimes 
 marked by different shades of the habitual color, or sometimes by dark 
 gray shades from venous congestion, or by the unusual pinkness, either 
 of the external or the internal layers. There are usually three layers, 
 thus pretty distinctly marked, though occasionally the eye is capable 
 of distinguishing six. It is not at all uncommon to find a certain 
 tendency to separate in the external layer ; but this is occasionally so 
 marked in elderly persons, and in those who have labored under symp- 
 toms of imbecility, as to be obviously a morbid state. In these cases, 
 when the membranes have been drawn off, if a convolution be gently 
 pinched between the finger and thumb, a considerable portion, of 
 about the thickness of a wafer or more, but uniform in its depth, comes 
 away, leaving an even surface. This state of the cineritious substance 
 has appeared to me sometimes to be the result of habitual excess in fer- 
 mented liquors, and is likewise found where febrile diseases have been 
 accompanied with delirium and tremor. Although this condition of the 
 cineritious substance is by no means uncommon, I do not know of any 
 author who has referred to it, except Dr. Foville." 
 
 Cineritious substance is often found of a gray color, approaching in 
 some cases to a deep violet color. Dr. Bright attributes it to venous 
 congestion, and considers that it is sometimes increased by the morbid 
 condition of the blood, produced by its imperfect decarbonization. 
 "The vessels, filled with dark blood, may often be distinctly seen by 
 the assistance of a lens, and the numerous orifices, by which they have 
 communicated with the pia mater, may be seen, of unusual size, upon 
 the surface of the convolutions. This state is usually attended with 
 decided symptoms of congestion, and of cerebral oppression during life; 
 it is occasionally the result of fevers, particularly when they are accom- 
 panied with obstruction in the lungs. In cases of bronchitis, in diseases 
 of the heart which greatly obstruct the circulation, and, in cases where 
 suffocation has produced death, we find this gray appearance of the 
 cineritious substance." 
 
 The cineritious substance is sometimes of a yellow color, but I have 
 never seen this, except in connection with an alteration in the color of 
 the medullary substance, and I believe it to result from an extension of 
 disease from the medullary. I have seen the change in the latter alone. 
 
 The change in texture, as regards softening, varies in degree from 
 
 Reports of Medical Cases, vol. ii. p. 677. 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 307 
 
 % 
 
 that slight change which is only observable in consequence of its being 
 torn off in small patches, or the removal of the pia mater, and a soft, 
 pulpy state like thick cream. Sometimes, though seldom, it is most 
 unnaturally hard. Dr. Bright has associated this state with old inflam- 
 matory mischief of the part, as thickening or adherence of the membranes. 
 
 I have occasionally met with laceration of this ganglion, which Dr. 
 Bright was the first to point out as one of the effects of concussion. It 
 shows itself, says this author, " in two ways: by small ecchymoses of 
 clots in the cineritious substance, which are often found in various parts 
 at the same time ; or by an abrasion of the surface, which is thus re- 
 duced to a pulpy state mixed up with bloody points, giving the idea that 
 the mischief has in part resulted from the tearing off of the pia mater. 
 Convulsion of the features, and of the extremities of the opposite side, 
 is the frequent symptom attendant upon this lesion." 
 
 The hemispherical ganglion is sometimes very thin over the whole 
 cerebrum or cerebellum; '* but besides that," says Dr. Bright, " I have 
 seen it almost wanting over a small space, where a layer of lymph has 
 been thrown out between the pia mater and the convolutions. In one 
 or two instances I have also seen a clean excavation in the convolutions, 
 as if some portion previously injured or diseased had been absorbed." 
 
 Symptoms and Effects of Inflammation of the Hemispherical Ganglion. 
 We will next consider attentively one of the most important laws of vital 
 action which pathology has yet unfolded in relation to the nervous system, 
 namely, that the first effect of the first stage of inflammation of neurine 
 is to excite and to exalt to an unnatural degree, exactly the same kind 
 of power which we have reason to believe resides in it in a normal state. 
 For instance, the first effect of inflammation of the surface of the brain 
 is to excite the mental faculties, to produce great irritability of temper, 
 and constant restlessness or desire for action. If the inflammation be 
 arrested at this point, the patient recovers his reason ; but if it pursues 
 its ravages undisturbed, limiting its destructive effects to the spot where 
 it commenced, without extending to that portion of the brain which is 
 beneath, it annihilates the intellect, but does not affect the muscular 
 system; while, on the other hand, if the inflammation extend further, 
 reaching the instruments by which the will travels to the muscles, it 
 first produces convulsive action in these muscles, which afterwards be- 
 come perfectly paralytic ; in this case the integrity of the neurine, through 
 which volition traversed to call these muscles into action, is compro- 
 mised, and its power, therefore, as an instrument for the production of 
 voluntary motion, destroyed. 
 
 The same phenomena are presented to us by observations on the in- 
 struments of sensation, as far as we are at present acquainted with these 
 instruments, for we generally find, when inflammation attacks the tract 
 of sensation, (the first symptoms existing a sufficiently long time to be 
 accurately observed,) that previous to the obliteration of sensibility in 
 any texture, the normal sensibility of the part is exalted, the patient 
 suffering the most severe pain both at the spot where the nerves of sen- 
 sation originate, and in the brain itself where they terminate. 
 
 The first effect of unusual arterial action of the hemispherical ganglion 
 is to exalt the intellect; this effect is often so transient that it may be 
 
308 .* : , HUMAN BRAIN. 
 
 unobserved. We meet with a good illustration of it in the effect pro- 
 duced by alcoholic stimuli. Up to a certain point they render the indi- 
 vidual taking them lively ; his ideas come more rapidly and more clearly ; 
 he expresses them in better language, with greater facility, and more 
 rapidly; but this effect soon passes off. If the stimulus is continued, 
 the brain becomes oppressed, the muscles of the tongue sluggishly obey 
 the will, and the speech is thick and indistinct; his ideas are confused, 
 his language incoherent ; at last he loses consciousness, and becomes 
 wholly insensible to the external world. 
 
 As these views are based on a belief in the truth of the two following 
 positions, it will be necessary to adduce further arguments in support of 
 them : 1st. That the hemispherical ganglia are intimately connected with 
 the intellectual powers, and that it is in them peculiarly, and not in the 
 whole cerebral mass, that these powers reside. 2d. That the medullary 
 substance beneath is, in all probability, merely the passive servant, as it 
 were, of the cineritious, either as the conductor of its commands to the 
 muscles, or of the materials, namely, the various impressions made on 
 the peripheral extremities of the nerves of sense, which the cineritious 
 perceives, and with which it works. 
 
 Such, as elsewhere stated, appears to be the opinion of MM. Foville 
 and Pinel-Grandchamp, and such also is the opinion of Bouillaud, who, 
 when investigating the localization of the cerebral functions, says,* " If 
 we reflect that disturbance of the intellect can exist independently of 
 every other derangement of the cerebral functions ; if we reflect, more- 
 over, that disturbance of the intellect appears to coincide constantly with 
 an alteration of the cortical substance of the brain, we shall be obliged 
 to admit as very probable this double opinion, namely, that the injury 
 of the intellect depends upon that of a distinct part of the cerebral mass, 
 and that the distinct part of the brain the injury of which produces de- 
 rangement of the intellect, is the cortical substance of that organ." He 
 then refers to the following cases in support of his opinions. 
 
 Case 12. Alteration of the intellectual functions without lesion of the locomotive functions ; then 
 convulsions, grinding of the teeth, loss of intelligence : death the third day. Inflammation, unth soft- 
 ening of the gray substance, arachnoiditis.^ Maintion, 43 years of age, house-painter, married, 
 entered, the 18th of November 1823, the hospital of La Charite: six years ago he left the 
 military service, and had only been in Paris two months. Since two years he had shown 
 signs of imbecility, and had completely lost all memory. Whilst he WHS a military man, 
 he had shown, at different periods, derangement of the intellectual faculties. Last year, at 
 Versailles, he had symptoms of acute meningitis: two months ago, these same symptoms 
 having re-appeared, a seton was inserted in the nape of the neck : besides, for two years he 
 has complained of constant pain of the head and at the root of the nose, with a smell of 
 putrefaction in this cavity. For a twelvemonth he has been weak in his legs. He has always 
 had a good appetite. After having taken cold baths for a month when he was in the hos- 
 pital of St. Michel, he fell in a state of great exhaustion, and experienced lipothymiae. 
 
 The 17th of November he lost his mind, had repeated attacks of convulsions, with loud 
 and unequal respiration. 
 
 The 18th, at ten in the morning, general convulsions; eyes wandering; white froth from 
 the mouth; rigidity of the limbs; sometimes grinding of the teeth and contortion of the 
 mouth ; sensibility remaining in the upper extremities, which he draws back when pinched, 
 and makes grimaces; no motion in. the lower extremities when pinched, but they are less 
 rigid than the upper. Total loss of intelligence; respiration rattling; pulse pretty strong, 
 full regular and slow. (Thirty leeches to the neck, ice to the head, sinapisms to the inferior ex- 
 trewities i a purgative enema.') The agitation continued the remainder of the day; the convul- 
 
 0p.dt f OP- oil, 0. XV. p. 88. ; !; , 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 309 
 
 sions are universal ; the face is red and tumefied, the mouth is deformed, the lips projecting 
 anteriorly. With the ice, the head is exceedingly hot ; the forearms are strongly flexed ; 
 intellect is entirely lost. He was in the same state during the night. 
 
 The 1 9th, in the morning, the right arm is almost without motion, the left alternately rigid 
 and convulsed ; eyes shut ; he shuts his jaws when he is desired to drink, and appears to 
 feel a little when the left arm is pinched very hard: slight heat of skin ; pulse 112, full and 
 regular. (Venaesect. ad xij. purgative enema, sinapisms, &c.) In the course of the day 
 the patient died in the greatest agony. 
 
 Jlutops. cadav. twenty-four hours after death. The arachnoid is adhering in eight or ten 
 places in the superior surface of the brain : in removing it, the cortical substance comes 
 away with it in pieces of about the size of a franc, and about a line in thickness ; the me- 
 dullary substance is a little injected. The left lung is a little hard posteriorly, deprived of 
 air, and somewhat hepatized. The right is red, and congested in about the same place. 
 The mucous membrane of the stomach is red in its splenic portion. All the other organs 
 are healthy. 
 
 Case 13. Alteration of the general intellect from time to time, loss of mind, stupor without 
 paralysis or convulsions ; erysipelas of the face, and death. Inflammation and softening 'of the 
 gray substance, with injection of the white substance.* Victoire, 46 years of age, was an infirm 
 patient in the hospital Saint Louis for the last two years. She was subject to attarks cha- 
 racterized by a sudden loss of mind, convulsive motions of the lips, and an embarrassment of 
 the tongue analogous to the apoplectic ; it was observed that sensibility was almost extinct. 
 At the end of four or five minutes she regained her senses ; but she remained as if it were 
 not in her power to move ; her looks were fixed, she stammered, and seemed as if she awoke 
 from a lethargic sleep. She completely recovered in about an hour. For some time her 
 courses had been irregular; eight months had elapsed since they had made their appearance. 
 During this time the attacks just described became more frequent, when she was frequently 
 bled from the foot. One day Victoire fell from a height of three feet, and greatly contused 
 her left lumbar region. She merely applied pressure to the swelling. After a time, a 
 phlegmon, which afterwards formed an abscess, made its appearance ; the abscess was 
 opened. Shortly after another swelling was formed near to the former: it was also opened; 
 but would not cicatrize. The first wound which was closed soon re-opened, and from that 
 time a very large quantity of pus escaped from this double fistulous ulcer. She was desired 
 to keep quiet ; but she began her accustomed work, and for two years nothing particular 
 occurred. 
 
 The cerebral symptoms seemed to be progressive. Victoire often complained of headache, 
 and then her face was of a dark red color; she feh some pain in her left arm, which she 
 said wanted strength. Her intellect daily got worse'; more stupefied; when spoken to she 
 looked like an idiot, and if asked whether she had heard, she would briskly answer Yes y 
 without any other emotion. She was often giddy, and she often seized things to prevent 
 herself from falling. She was losing strength, the circulation languished, the breath was foul, 
 the appetite little altered. With all these inconveniences, Victoire fulfilled her services as 
 night-nurse with an ardent zeal. Being attacked with erysipelas, she was obliged to take to 
 her bed. It was accompanied with great heat, and proceeded slowly. It was oedernatous: 
 two grains of tartar emetic produced abundant vomiting ; and after this the swelling of the 
 face abated. The secretion of the lumbar fistulas also ceased. Little attention is paid to this 
 phenomenon: three ounces of manna are ordered, which produce a few stools. The con- 
 junctiva of the right eye then suppurated, for which a blister was applied at the nape of 
 the neck. The patient complained of great pain in the hypogastrium. Manna was again 
 ordered. Nevertheless the suffering increased, and she had no sleep the next night. The 
 next, when I saw her, she was lying on the back, with the head inclined backwards, the 
 face discolored, the lips black, voice almost gone, respiration very difficult, frequent pulse, 
 skin cold. From the dyspnoea, we suspected a latent pneumonia, and then we endeavored 
 to re-establish the running of the fistulse. For this purpose a large blister was applied, but 
 without any effect, she having died at five in the morning. 
 
 Jlutops. cadav. twenty-four hours after death. 
 
 1. Cranium. The membranes were healthy, except at the superior and middle part of 
 the right hemisphere; there was a slight infiltration of the sub- arachnoid cellular tissue, and 
 the pia mater adhered at this point. The gray substance was natural, but the white injected ; 
 in cutting it, the blood flowed from the orifices of its vessels ; its consistence was not changed. 
 The gray substance, in the space of three convolutions, corresponding to the spot where the 
 membranes were altered, was of a red, mixed with a yellow color; it had lost the shining 
 appearance of the other convolutions; it was unequal, and, as it were, tubercular, and seve- 
 ral small red paints were to be seen on its surface. Its consistence was not every where the 
 
 * Op. cit., Case XVI. p. 88. 
 
310 HUMAN BRAIN. 
 
 same : the superficial layer could easily be removed by the handle of the scalpel, and seemed 
 as if it had been boiled ; the deep layer was much injected, and was nearly of the same 
 consistence as the neighboring parts. The gray substance was thinner in the extent of the 
 affection than elsewhere. 
 
 2. Abdomen. There were evident traces of chronic peritonitis. The abdominal organs 
 presented some peculiarities which it would be useless to relate here. 
 
 3. Thorax. The pleura pulmonalis of the left side strongly adhered to the pleura costalis. 
 The left lung was slightly congested posteriorly, and easily torn. The right lung was per- 
 fectly healthy. The heart was nearly in a normal state. 
 
 The two cases just related are very remarkable, because both the patients show no other 
 signs of cerebral disorder than a slight defect in the intellect. It is known that latterly MM. 
 Foville and Pinel-Grandchamp have maintained that the gray substance presides over the 
 intellectual phenomena, and the white over the movements. If their assertion is correct, 
 it follows, that in both these patients there ought to have been lesion of the gray substance 
 only: this is also what we have seen. It is true that the last patient had general convul- 
 sions : but this phenomenon evidently depended on the inflammation of the arachnoid, which 
 showed itself in the last days, and to which she fell a victim. 
 
 Case 14. Great grief ; torpor of the left arm ; a stupid and imbecile look ; alteration of in- 
 tellect ; loss of the power of speech,- death 24th day. Ramollissement of the convexity of the cere- 
 brwm, particularly of the gray substance ; albunrinous granulations, with an ash color of the sur- 
 rounding parts, and injection of the meninges.* Mary Morlet, 23 years of age, a laboring-wo- 
 man, strongly built, of a melancholic character, has been constantly fretting for about a year, 
 or since she left her native place. She is taciturn, and for some time has not spoken to the 
 women working with her ; for the last four months she has not been regular, which makes 
 her fear that she is in the family way. This idea augments her troubles. Her superior 
 extremity is now in a state of torpor, and she is taken to the Hospital Cochin, the 31st De- 
 cember, 1821. 
 
 The 1st of January, 1822, she is very much depressed, and complains of pain all over the 
 body and of torpor of the right arm, symptoms which greatly disturb the patient ; she ap- 
 pears stupid; her ideas seem fixed; her answers are not pertinent; her face is without 
 expression; the pulse small, contracted, as if convulsive; the breath slightly fretid ; skin 
 hot and dry, and there is pain in the epigastrium. (Twenty keches on the abdomen; lemonade ; 
 low diet) 
 
 No change in the following week. She appeared indifferent to all that surrounded her; 
 she seemed to be consumed by a series of dominating ideas. (Venesect, at the arm; blister to 
 the nape of the neck; demulcent drink and bouillon.') 
 
 Jan. 9. The patient answers none of our questions, and merely says Faut-il? which she 
 constantly repeats in a sad tone of voice ; the arm is paralyzed, stiff, and oedematous ; the 
 features are contracted, the forehead is corrugated; she coughs, and her respiration difficult; 
 face red, pulse frequent and irregular; the pulse consists of a series of precipitated oscilla- 
 tions, separated by very sensible intermittences ; face terreous ; nose cold and pointed . 
 (Sinapisms to the feet, which scarcely redden the skin) 
 
 The 10th. Same state. (Blister to the nape of the neck, which does not take.) 
 
 The 12th. Her physiognomy appears animated ; the features are more expanded ; she 
 seems to understand what is said to her, but makes no answer, and only says Fautil? 
 
 The 13th. Urinary and alvine excretions involuntary; sinking; eye fixed; concentrated 
 pulse, soft, slower. 
 
 The 14th. More motion of eye; expression not so sad; she smiles. 
 
 Same state till the 17th. (Arnaca; bouillon.) 
 
 The 18th. Sadness returned; eyes black and blue, sunk; same state of the intellectual 
 functions. 
 
 The 19th, 20th, and 21st. The depression increased, vomiting. (Another blister to the head, 
 which does not take) 
 
 The 22d. In the evening, profound coma; little pulse, thread-like, and frequent; respira- 
 tion plaintive and suspirious; eye widely open, fixed; foolish look, and trismus. 
 
 The 23d. Eye fixed and dull; pupils dilated, immovable; respiration noisy, rattling; 
 plaintive sighs; convulsive agitation of the left arm. ( Venestet . in the arm.) Death at three 
 in the afternoon. 
 
 Autops. cadav. thirty-six hours after death. 
 
 Encephalon. The arachnoid covering the dura mater is healthy; the surface of the brain 
 red and much injected, especially at the posterior convolutions of the right hemisphere; red- 
 ness and injection, which appear to be owing to the presence of the pia mater, the tissue of 
 which is much gorged with blood. Having removed this vascular network^ the surface of the 
 
 * Op. cit., Ca.se XYU. p, 93. 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 311 
 
 cerebral convolutions is covered by an infinite number of clots of blood ; concrete albuminous 
 granulations are spread here and thereon the convexity of the left hemisphere, and extend to 
 that part of the right hemisphere which corresponds in the middle to the great cerebral division. 
 These granulations are grouped, and, as it were, agglomerated in three principal places, which 
 are the seat of the mischief. The most extended of these groups implicates the two hemi- 
 spheres of the brain, but the left much more than the right, and it occupies the middle and 
 internal convolutions of the superior surface of this organ : there the arachnoid which adheres 
 to the brain is covered by granulations; it is opaque and thick : beneath it the cerebral sub- 
 stance is softened ; its consistence is pulpy, of a gray red color, much resembling the ence- 
 phaloid tissue, softened and combined with a certain quantity of blood. This softening ex- 
 tends about four or five lines in depth, and its longitudinal diameter is from eight to ten lines. 
 The other smaller places present the same characters; the albuminous granulations are of 
 the size of a grain of hemp-seed, and resemble the tubercles often found on the external 
 surface of the intestines. These granulations are found in the seats of the disease, so that 
 there exist at the same time softening and hardening of the cerebral substance. There is 
 here tuberculous and encephaloid-lookiug matter, evidently produced by phlegmasia. The 
 gray substance surrounding ttiese parts is of a well-marked ash-color. The lateral ventricles 
 only contain a few drops of sanguineous serum; the cerebellum and spinal marrow are 
 healthy ; the pia mater which envelops them is red and injected. 
 
 Thoracic Organs. The lungs are healthy; the pericardium distended, fluctuating; it ex- 
 tends as far as the right side of the chest, and contains from six to eight ounces of lemon- 
 colored serum. The heart, swimming in this fluid, is not at all changed; its right cavities, 
 gorged with blood, are a little dilated. 
 
 Abdominal Organs. The stomach and small intestines are in a normal state ; there are a 
 few ulcerations in the large intestines. The uterus is healthy. The tissue of the tube and 
 ovaries is red and as it were erectile : the fimbriated extremity of the tubes adheres to the 
 ovaries, on which it (if I may use the term) is grafted. 
 
 In this last case the softening had proceeded slowly ; the phlegmasia had certainly been 
 a chronic one, whilst in the preceding cases it had proceeded in a very rapid manner, and 
 the inflammation in general had been of an acute kind : we find the same thing in the fol- 
 lowing case related by M. Avoyrie : 
 
 Case 1 5. Cephalalgia ; furious delirium ; convulsions alternating with a state of collapse : 
 death. Arachnitis, with softening of the cortical substance of the cerebral hemispheres* A. Ma- 
 hon, 30 years of age, of a sanguineous biliary temperament, having got drunk, fell from a 
 first story, the 1st of January, 1846. No serious mischief arose immediately after the acci- 
 dent; he lost a little blood from the left ear, and cephalalgia supervened, which continued; 
 but on the fourth day it greatly augmented: on that day, towards evening, he was seized 
 with violent delirium, and was admitted into the Hotel Dieu, where he was tied to prevent 
 his getting out of bed. At the end of the night he suddenly fell into a state of drowsiness. 
 The fifth day the drowsiness was so great that nothing could rouse him ; the face, a little 
 pale, had a gloomy appearance; the eyelids were shut; in separating them the eyes were 
 directed to the right side ; the head was inclined to the same side, and if this position was 
 changed, it was immediately regained; the jaws were firmly shut; the pulse slow but full; 
 the patient now and then agitated his arms, and sighed frequently. Neither the cranium 
 nor the other parts of the body showed any trace of contusion. (Infusion of Roman chamo- 
 mile with tamarinds ; blister to the nape of the neck ; sinapisms to the knees.') Drowsiness dimi- 
 nished during the day, without the return of the intellectual faculties ; in the evening furious 
 delirium appeared at intervals. The 6th, in the morning, delirium had ceased; drowsiness 
 not so great. He now and then opened his eyes, but soon shut them again : he moved his 
 limbs, but he constantly sighed ; the eyes were still directed to the right, and the jaws shut, 
 the face a little discolored. ( Three leeches on each side of the neck, and cupping-glasses on the 
 tvounds.') The patient was sensible of the application of the cupping-glasses, and had no de- 
 lirium in the night. The seventh day, in the morning, very nearly the same state; some- 
 times the eyes were open for a length of time, but without sight. (Hydromel; tamarinds; 
 ice on the head ; sinapised fomentations.') In the evening he began to sink, and continued so 
 till the morning at six, when he died. , 
 
 Autops. cadav. The cerebrum was disorganized in many places on its superior surface, 
 and there were collections of blood between the pia mater and the arachnoid. This disor- 
 ganization, which was only superficial, was rather deep in the posterior part of the posterior 
 lobe of the left side; all the encephalic mass was red, yellow at some parts, and very soft. 
 The lateral ventricles, extraordinarily dilated, contained a large quantity of serum. All the 
 other parts of the body were healthy. 
 
 The symptoms in this case did not indicate the existence of an acute inflammation of the 
 
 *..i - ' ' - ' ' 
 
 * Op. cat., Case XVIII. p. 98. 
 
312 HUMAN BRAIN. 
 
 arachnoid ; but you see that the phlegmasia is not confined to the meninges, since the corti- 
 cal substance of the superior convolutions of tbjC brain was disorganized in many places, with 
 very considerable injection. The intellectual disorder must be attributed to the irritation of 
 the gray substance which accompanies inflammation of the arachnoid. You are aware that 
 MM. Parent and Martinet have shown, by a great number of facts, that delirium corre- 
 sponded to inflammation of that portion of the arachnoid which covers the convexity of the 
 brain, which tends to confirm the opinion of those who think that the intellectual faculties 
 reside in the gray substance of the convolutions. 
 
 Case 16. Contusion of the cranium; no remarkable cerebral symptoms the first days, then 
 furious delirium ; coma ; death the 20th day. Abscess in the gray substance of the convexity of the 
 cerebrum; inflammation and disorganization of the arachnoid* Antoine Broussart, 65 years of 
 age, having experienced great losses in commerce, and being reduced to great misery, gave 
 himself, on the 6th of January, in the morning, many blows on the head with a hammer; 
 but not succeeding in killing himself, he takes a bad pair of scissors, seizes the right testicle 
 with the left hand, and removes it with the scissors. This furious fellow is mastered, and 
 is taken to the hospital La Charite. On the road he tried, but in vain, to strangle himself. 
 On his arrival the surgeon who was present observed about the line of union of the parietal 
 bones with the frontal, a considerable tumor, which he opened by a crucial incision, to allow 
 the extravasated blood to escape, and to ascertain whether there was any fracture. The 
 next day, the 7th, M. Roux examined the wound, and stated that there was no fracture, and 
 had it dressed in the ordinary way, as well as that of the scrotum. (Low diet, petit lait erne- 
 tise.) The 8th, no accident has occurred. The following days the patient was getting bet- 
 ter, when the wound of the head, which till then had secreted a large quantity of pus, began 
 to get dry. The 20th he fell into a state of coma; his pulse became hard and quick, his 
 skin exceedingly hot; an ichorous matter flowed from the nostrils. To this, furious delirium 
 supervenes; the patient jumps out of bed, threatens his neighbors, wishes to fight them, 
 when he is seized by two nurses, who replace him in bed and tie him to it. He expires in 
 a quarter of an hour. 
 
 Jlutaps. cadav. The dura mater, which is thickened, is covered by a yellow false mem- 
 brane, and on its internal surface are a few black tubercles ; the pia mater is equally thick- 
 ened ; the arachnoid is nearly altogether disorganized, especially between the convolutions 
 of the cerebrum, which are bathed with pus ; the superficial layers of this part are softened, 
 and in a state of suppuration : there is nothing else worthy of remark.f 
 
 This case confirms what we have already said, viz., that a circumscribed lesion of the 
 gray substance has no direct influence on the movements of tho extremities. Effectively, 
 the patient rises in a furious state the day of his death, threatens to maltreat his neighbors, 
 and cannot be kept quiet until he is tied. On opening the cranium, an abscess was found, 
 terminating in the gray substance of the brain. As to the delirium, the agitation, and the 
 fever, they are accounted for by the phlegmasia of the arachnoid. 
 
 Case 17. Slow answers ; alteration of the intellectual faculties ; a species of idiotism, without 
 paralysis or convulsions of the extremities ; death the 31th day. Two large abscesses, occupying 
 the middle of the cerebral hemispheres.^ A soldier, twenty six years of age, brown, robust, 
 and sanguineous, was in the military hospitals of Pan in November, 1813. At his arrival 
 he said he had been unwell for fifteen days; but, his ideas being confused, this statement 
 could not be relied upon, and he could give no exact account of the phenomena of the inva- 
 sion. He was tranquil, scarcely answered, the eyes wide open, with a stupid look, and he 
 complained of nothing. He could get up to ease himself. His face was much colored, 
 especially the cheeks; tongue red, abdomen painful on pressure, the skin extremely hot to 
 the touch, pulse rather slow, pretty full and developed, appetite fair. 
 
 After ten or twelve days he appeared to be convalescent; but the stupidity and quietude 
 remained. He seldom answered, and with much brevity ; he frequently refused to get up, 
 but frequently sat up in bed, and looked stupidly at that which was going on about him. 
 He only spoke when he wanted something to eat, or to satisfy some other want. At the 
 end of five or six days the heat and frequency of the pulse re-appeared; diarrhoea then 
 came on, and the febrile action subsided. The torpor increased, the wants were no longer 
 known, and he died, without convulsions, the twenty-second day of his arrival, and the 
 thirty-seventh of the invasion, according to his account. 
 
 dutops. cadav. Head. Two large places filled with greenish pus, sticky, and inodorous, 
 each occupying the middle of one cerebral hemisphere, not communicating with the lateral 
 ventricles, but surrounded by a white cyst, formed of a sort of concrete pus easily broken 
 up ; with this a considerable injection of all the encephalori. 
 
 * Op. cit., CaseXXTI.p. 116. 
 
 t This case was reported by Dr. Hennelle, then house student at the hospital of La 
 Charit& J Op. cit., Case XXVI. p. 128. 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 313 
 
 u If we take into consideration these facts," says M. Bouillaud, " which might be multiplied 
 ad infinitum ; if you remark, besides, that tho.se physicians, who have recently employed 
 themselves in the study of mental alienation, have remarked that it was always accom- 
 panied with a disorganization more or less deep of the cortical substance of the superior 
 convolutions of the brain ; if you reflect, lastly, that, as has been truly observed by MM. 
 Parent and Martinet, delirium is connected with inflammation of that portion of the arach- 
 noid which covers the convexity of the brain you will certainly be very much disposed to 
 agree with the opinion of MM. Fovel and Pinel-Grandchamp, which places the seat of in- 
 telligence in the cortical substance of the superior part of the brain." 
 
 I quite agree with Dr. Abercrombie that it is impossible to separate 
 inflammation of the arachnoid and pia mater, either in diagnosis or in 
 treatment; but I may again add also, that it is impossible to separate 
 inflammation of these membranes from that of the hemispherical ganglion 
 or cortical substance of the brain. 
 
 Dr. Abercrombie employed the term meningitis to express the disease, 
 meaning thereby inflammation of the arachnoid, or pia mater, or both, 
 as distinct from inflammation of the dura mater. 
 
 Andral* says that most of the lesions of which medical men place the 
 seat in the arachnoid are really diseases of the pia mater. In almost all 
 the cases, for instance, where the convexity of the cerebral hemispheres 
 was covered with a layer of serum or pus, this layer had its seat beneath 
 the arachnoid ; on passing the back of the scalpel over the latter mem- 
 brane, the morbid product is displaced, but not removed. However, 
 whilst we admit that in the diseases designated by the name of arachnitis, 
 or more properly meningitis, anatomy discovers lesions in the pia mater 
 much more frequently than in the arachnoid, still we should not assert, 
 as some writers do, that the arachnoid always remains unaffected. 
 
 Dr. Abercrombie considered the phrenitis of systematic writers in- 
 flammation of the membranes of the brain. " It is characterized," says 
 this admirable observer, " by fever, watchfulness, acute headache, im- 
 patience of light, suffusion of the eyes, and maniacal delirium. This 
 affection, however, is seldom met with as an idiopathic disease, except 
 in a few cases in which it is brought on by the abuse of strong liquors, 
 and in warm climates by exposure to the intense heat of the sun. As a 
 symptomatic affection, it is met with occasionally in fever, and in ma- 
 nia ; and a condition nearly allied to it sometimes occurs after injuries 
 of the head. Circumstances will be afterwards mentioned, which ren- 
 der it probable that in this form of the disease the inflammation is prima- 
 rily seated in the membranes of the brain. When fatal, it is generally 
 by a rapid sinking of the vital powers supervening upon the high excite- 
 ment, without producing much disorganization of the parts which appear 
 to have been the seat of the disease ; for the cases which are referable 
 to this class, when they terminate fatally, are generally rapid in their 
 progress, and the appearances on dissection are often unsatisfactory. 
 There is an affection of frequent occurrence, which, perhaps, maybe re- 
 ferred to this head. It is characterized by a peculiar aberration of mind 
 without any complaint of pain. There is a remarkable restlessness, 
 quickness, and impatience of manner, obstinate watchfulness, and inces- 
 sant rapid talking, the patient rambling from one subject to another with 
 little connection, but often without any actual hallucination ; he knows 
 
 * Clinique M&Ucale Trans., by Spillan, p. 42. 
 
 .' *" 
 
314 HUMAN BRAIN. 
 
 those about him, and generally answers distinctly questions that are put 
 to him. There is a rapid pulse, but without the other symptoms of 
 fever, and the disease is apt to be mistaken by a superficial observer for 
 mania, and consequently to be considered as not attended with danger. 
 But it is an affection of very great danger, and often rapidly fatal. The 
 nature of it is obscure, and the appearance of it on dissection rather 
 unsatisfactory ; it consists chiefly of a highly vascular state of the pia 
 mater, without any actual result of inflammation." 
 
 We cannot, I think, ascribe the mental disturbance, excitement, ex- 
 cessive pain, intolerance of light, delirium, and insanity, which have 
 been observed as the diagnostic marks of inflammation of the arachnoid 
 and pia mater, to a simple lesion of either a serous or vascular mem- 
 brane ; we are compelled to refer them all to the injury which that por- 
 tion of the brain that is in contact with these membranes has received 
 from inflammatory action. 
 
 Bayle,* in his admirable work on diseases of the brain, strongly sup- 
 ports the opinion that inflammation of the arachnoid is characterized by 
 mental alienation. 1st, he states distinctly and broadly that " most 
 mental alienations are a symptom of chronic primary phlegmasia of the 
 membranes of the brain." He also draws an important distinction be- 
 tween inflammation of the arachnoidea reflexa, or that lining the dura 
 mater, and the arachnoidea investiens, or that in contact with the pia 
 mater and covering the brain. The first he calls chronic or latent 
 arachnitis, the second chronic meningitis, because it affects both arach- 
 noid and pia mater. 
 
 Bayle considers that a certain number of monomaniacs and melancho- 
 lic patients have primarily derived the disease from a deep and durable 
 lesion of the moral affections, and to a ruling error which controls more 
 or less the will of the patient, and becomes the basis of an excessive de- 
 lirium. But he says, U I am far from saying that matter has no influ- 
 ence in the development of these species of derangement. I do not 
 speak of their origin, which is purely mental ; but we shall see that in 
 certain hereditary and constitutional predispositions, these mental de- 
 rangements produce upon the brain and its appendages certain effects, 
 which in their turn become a cause of certain symptoms, and that thus 
 there is a re-action of the moral on the physical and of the physical on 
 the moral." 
 
 This accords with the affection which I have described as inflamma- 
 tion of the hemispherical ganglion from within as distinguished from 
 meningitis. 
 
 Bayle considered that some very rare alienations depend on a specific 
 or sympathetic irritation of the brain. If Bayle means that any mental 
 alienation exist without a temporary or permanent morbid concretion of 
 the capillary system of the brain, I do not agree with him. 
 
 The more I have seen of the post-mortem appearances which are left 
 in cases of mental derangement, the more I am convinced that each 
 form has its respective lesion, though I am far from pretending that they 
 have been all discovered. The signs of meningitis during life are varied 
 and obscure. 
 
 * Trait^ des Maladies du Cerveau et de ses Membranes, par A. L. Bayle, 1826. 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 315 
 
 Parent Duchalelet and Martinet* divide the stages of arachnitis into 
 three. The first is generally manifested by an exaltation of sensibility, 
 from whence arises cephalalgia, one of its most constant characters. 
 When it is seated at the base of the brain, there is frequently a tendency 
 to drowsiness, which may give place to nausea and vomiting ; generally 
 there is some fever. The stage of excitement is very variable in its 
 form, according to the age of the patient, the part that is inflamed, the 
 constitution and the degree of sensibility of the subject of it. Its dura- 
 tion varies from some hours to one, two, three, or four days ; sometimes 
 it is prolonged up to two weeks, but this is rare, and the symptoms are 
 then very vague and uncertain. The patients are in a mixed state of 
 health and disease. When this occurs, it is generally in weak cachectic 
 persons, or in infants. 
 
 The second period is a true period of reaction, accompanied with 
 disturbance of the muscular system, corresponding to that of the brain, 
 convulsions, delirium, agitation, contractions, oscillation, and the com- 
 mencement of dilatation of the pupils. In this period the headache is 
 less constant than in the first. This period is usually the longest in its 
 duration, varying from two, three, or four days up to one or two weeks. 
 It presents some differences according to its seat. Inflammation of the 
 arachnoid at the base and in the ventricles is almost essentially combined 
 with convulsions, agitation, affection of the globe of the eye, while 
 that on the convexity or the upper part of the hemispherical ganglion is 
 characterized by delirium. 
 
 The third period is the shortest in its duration, varying from some 
 hours to three or four days, rarely prolonged beyond this. It is the period 
 of collapse, of the abolition of the senses, a loss of movement, local and 
 general paralysis, coma. At this period it is difficult to distinguish posi- 
 tively the existence of simple arachnitis. My own observation corre- 
 sponds with the above authors in the general characters of these symptoms, 
 especially in the distinction between the symptoms which attend lesions 
 at the base of the brain and in the ventricles, from that which accompany 
 inflammation of the upper part of the ganglion. But I do not think they 
 have laid sufficient stress on the mental excitement. 
 
 Dr. Neisserf remarks very justly that the symptoms of effusion are 
 sometimes marked by the excitement of the brain resisting the oppres- 
 sive effect of the extravasated fluid, so that there is a sort of balance 
 between the symptoms. 
 
 AndralJ bears his testimony to the constancy of lesions of intelligence 
 accompanying meningitis ; such lesion presenting itself either under the 
 form of delirium or coma. The delirium may present the greatest varie- 
 ties with respect to its nature ; in some it is very violent, accompanied 
 with loud cries, and a great development of muscular strength. In others, 
 on the contrary, it is of a silent description, and the patients appear very 
 
 * Recberches sur I'lnflammation de l'araoh d . cerebral et spinal, ouvrage fait conjointement. 
 Paris, 1821. 
 
 f Die Acute Entziindung der Sercisen Haute des Gebirns und Rtickenmarks nacb eigenen 
 Beobachtungen am Krankenbett Gesclirieben. Von Pr. Joseph Neisser, Prakt. Arzt. zu Ber- 
 lin, 1845. 
 
 j P. 56, op. cit. 
 
 
316 HUMAN BRAIN. 
 
 ^ 
 
 much prostrated in strength. Sometimes one single idea engages the 
 mind of the patient ; sometimes ideas of the most heterogeneous descrip- 
 tion occupy his thoughts. In some this disturbance of intellect attains 
 its highest degree from the very commencement; in others it comes on 
 gradually and insensibly. On reviewing in each case the numerous 
 varieties of form which the delirium presented, we might arrive at this 
 important conclusion, that no single one of these various forms charac- 
 terizes meningitis, that there is not one of them which may not be found 
 in the different cerebral irritations which are purely sympathetic, and 
 unaccompanied with any structural alteration of the membranes appre- 
 ciable on the dead body. 
 
 When once the delirium has developed itself, it may not cease, pre- 
 senting merely alternations of exacerbation and remission ; it may also 
 be only transitory. There are some patients in whom this disturbance 
 of the intellectual faculties is but of very short duration; then at the end 
 of a period more or less long, it returns; the intermissions become more 
 and more short, and at last the disturbance becomes continued. In some 
 the delirium commences only at night, and the clearness of the intel- 
 lect during the day seems, at first, to exclude the idea of meningitis 
 altogether. In some, a delirium of several days' duration suddenly 
 disappears a little before death, when the other symptoms become 
 more aggravated. Wherefore, when it is attempted to distinguish the 
 delirium produced by meningitis from the delirium produced by sympa- 
 thetic irritation of the brain, it is wrong to lay it down that the latter 
 only can be intermittent, for numerous cases prove, beyond all doubt, 
 that delirium arising from meningitis may be accompanied with perfectly 
 lucid intervals. The period of the disease at which the delirium appears 
 is far from being the same in every case. Very rarely this phenomenon 
 marks the outset of the malady ; so that, in the midst of health, when 
 delirium does suddenly come on, it is not at all probable that it is depend- 
 ent on meningitis. In the great majority of cases, pain of head precedes 
 it; and oftentimes six, eight, twelve, and even fifteen and twenty days 
 pass on between the period at which the pain of head presents itself 
 and that at which the intelligence commences to be disturbed. 
 
 Andral considers that the diversity of the lesions of intelligence in 
 meningitis can only be accounted for by referring to the differing sus- 
 ceptibility of the brain to impressions. 
 
 My reason for dwelling so fully on these symptoms of mental excite- 
 ment as indicative of inflammation of the hemispherical ganglion, is the 
 belief that the condition of the intellectual faculties is not sufficiently 
 attended to as part of our chain of evidence when we attempt to diag- 
 nose affections of the brain. 
 
 We may next consider the various causes which induce meningitis 
 or inflammation of the hemispherical ganglion, (and in using the term 
 meningitis I do so for its brevity,) and the symptoms and circumstances 
 which are peculiar to these varieties. 
 
 Concussion of the Brain. In both a practical and a physiological 
 point of view all injuries of the skull, as productions of meningitis, are 
 especially interesting; almost every case presents some new and peculiar 
 feature worthy of attention. For beautifully as nature has protected 
 
CONCUSSION OF THE BRAIN. 317 
 
 the brain, the bony case which has been contrived for this purpose 
 cannot be seriously injured without some disturbance of the organs con- 
 tained within it. And we find in practice that all injuries of the skull 
 occasion more or less derangement of the intellectual faculties. 
 
 After what has been stated regarding the connection between the in- 
 tellectual faculties and the cortical substance of the upper portion of 
 the brain, we shall be prepared to observe the effect produced by any 
 serious injury to the textures which are placed in such close contact to 
 this organ. 
 
 The most frequent consequence of a severe blow on the head is con- 
 cussion of the brain. Inasmuch as this injury frequently leads to in- 
 flammation of this organ, it will be well now to consider its symptoms. 
 
 Simple concussion or shaking of the brain obliterates, for a longer or 
 shorter period, according to the degree of violence, the mental pheno- 
 mena which are exhibited during a state of health. The patient who, 
 a moment before, was in complete possession of all his mental faculties, 
 receives a violent blow on the head, and in an instant loses his con- 
 sciousness, and lies dead to the world around him. This result we sup- 
 pose to depend on the particles of neurine, of which the brain consists, 
 being put into a state of vibration, an effect which interrupts for a time 
 the natural functions of the organ. 
 
 The state of insensibility sometimes continues only for a few minutes ; 
 in other cases it will last for some days, the patient remaining in a kind 
 of sleep, insensible to ordinary stimuli ; the eyes, for instance, may be 
 opened in a moderate light, and he will not apparently be aware of the 
 presence of any one; but if a strong pencil of rays be thrown upon the 
 iris it will contract, to prevent too many impinging upon the retina, and 
 he will perhaps turn his head away from the light. A conversation 
 may be kept up by his bedside without disturbing him ; but if he is 
 called loudly by his name he gives evidence that he is aware of the cir- 
 cumstance. As recovery gradually takes place, the patient will answer 
 questions, but incoherently, evidently neither understanding their im- 
 port, nor able sufficiently to collect his thoughts to give a particular 
 answer. If the case proves favorable, these symptoms disappear by 
 degrees, the patient recovers, and no traces of the accident remain. 
 If, however, inflammation supervene, another train of symptoms makes 
 its appearance, and then the consequences are generally fatal. 
 
 No one who has once observed a case of concussion can doubt that 
 the intellectual faculties are dependent in some way or other on the 
 brain ; but at the same time it is clear that, in a physiological point of 
 view, this is the whole amount of evidence furnished. 
 
 It is extremely important in all cases of concussion to be very early 
 alive to the symptoms which indicate the commencement of meningitis. 
 Of all effects of inflammation on the human frame this is most to be 
 dreaded. We cannot be too much on our guard to prevent its intrusion, 
 or too careful in our endeavors to distinguish the symptoms which indi- 
 cate its approach. When once set up it is difficult to arrest, and when 
 arrested it too often leaves behind it consequences which are felt for the 
 remainder of life. In cases of injury to the skull, the surgeon so much 
 
318 HUMAN BRAIN. 
 
 more frequently observes the effect of injury to the brain as a whole, 
 than merely to the membranes primarily and the hemispherical ganglion 
 secondarily, that he is more in danger of overlooking such symptoms 
 than the physician, whose attention has been directed to this disease in 
 its idiopathic form. 
 
 When inflammation follows concussion of the brain, it is more usually 
 inflammation of the substance and the lining membrane of the ventricles 
 than of the cortical substance, and the whole train of symptoms are de- 
 cided and unequivocal from the first ; but sometimes the effect of the 
 concussion passes over quickly, and the patient is considered out of 
 danger; but after a few days meningitis supervenes in such an insidious 
 manner, that it is overlooked by the friends, the services of the medical 
 man not being, as they suppose, any longer required. 
 
 I believe that the origin of many cases of insanity might thus be traced 
 which might have been prevented if the first symptoms had received the 
 attention which they deserved. 
 
 The following case is peculiarly interesting and instructive in this 
 point of view : 
 
 Case 18. James Coker, a lad, set. 14, was admitted into St. Thomas's Hospital, May 9th, 
 1846, under Mr. Solly, with general symptoms of concussion. About five o'clock in the 
 afternoon, while working as a bricklayer's laborer, on some scaffolding at Woolwich, he 
 slipped, and fell from a height of seventy feet. He fell across a piece of timber, first strik- 
 ing the lower portion of the abdomen and afterwards his head. Mr. Denne, surgeon, of 
 Woolwich, who saw him a few minutes after the occurrence of the accident, states, that he 
 was insensible, pale, cold, and almost pulseless. Warmth was applied to the body, a slight 
 stimulus given, and when reaction had sufficiently taken place, he was sent up to the 
 hospital. 
 
 On admission he was partially insensible, answered when spoken to, but in a snappish 
 way, barely answering the question put to him; pulse somewhat accelerated, and fuller 
 than natural; pupils dilated, but sensible to light; skin moist; there was a considerable 
 swelling on the left groin, and tenderness in that region. Ordered, by the house surgeon, 
 cal. gr. iij. stat. Hirud. xij. inguini sinistro. 
 
 May 10th, 9 A.M. Has passed a restless night, but is more sensible; pulse 100, pupils 
 dilated, countenance pinched, legs drawn up in bed, crying out as though in pain, swelling 
 in the groin much diminished. Ordered Hyd. c. creta gr. iij. stat. Head to be shaved, 
 Hirudines iij. sing, temporibus; a patient was required to sit by his side to keep him in bed. 
 
 May 10th, 9 P.M. When Mr. Solly paid his visit to-night, he found him in the following 
 state: His countenance pinched and anxious, refusing to answer any questions, making use 
 of bad and violent language, and very noisy, disturbing the whole ward. Pupils dilated, 
 contracting sluggishly to the light of a candle, right rather more dilated than the left. He 
 could not detect any local injury of the head, and the patient said he had no pain there. 
 There was some tenderness over the abdomen ; he moved his left leg about a good deal. 
 
 His extreme irritability and restlessness, and his semi-conscious state, led Mr. Solly to think 
 that some inflammatory action was commencing in the hemispherical ganglia. Ordered, 
 calomel gr. i. quaque hora, donee alvus soluta sit. postea duabus horis. Hirud. xx. capiti 
 applicand. 
 
 May llth, 8 A.M. Not much change has taken place; he has been very restless during 
 the night ; his bowels have not been relieved. Still continues violent, obstinate, abusive, and 
 uses most vile language. 
 
 The calomel to be continued, and thirty leeches to be applied to the head. 
 
 l P. M . His bowels have been freely opened, and a large quantity of solid feculent 
 matter voided. 
 
 g p. M . I s a little better, more conscious, and quieter, bowels purged, mercurial stools, 
 pulse jerking 144, right pupil rather more dilated than the left. Kept. Hirud. xxx. 
 
 Hyd. c. creta gr. ij. Ext. Aconiti gr. i. Pulv. Doveri gr. ij. 4ta quaque horl 
 
 May 12th. Has passed a better night; quieter, and not so violent, irritable or abusive; 
 in answer to a question, says he is nicely, better, that he has no pain in the head ; appears 
 to suffer pain in the abdomen, but does not say so. Emp. Lyttae abdomini Ung. Hydrarg. 
 Fort, for dressing. 
 
CONCUSSION OF THE BRAIN. 319 
 
 1 P.M. Sleeping; head rather hot; hands cool ; cries out occasionally without any appa- 
 rent reason ; when asked why does not know. If any pain answers no. Cold lotion 
 to be applied to the head. 
 
 10 P.M. Much better, quieter, and more sensible. 
 
 May 13th, 8 A.M. Sleeping quietly, rested well during the night, pulse 116, soft; when 
 he awoke he said, Oh, give me somebody to take care of me ! When asked why because 
 I feel so queer ; if he had any pain in the head or abdomen said he did not know. He 
 recognized Mr. Solly, but soon dozed off again. 
 
 14th. Sleeping; when he awoke, said he was quite well; rambling; head very hot; 
 tongue furred; pulse 124. Hirud. xx. capiti. Discontinue the Dover's powder and increase 
 the Hyd. c. creta to gr. iij. 
 
 Vesp. Much the same, pulse 120. 
 
 15th. Pale; has been excessively irritable during the night, but not incoherent; much 
 purged; stools bright yellow; pulse 116, irregular, not much power. Pulv. Ipec. Co. gr. iij. 
 4ta honL 
 
 7 P.M. Quieter than usual ; during the day less purged. Pulse 124. 
 
 loth. Much the same; pulse 120. 
 
 1 7th. Improved in appearance, talkative, but still irritable in temper ; appears to enjoy 
 his food; pulse 116; bowels regular; tongue cleaning. 
 
 18th. Much better; countenance natural; pulse 104. 
 
 19th. Complains of pain over lower part of belly. Kept. Emp. Lyttae. 
 
 20th. Free from pain; countenance much the same; pulse 130. 
 
 21st. Better in every respect; wishes for more food, and to get up; pulse 110. 
 
 30th. Is up to-day; complains only of weakness. 
 
 June 15th. He was presented to-day, quite well. It was quite striking the difference in 
 his language and manner. His language, instead of being rude, foul, and abusive, \vas civil, 
 respectful, and correct ; his manner quiet, instead of being excited and snappish. I have 
 no doubt whatever, that if the case had not been treated as one of inflammation of the 
 hemispherical ganglion, but had been passed over because there was an absence of the 
 usual symptoms of serious injury to the head, the boy would soon have been decidedly in- 
 sane, and then the same measures would have been comparatively useless. It cannot be 
 too often repeated that, when once the delicate texture of a ganglion is in an acute stage of 
 inflammation, it soon becomes disorganized, and all medical treatment is unavailing. 
 
 The following short case illustrates very well the ordinary course of 
 a case of simple concussion of a slight character, though the primary 
 effects were so severe that the existence of the patient was in danger : 
 
 Case 19. Wm. Johnson, a?t. 30, gardener's laborer, stout, hearty looking man, was driv- 
 ing his master's cart in Bishopsgate-street, December 18th, 1841. The day was cold, and he 
 had been drinking spirits in the morning: when attempting to make some alteration in the 
 harness, he fell from the shaft, pitching on his head ; the wheel went over his pelvis as he 
 lay on the ground. I was sent for to see him a few minutes after the accident, in Mr. 
 Beale's surgery, Bishopsgate. He was then quite insensible, pulse slow and distinct, totally 
 unconscious of everything. On examination of the head, I found a spot about the size of a 
 crown, over the superior posterior angle of the left parietal bone, puffed and swollen, but no 
 irregularity of surface indicating fracture. There was much bruising over the right ilium, 
 showing the course of the wheel, without any fracture of the pelvis. I sent him down 
 immediately to the hospital. I saw him there again half an hour after the occurrence of 
 the accident; he now shows some signs of returning intellect by endeavoring to articulate 
 his wife's name, and crying, from a half consciousness of his situation, but he could not 
 utter any distinct articulate sounds, and soon sunk into a quiet insensible state again. Or- 
 dered Pulv. Jalap, c. Hyd. Chi. gr. xv. stat. M. S. C. 6ta hora postea. Hirud. xx. capiti, if 
 his pulse got up in the evening, and the dresser thought he required them. 
 
 Dec. 19th. Quite rational; vomited about two hours after I left. Sister considers he re- 
 jected some of the powder; bowels open; leeches not applied. Repeat the powder, and 
 as he complained of some pain on the left side of the head, ordered Hirud. xx. stat. 
 
 20th. Quite well ; permitted him to leave the hospital. 
 
 The following case from Mr. Abernethy shows the more serious effects 
 of concussion : 
 
 Case 20. W. Thomas, about 30 years of age, fell from the top of a brewhouse, a height 
 of at least 80 feet. His hand being stretched out, first sustained the shock, by which the 
 
320 HUMAN BRAIN. 
 
 carpal bones were separated, and driven upwards, some before and others behind the ends 
 of the radius and ulna ; the articular surfaces and periosteum being at the same time forced 
 off the latter bones. I mention these particulars to show the great violence of the fall. 
 The man's head afterwards struck the ground, as appeared by a bruise on his face ; but the 
 cranium was not injured. When brought to the hospital, he appeared almost deprived of 
 life, his body being cold and his pulse scarcely to be felt. The gentlemen then attending 
 put his feet into warm water, and gave him an opiate. After this he gradually became 
 warmer, and it was observed that there was not much dilatation of the pupils, and but little 
 stertor in respiration. I saw the patient next morning, at which time his skin was very 
 hot, and he perspired copiously. His breathing was repeated at regular intervals, but the 
 expirations were made with unusual force. The pulse was extremely irregular, both in 
 frequency and in strength ; generally about 140 in a minute. His pupils were moderately 
 contracted, his eyebrows drawn into a frown, as if he suffered pain. When I spoke to him 
 softly, he did not answer. ^1 pinched his hand slightly, but he did not move ; but when I 
 repeated this a little harder, he drew it away with seeming vexation. He disliked that his 
 eyes should be examined. When, by speaking loud, I roused him, and inquired if his 
 head ached, he answered yes. I got him to swallow some opening medicine, which emp- 
 tied his bowels; and four leeches were applied to his temples, but they extracted very little 
 blood, and I thought his pulse countermanded any further evacuations. 
 
 In the afternoon he appeared better. His pulse was more regular, and his skin of a more 
 natural temperature ; his pupils, however, were more contracted, and his sensibility increased. 
 I tried the effect of giving him forty drops of tinct. opii, thinking it might diminish sensibi- 
 lity, and keep him quiet for some time, during which the vascular system (which seemed to 
 be particularly deranged) might, perhaps, regain its powers. The opiate increased his dis- 
 position to sleep, and he appeared to suffer less pain; but in the evening his pulse was more 
 feeble and frequent, and his skin hotter, and quite wet with perspiration. Wine was now 
 given to him, but without any apparent benefit; the powers and. actions of life gradually di- 
 minished, and before morning he died. 
 
 On dissection there appeared every mark denoting violent inflammation of the brain and 
 pia mater. The minute arteries of the pia mater were turgid with blood ; in many places 
 there was the appearance called blood-shot, which was also to be seen in the lining of the 
 ventricles. Dark colored, and, in some places, bloody, coagulated lyrnph filled all the re* 
 cesses between the tunica arachnoidea and the pia mater. On dividing the substance of the 
 brain, all its vessels appeared as if injected with blood. 
 
 I am inclined to believe that the medical treatment of the patient did him neither much 
 good nor harm. The means employed seem to have acted on him as on a person in health. 
 The opening medicine rendered him cooler, and quieted a little the disturbed actions of the 
 system. The opiate made him more still, and disposed him to sleep. 
 
 I leave it to practitioners to consider whether cordials would have been of any service in 
 this case. Would they not rather, by stimulating the nervous system, have increased the 
 disturbance of the sensorium, and by exciting the heart and arteries, have tended to aggra- 
 vate the inflammation of the brain ? 
 
 This case is a good illustration of the consequences of concussion 
 when the disorder is uncontrolled by surgical treatment. Reasoning 
 from what I have seen in other cases, I cannot but think that if the 
 patient had been freely depleted locally and mercurialized, as soon as 
 44 his pupils became more contracted," he might have recovered. 
 
 I regard this condition of the pupils, taken conjointly with a hot skin, 
 as a very clear indication of the commencement of inflammatory mis- 
 chief. 
 
 I regard the administration of opium in such a condition as decidedly 
 injurious. 
 
 Fractures of the skull more frequently than mere concussion lead to 
 meningitis; the inflammatory action passing continuously from the bone 
 and its periosteum the dura mater, to the arachnoid and pia mater. 
 
 The following case marks well the train of symptoms which I believe 
 indicate inflammation of the hemispherical ganglion, consequent on frac- 
 ture of the skull. 
 
INFLAMMATION OF THE DURA MATER. 321 
 
 Case 21. Betsey Rankin, get. 18, was admitted into St. Thomas's Hospital, under my care, 
 as Mr. Travers' assistant, April 20, 1841. 
 
 She walked down to the hospital with her mother, and came to the surgery as a casual 
 patient. Her mother stated that she had been thrown out of a swing at Greenwich fair, a 
 month previously to her admission; that she was stunned at the time, and has suffered se- 
 verely from pain in the head since; but she was not considered severely injured. At the 
 time she presented herself, she exhibited an unnaturally excited appearance of the eye; but 
 her answers to questions were perfectly rational, though her manner was rude and abrupt. 
 
 One of my colleagues happening to see the case immediately after she was in bed, before 
 I came into the ward, and believing it to be his own, cut down upon an irregularity, which 
 he found upon the surface of the skull; the pain of the incision made her very violent and 
 disgustingly abusive in her language. The incision permitted the escapeof some coagulated 
 blood; the division of the temporal artery gave rise to a free haemorrhage of about eight 
 ounces. It exposed a fracture extending horizontally through the parietal to the frontal bone, 
 and another running perpendicularly from the above. 
 
 11 p. M. Same day. Still very violent and abusive in her language when spoken to, 
 otherwise quiet and dozing; tongue foul; pulse quick. I explained to the sister of the ward 
 that her violent language was to be considered as a symptom of disease, and that everything 
 was to be effected by a soothing system and by kindness. This was scarcely at first under- 
 stood; but my directions were most fully carried out, and their value afterwards thoroughly 
 appreciated. When I saw her, I ordered Mist. Sennas Comp. stat. Hyd. Chlorid. gr 1 . ij. 
 quaque tertia hora. 
 
 21st. Bowels freely opened; last evacuations watery. Her manner is still excited; but 
 she expresses herself much relieved, adding, in a sharp tone, that she only wanted to be left 
 quiet. On account of the diarrhoea, I ordered the calomel to be discontinued, and Hydr. c. 
 Creta gr. iij. 6ta quaque hora. 
 
 22d. As the bowels are now quiet, ordered the calomel to be renewed; she is rather 
 more rational. 
 
 23d. Bowels relieved, but not purged; complains of pain in her head, which is un- 
 naturally hot. Ordered twelve leeches to be applied, if the sister could persuade her to have 
 them on ; but not to use any violence. 
 
 24th. The leeches were applied without much difficulty ; her head is relieved, and she 
 is dozing nearly the whole day. 
 
 27th. I made, by Mr. Travers' direction, an incision at right angles to the original one ; 
 this caused her to be very angry and violent. 
 
 28th. Better. 
 
 29th Much better; says that she has very little pain in the head, and no heat; ordered 
 a little fish. Her conduct and manner to-day were quiet, natural, and well-behaved. I 
 found her in the middle of the day sitting up in her bed, knitting. 
 
 May 1st. As she was not quite so well to-day, exhibiting some of her previous excited 
 manner, and fearing return of the inflammation, I ordered, as I did not think her constitu- 
 tion would bear any more calomel, aconite gr. ij. t. d. Hirud. xij. 
 
 8th. Pil. Hydr. gr. v. ter in die. Quite rational ; says her head is quite well, the wound 
 healthy and discharging freely. 
 
 llth. I ordered her sarsaparilla and the blue pill to be given twice, instead of three 
 times a-day. The aconite was also omitted, from there not being any more ready at the 
 shop. 
 
 12th. Exceedingly violent and excited about her mother; ordered Hirud. xij. The effect 
 of the leeches was very decided, and sleep soon followed their application. 
 
 13th. Manner not so quiet or natural as previous to the omission of the aconite ; ordered 
 to resume the aconite. 
 
 This last medicine was continued, with small doses of blue pill, until the 29th, when she 
 was dismissed quite well. Her manner was modest and unassuming, and she expressed 
 herself exceedingly grateful for everything that had been done for her in the hospital. 
 
 The surgeon often witnesses inflammation of the dura mater, seldom 
 as an idiopathic, or spontaneous disease, but generally either the con- 
 sequence of syphilis or of local injury. 
 
 Dr. Watson* considers that the dura mater may be inflamed while the 
 pia mater remains unaffected ; and that the arachnoid may suffer inflam- 
 mation and leave the subjacent pia mater untouched. Whether the 
 arachnoid ever escapes participating in the inflammation of the dura 
 
 * Lectures, Med. Gaz., vol. xxvii. p. 17Q. 
 
 21 
 
322 HUMAN BRAIN. 
 
 mater on the one side, or the pia mater on the other, is to be doubted. 
 41 But it seems to me scarcely possible that inflammation of the pia mater 
 should take place without implicating also the surface of the convolu- 
 tions." 
 
 I agree with Dr. Watson in his opinion regarding inflammation of the 
 dura mater; but I doubt that the investing portion of the arachnoid is 
 ever inflamed without the pia mater being more or less implicated, and 
 with it the hemispherical ganglion. I have long felt convinced that 
 there is no such thing as inflammation of the pia mater independent of 
 the brain, and that much mischief has accrued from our systematic 
 writers treating of inflammation of the membranes of the brain as dis- 
 tinct from inflammation of the brain itself, instead of distinguishing be- 
 tween inflammation of the hemispherical ganglion, the tubercular portion 
 beneath, and other cerebral ganglia. 
 
 Dr. Watson, in his lectures,* relates the following case, which une- 
 quivocally illustrates his opinion that inflammation of the dura mater 
 may be confined to it, and the reflected portion of the arachnoid, and 
 not extend to the pia mater or brain. 
 
 Case 22. A man came to the hospital to have a small incised wound of the scalp looked 
 at. The injury appeared trivial ; the cut was dressed, and the man made an out patient. 
 A few days afterwards he came again perfectly paralytic on one side of the body. I saw 
 the man's skull trepanned ; he was perfectly calm and collected : that part of the dura 
 mater that corresponds to the wound was inflamed, and there was pus effused over the 
 arachnoid, covering the cerebral convolutions on the same side. He sank quietly into a 
 state of coma, and so died. Not the slightest incoherence or delirium had been mani- 
 fested ; there had been no convulsions, nor was there any other morbid appearance within 
 t he cranium. 
 
 Inflammation of the dura mater sometimes occurs continuously from 
 the petrous portion of the temporal bone and the lining membrane of 
 the internal ear; and sometimes without any disease of the bone, it ex- 
 tends along the sheath of the auditory nerve. This affection is not un- 
 common among the poorer classes and those whose diathesis isstrumous. 
 It occurs more frequently in childhood than in either adult, or old age. 
 Its progress is very gradual and insidious. The knowledge that such a 
 consequence may result from otitis or inflammation of the internal ear, 
 should make us very careful in our treatment of this affection, and very 
 guarded in our prognosis. I have found that the best treatment in such 
 cases, is to use very mild and unstirnulating lotions, and even these very 
 carefully ; counter-irritants behind the external ear, and anti-strumous 
 medicines, of which none are equal to the cod-liver oil. 
 
 I remember having a case of chronic otitis under my care at the 
 Aldersgate-street Dispensary for some weeks, without being able to 
 effect any improvement until I gave her the cod-liver oil. She recovered 
 rapidly with this medicine, and the discharge disappeared without any 
 local treatment. 
 
 The subject of the following case I saw only a few days before her 
 death, but it illustrates the insidious and fatal character of the disease. 
 
 Case 23. Otitis terminating in abscess of the cerebellum. Phoebe Whittington, aged 5 years, 
 had had an occasional discharge from the ear ever since her birth ; but the mother yays, that 
 she was always a very lively, healthy-looking child, and never appeared ill until seven days 
 
 Med. Gaz., vol. xxvii. p. 771. 
 
INFLAMMATION OF THE DURA MATER. 323 
 
 previous to my seeing her, at which time the discharge stopped, and she then complained of 
 ear-ache. 
 
 I first saw her on Wednesday, the 17th ; she then looked pale and in pain, but not diseased. 
 I discovered a small fluctuating turner behind the right ear, over the temporal bone, about 
 the same size as the external circumference of the ear. The skin was not discolored. The 
 head was violently drawn back, and the sufferings of the child were evidently very great. 
 I opened the swelling with a lancet, but I had to divide it very deeply to reach the matter, 
 as no absorption of integument had taken place. The pus was excessively foetid. I ordered 
 a simple aperient. The following day, finding the child but little relieved, I ordered her 
 small doses of gray powder with a slight sedative ; but she remained in great pain, screaming 
 violently till about twenty hours before her death, when she became comatose, and died just 
 ten days after the invasion of these fatal symptoms. 
 
 Post-mortem. Cerebrum presented no morbid appearance ; layer of pus under the ten- 
 torium; abscess in the cerebellum; thickening of the neurilemma of the auditory nerve, 
 whole sheath filled with pus; dura mater covering the posterior face of the petrous portion 
 of the temporal bone separated from it by pus. The surface of the bone not carious, only 
 denuded. 
 
 The abscess formed a thick layer on the centre of the right lobe of the cerebellum, occupy- 
 ing, in a horizontal plane, nearly the whole of the outer circumference of that lobe, and ex- 
 tending across the mesial line a little way into the left lobe. The neurine round the abscess 
 was not altered in color for more than a line or two at the most. 
 
 Labyrinth of the ear filled with pus, and the whole disorganized. 
 
 I considered that this case was originally one of inflammation of the lining membrane of 
 the ear, which extended along the neurilemma of the nerve to the cerebellum, inasmuch 
 as the temporal bone was not diseased, nor the dura mater covering it. 
 
 Inflammation of the dura mater may spring from syphilis in two ways; 
 first, and most commonly, as a continuous inflammation from a diseased 
 cranium ; secondly, from the direct action of the poison, as in other fibrous 
 tissues and periosteal membranes in other situations : in the latter instance 
 it assumes much of the rheumatic character, and requires to be treated 
 like rheumatism in other parts of the body, only more actively. 
 
 In considering the hyperaBmic affections, and the effects of hypersemia 
 of the dura mater, we must not omit osseous deposits. The dura mater, 
 it must never be forgotten, is the nutritive membrane of bone. Its ves- 
 sels sometimes, like vessels in other situations sometimes, overdo their 
 duty, and the bone is deposited in small patches. This deposit is not 
 confined to that portion which lines the skull, but it is not unfrequently 
 found on the falx and tentorium. It always acts more or less as an irri- 
 tating body. 
 
 Case 24. When dressing for Mr. Travers, in 1823, a man was brought under my care 
 who cut his throat in a watch-house. He died; and when we were making an examination 
 of his head in the dead-house, on mentioning that he had been an extremely irritable, violent- 
 tempered man during life, frequently illustrating the old line, " Ira furor brevis est, : ' Mr. 
 South said, " look particularly at his dura mater, and see if there are any osseous deposits." 
 In this case there were rough bony deposits on the falx major. 
 
 Since then I have frequently remarked the same connection between 
 this morbid growth and mental irritability amounting to insanity. The 
 following is one among many others which I might detail : 
 
 Case 25. J. L. had been peculiar in his habits and manners during his whole life, but 
 latterly it became necessary to place him in an asylum, from the sudden outbreaks of violent 
 temper over which he apparently had no control. In the intervals between the paroxysms, 
 which were very uncertain, he was rational, though latterly he became rather imbecile. The 
 paroxysms were easily excited by any slight circumstances which annoyed him. 
 
 He sank more apparently from the effect of the intestinal than the cerebral disease. 
 
 Post-mortem, 24 hours after death. Weather cool March 1839. 
 
 Skull. External appearances. Supra-orbitar region fully developed, frontal region rather 
 small, occipital and posterior parietal full and large. 
 
324 HUMAN BRAIN. 
 
 The bones generally much thinner than usual, especially in the frontal and temporal 
 regions. 
 
 Dura Mater. External surface healthy ; ossific deposits on its visceral surface. These 
 were three in number, situated very near to the longitudinal sinus on the right side; the 
 most anterior of which was situated opposite the coronal suture, about the size of a large 
 pea, but with sharp, irregular-pointed edges ; the next, about an inch behind, the form 
 of the letter Y, about an inch in length, an eighth of an inch wide, very rough ; the pos 
 terior patch was much like the anterior. 
 
 Cerebro-spinal fluid in very large quantities under the arachnoid. The convolutions 
 on the upper part of the anterior lobes slightly atrophied, their surfaces pinched up, and 
 the fossae wide. 
 
 Cerebellum full and large. 
 
 In tearing off the pia mater, portions of the hemispherical ganglion were removed with 
 it, in consequence of some softening of its texture, more particularly in the neighborhood of 
 the osseous deposits. 
 
 Three layers of cineritious neurine were distinctly visible in this ganglion. The external, 
 the darkest ; the middle, the lightest in color ; the most internal, the next in tint to the 
 external. The white fibres, running through them, were beautifully distinct. 
 
 Chest. Viscera healthy. 
 
 Abdomen. Flatulent distension of the colon ; ulceration of the mucous membrane of the 
 ilium, close to the ilio caecal valve. 
 
 The extreme thickness of the skull, which is not unfrequently met 
 with in insane patients, must be regarded as the result of long-continued 
 and general hypersemia of the dura mater. 
 
 The spiculse of bone which are found sometimes shooting from the in- 
 ternal surface of the skull, though scarcely coming into this category, 
 deserve mention here. There is generally an abnormal development 
 of normal projections ; we meet with them not unfrequently springing 
 from the temporal and parietal bones in the temporo-sphenoidal fossae. 
 I have seen them in cases where they have evidently lacerated the brain 
 after a severe blow has been struck on the skull. The brain, in such 
 cases, is shaken violently and moved within the skull, so that the sharp 
 projecting spiculum is jerked out of the fossa in the brain in which it 
 lies quietly at rest, and lacerates the brain on the side. The following 
 case illustrates this, and also organic disease, in connection with which 
 subject, I shall again have occasion to refer to it. 
 
 The anterior and posterior clinoid processes are not unfrequently so 
 abnormally developed that they act as irritating extraneous bodies. They 
 have frequently been considered as the proximate cause of epilepsy, and 
 they have certainly been often found diseased in this formidable com- 
 plaint. I had the opportunity of making a post-mortem examination in 
 the following case, through the kindness of my friend, Mr. Ebenezer 
 Smith, of Billiter Square. 
 
 Case 26. E. W., aged thirty-two, suffered from epilepsy since she was twelve years of 
 age. The first attack followed a blow on the back part of the head, occasioned by a fall ; 
 latterly the fits occurred very frequently, four or five times in the night, with an occasional 
 interval of four or five days. Her temper was excessively irritable, and her mind had gra- 
 dually become imbecile. She died during the fit, apparently in a state of asphyxia. 
 
 Post-mortem. Sub-fascial cellular tissue of the cranium abnormally vascular and firm. 
 Bones of the skull vascular, compact, and thick, particularly at the centres of ossification 
 in the frontal and parietal bones. 
 
 The frontal bone in the mesial line thin. Vessels of the dura mater enormously dis- 
 tended; bled very freely on separating it from calvarium. Arachnoid slightly opaque. 
 Vessels of pia mater very full of blood. Fossae digitate between the convolutions in the 
 parietal and frontal regions large ; cerebro spinal fluid abundant. Cortical substance of the 
 cerebellum rather darker than usual; the medullary more vascular; the whole rather soft. 
 On making a section of the centrum ovale, we were struck with the distinctness of the line 
 
INFLAMMATION OF THE DURA MATER. 325 
 
 of demarkation between the cortical and medullary substance, both of which were very- 
 vascular ; softening of the fornix. Choroid plexus large, and almost fleshy. In the right 
 temporal sphenoidal fissure we found an abnormally developed mammillary process, about 
 the sixth of an inch in length, sharp at its point, but wide and broad at its base, projecting 
 like a spine from the squamous portion of the temporal bone ; and on the middle lobe 
 of the brain, corresponding to this projection, there was distinct softening of the cortical 
 substance. 
 
 No other cavity examined. 
 
 Inflammation of the dura mater must always be treated actively. If 
 it is not arrested in an early stage, it soon runs on to the other mem- 
 branes, and thence to the hemispherical ganglion. Sometimes it stops 
 short of the brain, but causes fatal effusion from the arachnoidal surface. 
 
 The following shows the disease advancing from syphilitic affection 
 of the cranium. I had the case under my care in Job's Ward, St. 
 Thomas's Hospital. 
 
 Case 27. The patient, named Hawkins, had not long been suffering from secondary 
 syphilis. He had been in the house some months before he came under my care. He had 
 necrosis from nodes of portions of the frontal and parietal bones, but without any symptoms 
 of cerebral disease, or even irritation. 
 
 I happened, however, to remark to the pupils, that such cases were not unattended with 
 danger, as inflammation of the dura mater, arachnoid, arid pia mater, sometimes suddenly 
 supervened, and that the patient would then sink from such effusion ; about two days after 
 this I was called to him, in consequence of his becoming drowsy and stupid : when I arrived 
 I found him not quite insensible, but scarcely able to answer any question when roused, and 
 when left undisturbed, he was in a semi-comatose condition. I immediately ordered five 
 grains of calomel every four hours, a blister to the back of the neck, and to be dressed with 
 the strong mercurial ointment; he got rapidly worse, and soon became quite insensible ; but 
 in twenty-four hours the mercury began to take effect, and it was most delightful to see the 
 rapidity with which the cloud was again removed from his intellects ; in forty-eight hours 
 he was sensible enough to answer questions, and ultimately quite recovered. It was also 
 interesting to observe an immense improvement in all his syphilitic symptoms. His nodes 
 became healthy, and some large rupial sores which he had on his thighs and legs began to 
 heal, and progressed most favorably. Previously to this attack, he had been taking the iodide 
 of potassium and sarsaparilla, and a generous diet. 
 
 Inflammation of the dura mater, followed by fatal effusion, sometimes 
 arises from traumatic necrosis of the cranium. 
 
 Case 28. On the 19th of January, 1843, a seaman, of the name of John Richardson, was 
 admitted into Abraham's Ward, St. Thomas's Hospital, under the care of Mr. Tyrrell. He 
 was 34 years of age; he had an extensive sore on the forehead, at the bottom of which 
 there was a large piece of blackened dead bone. The appearance presented was so cha- 
 racteristic, that I had a drawing made of it immediately. 
 
 He stated that he had received a blow on the forehead, from a piece of log-wood, when 
 in the ship's hold, six years previous to his admission ; he was stunned by the blow, and had 
 not been fit for much hard work since. On admission, he complained of pain in his head, 
 but there were no symptoms of any cerebral mischief. 
 
 The treatment during the short time he was in the hospital, for he only survived seven 
 days, was alterative medicines internally, and poultice to the wound. 
 
 On the evening of the seventh day after his admission, a sudden change took place, the 
 discharge from the wound stopped, and the offensive smell ceased ; he became insensible, 
 and sank, quite comatose, about five the next morning. 
 
 There was no raving, no delirium, slight muttering, as if he were scolding somebody. 
 From the commencement of these symptoms he was never sufficiently conscious to answer 
 any questions. 
 
 No post-mortem examination. 
 
 I have seen in the venereal wards of our hospital rheumato-syphilitic 
 inflammation of the dura mater pass on to the brain and produce in- 
 sanity. The following case is a good illustration of it, and the, value of 
 active treatment : 
 
326 HUMAN BRAIN. 
 
 Case 29. Henry Glazier, set. 25, a bricklayer, of unhealthy aspect, pale complexion, and 
 spare frame of body, was admitted under my care, as Mr. Green's assistant, into Job's Ward, 
 on the 1st of February, with iritis and secondary eruptions, for which calomel and opium 
 were administered, so as to affect the mouth, and he rapidly improved. He appeared to be 
 in his usual good health till Wednesday, when the sister observed something sharp in his 
 manner, and a wild expression of countenance. The same morning he left the ward with- 
 out his hat and coat, and remained out the whole of the day, the weather being very cold 
 and wet; he returned in the evening, and complained of pain in all his limbs; it was found 
 that his knees and ankles were swollen and red; he passed a sleepless night, frequently 
 changing his position in bed, and occasionally crying out with a loud voice. On the follow- 
 ing day the joints were free from all swelling; the man, however, when questioned as to 
 pain, complained of headache ; the expression of his countenance was vacant, wild, and 
 suspicious; he said that he had committed some crime, and that he ought, therefore, not to 
 lie in bed, and it was with difficulty that he could be prevailed upon to do so ; he refused to 
 take any nourishment or medicine, but he answered questions that were put to him quite 
 correctly, though during the day he was sometimes so obstinately silent that no answers 
 could be elicited from him. The pulse was quick, but soft and compressible ; the tongue 
 furred and moist ; the heat natural ; the bowels open ; no intolerance of light or sound. I 
 told the pupils that I considered the man was suffering from inflammation of the mem- 
 branes of the brain, caused by metastasis from the sudden recession of rheumatic inflamma- 
 tion. 
 
 It appears that the habits of the patient have always been regular and temperate ; none 
 of his family have suffered from insanity. He was ordered Pulv. Jalapse c. Cal. )j. M. S. 
 C. Liq. Amm. Acet. ^fs. Vin. Colchici TT^xl. Mag. Carb. ) j. Aq. Menth. Pip. 6''" horis. Vene- 
 sectio ad ^viij. Cal. gr. v. 4 tlS - horis. 
 
 28th. On the following day he was quiet and composed ; he no longer refused to take his 
 food or medicine, and he said the headache was better. The same afternoon, however, the 
 symptoms returned, and he was inclined to be violent. The bowels had acted freely. 
 
 Ordered Emp. Lyttse nuchse. Ung. Hydrarg. 
 
 B. Aconite gr. j. Hyd. c. Greta gr. v. 6''" horis. 
 
 Morphise Hydrochlor. gr. j. o. n. 
 
 Ext. Colchici. gr. iij. 6 tis - horis. 
 
 March 1st. Appears to-day quite comfortable; the countenance is nearly natural, and he 
 passed a good night; he makes no complaint. 
 
 4th. He has continued improving daily since the last report ; he now appears to be per- 
 fectly rational, and he sleeps well. 
 
 Ordered Hyd. c. Creta gr. ij. 6 tls - horis. Beef tea, Vin. Colchici TT^xx. 
 
 No change occurred in this patient's progress ; he perfectly recovered, and went out quite 
 well. 
 
 I have no doubt that chronic inflammation of the dura mater is a very 
 frequent cause of insanity. The skull is so frequently found thickened 
 and vascular, as well as the arachnoid, after death in these cases, that 
 the condition of the skull should always be noted in seeking for morbid 
 lesions to account for irritation of the hemispherical ganglion. 
 
 I have selected the two following cases from many which I inspected 
 at Hanwell. The facts are interesting in a phrenological point of view, 
 though of course they prove nothing unless they are supported by many 
 such cases. It has not fallen to my lot to observe others in support of 
 the phrenology of the subject, but I give these, as I recorded them at 
 the time. 
 
 Case 30. Thickness of the os frontis producing melancholia. Hanwell, March 2d, 1841. 
 Death from fever supervening on melancholia, during which the patient was almost con- 
 stantly crying and moaning ; she could v only make incoherent replies. During the febrile 
 excitement she occasionally gave distinct answers, and protruded her tongue when re- 
 quested. 
 
 History of case unknown. 
 
 Post-mortem. 28 hours. Body much emaciated. 
 
 Cranium exceedingly thick in the frontal region, especially over the organs of mirth ful- 
 ness, ideality, and hope, where it was nearly a quarter of an inch in thickness, as proved by 
 perforating it with a gimlet, and measuring the section. The rest of the skull was slightly 
 
INFLAMMATION OF THE DURA MATER. 327 
 
 thicker than natural, especially the anterior portions of the parietal bone, as shown by the 
 great depth oi' the arterial ibs^ae. 
 
 Brain. Fibrous neurine more vascular than natural. Cineritious substance of the ante- 
 rior convolutions decidedly darker than natural, and much more so than the posterior. 
 
 Weight of brain and cerebellum, 2 Ibs. 13 oz. 
 
 Lung. One tubercle, in the lower portion of upper lobe of right lung. 
 
 Liver. Peritoneal covering slightly thickened by white deposit. Pancreas firmer than 
 usual. 
 
 Remarks. I consider that in the preceding case, the disease commenced with chronic in- 
 flammation of the dura mater, covering the anterior part of the brain, producing, as in ordi- 
 nary cases of periostitis, gradual thickening of bone, and that the thickened bone, pressing 
 on the organs of ideality, mirthfulness, and hope, and partially on the reflective organs also, 
 gave rise to the peculiar form of insanity melancholia. The absence of all appearance of 
 maniacal excitement was to be accounted for by the absence of all appearance of inflamma- 
 tion of the arachnoid and pia mater. It is very much to be regretted that there was no 
 early history of the case, either as regards the probable cause of the disease or its progress. 
 
 The following case, derived from the same source, appears to me 
 confirmatory of this view : 
 
 Case 31. Han well, April 1st, 1841. John Buckingham, set. 48. Insane ten years Men- 
 tal imbecility supervening on anxiety. 
 
 Post-mortem. 37 hours. 
 
 Head. Skull generally thick at the anterior part ; arterial fossse numerous and rather 
 deep. In the centre of the frontal bone it was two-filths of an English inch in thickness (4 
 French lines). Dura mater strongly adherent to the skull. 
 
 Brain. Cortical substance pale, softening of that portion of the longitudinal commissure 
 called the septum lucidum. 
 
 Weight of cerebrum and pons, 3 Ibs. 6 oz. Cerebellum and medulla 6 oz. 
 
 Death from excited hydrothorax, atrophy of right ventricle of heart, disease of liver. 
 
 Sometimes these cases are most obstinate and obscure. 
 
 Case 32. I had under my care a poor fellow, in the venereal wards of the hospital, 
 whose sufferings were excessive. When 1 first prescribed for him I did so under the belief 
 that he had this form of inflammation, but finding that all the remedies which I have ordi- 
 narily found successful in the treatment of these cases, such as mercury, leeches, and the 
 iodine of potassium, entirely fail, I thought T must have mistaken the case ; and as there 
 were no cerebral symptoms, I ventured to prescribe for him such medicines as are benefi- 
 cial in neuralgia, but without any improvement. Having failed in all my endeavors to alle- 
 viate his sufferings, I got one of our physicians kindly to take him under his care, who sali- 
 vated him most freely ; but he kept getting worse, at last becoming paralyzed on one side 
 of his face, and totally deaf. The disease, however, stopped here. He did not lose his in- 
 tellect, or become more paralytic. 
 
 Among the causes of inflammatory affections of the brain we must not 
 omit the poison of scarlatina. 
 
 Sometimes the brain is attacked in the first instance, before the erup- 
 tion appears; and sometimes, the eruption not appearing at all, the na- 
 ture of the case is misunderstood. I knew one family in which three 
 children were carried off, in the course of a few days, with cerebral 
 symptoms, which could not be accounted for until the fourth child ex- 
 hibited the true eruption of scarlatina. In these cases depletion must 
 not be attempted, but everything to determine the poison to the skin. 
 
 The sequelae of scarlatina are, however, every now and then most for- 
 midable in relation to the brain. Every practitioner has seen these 
 cases. The patient is apparently recovering from a mild attack of scar- 
 latina, when suddenly he is seized with headache and blindness, with or 
 without convulsions. These symptoms may have been preceded by the 
 anasarca which frequently follows scarlatina, and on that account, says 
 Dr. Abercrombie, " are apt to be ascribed to sudden effusion in the 
 
328 HUMAN BRAIN. 
 
 brain ; but the disease is entirely inflammatory, and the patient can be 
 saved only by the most vigorous treatment, by blood-letting, purgatives, 
 and other similar remedies." It should, indeed, be borne in mind that 
 all the sequela of scarlatina are inflammatory ; the anasarca quite as 
 much so as any other. 
 
 Inflammation of the Hemispherical Ganglion from within. There is 
 perhaps no single cause which so frequently produces inflammation of 
 the hemispherical ganglion or meningitis as sudden emotion, whether of 
 joy or fear. The latter is, however, much more common. Dr. Aber- 
 crombie and Andral relate several cases.* The remedial treatment 
 should be physical, though the cause is metaphysical; moral treatment 
 alone will not arrest inflammatory action. 
 
 The pathological state must not be lost sight of on account of the 
 metaphysical state. 
 
 When inflammation of the hemispherical ganglion is excited by moral 
 impressions, the existing cause of the attack travels through the nerves 
 of sense from without inwards, centripetally. It ought to be distin- 
 guished from those attacks which are induced by external causes, such 
 as those w r e have just been considering. 
 
 The following cases will illustrate what I mean by inflammation of 
 this ganglion from within inflammation induced by impressions carried 
 to the brain by the nerves of sense, giving rise to unnatural and undue 
 action of the organ. 
 
 In the second of these two cases I believe that the inflammation was 
 of a very low and feeble character, not confined to this ganglion, but 
 extending to the tubular substance and lining membrane of the ventri- 
 cles, and accompanied by some serous effusion. 
 
 Case 33. Inflammation of hemispherical ganglion produced by fright. On the 2d of June, 
 1842, I was called by Mr. Wildbore, of Shoreditch, to visit Miss E. R, who was suffering 
 from cerebral symptoms. I found her lying in bed; countenance pale and anxious; pupils 
 dilated, and sluggish to the stimulus of light. When I first inquired if she had pain in the 
 head, she said no; but after she had raised herself and lain down again, she complained of 
 violent pain; pulse 84, and small; head hot; tongue furred, but not dry; understands what 
 is said to her, but answers slowly. 
 
 History. She was a nervous person when in health, and naturally rather irritable and ex- 
 citable. She went to Greenwich fair unknown to her parents, and therefore concealed her 
 illness. When at the fair she was suddenly pushed by a stranger to make her run down 
 the hill. She fell, was not hurt, but much frightened, and made excessively angry. She 
 was menstruating at the time. She continued to cry and sob hysterically for seven or eight 
 hours afterwards, and for three weeks she seemed to brood over it, getting gradually worse. 
 She would not complain ; but her sister remarked that her head was drawn back. When 
 asked why she did so, she said it was so heavy. She also became silly in her expressions, 
 excessively irritable, sullen, and taciturn. She said that when her head was on the pillow, 
 she could not raise it again ; she also complained that everything she saw became double its 
 size, and fiery; when lying in bed she would scream out that she was falling. 
 
 Considering from the symptoms and previous history, that the case was one of meningitis, 
 we ordered Hydrarg, proto-iodide gr. j. and a large blister with 60 leeches to her head. 
 
 2d day, ^ past 9 A.M. Has not slept much during the night; complained a good deal of 
 her head; pupils very much dilated; anxious when spoken to, but every now and then 
 jumps up, and cries out, as if frightened; complains of her head, and pain in the ball of the 
 eye; says to those about when speaking in their ordinary tone, "Don't holloa so;" shows 
 immense muscular power in her arms. Emp. Lytta? to be dressed with mercurial ointment, 
 and as there was difficulty in getting her to take pills, we substituted Hyd. bichlorid. gr. 
 T l ff 4 ti8 hor. in mint water. Hirud. xx. to the head. 
 
 Dr. Prichard (op. cit., p. 371) makes some interesting obseivations on this subject. 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 329 
 
 10 P.M. Has been much quieter, and apparently more easy, after the application of the 
 leeches. 
 
 The same principle of treatment was carried out, and she ultimately recovered, but it was 
 ten weeks before she was well, and her memory has been deficient ever since. She did 
 not menstruate for four months. 
 
 Case 34. Nervous fever succeeding to natural labor, after many days' congestion of the brain 
 supervening, unth probable effusion. C. J. B., a-t. 30, the wife of a medical man in the coun- 
 try, was delivered of her fourth child, January 2d, 184-, after an easy and natural labor 
 of six hours. The child was large, and she being, to use a common and well-understood 
 term, constitutionally weak, her husband gave her, towards the completion of delivery, 
 about an ounce of sherry in a little hot water, at short intervals, the effect of which stimulus 
 was obvious in expediting the expulsion of the head. 
 
 Having lost by death her preceding infant at the age of eleven weeks, from some con- 
 genital defect in the organs of circulation, she was now. and had been heretofore, acutely 
 anxious about the welfare and survival of the present child. Her former nurse, a decided 
 favorite, had been ailing for some weeks, and it had been doubtful whether she would be 
 able to wait upon her at this period. On this point the patient had been solicitous, more for 
 the child's sake than her own, as she naturally enough believed that no other person could 
 take the same care, or do equally well. The nurse, however, now attended, much to her 
 patient's delight. 
 
 The after pains were more severe than before, and for this reason the liquor opii sed. was 
 given, and repeated more frequently, together with some hyoscyamus and morphia, during 
 the two first days. They did not, however, succeed in procuring much, or good, sleep, and 
 induced a numbness in the hands and face, which rather alarmed so timid a patient. With 
 this exception, and the circumstance of there being (as on the two last similar occasions), 
 considerable relaxation of skin, evinced by copious and warm perspiration, everything went 
 on as satisfactorily as could be desired for three days immediately following her delivery. 
 Some little mental disquietude was yet perceptible, at the nurse displaying signs of severe 
 illness. Lactation was, nevertheless, very good, as also was the lochial discharge; and ape- 
 rient medicine had, to all appearance, its proper effect upon the bowels. The child was 
 very healthy, and afforded no cause for extra attention. 
 
 We now arrive at a particular point of our patient's history. Early on the fifth day the 
 nurse announced to her that she was compelled, from increasing infirmity and suffering, to 
 give up her situation. This, in the patient's own words, "gave her quite a turn." The best 
 substitute that could be found was obtained, but she was a woman of inferior intelligence, 
 and wanting in the art of pacifying the child as readily as her predecessor. Not being also 
 similarly expert in the various little offices incidental to the lying-in chamber, and those 
 which the patient requires from her monthly attendant, she failed at first to inspire much 
 confidence; and it may be here added, that she gave no better satisfaction afterwards. No 
 bad consequence was, however, yet observable; for during the three or four subsequent days 
 the patient began to take light animal food and broths, as she had usually done one day 
 partaking of partridge, another of pheasant, and the third of hare, whilst on the tenth day 
 she was allowed about ^iv of porter, and a mutton chop; of the latter she ate scarcely half, 
 but enjoyed her porter. During the intermediate days (from the fifth, namely to the tenth) 
 she had not slept well, disturbed partly by the child's crying, but excited rather from this 
 circumstance, by want of confidence in the fresh nurse, which feeling had been gradually 
 growing upon her, although the cause was really more in her own fears than from incapa- 
 bility on the part of the woman. 
 
 On the 15th of January, this state of nervous irritability had much increased, every cry 
 of the child seeming to aggravate it, so that the nurse and child were removed to another 
 room, but without ultimately producing any improvement in the matter. All matters con- 
 nected with the uterus were quite satisfactory. There was no abdominal or hypogastric 
 tenderness. The lochial discharge was naturally subsiding, but had not ceased altogether. 
 The milk was certainly diminished, but not more than might have been expected from the 
 diminution of nutriment, in consequence of the total loss of appetite which had ensued. She 
 both experienced and expressed great fatigue in nursing the child, which, as was to be ex- 
 pected, was not satisfied. 
 
 After this period, anorexia persisted, along with nausea and tendency to sickness, and 
 there was considerable derangement in the excretions from the bowels. One or two grains 
 of calomel, carried off by half-ounce doses of senna mixture (her ordinary quantum), brought 
 away, in seeming plenty, disordered stools to the amount of four or five each time. Still, 
 the impression was strong upon her mind that the bilious matters required more calome). 
 The pulse had varied from 110 even to 140, evidently kept up by mental, or more properly 
 nervous, excitement. The perspirations had subsided, but an undue temperature of the skin 
 complained of, which was also sensible to the touch; the tongue exhibited posteriorly a 
 
330 HUMAN BRAIN. 
 
 rough white fur, though not thick; some thirst; there was frequent headache, not of long 
 continuance, attended by a feeling of faintness. She had taken no sustenance besides gruel 
 and tea, with a very small quantity of bread and butter, or biscuit; as other substances, even 
 weak broth, gave rise to most unpleasant heat, in addition to their being loathed. Under 
 these circumstances, I prescribed the Hydr. c Greta, gr. viij ; with gr. v. of Pulv. Rhaei. One 
 dose of these she took on the morning of the 16th, but failing to operate by the evening, it 
 was then repeated: this also producing no effect, on the following morning half an ounce 
 of black draught was quickly succeeded, as before, by seven or eight evacuations of a foul 
 and offensive character. The slight indolence of the bowels just mentioned disconcerted 
 her not a little throughout the 16th, and then excessive action next day, conjoined with this 
 disturbance of mind, manifestly depressed, still further, her reduced strength. The nervous 
 symptoms previously marked were also aggravated. These were, deficiency of memory, 
 great anxiety, and timidity regarding her own state of health, though not expressed at the 
 time, yet plainly indicated by countenance, manner, and watchfulness, but not what could 
 be called restlessness, nor was there any complaint of want of sleep ; she expressed herself 
 rationally. 
 
 January 18th. The nervous irritation was unrelieved, as likewise the concomitant febrile 
 excitement. The bowels had been freely acted upon by saline aperient medicines, but dur- 
 ing the day she made complaint of pain and sense of obstruction at the lowest part of the 
 sacrum, accompanied by endeavors at expulsion, as if there was some lodgment in the rec- 
 tum. An enema of plain warm water was used in the evening, and some softened scybala 
 passed in the night at three different times. She was much alarmed by the passage of these. 
 But the enema, when repeated on the following morning, brought nothing further away, save 
 the small amount of mucus adhering to the bowels. 
 
 About the middle of this day (the 19th) she felt suddenly more faint, and twice expressed 
 the fear that she was dying; nervous symptoms much the same, and general debility such as 
 to oblige her being carried out of and into bed, during the few minutes occupied^in making 
 it up. For the last two days she was unable to nurse the child, not unwillingly on her part, 
 as the exertion was too great for her, and the breasts had become more and more empty. 
 Indeed, for these reasons, the child had been gradually, and by longer intervals, kept from 
 the mother, and, being healthy and thriving, gave rise to no anxiety; of course, the breasts 
 were now relieved artificially of their contents. 
 
 Ordered Magn. Sulph. ^i. Liquor Amm. Acet. ^iij.Sp. JEtheris. Nit. Zi. Mist. Carnph. ^vj. 
 6 tu - horis. Also a night draught, containing, in addition to the above, nve grains of Dover's 
 powder. v ^*n 
 
 This latter procured an excellent night's rest, and in the morning (20th) the pulse had 
 fallen from 110, and upwards, the day previous, to 84, was soft and compressible, and con- 
 tinued so throughout the day. She complained of nausea and headache, and refused her 
 morning tea, but the manner was nearly natural again, and she spoke of herself as much 
 better than she ever expected to be; the bowels were freely moved, but the secretions too 
 dark and offensive ; nourishment was obviously required, and towards the latter part of the 
 day more was taken than for several preceding days, in the shape of arrow-root and gruel, 
 in the last of which, she had, at two different times, altogether nearly t ^fs. of brandy. Not- 
 withstanding this, there existed much confused sensation in the head, the sequel of the morn- 
 ing headache, not severe, and nausea, resulting, in her opinion, from the anodyne ; the latter, 
 of which she expressed a great horror, was not repeated at night, as she felt inclination to 
 sleep, and did sleep naturally from eleven to three. 
 
 21st. At the last-mentioned hour she awoke with intense pain in her head, but did not 
 send for her husband till seven o'clock. He found her more excited than ever, and most 
 apprehensive about herself; the pulse was again above 120, but not hard or full, though 
 certainly approximating to these characteristics for the first time ; tongue as before ; thirst 
 rather urgent; considerable heat of skin; general expression of countenance anxious, espe- 
 cially indicated by the eye. Supposing the present pain to be still referable to the opiate, 
 and the bowels not being so fully opened during the last twelve hours, the saline draughts 
 were repeated more frequently, and front part of the head covered with rags wetted in cold 
 vinegar and water. The secretion of milk, though slowly diminished, was still going on in 
 the breasts, which were regularly drawn, and there was no cessation of the trifling and natu- 
 ral lochial discharge. The milk had lost its sweetness, and was more pale than natural. 
 
 A drowsiness, manifestly increasing, was noticed in the afternoon, and she, when interro- 
 gated, stated that she had less pain. Deafness came on rapidly in the evening about six 
 o'clock, and by this time, unless aroused, she seemed wholly unconscious and unobservant 
 of external matters. The aspect of the eyes still betrayed anxiety, and a stare was now 
 perceptible; the irides were naturally contracted, and there was no increase of conjunctival 
 vascularity. The head was hot, and the carotids beat forcibly. Her position in bed was 
 easy, and on the side. Pulse at 130, rather thrilling, very regular respirations, 40 in the 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 331 
 
 minute, somewhat nasal, with the alse nasi contracted and visibly in motion; tongue, hereto' 
 lure rnoist, had a tendency to dryness, and to assume a brown color. Bowels had been 
 twice acted upon during the day, the stools the saane as before, and after each she said she 
 experienced relief in the head. The urine had not for the last twenty-four hours been so 
 plentiful as of late, and, in fact, might be pronounced scanty ; about five ounces, perhaps, in 
 this period. 
 
 A large blister was applied over the entire cervical spine at seven o'clock, when she had 
 become flushed, and more heated, and more thirsty. Two grains of calomel, with three of 
 Jarnes s powder, were administered. The latter was directed to be repeated every three 
 hours, along with the saline draughts and ^fs. of Mist. Sennae two hours after the calomel; 
 at nine there were noticed slight catchings of the hand and forearm, and also twitchings 
 about the mouth. Six leeches were immediately put on one temple, and obtained the de- 
 sirable quantity of blood ; the blister was rising well ; deafness was more marked, and the 
 drowsiness augmented; but consciousness, when she was roused and spoken to, was appa- 
 rently unaltered, though her natural quickness of manner was lost, and had been going 
 probably for the last six hours. On the side of the head, opposite to that on which she was 
 lying, a small blister was placed behind the ear, and upon the temple; about twelve o'clock, 
 she took diluents and the medicines readily from her husband, whose voice alone she recog- 
 nized, but refused them from others. 
 
 Up to this period the patient had been under the care of her husband and his partner. 
 
 At 4 A.M. of the 22d, the exhibition of mercury was advised by Mr. Wickham, of Win- 
 chester, and calomel was given in two-grain doses every two hours ; the head was shaved, 
 and slightly enveloped in cloths wrung out of iced water. The condition of the eye was 
 then unchanged, but all the former symptoms were continuing, and. if possible, aggravated, 
 excepting the subsultus, which was visibly abated: congestion of blood in the brain was 
 considered to exist by Mr. Wickham and the other surgeons. They agreed as to the danger 
 to be apprehended from effusion on the one hand, and, on the other, from depression of the 
 vital powers (never other than feeble in this patient, as before stated) by mercury, and the 
 other remedies necessary. Had she not been in this doubtful state, Mr. W. thought the 
 pulse would have justified further abstraction of blood, even from the arm. This, however, 
 he could not recommend, but he would not hesitate to resort to leeches again, if. the power 
 of the pulse continued much longer unabated. It should have been mentioned, that by the 
 hour of his visit the pulse had acquired a hardness, and increased thrilling. In the supply 
 of nourishment, the greatest caution was hereafter requisite. The strength was to be sup- 
 ported by beef tea, and arrow-root, and other farinaceous substances, in quantities to be regu- 
 lated by the pulse, heat of skin, and degree of cerebral symptoms. Dry warmth was applied 
 to the breasts, which had been drawn twice in the previous six hours, and yielded each 
 time upwards half an ounce of milk. At 8 o'clock A.M., the flushing has subsided simultaneously 
 with diminution of carotid action and the absence of pain, and the whole face became 
 pinched and shrunk, and deathly pallid; the tongue had not become dry; pulse and respira- 
 tion the same in frequency; the former less thrilling, and the latter remarkably gentle and 
 not so nasal. All three blisters had risen, and discharged copiously. In this state of appa- 
 rent depression she continued for the next twelve hours, with the alteration of a flush, 
 lasting about two hours ; between two and four o'clock equally conscious, though inca- 
 pable of returning answers quite coherent, when excited to take food or medicine, and as 
 easily aroused for this purpose. But, these times excepted, she lay throughout the whole 
 day on her side as before, utterly indifferent to all things and persons around her, with the 
 eyes constantly closed as if in the softest sleep, whilst this state of heavy drowsiness re- 
 curred directly after she had swallowed either food or medicine. These she still took most 
 readily from her husband, and in quite sufficient abundance. Several copious evacuations 
 had passed involuntarily from the bowels, of the former appearance ; and urine also more 
 freely in the same way. An evaporating lotion, composed of spirit and muriate of ammo- 
 nia, was substituted for the iced water, and compound spirit of aether was dropped upon the 
 scalp at short intervals, the heat of head being undiminished, as also the excessive carotid 
 impulsion. A second large blister was applied over the upper site of the former, at the 
 nape of the neck, at six o'clock, and the former remedies had been regularly exhibited. 
 
 23d, 8 A. M. About ten o'clock last night her husband had great difficulty in rousing her 
 to take sustenance, on two separate occasions, arid at intervals of only a few minutes ; and 
 when she temporarily awoke out of this stupor, or extreme somnolence, the stare was more 
 strongly visible, though the pupils were naturally susceptible of contraction, and the eyes 
 indicated no other morbid or unnatural expression. Pulse between 120 and 130, less pow- 
 erful, but not soft; respiration 36; flapping of both cheeks during each expiration, attended 
 by an audible purring sound ; this peculiar state of breathing lasted not above a quarter of 
 an hour. Considerable flushing of the face succeeded to this, with increase of general heat, 
 and force of pulse, as well as rapidity. Two grains of ammonia had been given twice, 
 
332 HUMAN BRAIN. 
 
 nearly an hour apart, while the depression attendant on that special state of respiration 
 lasted. The blister was taken off at twelve, and had produced a good quantity of serum. 
 The remedies have been persisted in, with the cautious supply of nutriment, and at two 
 o'clock she displayed some excitability. She moved the lower extremities about in bed, and 
 asked questions in a loud tone, but incoherent manner, of the two female attendants beside 
 her. Her husband at once stilled her, and of him she took slight notice, and began to make 
 inquiries in a mode different from that recently shown. Since then a return of general 
 sensibility has been perceptible. Pulse now 120, firm, and rather hard ; respirations reduced 
 to 34, and quite regular, also freer; bad been now and then slight sighing, and stertor ; three 
 dark motions, the product of calomel, have been voided involuntarily, with a good deal of 
 flatus ; urine passes also unrestrained. Nourishment to be taken less liquid, though thirst is 
 urgent; this is to be relieved by effervescing draughts, ad libitum. 
 
 8 P.M. Through the kindness of Mr. Solly, who accompanied him, Dr. Cape visited the 
 patient about six o'clock. In addition to the plan we were pursuing, he prescribed Camphor 
 two grains, reduced to powder, with spirit of wine, and carefully rubbed down with muci- 
 lage, so as to be suspended in the fluid form, with eighteen minims of tinct. Hyoscyami, 
 every three hours. The margin of the lower gums evinced slight redness, although the 
 calomel affected the bowels a good deal. During the day the pulse had fallen to 1 10, but 
 had lost little of its power, and the respiration was now at 30. On first seeing her, Dr. 
 Cape found the pulse at 120, but on re-entering her room about an hour afterwards, it did 
 riot exceed 108. There was exhibited on the tongue, still moist, a trifling copper colored 
 fur, attributed to the local as well as a general action of the calomel. Soothing and cheering 
 words have visibly had an excellent effect upon her the last four hours, and the comfort and 
 consolation Dr. Cape afforded her, by confidently assuring her of recovery, were evidently 
 particularly exhilarating. The disposition to sleep was yet strong, and as there were no 
 longer the same heaviness and hebetude in its character, now nearly natural, it was evi- 
 dently refreshing, and, when asked, pronounced it such herself. Of course the strictest qui- 
 etude has been observed throughout, and was now more requisite than ever. In the morning 
 she had complained of shortness of breath, but there was no dyspnoea observable, and the 
 feeling passed off after two small doses of ammon. carbon. The nutriment was as dry and 
 astringent as she could take, namely, beef tea thickened with isinglass, arrow-root and 
 biscuit boiled into jelly. She now requested frequently to have her thirst satiated by the 
 effervescing medicines. 
 
 24th, 8 A. M. The calomel has been latterly given every three hours, as its general lower- 
 ing influence was manifested in the system, and the local action on the gums was com- 
 mencing. Pulse about 108, or rather below this number, softer, and less resisting; respira- 
 tions 26 and 24 ; more free, and natural ; surface of the body and limbs warm, the heat 
 having diminished; bowels acting freely, the dejections dark, and containing mucus; 
 passed but little urine, though feeling desire to do so : has been conscious when evacuating. 
 The restoration of consciousness and general sensibility is still more perceptible, together 
 with more normal voice and manner. She says her head feels dizzy, and acknowledges 
 some pain about the forehead and occiput, and also that from the blistered surfaces. Shows 
 aversion to light, but no intolerance of sound ; expresses comfort from the ether and cold 
 applications to the scalp, and begs often for them to be re-applied ; calls likewise for the 
 effervescing draughts to allay the great thirst, another subject of complaint now made by her. 
 
 8 P. M. Symptoms have continued improving ; in addition to the matters complained of 
 by her this morning, she feels the griping of the bowels, and lays it to the effervescing (or 
 " lemon") draughts, of which she objects to take more. She being unable to void urine, after 
 frequent and anxious attempts, about a pint was removed by the catheter, clear and healthy, 
 at one o'clock. Pulse averaging from 98 to 108, much softer, and diminished ; breathing 
 nearly natural ; has enjoyed much calm and quiet sleep, to which there is a great readiness, 
 but not the previous constant strong inclination. Our former remedies have been persevered 
 in as yesterday, except the effervescing draughts ; and the beef-tea, arrow-root, &c., have 
 been daily taken. 
 
 25th, 8 A.M. Since 12 last night, the calomel has been given in one-grain doses every 
 three hours, as by that hour the gums were whitened, and, in the judgment of Mr. Solly, 
 and her husband, the force of the circulation was materially arrested. She is still very 
 sleepy ; skin moist, and breathing natural ; bowels moved freely in the last 24 hours, and 
 evacuations, as was to be expected, the same. No urine has been discharged, but the blad- 
 der is not distended, nor uncomfortable; some tenderness, however, on pressure over it. 
 Pulse 98, during sleeping; open and soft; when she is roused, about 108 ; tongue moist, and 
 inclining to whiteness; the flushings have recurred occasionally, but more slightly; heat of 
 iiead externally not diminished, and the ether and evaporating lotion are equally grateful: 
 the thirst has been less urgent, and the saline draughts, therefore, unnecessary ; otherwise, 
 the diet and medicines have been the same. 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 333 
 
 8 p. M. She hag had no calomel since nine this morning, as its effects have become more 
 apparent in the mouth, and the odor of the breath. The bowels, too, are a good deal irritated, 
 but there is not much complaining from this cause ; feels her head dizzy, and occasional 
 trifling pain therein. Pulse 98, soft but not flagging; skin comfortable ; the camphor and 
 hyoscyamus have been taken, but no other medicines; rather more than a pint of urine was 
 drawn off again at two p. M., previously to which she had expressed considerable uneasi- 
 ness. 
 
 26th. 8 A. M. It was necessary to draw off the urine again this morning, at two o'clock, 
 in consequence of the patient having made painful efforts of expulsion there was about a 
 pint, and equally clear ; motions from the bowels continue of the same nature, and very 
 copious and watery; she is generally conscious when passing them. Pulse 96, unaltered in 
 character; soreness of the mouth complained of; tongue white, and more furred, and the 
 gums more affected ; sleepiness undiminished, but sensibility and sensation obviously increas- 
 ing. There has been no further occasion for calomel ; the camphor, &c., has been regularly 
 exhibited, and the saline draught once or twice. 
 
 8 P. M. There has been less disposition to sleep, and a very perceptible acquisition of 
 sensibility and memory. The bowels have not been so much acted upon, and she has voided 
 urine by her own endeavors. Pulse, during present sleep, 90. By her own desire, she has 
 partaken of more nourishment during the day, and has shown improved strength ; one large 
 watery stool was discharged this afternoon involuntarily. 
 
 27th. Was permitted to sleep for five hours together last night, as she rested so tran- 
 quilly and naturally ; there has been considerably less flushing. Pulse 90, not weak ; but 
 soft, and with nearly a natural stroke. The faeces and secretions of urine have been passed 
 consciously, an d the former, more sparingly and fewer, changing gradually to a lighter green, 
 are now yellow. Has eaten a little sopped bread at her own request, and could have taken 
 more but from the increasing soreness of her mouth; on this latter account, she finds the 
 effervescing medicine again agreeable ; the camphor and hyoscyamus are continued every 
 four hours, with the former allowance of beef-tea, jelly, arrow-root, &c. In proof of return- 
 ing sensibility, it may be mentioned, that she, this morning, sent her nurse up into the nursery 
 to bring her word how the children were, and made many inquiries, and gave directions 
 then in her usual manner, as well as respecting some other affairs ; and, in proof of strength, 
 also, being gained, when it was necessary, last night, to arrange her bed, she experienced far 
 less fatigue from being moved than on the day only previous. 
 
 28th. The strong disposition to sleep is wearing off, though she continues perfectly quiet ; 
 says she can hear better, and shows some slight intolerance of sound, but has sensibility 
 to light. The wet cloths are also uncomfortably cold, and the heat of head not now 
 being greater than natural, they are omitted. Pulse 80, during sleep, 90 when awake, quite 
 natural; bowels still relaxed, but the faeces natural; passes urine by herself, and in plenty ; 
 there is slight vertigo, together with occasional uneasiness, referred to the head ; but she may 
 be now pronounced perfectly conscious, and free from the least aberration of mind, though 
 the power of recollection is very feeble. She displays some anxiety concerning the future 
 management of the child, but this has been apparently allayed. Camphor, &c., to be taken 
 at intervals of six hours, and the diet more astringent; mouth and gums relieved by gargling 
 with the chlorides in barley water. 
 
 29th. Has had less sleep, both by night and by day; pulse and other symptoms as yester- 
 day. Chief complaint made of the mouth, which looks well; bowels restrained, and voids 
 her urine without difficulty. Both takes and has desire for more nourishment. Continue as 
 yesterday. Hydr. c. Greta gr. iii. Pulv. Rhaei. gr. v. P. Pulv. hac nocte sumend. 
 
 39. Some nausea and pain were produced by the powder, but subsided as soon as the 
 bowels, which have not acted for 36 hours, were moved by it. Has had four stools, relaxed 
 and quite healthy. Pulse as yesterday ; there has been scarcely any sleep in the night, from 
 the disturbance just mentioned, but is now sleeping tranquilly ; gums and mouth rather better, 
 and she feels appetite. 
 
 This patient perfectly recovered, and is now. well and hearty too, 1846. 
 
 Early in the year 1845, when the railway mania was at its height, I 
 was requested to visit a gentleman at an hotel in the City, who was 
 quite insane. When I entered the room he immediately ordered, in a 
 loud authoritative tone, his attendant to leave the room. He looked at 
 me to know if he was to do so, and as I was quite sure that I should be 
 of little service if I did not obtain the confidence of my patient, I im- 
 mediately assented. My patient, who was a fine tall muscular man, 
 was lying on the sofa ; he now rose and asked me what I wanted. I told 
 
334 HUMAN BRAIN. 
 
 him that I came to prescribe for him, as I understood that he was not 
 well. He then asked me if I was a physician or a surgeon. On rny 
 informing him that I was the latter, he said, "Very well, that will do ; 
 they are not humbugs generally." He then said, u But I want no medi- 
 cal advice; I never was better in my life," and began talking incessant- 
 ly, telling me he had made an enormous fortune in railways, and how 
 the Almighty had enabled him to do so. His conversation was rambling, 
 incorrect, and founded on the most absurd delusions. His head was 
 hot, and his face flushed, and he had had no sleep for several nights. 
 I learned that he had first shown decided mental derangement only a 
 few days previous to ray visit. Morphia had been administered in large 
 doses, but without the slightest effect. He was always worse at night. 
 I ordered forty leeches to the forehead, fomentations to promote bleed- 
 ing, and afterwards cold lotions ; five grains of calomel with rhubarb 
 and jalep, and a second draught in the morning. I found him more 
 tranquil the next day, having had about an hour's sleep. I repeated 
 the leeches and the calomel. On the third day he was so rational and 
 quiet that he accompanied me in my own carriage, the attendant riding 
 on the box, to a cottage in the neighborhood of the Regent's Park. 
 Here I pursued the same plan of treatment, leeching the head freely, but 
 always first persuading him that they were necessary for his recovery. 
 Each night he got a little more sleep, though it was slow in returning. 
 About the fifth night he slept quite naturally, and without a grain of 
 opium in any form. I gave two grains of gray powder, with a grain of 
 aconite, three times a day. He took a great deal of exercise, and re- 
 covered perfectly in a fortnight from the date of my first visit. 
 
 If a different course of treatment had been pursued in the case, I 
 have very little doubt he would have been rendered a confirmed lunatic. 
 If, for instance, the strait waistcoat had been applied at night when 
 he was noisy and riotous, instead of being soothed and talked to kindly, 
 or if he had been confined in one of the old-fashioned insane establish- 
 ments with barred windows and bolted doors, the disease would have 
 been confirmed, and the brain most probably irremediably injured. 
 Harsh treatment to a lunatic produces as much mischief to his inflamed 
 brain as the jolting of a wagon without springs would to a compound 
 fracture of the leg. 
 
 I have had three very similar cases, all of which recovered under the 
 same general plan of treatment. 
 
 The following, from Andral, is a good case in illustration of the fact 
 that the cerebral circulation may be suddenly excited by an impression 
 from moral causes carried centripetally. 
 
 Case 35. Jlpoplexy with Hemiplegia in consequence affright. A robust, and rather plethoric 
 woman, thirty-eight years old, was in perfect health, and speaking to a neighbor, when her 
 servant girl frightened her by brandishing a bright spiral wire over her head, so as to make 
 it look as if a snake were falling on her. In her fright, the woman suddenly fell down as in an 
 apoplectic fit, and remained for some time nearly unconscious. When examined, she com- 
 plained of a noise and beating in the left side of her head, deafness of the left ear, and of 
 blindness and loss of taste on the same side. She could not move any part of the left side 
 of the body, and in every respect resembled a patient suffering from hemiplegia, in conse- 
 quence of sanguineous apoplexy. By active antiphlogistic treatment, and various other 
 measures, she was gradually restored from this state in about three months. 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 335 
 
 Worry in business, mental anxiety, and vexation of spirit, will some- 
 times bring on spasmodic action of the muscles, and paralysis. In some 
 cases the anxiety and mental irritation induce disease in the hemispheri- 
 cal ganglion, seriously affecting the temper, but not affecting the intellect. 
 Such cases are familiar to all practical men, but it is very difficult to 
 explain their pathology. I suppose that the disease or diseased action 
 excites unnaturally the tubular neurine, which, commencing in this gan- 
 glion as the motor tract, conducts the will to the muscles; and the con- 
 sequence of this excitement is an irregular supply of stimulus to the 
 muscular system exhibited by the twitchings and spasms. This irregular 
 action the mind can more or less control and arrest when awake; but as 
 soon as sleep takes place, then the spasms commence. I suspect that 
 epilepsy is a form of this irregular innerv r ation, only that in epilepsy 
 the nervous or electric fluid accumulates in undue quantity? and passes 
 off in a large quantity at once, like the discharge of an electric battery. 
 In many cases of epilepsy, the discharge takes place in small quantities 
 both before and after the complete fit. I have two patients" under my 
 care now who suffer seriously in this way : one, a single man, has always 
 warning of the advent of the fit by twitchings of the right leg as soon 
 as he drops off to sleep ; the other, a married man, has these twitchings 
 so constantly in bed, that his wife is often kept awake during a whole 
 night. In the non-epileptic cases, though electric fluid is secreted in 
 undue quantities, still it does not accumulate, so as to produce a com- 
 plete convulsive fit, but is constantly oozing out. Whether this idea is 
 correct or not, it is difficult to say; but the following case will, I think, 
 show that it is of value: 
 
 Case 36. A medical man, aged 40, nerve-sanguineous temperament, who had been en- 
 gaged in practice for some years in the North of England, consulted me in the spring of 
 1842 with the following symptoms: Some numbness down the right leg and arm, dragging 
 of both lower extremities, but especially the right. This partial paralysis was so severe, 
 that it was with difficulty he walked a mile; on going to sleep, his limbs started so violently 
 as to wake him. He gave me the following account of himself. General health in every 
 respect was quite good until four months ago ; when one night, on dropping off to sleep, a 
 sudden catching up of the thighs came on; soon after this the starting affected the whole 
 limb. This condition came on four or six times every night before going to sleep. There 
 was also numbness of the right thigh and pain in the course of the sciatic nerve, odd erratic 
 thrills of pain in the muscles of the same side and head. No convulsive action of the upper 
 extremity at any time. Walking soon fatigued the right leg. On napping after dinner, these 
 startings always came on, so that he often stood up to be free from desire to sleep. 
 
 Stomach and bowels in good condition. He went to the sea-side about six months after 
 the appearance of these symptoms, and by the advice of an eminent physician and surgeon, 
 took Pil. Hyd. gr. v. t. d., and applied blisters to the spine, and a seton in the neck, which 
 remained two years. He was much relieved from the catchings, but reduced by the 
 treatment. During the summer the lowering effects of mercury were overcome, and he 
 attended lightly to practice, but in the autumn the symptoms were renewed. He says, " I 
 dragged on through the winter with feeble power, irregular muscular convulsions, and pain 
 in the course of the sciatic nerve." Early in the spring his medical friends urged his giving 
 up practice ibr a year or two. Up to this time his complaint had been considered spinal, 
 and the counsel he received was often contradictory 5 one very eminent surgeon recom- 
 mended tonics and to live well ; another considered it spinal irritation reflected from the 
 digestive organs. 
 
 After conversing with him for some time, and knowing previously a good deal of his 
 mental and moral qualities and excitable temperament, observing the way in which he was 
 constantly putting his hand to his head, impelled by a feeling of uneasiness there rather than 
 severe pain, 1 felt convinced that the affection was cerebral, and not spinal. 
 
 In a consultation whi h I had with two of those medical friends under whom he had 
 been before seeing me, J urged my reasons for so thinking, and they acquiesced in my view 
 of it. Previously they had recommended a voyage to India as surgeon to the vessel ; this 
 
336 HUMAN BRAIN. 
 
 was with the view of saving unnecessary expense. On this I remarked that if he did so, 
 the sailors would drive him mad. I urged, that the only chance of saving him from actual 
 mental derangement was entire rest of mind and abstinence from bodily fatigue. 
 
 The observation that I made with regard to the sailors, of course, was not repeated to 
 him ; it was, therefore, curious that in one of his letters, written during the course of the 
 next summer from Jersey, he should have said " I have often felt the wisdom of your 
 urging me not to take the voyage to India; the worry of the crew would have bothered me 
 to death." 
 
 Without going through all the details of his progress, I will quote a few passages from 
 his letters written during his absence from home. Italics my own. 
 
 June 3d, 1842. "During the month I have been from home I have experienced little, if 
 any, mitigation of the convulsive catchings which come on as I am passing into sleep. The 
 uneasiness of the head remains the same, and the sense of heaviness or confusion under 
 much fatigue or excitement. The kg is much better, and were it not soon fatigued by mus- 
 cular exertion, I think I could walk as well as ever. My spirits are generally good, and my 
 general health may be called excellent. I continue the gr. ij. of blue pill every night, 
 which you will remember I recommenced at your suggestion near three months ago. I 
 keep the head shaved, and commonly sit without my wig." 
 
 July 4th, 1842. "I certainly am not worse than when I wrote a month ago ; I have con- 
 tinued the blue pill till the last few days; I now substitute the sarsaparilla with liq. hyd. 
 bichlorid. The gums have been slightly tender ; I have felt very feeble, and since your last 
 favor have most carefully avoided fatigue ; I rarely get up till twelve or one o'clock. The 
 iodine has been painted over the whole of the shaved scalp even to your heart's content ; and 
 much smarting every other night and a plentiful exfoliation of cuticle does it keep up. I 
 have little other pain; the right leg gets numb now and then, and would, I dare say, if I 
 tried to walk much, soon tire. Writing gives me some uneasiness of head, &c. The ' catch- 
 ings and jerkings' of the body come on every night on my going off to sleep. This condition 
 abiding, I must deem myself about in statu quo, though the quietude I cultivate and the dis- 
 cipline I undergo, through your most judicious advice, must be favorable for damaged structure 
 to recover its original condition. 1 ' 
 
 August 1st, 1 842. " When I was in Dublin I was induced to see Graves. He said I 
 should not continue longer the mercury, that it had done its work right enough ; that if I 
 was to be opened at once, no disease would be discovered ; he supposed chronic arachnitis 
 had existed, &c. ; bade me take Argent. Nit. gr. t d., avoid wine and eggs, take a tepid 
 shower bath daily, and continue the seton. 
 
 "I have the last few days suspended the bichloride of mercury; I have had four months 
 of it and blue pill, but I have not taken the nitrate of silver. Graves says you know it is 
 a tonic which does not determine to the head. What say you "?" 
 
 I wrote to hirn saying that I had no objection to the Argent. Nit., but I was doubtful of 
 its being of service. 
 
 He began it, and continued it for about three weeks, but it did not seem to agree so well 
 with him as the mercury. 
 
 About the 18th of August I wrote to him, recommending the application of four leeches 
 every night for a week, the bleeding encouraged by exhausted glasses. 
 
 One or two moderate doses of salts in the morning. 
 
 "Under this plan." says this gentleman in a letter I lately received from him, "the head 
 was much relieved in so marked a degree that I dated recovery from this period. Leeches 
 were applied over and over again at intervals for many weeks, eight or ten at a time. It 
 always appeared to me that the leeches and the small tloses of mercury did a vast deal of 
 good, but the ' catchings' were not cured by them. 
 
 " Through the autumn and winter while in Spain the same treatment was more or less 
 adopted (dry cupping often over the scalp), but the blue pill gr. iij. was left off; resumed 
 again in January in small doses, and continued ten or twelve weeks. 
 
 "I returned to England in May, 1843, in every way very much improved well except 
 the occurrence now and then of 'catchings.' The last three years I have been in general 
 good health; but have the jumpings come on very much after fatigue or worry, or tea before 
 going to bed. Now, October, 184(5, I feel generally as well as ever; have been so for the past 
 year; and during the last month have often walked for four, six, or eight hours a day, with 
 gun, and powder, and shot, with ease and enjoyment, but the catchings are not gone clean 
 away." 
 
 Mr. Dunn, of Norfolk Street, has related a most interesting case in 
 the twenty-fifth volume of the Med.-Chir. Transactions, which corrobo- 
 rates my view of the pathology of the above case. Dr. Dunn's case is 
 well worthy of perusal in full, but I shall only refer to those points which 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 337 
 
 bear upon the present division of our subject. The patient was a little 
 boy two years old, a fine, intelligent child ; the first indication of disease 
 was a change in the disposition of the child. From being a happy, pla- 
 cid child, he had become irritable, peevish, and petulant, impatient of 
 control. This was going on for four months before the parents, intelligent 
 people, considered the child bodily ill, requiring medical advice. Mr. 
 Dunn was called to him six weeks previous to death. He had awoke 
 as usual, between six and seven o'clock in the morning, and his mother 
 was alarmed by observing his left hand begin suddenly to twitch and 
 jerk convulsively. The intellectual faculties were not then affected ; 
 the child was laughing and talking, and perfectly sensible. The child 
 had fallen down stairs fourteen days previously to this attack. On the 
 third day from first occurrence of the convulsive action of the arm, Mr. 
 D. observed an imperfect paralysis of the hand and arm. On the fourth 
 day the convulsive jerkings were not confined to the arm, but involved 
 the whole of the left side and lower extremity, with twitchings of the 
 eye and angle of the mouth. These fits increased in violence. To- 
 wards their termination, (and they lasted about two hours,) he cried 
 and screamed violently, but throughout their continuance he was sensi- 
 ble, and could at times be soothed by kind attentions from his parents. 
 The fits were followed by profound sleep for several hours, and the side 
 was left partially paralyzed. The paralysis was not persistent. A few 
 days previous to his death, the right side was also affected. He had 
 these convulsive attacks, with slight intermissions, throughout the day 
 before he died, screaming violently at intervals. The rest is given in 
 Mr. Dunn's own words : 
 
 "The head was hot, face flushed, pulse hurried, pupils dilated, eyes squinting, and turned 
 inwards, insensible to light, eyelids constantly open, and only at times recognizing the per- 
 sons about hirn. On the subsidence of one of these attacks, he gradually sunk, at a quarter 
 past four o'clock on the morning of the 15th of November. 
 
 " I was assisted in the post-mortem examination of the brain by Dr. Todd and Mr. Bow- 
 man, of King's College, and I am indebted to the kindness of the former distinguished phy- 
 siologist for the following account of the morbid appearances. 
 
 " The scalp was pale and bloodless, like the rest of the body, which was much emaciated. 
 The dura mater healthy. The vessels on the superficies of the brain were tinged with dark 
 blood, but there was no sub-arachnoidal effusion. The arachnoid cavity was natural. On 
 the surface of the right hemisphere of the brain, both under the arachnoid and pia mater, 
 there was a deposit of tubercular matter in patches of irregular shape and size, but the whole 
 occupying a surface of about two inches square. The deposit was most abundant on the 
 surface of the convolutions; it nevertheless descended into the sulci between them, a cir- 
 cumstance which proved its connection with the deep surface of the pia mater. -The corti- 
 cal substance of the brain in contact with the tubercular matter was reddened and greatly 
 softened; and, on microscopic examination, evinced a nearly total destruction of the tubules 
 in it; a great enlargement of the proper globules of the gray matter, and of the pigment 
 granules which adhere to them. The softening extended a slight, way into the subjacent 
 white matter. On the edge of the left hemisphere, corresponding to the diseased patch of 
 the right, a slight tubercular deposit had taken place in a similar manner, producing a red 
 softening of the gray matter in contact, but. not occupying more than half an inch square iu 
 surface. The ventricles contained more water than natural about double and did not col- 
 lapse when laid open. The cerebral substance throughout, excepting at the diseased part, 
 was firmer than usual at the patient's ago. This firmness was no doubt owing to the com* 
 pression of the fluid, which probably at an earlier period of the disease was more abundant. 
 
 "It is, I believe, generally admitted that irritation of the membranes and cineritious sub- 
 stance of the brain is attended with convulsion.-, without decided or persistent paralysis, and 
 that it requires the medullary matter to be involved to render the paralysis permanent. Mjr 
 own observation, so far as I have had an opportunity of investigating this interesting subject, 
 accords with this opinion. In the present case, the paralysis was not persistent until after 
 
 22 
 
338 HUMAN BRAIN. 
 
 the violent attacks of cramp, and from this time may probably be dated the implication of 
 the medullary substance in the inflammatory process. Admitting the justness of the view, 
 that red softening of the brain is the result of chronic inflammation of its substance, persistent 
 paralysis was not to be expected until the inflammatory action had involved the medullary 
 substance. 
 
 " On comparing the two hemispheres, the diseased portions and parts adjacent, the left 
 presented evidences of more recent inflammation than the right; and this was to be ex- 
 pected from the history of the case." 
 
 Thus I think it may be considered established that meningitis, though 
 always accompanied with derangement of the mind and temper to a 
 greater or less extent, is in many cases accompanied with derangement 
 of the motor powers. The character of these lesions of motion depend 
 upon the extent of the disease. In the early stage, before it has ad- 
 vanced far, different kinds of spasms exist, from a mere trembling or 
 subsultus tendinum up to the most violent contractions. 
 
 " Convulsions, properly so called," says Andral,* "are among the most 
 common phenomena accompanying acute meningitis. These are some- 
 times, though very rarely, general. When partial they are sometimes 
 confined to the same part, at other times they affect different parts of the 
 body successively. The parts most usually affected with convulsive 
 motions in meningitis are, the globes of the eyes, the eyelids, the face, 
 the lips, and finally the extremities. Tonic spasms, as they are called, 
 are not less frequent than clonic, in the disease now under considera- 
 tion ; thus permanent flexion of the forearm on the arm is often observed. 
 Retroversion of the head, its inclination to the right or left, are sometimes 
 observed in cases of meningitis, as also tetanic rigidity of the jieck, trunk 
 or extremities, trismus, &c. 
 
 " Under the second class, in which motion is diminished or altogether 
 destroyed, may be reckoned those numerous varieties of paralysis ob- 
 served in meningitis. This paralysis may affect the muscles of the eye, 
 of the eyelids, face, lips, or limbs ; either one or several of these may be 
 deprived of motion. In these different parts the paralysis may be estab- 
 lished either slowly or as instantaneously as the loss of motion succeed- 
 ing cerebral hemorrhage. The paralysis may supervene from the com- 
 mencement, or succeed one of the forms of spasms already mentioned ; 
 it may alternate with these spasms ; it may, in fine, co-exist with them ; 
 and we have witnessed, more than once, one of the upper extremities 
 completely deprived of motion, whilst the other was more or less vio- 
 lently convulsed. There are also some cases in which the paralysis 
 appears and disappears by turns; a phenomenon which will not surprise 
 us, when we have seen that in meningitis, paralysis can exist only when 
 there is compression of the brain. Simple hyperaemia of the pia mater, 
 slight purulent infiltration of this membrane, are capable of producing it, 
 or, to speak more accurately, are capable of producing in the brain that 
 modification, inappreciable after death, which gives rise to it." 
 
 Dr. Abercrombief makes the following acute observations on a form 
 of meningitis which I have more than once had the opportunity of ob- 
 serving : 
 
 11 A dangerous modification of the disease, which shows only increased 
 vascularity. 
 
 * P. 51. t P- 61 > viii. 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 339 
 
 "Another important modification of the disease occurs in an insidious 
 and highly dangerous affection, which, I think, has been little attended 
 to by writers on the diseases of the brain. It is apt to be mistaken for 
 mania, or in females for a modification of hysteria ; and in this manner 
 the dangerous nature of it has sometimes been overlooked, until it proved 
 rapidly and unexpectedly fatal. It sometimes commences with depres- 
 sion of spirits, which, after a short time, passes off very suddenly, and is 
 at once succeeded by an unusual degree of cheerfulness, rapidly followed 
 by maniacal excitement In other cases these preliminary stages are less 
 remarkable; the affection, when it first excites attention, brings us its 
 more confirmed form. This is in general distinguished by remarkable 
 quickness of manner, rapid incessant talking, and rambling from one 
 subject to another, with obstinate watchfulness and a small frequent 
 pulse. Sometimes there is hallucination, or conception of persons and 
 things which are not present, but in others this is entirely wanting. The 
 progress of the affection is generally rapid ; in some cases it passes into 
 convulsion and coma, but in general it is fatal, by a sudden sinking of 
 the vital powers, supervening upon the high excitement, without coma. 
 The principal morbid appearance is a highly vascular state of the pia 
 mater, sometimes with very slight effusion between it and the arachnoid. 
 The disease is one of extreme danger, and does not in general admit of 
 very active treatment. General bleeding is not borne well, and the 
 treatment must in general be confined to topical bleeding, with purga- 
 tives, antimonials, and the powerful application of cold to the head. 
 The affection is most common in females of a delicate, irritable habit, 
 but also occurs in males, especially in those who have been addicted to 
 intemperance. I have, however, seen it in one case, in a gentleman 
 between 40 and 50, of stout make and very temperate habits. The 
 cause of death is obscure; it seems in general to be a sudden sinking of 
 the vital powers, supervening upon the high excitement, without any of 
 the actual results of inflammation." 
 
 The following cases are related by Dr. Abercrombie to illustrate this 
 class of symptoms, and the first is one of those cases which illustrate 
 inflammation from within, excited by mental causes. The color of the 
 hemispherical ganglion unfortunately was not noted, but the inflamma- 
 tion of the pia mater without that of the arachnoid is particularly de- 
 scribed. 
 
 Case 37. A lady, aged 23, had suffered much distress from the death of a sister, and had 
 been affected in consequence with impaired appetite and want of sleep. This had gone on 
 for about two months, when, on the 4th of August, 1825, she sent for Dr. Kellie, and said 
 she wished to consult him about her stomach. He found her rambling from one subject to 
 another with extreme rapidity and considerable incoherence; and on the 5th, she was in a 
 state of the highest excitement, with incessant talking, alternating with screaming and sing- 
 ing: pulse from 80 to 90. In the evening she became suddenly calm and quiet after an 
 opiate ; continued so for an hour or more, then fell asleep, and after sleeping two hours, awoke 
 in the same state of excitement as before. The same symptoms continued on the Gth; the 
 pulse in the morning was little affected, but after this time it became small and very rapid. 
 On the 7th, after a night of great and constant excitement, she had another lucid interval, but 
 her pulse was now 150. The excitement soon returned, and continued till four in the after- 
 noon, when she fell asleep. She awoke about eight, calm and collected, but with an evi lent 
 tendency to coma; pulse 150, and small. She now took food and wine, and passed the night 
 partly in a state of similar excitement, and partly comatose; and died about midday of the 
 8th, having continued to talk incoherently, but knowing those about her, and in general uru 
 derstanding what was said to her. 
 
340 HUMAN BRAIN. 
 
 Inspection. The only morbid appearance that could be discovered was a highly vascular 
 state of the pia mater, with numerous red points in the substance of the brain. 
 
 Case 38. A gentleman, aged 44, of a stout make, and very temperate habits, ber-ame sud- 
 denly affected, without any known cause, with extreme depression of spirits, accompanied 
 by a good deal of talking and want of sleep. After this condition had continued for two 
 days, it went off suddenly, and he recovered excellent spirits and talked cheerfully. This, 
 however, was soon succeeded by a state of excitement, with rapid incoherent talking, and 
 obstinate watchfulness, and the pulse rose rapidly to 160. This state continued without 
 abatement for about four days, when he suddenly sank into a state of collapse, and died. 
 
 Inspection. The only morbid appearance was a highly vascular state of the pia mater and 
 arachnoid, with slight serous effusion betwixt them. 
 
 There is a case related by Morgagni, Epist. LXII. No. 5, something 
 similar to the last. 
 
 Case 39. The patient in the first instance was lalx>ring under a false impression, which, 
 producing excessive fear, was followed by tremors, convulsions, pain in the head, and loss 
 of speech, but not of consciousness. He died seven days after the appearance of the first 
 symptoms, and the morbid appearance discovered after death was merely congestion of the 
 pia mater. 
 
 Although headache is the usual concomitant of meningitis, still there 
 are cases in which this symptom is absent. Out of twenty-eight cases 
 reported by Andral,* there were sixteen in which the headache existed, 
 and twelve in which this symptom was not observed ; but in these twelve 
 there was one case in which the patient was not minutely watched, and 
 another in which the delirium having existed from the commencement, 
 the pain of the head could not be complained of by the patient. 
 
 In the sixteen cases in which the pain did exist, the alterations dis- 
 covered after death were as follows : In two of these cases the patients 
 presented tumors developed primarily in the dura mater, which had com- 
 pressed the nervous substance in contact with them. In two other cases 
 an effusion of blood existed in the great cavity of the arachnoid. 
 
 In two subjects, no other alteration was observable but considerable 
 effusion of liquid serum into the cerebral ventricles. Three other sub- 
 jects presented nothing but redness of the meninges. Another case 
 presented pseudo-membranous concretions deposited within the great 
 arachnoid cavity. 
 
 In five post-mortem examinations the pia mater was found, whether of 
 the convexity or of the base, infiltrated with pus. In one of these five 
 there were also found cellular adhesions intimately connecting together 
 the two reflections of the arachnoid covering the convexity of the brain. 
 This individual had been all his life tormented with headache. 
 
 In only one case were the ventricles found filled with purulent fluid. 
 '* From these facts," says Andral, " we are warranted in concluding that 
 the pain accompanying diseases of the rneningis may exist with diseases 
 of these membranes, widely differing from each other both in their nature 
 and their seat. 
 
 44 Let us now inquire what lesions were found in the membranes in 
 the twelve patients who complained not of headache. In two of them 
 the pia mater was infiltrated with pus, either the portion of it extended 
 over the convexity of the cerebral hemispheres, or that covering the base 
 of the brain. A sero-purulent liquid filled the ventricles in one case. 
 
 44 From these facts it follows that the diseases of the membranes, 
 
 * P. 47. 
 
INFLAMMATION OF THE HEMISPHERICAL GANGLION. 341 
 
 during which no headache was observed, differed neither in their nature 
 nor in their seat from those in which pain of the head was one of the 
 symptoms." Andral goes into the details of this subject with great care, 
 and his facts are worthy of attention. 
 
 " It has not been found," he says, " that the different degrees of the 
 intensity of the headache depended either on the nature of the lesions of 
 the membranes, or on their seat. We have found it as acute in cases 
 where there was but simple injection of the pia mater, as in those where 
 the pia mater was infiltrated with pus, or where a false membrane covered 
 the arachnoid. With respect to the seat of the lesions, we find that, in 
 cases where the headache was most intense, some related to meningitis 
 of the convexity of the hemispheres; others to meningitis of the base of 
 those hemispheres; others to inflammation of the entire membranes sur- 
 rounding the nervous centres; others, again, to effusions of pus or serum 
 into the ventricles. 
 
 "Between these cases and those where the pain of head was either 
 much weaker, or none at all, we do not find any difference with respect 
 to the lesions; and in order to explain so many varieties, we are always 
 obliged to admit individual dispositions, which, with lesions apparently 
 identical, produce, according to the subjects affected, phenomena of the 
 most different kind. 
 
 " The nature, also, of the pain felt by patients attacked with menin- 
 gitis is not the same in all. Some think that there is an enormous weight 
 on their skull; some complain of violent lancinating pain either con- 
 tinued or returning at intervals; several fancy that a tight band com- 
 presses their forehead ; some say that their head is squeezed, as it were, 
 in a vice. AH motion applied to the head, or even to the other parts of 
 the body, is oftentimes intolerable. We have seen some patients whose 
 headache was increased by slight pressure made on the integuments of 
 the cranium. We never saw, on the contrary, this pressure diminish the 
 headache, as so often happens in the cases of headache called nervous. 
 The period when the headache appears is not the same in all cases. 
 Most frequently, however, it shows itself from the commencement, some- 
 times dull at first, and gradually becoming intense ; sometimes, on the 
 contrary, attaining at once its maximum of severity. In several cases of 
 our own, in very many published by MM. Parent and Martinet, and in 
 nearly all those of M. Dance, the pain of head showed itself from the 
 very commencement. The cases in which headache marks the com- 
 mencement of the disease seem divisible into two series, according as 
 the headache develops itself singly, without any other morbid pheno- 
 menon accompanying it, or according as its appearance coincides with 
 that of other symptoms. The first series includes the most numerous 
 cases. The time during which the headache continues, the only appre- 
 ciable morbid phenomenon may vary from some hours to several days. 
 When this headache thus precedes the other symptoms, there are some 
 cases in which it seems to have nothing serious in it. It sometimes re- 
 sembles mere rheumatic pain ; sometimes it might be taken for neuralgia. 
 There are some individuals who for some time seemed to have merely a 
 megrim more or less violent ; the mistake was easily fallen into in those 
 cases, where, a little after the appearance of the headache, vomiting 
 
342 HUMAN BRAIN. 
 
 supervened. The second series includes those cases in which the head- 
 ache still presenting itself at the commencement, is accompanied, from 
 the moment of its appearance, by other symptoms, whether of mere 
 febrile commotion, or of different disturbances of innervation. There 
 are some rare cases in which the pain of head continues with great in- 
 tensity during the entire disease ; but most frequently there are developed 
 on the part of the nervous system more severe symptoms, which soon 
 prevent it from being perceived or complained of by the patient. It 
 may then be laid down that the pain of head generally exists only during 
 the first period of meningitis. It is very uncommon to see it come on 
 after this period. Headache is almost the only modification ef sensibility 
 observed in the ordinary cases of meningitis. In some few of the cases 
 reported by us, the cutaneous sensibility was rendered rather obtuse; 
 but it may be remarked, that in one of them the brain itself was the seat 
 of considerable pressure, made by a tumor developed in the dura mater. 
 There was one case also where the sensibility was very much exalted. 
 From several cases published by M. Parent and also by M. Dance, we 
 feel warranted in laying it down, that in the meningitis of adults, modi- 
 fications observed in the cutaneous sensibility may be considered as mere 
 exceptions ; when they do exist, they are to be referred to a peculiar 
 disposition in the subject, and not to any specific lesion." 
 
 The great practical point, as it appears to me, with regard to the infor- 
 mation derivable from the existence of pain in the head, its peculiar 
 character, seat, and duration, in the diagnosis of cerebral disease, is 
 this that pain alone cannot be regarded as affording any instruction, 
 but that when it is weighed in the balance, with other signs significant 
 of disease of the nervous system, then the character and seat of the 
 pain become important. 
 
 For instance, if the patient has violent pain in the head, but the temper 
 and mind are not unusually disturbed and excited, and there is no indi- 
 cation of incipient paralysis or irritability of the muscular system, no 
 insornnolence except such as would be occasioned by severe pain in any 
 part of the body, then is the pain no indication of cerebral disease. But 
 if, with such symptoms as above described, the patient complains of pain 
 in the head, then is its existence a most important sign of inflammatory 
 mischief, requiring more or less local depletion and derivation of the 
 blood to other organs; the intestinal canal with its extended surface 
 always affording an open field for rapid evacuation of the nutritive 
 fluids. 
 
 The whole subject of headache is one of great interest, but regarding 
 its pathology we have still much to learn. Dr. Bright* observes u That 
 this symptom depends on various causes, and that it is connected with 
 different conditions of the circulation in the brain, is not improbable; 
 but in by far the majority of cases the actual condition of the vessels at 
 the moment of the existence of headache is a state of congestion. Ex- 
 haustion from fatigue, exhaustion from the loss of blood, exhaustion 
 from over excitement by mental exertion or bodily excesses, all tend to 
 produce a state of debility in the vessels of the brain which favors con- 
 
 * Op. cit., p. 222. 
 
INFLAMMATION OF THE HEMISPHERES. 343 
 
 gestion ; and these are the more ordinary circumstances, under which 
 headache occurs. The headache which follows apoplectic and epileptic 
 attacks, that which torments the hysteric female, and that which so often 
 attends on the dyspeptic stomach, all probably depend on cerebral con- 
 gestion variously modified and combined, according to the causes which 
 give rise to it, or to the peculiar state of the constitution in which it 
 occurs." 
 
 I am acquainted with a gentleman who suffers occasionally from dys- 
 peptic headache ; and indiscretion in diet will bring it on, especially if 
 he has been at all worried in business and much confined in London. 
 But his headaches are always hemicranial, confined entirely to one side 
 of the head. And they alternate regularly ; for instance, if he has a pain 
 on the right side one week, and the pain has entirely disappeared, the 
 next time it will be strictly confined to the left side. Sometimes the 
 pain is so severe as to keep him awake at night, and if he falls asleep 
 it will awake him. A slight mercurial purgative will always remove it 
 when very severe ; cold applications relieve it, all motion aggravates it, 
 and the contact of the foot with the ground jars the head ; it does not 
 affect the mind even at the time of its duration, and leaves no ill effects 
 afterwards. Does this depend on local congestion ? I can scarcely 
 believe so. Nor do I see any reason for attributing it to anaemia. 
 
 From these cases, which seem to illustrate the effect of inflammation 
 on the instruments of volition and the organs of intellect, let us next 
 turn to the consideration of inflammation of the substance of the hemi- 
 spheres the tubular neurine ; the following cases certainly demonstrate 
 that the sensibility may be exalted first, and impaired afterwards, as well 
 as that muscular contraction may be excited first, and destroyed after- 
 wards, without the intellect being affected, when the inflammation is 
 confined to that portion of the cerebral substance which is within the 
 gray matter of the convolutions, that matter remaining itself unaffected. 
 The important conclusions which may be drawn from these facts, regard- 
 ing the office of these two portions of the brain, are equally interesting 
 to the physiologist and the practitioner. 
 
 I believe that inflammation of the substance of the hemispheres, or 
 rather, it should be said, of the tubular portion, is characterized by the 
 appearance of convulsions previous to any sign of mental excitement. 
 This inflammation frequently terminates very rapidly in ramollissement. 
 
 This form is extremely insidious f the absence of any disturbance of 
 the intellectual faculties prevents the attention of the patient and the 
 friends being called to the ailment as serious in its nature. 
 
 The headache which accompanies it is generally slight, but still if the 
 patient is intelligent, and can describe the pain he suffers, he will say 
 that it is different from any he ever felt before, that it is not severe pain, 
 but that it is a most uncomfortable feeling. There is another symptom 
 of a most serious import, and one which should never be neglected it 
 is vomiting. 
 
 The convulsions are occasionally followed by coma and then all doubt 
 regarding the danger of the attack is at rest: though it is true, as stated 
 by Dr. Abercrombie, that sometimes after the coma has lasted for a cer- 
 tain time, perhaps for twelve hours, there is a complete recovery from 
 
344 HUMAN BRAIN. 
 
 it, and for several days the patient appears to be in a favorable state ; 
 when, without any warning, the convulsion returns, and terminates in 
 fatal coma. If there is one thing more inexplicable than any other in 
 cerebral diseases, it is their cessation and remission, sometimes amount- 
 ing to an almost regular periodical intermittent. But still the effect of 
 quinine in such cases is, like other stimulants, deleterious. 
 
 In the early stage of this complaint the pupil may not be affected, but, 
 generally speaking, if the case is carefully and constantly watched, one 
 pupil, if the disease is very limited (and it is quite extraordinary how 
 isolated and limited the seat of inflammation frequently is) will be found 
 first contracted and afterwards dilated. Injuries of the head have been 
 already cited as among the causes which produce inflammation of the 
 hemispherical ganglion, and thus affect the intellect; we must again refer 
 to them in relation to the tubular substance beneath, and the effect on 
 the conducting instruments of the brain, as shown by involuntary con- 
 vulsive actions of the muscles. When an injury to the head is immedi- 
 ately followed by convulsions, it is generally a sign of very serious and 
 severe injury to the substance of the brain, usually a laceration. 
 
 When convulsions, after a few days, supervene on a blow of the head, 
 they must be promptly attended to, as indicative of inflammatory mis- 
 chief in the tubular structure or under surface of the ganglion. The 
 following case illustrates this subject well : 
 
 Case 40. Thomas Smith, aged 14, was admitted from Woolwich into George's Ward, St. 
 Thomas's Hospital, under Mr. Solly, as Mr. Green's assistant, May llth, 1846, stated to have 
 fallen from a scaffold about twenty feet high, pitching upon his head. When picked up he 
 was found quite insensible, and bleeding from the right ear. The accident occurred at 7 
 A.M., when he was sent to the hospital, and seenby Mr. Solly at half-past 9 A.M. He had 
 been insensible up to the time of admission, and continued so at that time. His head was 
 shaved, and cold lotion applied; at half-past 1 p. M. he had recovered his senses; his pulse 
 was somewhat slow and laboring; pupils dilated, particularly the left, but contracting upon 
 the admission of light; he complained of pain in the head, and was very drowsy. 
 
 At 9 P.M. was much the same as in the middle of the day. 
 
 Treatment. 9 A.M., Hydr. Chlor. gr. v. stat. sum end. 
 
 2 P. M. R. Hydr. Chlor. gr. ij. quaque 2 d> - hora surnenda. Himd. xx. ad caput applicand. 
 
 9 P.M. Venesectio ad 5jxij. 
 
 May 12th, 8 A.M. Complains still of pain in the head; continues drowsy; pulse 72; 
 bowels not opened, although he has taken eight doses of calomel. 
 
 8^ A. M. Hirud. xxx. Hydr. Chlor. gr. v. quaque hora donee alvus saluta sit. 
 
 I P.M. Pergat. 
 
 II P.M. Enema statim, rep r> donee alvus solnta sit. Sleeping; sensible when roused, 
 but complains of his head, more particularly the left side. Bowels not yet open; has 
 taken nine 5-grain doses of calomel : the calomel to be omitted till morning. 
 
 May 13th. Sleeping; not easily roused, but quite sensible when awake; answers I 
 have got the headache, sir then dozes off again. Pulse 64. Bowels opened twice by the 
 enema; stools lumpy and dark brown. Hydr. Submur. gr. v. mane primo. 
 
 1 P.M. Rather more drowsy; becoming" forgetful. Hirudines xxx. applicantur. 
 
 7 p. M. The sister observed that he had slight grating of the teeth, and almost immedi- 
 ately afterwards thrust his tongue from his month, which remained out ; the right arm was 
 at the same time drawn up, and there was working of the eyes. The sister thought he was 
 conscious, but he could not speak ; she then sent off immediately for Mr. Solly. 
 
 8 P.M. Countenance more anxious; not so easily roused ; answers less readily ; speaks 
 in a more drawling way; pulse 76, not so full. Mr. Solly opened a vein in the arm, but 
 the blood, which was very dark, flowed so slowly that he opened the temporal artery; the 
 patient was raised from the pillow, and as soon as a little more than an ounce of blood 
 had flown, he had a convulsive fit, it was slight, and accompanied by a low moan. The 
 artery was then divided, and he laid again on the pillow, the bleeding being stopped. He 
 almost immediately recovered his consciousness, his countenance was pale, and his surface 
 covered with a cool sweat. Pulse 56, irregular. After a few minutes he seemed a little 
 
INFLAMMATION OF THE HEMISPHERES. 345 
 
 more conscious, and said, in answer to a question, that he was easier. R. Hydr. c. Creti 
 gr. ij. 4 tis- horis. 
 
 May 14th. Says lie is very bad, but seems more conscious; has had no more convulsions ; 
 says that his head aches. Pulse 72, soft; month a little tender. 
 
 9 r M. Countenance better; more cheerful; head cooler; pulse 80; pergat ; says he is 
 a little better. 
 
 About 11 P. M., he had a convulsive fit, very short, mouth drawn to the right side, foamed 
 at the mouth, did not scrram ; a few minutes before, he had started up in bed, and would 
 have fallen out but for his attendant; he had several such fits during the night. 
 
 May 15th, 8 A.M. Countenance very heavy and dull, scarcely answers any questions ; 
 right side of face slightly paralyzed, also the right arm; can feel when pinched, bu^ not 
 readily; bowels not open ; pergat. 
 
 7 P.M. Has had seven or eight fits during the day, not of great length or severe. 
 Countenance much the same; answers questions slowly, but rationally; bowels relieved 
 this afternoon; motions loose and green; pulse 80; pergat. Acet. Lyttae, pectori. Ungt. 
 Hydr. to the blistered surface. 
 
 May 16th. Pulse 80: not so conscious, or well in other respects. 
 
 May 17th. V<ery drowsy, little conscious; has frequent fits: countenance bad; pulse 
 140 ; cannot get him to take any food. 
 
 May 18th. Much worse; countenance anxious; can scarcely answer any questions f 
 says he wants his breakfast; always expressing a feeling of hunger. Pulse 150, small. 
 Has convulsions every ten minutes. 
 
 May 19. Countenance worse, and more anxious; says that he is better, and the pains in 
 the head less, but has greater difficulty in speaking. Pergat. 
 
 May 20th. Countenance much the same; says he is a little better, but does not appear 
 so ; pupils act to light ; right arm paralyzed, but not the leg. Convulsions continue. Pergat. 
 
 May 21. Convulsions not so frequent in occurrence, but continue for a greater length of 
 time, and are more violent; he is not so drowsy, his countenance is improved, and he is 
 perfectly conscious; says he has less pain in his head; pulse 130; bowels open; tongue 
 cleaner. Continue treatment. 
 
 May 22d. The convulsions continue very violent, but occur less frequently than yester- 
 day ; still pain in the head; pupils contract to light; pulse 120 ; bowels open ; says he feels 
 better. 
 
 May 23d. Little alteration as regards the frequency and violence of the convulsions ; 
 has the power of moving his right arm, which was paralyzed on Wednesday, and can close 
 his hand ; countenance much improved ; pulse 120 : bowels open. Continue treatment. 
 
 May 24. Has had no fit since last night ; almost entirely recovered the use of his right arm, 
 and appears much relieved, the pain in the head being less severe ; countenance good ; 
 tongue cleaning ; bowels open; pulse 112; complains of his gums being tender. Continue 
 treatment. Lotio frigida ad caput applicanda. 
 
 May 25th. Continues free from fits; has quite recovered the power in his right arm. 
 Pulse 108 ; bowels open : appetite improved. Cont. Piluke nocte maneque. Omitt. Ung ti- 
 applicatio. 
 
 May 26th. Has passed a very good night; no recurrence of the fits; pain in the head 
 slight, and confined to the frontal region; bowels open; pulse 108. 
 
 May 27th. Says he is better; has but little pain in the head ; countenance good ; tongue 
 cleaner; pulse 112 ; bowels confined. Ordered by Mr. Solly to take Comp d - Colocynth pill 
 ten grains, to be repeated, if necessary ; he had a relief shortly afterwards, consequently 
 the aperient was not administered. 
 
 May 28th. Is progressing favorably. 
 
 June 3d. His gums being still tender, and he generally much improved, to take the mer- 
 cury less frequently. R. Hydr. c. Creta (gr. ij.) alt. noct. 
 
 June 7th. Is much better ; says he has no pain in the head or elsewhere ; bowels open ; 
 tongue clean ; appetite good ; pulse 90. 
 
 June 13th. Appears and describes himself as feeling quite well, and is rapidly gaining 
 strength. The use of the mercury to be discontinued. 
 
 Presented, June 29th, quite well. 
 
 I believe that the pathological course of this case was thus : first, 
 concussion of the brain, with either slight fracture or displacement of 
 bones at the base of the skull, as indicated by the bleeding at the right 
 ear; serious injury to the right side of the brain, indicated by dilatation 
 of the left pupil, taken in connection with the bleeding from the right 
 ear. The injury of the brain confined to the base, indicated by the ab- 
 
346 HUMAN BRAIN. 
 
 sence of much intellectual disturbance; effusion of blood into the tubu- 
 lar structure not in sufficient quantity to produce immediate paralysis, 
 but sufficient to irritate and excite inflammation, indicated by the spas- 
 modic action and convulsions; effusion of lymph consequent on the in- 
 flammation indicated by the paralysis; arrest of inflammation by blood- 
 letting and mercury ; absorption of lymph by continued action of mercury, 
 restoration of the injured brain recovery. 
 
 I never examined after death a case in which inflammation was limited 
 to the tubular portion of the hemispheres. In those cases on record 
 where this occurred, the disease was ushered in with headache, then 
 convulsions, soon followed by paralysis : if the disease extends upwards 
 and outwards to the hemispherical ganglion, then the mental faculties 
 will be more or less excited and perturbed ; if downwards to the ven- 
 tricles, then, effusion taking place, coma is the consequence. 
 
 The following case (and I think it supports my view of its pathology) 
 "is in point after the last ; I shall designate it acute stimulation of the 
 motor tract, as well as the hemispherical ganglion. It is from Andral.* 
 
 Case 41. dcute meningitis limited to the convexity of the left hemisphere of the brain; delirium ; 
 convulsive movements of the face and extremities of the right side. A tailor, 37 years of age, had 
 been sick four or five days when he entered the hospital, 17th July, 1821. On the 15th of 
 this month, without any known cause, he was seized with violent pain of the head, particu- 
 larly seated in the frontal region. On the day after, the headache continued, and the pain 
 became more general, being extended now to the parietal and occipital regions. On this 
 day he lost his appetite, and vomited some drink he had taken. In the evening constant 
 nauseau still appeared, followed from time to time by a throwing-up of some bitter yellow 
 matter. 
 
 On the 17th the headache continued, but the vomiting ceased ; some nausea still. Hav- 
 ing entered the hospital, he presented, on the next day's visit, the following state : face re- 
 markably pale ; pain of head, the precise seat of which cannot be pointed out by the patient; 
 at intervals this becomes so very severe as to make him utter piercing cries ; eyes dim and 
 languid ; slight involuntary motion of the muscles which move the commissure of the lips; 
 his answers accurate ; gives a perfect account of his state, and of everything which hap- 
 pened to him since the commencement of his illness ; the pulse moderately frequent and 
 regular ; everything else natural. 
 
 It was difficult to assign a precise seat to this group of symptoms ; the first complaints, 
 however, regarded the head ; the vomiting might be considered as connected with a com- 
 mencing cerebral affection, and the severe headache seemed to point out the head as the seat 
 of disease. The absence of any morbid phenomenon with respect to the alimentary canal, 
 repelled the idea that the headache was sympathetic of gastro-intestinal irritation. The ab- 
 sence of all febrile disturbance precluded the possibility of its being mere continued fever. 
 The state of the patient, however, appeared very alarming ; the appearance of his counte- 
 nance, and, amidst the absence of local symptoms, the great alteration already of his features, 
 obliged us to form a rather unfavorable prognosis. M. Lerminier suspecting a state of ence- 
 phalic congestion, applied, notwithstanding the extreme paleness of his face, twenty leeches 
 across each jugular vein. Demulcent drinks, and sinapisms to the lower extremities. No 
 change in the patient on the following morning. 
 
 On the 20th he was very much cast down, and answered questions with difficulty and re- 
 luctance; light was painful to him ; he kept bis eyes closed and his head concealed under 
 the bedclothes ; face very pale; pain of head not great; the convulsive movements of the 
 lips more frequent and more marked; pulse and skin natural. (Blister to the nape of tho 
 neck.) In the night he emerged from a state of stupor, in which he had been for the last 
 twelve hours. He got up out of bed suddenly, saying that some persons were pursuing him 
 to do him. harm. He raved during the night, and occasionally uttered several piercing 
 cries. 
 
 On the 21st he was kept in bed by force. The face had now become red; the head was 
 agitated by a continual movement, which carried it from right to left, and left to right ; the 
 muscles moving the lips, the aloe nasi, and the eyebrows, were in the highest degree of con- 
 
 Case VI., p. 6, op. cit. 
 
INFLAMMATION OF THE HEMISPHERES. 347 
 
 vulsive agitation ; saliva, slightly frothy, flowed in great abundance from the mouth ; he 
 spoke incessantly and with energy, but his articulation was unintelligible; great subsultus 
 tendinum, which prevented the pulse from being felt; its frequency did not seem very great. 
 (Bleeding from the arm, twenty leeches to the neck, cold applications to the head.) No 
 change on the 2 1 st. 
 
 On the 22d, violent delirium; convulsive motions of the muscles of the face; risus sar- 
 donicus ; continued motion of the right arm ; subsultus increased ; pulse more frequent ; tongue 
 moist and red. (Two blisters to the thighs ; ice to the head.) 
 
 On the 23d, head turned back, and to the right; strong contraction of the right arm; re- 
 spiration very irregular; occasionally accelerated; it then becomes slower than natural. The 
 patient silent and quite still ; eyes fixed, and void of expression ; mouth open and unmoved; 
 pupils neither contracted nor dilated; answers no questions; does not even seem to under- 
 stand them; original paleness of face returned; pulse sixty a minute, and regular; bowels 
 not free ; tongue cannot be seen ; teeth not dry. He remained quite torpid during the day, 
 but at night violent delirium re-appeared; uttered very loud cries. 
 
 On the 24th, this excitement was succeeded by profound coma; extremities cold ; a clammy 
 sweat covered the face ; respiration ralaut. Died in the course of the day. 
 
 Sectio cadav. On the upper surface a considerable difference in the color of the two cere- 
 bral hemispheres, the right being pale, while the left presented a well-marked red tint, which 
 resided entirely in the sub-arachnoid cellular tissue, which was traversed by numerous ves- 
 sels; neither serum nor pus in the tissue; the gray substance, constituting the most superficial 
 portion of the convolutions of the left hemisphere, participates in the injection of the pia 
 mater covering it. The ventricles contained scarcely two spoonsful (cuilleries a cafe} of 
 serum; nothing remarkable in the rest of the brain The lungs infarcted posteriorly; the 
 heart contained in its right cavity a large fibrinous clot, deprived of its coloring matter; the 
 mucous membrane of the stomach very thin towards its great cul-de sac. 
 
 Case 42. Softening of the right cerebral hemisphere; acute pains in the left extremities, which 
 subsequently became paralyzed, still continuing painful* A woman, 71 years old, had felt, for 
 about a year before entering the hospital, acute pains in the two extremities of the left side. 
 These, which were at first transient, became lancinating, occupying particularly the anterior 
 surface of the upper extremity, and the posterior surface of the lower extremity. 
 
 When they were intense, they gave rise occasionally to slight convulsive twitches of the 
 fingers, and particularly of the index finger; occasionally, too, but only after or during a pain, 
 the thumb was flexed on the palm of the hand, the flexion never lasting beyond ten or twelve 
 minutes. This was the first time the patient experienced such pains; by degrees they be- 
 came more frequent, and at last continued ; but at the same time, they abated of their origi- 
 nal severity, and ultimately the patient only felt in the extremities of the left side, and par- 
 ticularly in the upper, a sensation of formication. She continued thus for five months; she 
 then ceased to be able to sustain herself on her left leg as well as before; this limb seemed 
 to her dull and heavy, and she dragged it a little in walking. At this time also the left upper 
 extremity became weaker; she could no longer grasp or hold any weighty object with the 
 hand of this side. By degrees this paralysis increased, and at the end of six weeks it was 
 as complete as possible. But, what was extraordinary, from the time the muscles of the 
 extremities of the left side were entirely deprived of voluntary motion, the pains which had 
 marked the commencement of the disease returned with their original severity ; and from 
 time to time they increased so as to make her shed tears. This was the state she was in 
 when she was submitted to our inspection. She was at this time emaciated and pale, eyes 
 sunk, features drawn, and expressive of long suffering. Every two or three days the ex- 
 tremities were, as it were, furrowed by acute pains. The skin of these parts much more 
 insensible than those of the limbs of the right side. Power of motion completely destroyed 
 in them; right commissure of lips drawn up; tongue deviated sensibly to the left; skin of 
 face on right side less sensible than on left; the intelligence perfect. She told us, that from 
 her nineteenth to her twenty-third year she had been tormented with violent beating of the 
 heart, accompanied with great difficulty of breathing. These symptoms, however, com- 
 pletely disappeared. After remaining about a month in the hospital, a large eschar formed 
 on the sacrum: she gradually wasted away; her feet became cedematous, and she sank ex- 
 hausted, retaining her intellect to the last. 
 
 Sectio cadav. On a level with and external to the optic thalamus and corpus striatum of 
 the right side, we found considerable softening of the cerebral substance, which extended to 
 the base of the' brain. Anteriorly it was limited by a line, the internal extremity of which 
 might terminate at the junction of the anterior four-fifths With the posterior fifth of the cor- 
 pus striatum. Posteriorly it extended nearly to the posterior extremity of the hemisphere. 
 No ihjection in the softened portion. The softened cerebral substance is of a grayish white 
 
 * Andral, op. cit, Case XV., p. 145. 
 
348 HUMAN BRAIN. 
 
 in certain points, and yellowish in others. The fornix and septum lucidnm diffluent. The 
 two lateral ventricles distended with serum. The great arteries of the brain ossified. Heart 
 and lungs healthy; some ossifications in the aortic valves. The gastric mucous membrane 
 visibly softened towards the great cul-de-sac in several points. 
 
 The lining membrane of the ventricles is sometimes inflamed without 
 the arachnoid on the surface being affected. Andral remarked that dis- 
 eases of the former are not necessarily connected with diseases of the 
 pia rnater surrounding the brain, either at its base or convexity. 
 
 When the lining membrane of the ventricles is inflamed, without the 
 hemispherical ganglion having been previously attacked, as is usually 
 the case, the symptoms are peculiar ; for the arachnoid and pia mater 
 of the surface are most frequently attacked in the first instance, and that 
 of the ventricles subsequently. The diagnosis might perhaps be con- 
 sidered more interesting in a physiological than useful in a practical point 
 of view. But such is not the case, for this form of inflammation is so 
 insidious, and its formidable character so liable to be passed over until 
 it is too late to apply our remedies, that we cannot be too much alive to 
 the symptoms which indicate its presence. The following case illus- 
 trates this. When I related it to a medical society, some very sound 
 and careful practitioners remarked on its close resemblance to many 
 cases of hysteria which were occurring daily in their practice. 
 
 Case 43. In the summer of 1844, at 2 P.M., I visited in consultation a young lady, set. 15, 
 suffering in the following manner : I found her lying on a sofa, her countenance much 
 flushed, her head hot, pulse irregular and quick, but without much power; strabismus of the 
 right eye towards the nose, both eyes bright and rather staring. She was not able to an- 
 swer any questions, but sufficiently conscious to open her mouth slightly, and partially pro- 
 trude her tongue, the tip of which was brown and dry: her right arm was raised in the air 
 and jerked about spasmodically; afterwards she picked the bedclothes, but she was unable 
 to move the limbs on the left side at all. 
 
 The gentleman in attendance informed me that he had seen her occasionally for some 
 time past, with various symptoms ; at one time with a cough, very similar to hooping-cough ; 
 and on more than one occasion suffering from severe affection of the respiratory organs, and 
 the next quite well : she was also subject to many hysterical symptoms. She first men- 
 struated one year back; but she has since been irregular, three months having elapsed with- 
 out any show. 
 
 For the present illness Mr. F. visited her six days ago ; he found her with an exceedingly 
 quick, small pulse, without anything apparently to account for it : there was a general dull- 
 ness of expression; eyes looking heavy; pupils dilated; intellect rather blunted, giving per- 
 fectly correct answers, only very slowly. She complained of pain in the left side of the 
 abdomen, and slight pain in the head. He ordered her saline aperients and hyoscyamus in 
 very small doses. 
 
 Mr. F. informs me that no very decided change took place in her symptoms till the fourth 
 day, when she was much worse; she complained of cold chills, and soon after the parents 
 observed that the limbs on the left side lay like withered limbs, arid those on the right side 
 were seized with convulsive movements. She was still sufficiently sensible to complain of 
 the jerking of her limbs, which she said were mad. Her intellect became gradually more 
 dull, but she was not delirious. 
 
 I told Mr. F. that I considered that there was inflammation of the lining membrane of 
 the ventricles, with effusion, and I was afraid that there was some softening about the 
 thalamus, more especially on the left side. She died about eight hours after I saw her. 
 
 Post mor/fw, 84 hours. Lody plump, slightly green over the abdomen, but otherwise fresh. 
 
 Head Convolutions of the upper part of the brain flattened; no inflammation of the 
 arachnoid in this situation, or sub-arachnoidal effusion; slight softening of the great trans- 
 verse commissure ; ventricles filled, and distended with bloody serum mixed with some 
 pus. The lining membrane of the right ventricle slightly inflamed, studded all over with 
 ecchymosed spots; sero-sanguineous effusion into the left ventricle; suppuration, with soft- 
 ening of the right thalamus, some softening of the left, some effusion at the base round the 
 medulla oblongata. 
 
 Mdomen. Hydatid attached to each broad ligament of the uterus. 
 
INFLAMMATION OF THE HEMISPHERES. 349 
 
 It is sometimes difficult to decide whether the quantity of fluid con- 
 tained in the ventricles, is above the normal quantity, whether it is in 
 morbid excess. If the arachnoid and pia rnater are torn either at the base 
 of the brain, so as to open the inferior cornu of the lateral ventricles, or 
 at the foramen of Bichat, or at the fourth ventricle, then the fluid escapes 
 before these cavities are opened. If this fluid is greatly in excess, 
 the form of the convolutions and fossa digitataB at the vertex of the 
 brain indicates the fact ; the convolutions are flattened, and the sides of 
 the fossae in close contact. If we suspect an abnormal quantity of fluid, 
 it is important to mark their condition before opening the ventricles. 
 
 Andral considers that the presence of serum in the ventricles should 
 only be considered the result of a morbid process when its quantity ex- 
 ceeds an ounce in each lateral ventricle. Excess of serum is more fre- 
 quently met with in the ventricles than in the external arachnoidal sac. 
 
 Andral remarks, that when the quantity is very considerable, the sep- 
 tum lucid urn and fornix are always found softened. 
 
 It is difficult to say whether this softening is the result of the same 
 inflammatory action which gives rise to the effusion, or whether it is a 
 mere physical effect from imbibition, as stated by Dr. Hughes Bennett. 
 I have no doubt that it is sometimes one and sometimes the other, but 
 most frequently the effect of inflammation, and as such to be considered. 
 
 Inflammation of the corpus striatum does occur sometimes, though 
 seldom without some other portion of the brain being involved. Dr. 
 Abercrombie relates a case in which there was a small abscess in both 
 corpora striata, the rest of the brain being perfectly healthy. 
 
 In drunkards, and persons of excitable dispositions, who are much 
 harassed with the cares of life, I believe that the brain is liable to be 
 frequently congested, and that the blood-vessels become permanently 
 enlarged. 
 
 M. Max. Durand Fardel* has well pointed out the change which 
 takes place in these cases. He calls it a sieve-like condition of the 
 brain, etat crible du cerveau. u These little holes are usually surrounded 
 by perfectly healthy cerebral substance. They are circular, with well- 
 defined edges, scattered irregularly through the brain, varying in dia- 
 meter, and unchanged in form by a stream of water. If water is al- 
 lowed to flow on them for any time, the cerebral substance is gradually 
 washed away, and the little holes are seen to have been the artificial 
 openings of canals, each of which contained a vessel." 
 
 " The sieve-like condition of the brain is sometimes found unasso- 
 ciated with any other lesion; at other times, however, it co-exists with 
 the various forms of softening of the brain, and especially with the 
 general ramollissement of the cortical layer of the convolutions which M. 
 Calmeil has described as peculiar to the general paralysis of the insane, 
 with induration of the brain, &c. Evidence exists to prove that the 
 connection between the etat crible of the brain and other lesions with 
 which it is associated is not merely accidental; thus, in one instance, in 
 which idiotcy, attended with occasional attacks of mania, followed a 
 
 * Ga/ette Medicale, Jan. 15th, 1842, quoted in the British and Foreign Quarterly Medical 1 
 Review, vol. xiv. p. 225. 
 
350 HUMAN BRAIN. 
 
 blow on the head, induration of the brain, and the sieve-like condition, 
 were found confined to that hemisphere of the cerebrum on which the 
 injury had been inflicted. It is not unusual in cases of chronic soften- 
 ing of the brain to meet with this sieve-like appearance for some dis- 
 tance around the softened part, betokening the previous existence of 
 dilatation of the vessels. In the same brain, too, M. Fardel has met 
 -with recent ramollissement and injection of the vessels, and old ramol- 
 lissement with the etat crible" 
 
 From his observations, many of which are detailed at length, the 
 writer concludes that " the [etat] crible of the brain is produced by the 
 presence of a great number of small canals, perforated in the cerebral 
 tissue, each containing a little vessel, to the dilatation of which their 
 formation is doubtless owing. These canals, the existence of which is 
 normal in some parts of the brain, appear in a rudimentary state, without 
 being necessarily morbid, in some persons in advanced life. 
 
 " The usual seat is in the cerebral hemispheres, especially beneath 
 the convolutions, but they are likewise met with in the cerebral protu- 
 berance, and in the medulla oblongata. 
 
 " Though somewhat different in appearance, the little cavities so often 
 seen in the corpora striata are probably of a similar nature. 
 
 " The general or partial dilatation of a great number of the vessels of 
 the brain appears to be owing to chronic sanguineous congestion, or to 
 frequent recurrence of congestion of the organ. 
 
 u This opinion seems sufficiently warranted by the phenomena ob- 
 served during life, as well as by the alterations which are found after 
 death to co-exist with the etat crible of the brain. 
 
 " Twice this condition existed uncombined with any other appreciable 
 lesion of the brain. In one of these cases there was simple dementia, 
 in the other, dementia with general paralysis. 
 
 " It is found associated with superficial ramollissement of the convo- 
 lutions in insane persons affected with general paralysis, with general 
 or partial induration of the brain, and in the centre of, or around, por- 
 tions of softened brain. 
 
 " This state probably existed, but escaped notice in cases where 
 grave cerebral symptoms were not found to have given rise to any lesion 
 appreciable after death." 
 
 In considering the effects of inflammation on the cerebral substance, 
 we must not omit induration. We have already turned our attention to 
 softening, both as the result of anaemia and hypersemia, and it may seem 
 strange that the same action of the capillary system should produce a 
 totally opposite condition. 
 
 Induration of the Brain. The existence of such an alteration in tex- 
 ture is now acknowledged by all pathologists, and I believe it is gene- 
 rally admitted to be the result of hypersemia of the part. It may seem 
 strange that inflammatory action should produce both softening and hard- 
 ening, but such seems really to be the case. The induration accom- 
 panying hypertrophy has been already adverted to. It is to the more 
 partial induration that we must now direct our attention. Andral* 
 
 * Pathological Anatomy, p. 75. 
 
<*-{ INDURATION OF THE BRAIN. 351 
 
 mentions several instances. " Induration," says this author, " of the 
 centre of the medullary substance of the cerebral hemispheres was ob- 
 served by M. Pinel, in a woman who died in a state of insanity ; the 
 posterior and inferior margin of the cerebellum was also so indurated as 
 to become almost fibro-cartilaginous. M. Payen once found in a child, 
 six years old, a depression in the posterior third of the left cerebral he- 
 misphere, which was owing to the induration and shrinking of one of 
 the convolutions. The superjacent membranes, which were thickened 
 and white, accurately defined the extent of the diseased part. The girl, 
 who was of a melancholy temperament, but remarkably intelligent, had 
 from her birth a contraction of the right wrist and foot, together with 
 slight atrophy and incomplete hemiplegia of the same side." 
 
 Induration has been supposed by some to be a stage of inflammatory 
 action, antecedent to that which produces softening, and seems very 
 probable; but it must be considered of a slower and less acute charac- 
 ter. This is Dr. Copland's opinion, and quite accords with my own 
 limited observation. 
 
 The fact of its being so often found in the brain of lunatics is interest- 
 ing and important, as throwing further light on the pathology of that 
 disease, and pointing to the proper mode of treating it medically. 
 '-'-General induration of the brain," says Dr. Copland,* "generally oc- 
 casions loss of memory, confusion of thought, and derangement of the 
 mental manifestations, causing insanity without lucid intervals. When 
 the induration is advanced in degree, or considerable as to its extent, 
 or both, and especially when its long duration has been indicated by 
 continued mental derangement, a complete obliteration of the mental 
 faculties, or fatuity, is frequently its attendant towards the last periods 
 of life, and may, therefore, be considered as the consequence of the most 
 advanced degrees of this lesion. The signs of partial induration of the 
 brain will vary according to the extent and seat of the lesion. They 
 consist chiefly of a progressive defect of memory, inattention, or an ina- 
 bility to pursue a long train of ideas, indifference to momentary impres- 
 sions, and to present or future occurrences, difficulty of articulation, de- 
 rangement of ideas, with partial and total loss of the affections, appetites, 
 and desires, and, ultimately, increased loss of speech, palsy, convulsions, 
 or want of power over the muscles, 'fatuity, general or partial wasting, 
 and death." 
 
 In connection with hypersemic disease of the brain, the practitioner 
 must remember that the scalp is liable to various eruptive diseases; but 
 he must not set to work and heal them by local remedies, like dis- 
 eases of the skin in other parts of the body, without first ascertaining 
 how far they may have been set up by nature as a safety-valve to the 
 brain. In children, how often do we see eczema spring forth on the head 
 during the irritative fever of dentition, with the very greatest advantage 
 to the child ; and woe to the poor infant if the eruption is suddenly 
 checked! It ought to be regarded as a kind adviser, telling us what 
 may be going on within. It is surprising how soon it disappears if 
 we lance the gums freely, and give a grain or two of gray powder 
 
 .* . fi r^b 
 
 * P.221,op.cit. 
 
352 HUMAN BRAIN. 
 
 every other night, with a little magnesia and rhubarb every morning. 
 Scarcely a week passes that I do not see two or three such cases at the 
 General Dispensary, and I always watch them with interest for the 
 brain's sake. 
 
 Meningitis has been described by some authors as being occasionally 
 epidemic. It is possible as a form of fever, but in most cases I think 
 that it will be found there is some common moral cause which produces 
 it, rather than an atmospheric one. In the British and Foreign Quar- 
 terly Medical Review for July, 1844, there is an account, extracted from 
 the Memoires de PAcad. Roy. de Med., Paris, 1843, of this form of 
 disease. 
 
 It appears to have ravaged the garrisons of Versailles, Lyons, Bay- 
 onne, Groet, Metz, Strasburg, &c., and its not being confined to the 
 military gives it a title to be considered epidemic. The predisposing 
 causes were, extreme youth of the soldier, his having recently joined 
 the service, and being unaccustomed to military exercise. Prolonged 
 exposure to the sun, with or without subsequent chill, but, above all, 
 violent exercise followed by chill, appear to ha^ve acted most frequently 
 as immediate causes. Post-mortem examinations detected injection of 
 the membranes, with effusion of red-colored serosity, pus in the pia 
 mater, softening of the medullary substance of both brain and spinal 
 cord. The treatment recommended for simple meningitis is essentially 
 antiphlogistic, accompanied with derivatives to the extremities, purga- 
 tives, cold applications to the head, &c.: when the cases were treated 
 on the onset of the attack, this plan answered :. but when the inflamma- 
 tion had extended to the substance of the encephalon, then collapse was 
 so sudden and complete that depletion could not be resorted to until re- 
 action had taken place. In most of these cases, M. Rollett, finding that 
 the ordinary modes of exciting such action by blisters, sinapisms, and 
 ammoniacal ointment, fail, tried the actual cautery to the spine, and, at 
 the same time, sinapisms to the feet, vesications to the thigh, cupping 
 to the neck, and purgative enemata. The cauterization gave no pain, 
 but reaction took place in an hour or two afterwards, and then blood- 
 letting was employed. This severe treatment was found much more 
 successful than the older and more usual course in *such cases. 
 
 In the treatment of inflammation of the brain, whatever the form may 
 be, no time must be lost ; minutes are even of importance. Bleeding, 
 both topical and general, are important remedies, but they require great 
 judgment in their application ; as a general rule, venaBsectio brachii is 
 not so useful as bleeding by leeches from the head. But in cases where 
 there is evidence of there having been good constitutional power pre- 
 vious to the attack, for during the attack the pulse is very deceptive, 
 and the head is hot, and the face flushed, and the disease is progressing 
 rapidly, then general blood-letting is indicated. 
 
 The following cases, related by Abercrombie, illustrate the value of 
 general blood-letting. The third case shows that we must not be dis- 
 couraged in the employment of this remedy, if we have deliberately 
 decided that it is right to employ it, though it does not immediately pro- 
 duce a beneficial effect. 
 
TREATMENT OF INFLAMMATION OF THE BRAIN. 353 
 
 Case 44. A girl, aged 11, had violent headache and vomiting, with great obstinacy of the 
 bowels, and these symptoms were followed by dilated pupil, and a degree of stupor border- 
 ing upon perfect coma; pulse 130. She had been ill five or six days; purgatives, blisters, 
 and mercury to salivation, had been employed without benefit. One bleeding from the arm, 
 gave an immediate turn to this case; the headache was relieved, the pulse came down ; the 
 vomiting ceased; the bowels were freely acted upon by the medicines which they had for- 
 merly resisted, and in a few days she was quite well. 
 
 Case 45. A slender and delicate girl, aged 11, had scarlatina in a favorable form, in the 
 beginning of April, 1820. About the 16th she was so much recovered as to be allowed to 
 go about the house. A few days after this, she was affected with anasarca, for which she 
 took some medicine, with partial benefit. About the 26th, however, the anasarca had again 
 increased considerably, especially in the face, which was very much swelled. In the follow- 
 ing night she had vomiting. On the 27th, she complained of headache, which increased 
 rapidly in violence; towards the afternoon, she became delirious; the pulse very frequent, 
 about 160. Soon after this she was seized with violent and general convulsion, which re- 
 curred very frequently through the early part of the night, leaving her in a state of profound 
 coma. The treatment adopted during the course of these symptoms was repeated general 
 bleeding, to the amount of 28 ounces, followed by topical bleeding, purgatives, antimonial 
 solution, &c. Towards midnight the convulsion ceased, and some time afterward she gradu- 
 ally recovered from the coma. On the 28th she was free from any alarming symptom; 
 during the early part of the day, pulse about 108. In the evening she was seized with severe 
 symptoms of pneumonia, on account of which she was bled during the next twenty-four 
 hours, to the amount of upwards of thirty ounces, besides bleeding with leeches and the 
 other usual remedies. In a few days more she was restored to perfect health. 
 
 Case 46. A lady, aged 45, after the menses had ceased for four months, was seized with 
 headache, sense of weight in the head, much oppression, and double vision ; the pulse was 
 at first 72, but soon rose to 100. On the first day she was bled to twenty-eight ounces, with 
 little relief. On the second, topical bleeding, blistering, and smart purging were used, but the 
 symptoms continued unabated. On the third day, another bleeding of twenty ounces gave a 
 turn to the complaint, and, in a few days more, with brisk purging and spare diet, it terminated 
 favorably. The last symptom that yielded was the double vision. It subsided slowly, the 
 two images gradually approaching nearer to each other; but it was not entirely gone for 
 nearly a fortnight. 
 
 " Bleeding by leeches," says Dr. Holland,* " from the haBmorrhoidal 
 vessels might be much more frequently employed than it is in affections 
 of the brain, as well as in those of the spinal cord. I know no mode in 
 which a given quantity of blood can be removed with equal effect in the 
 cases where it is required. It may be difficult to give strict anatomical 
 reasons why this should be so; but what we know on the curious subject 
 of the changes of balance in circulation, will, at least, furnish illustra- 
 tion of it. Nor can I doubt that something here is due to that peculiar 
 relation between the blood in the portal circulation and the functions 
 and diseases of the brain, of which experience affords so many remarka- 
 ble proofs. For the practice itself, we have especial argument in the 
 frequent alternation of bleeding, hemorrhoids, with headaches, and other 
 graver affections of the head ; and also in the serious effects which some- 
 times ensue upon the suspension of such discharge, after it has long been 
 habitual to the system." 
 
 Dr. Prichardf observes: " The fact, that evacuations of blood from 
 the head fail to afford relief in many cases of nervous disease, is by no 
 means a decisive proof that the affection, in this particular instance, does 
 not depend upon, or is not connected with, increased vascular fullness 
 in the brain, since we often experience a similar disappointment in those 
 cases where we know the disease to consist in an overdistended state 
 of the vessels." 
 
 
 * P. 55, op. cit 
 
 t A Treatise on Diseases of the Nervous System, 1522, p. 236. 
 
 23 
 
t 354 HUMAN BRAIN. 
 
 Dr. Prichard* relates some interesting cases of maniacal disease cured 
 by the supervention of contagious fever. He had, he says, " an oppor- 
 tunity of frequently witnessing the effects of fever communicated to 
 maniacs, as male lunatics are placed in the same ward with persons 
 laboring under contagious fever." I will select the following, as I think 
 it illustrative of the pathology of insanity. The observations which fol- 
 low I entirely concur with. 
 
 Case 47. Anne Jaunery, admitted June 17, 1817. 
 
 Description. A married woman, aged 28 years, the mother of three children. She is of a 
 tall and slender make ; has brown hair, dark gray eyes, low forehead, sharp features ; her 
 natural disposition is irascible. 
 
 History. She has never been before affected with maniacal symptoms ; this attack is 
 supposed to have been produced by intemperance. Her husband is insane, and is confined 
 in this house; his disorder is attributed to vexation in consequence of the loss of property. 
 
 Present state. She is extremely irritable ; talks incessantly on different subjects 5 frowns, 
 and closes her eyes as if intolerant of light. 
 
 Treatment. Shave her head ; Haust. Cath. nocte maneque ; house diet. 
 
 July 20. The purging has been continued ; little or no amendment ; cold shower-bath ; 
 continue the purgatives. 
 
 Aug. 17. No improvement has taken place; pulse full, not quickened; complains of 
 weight and pain in the head ; is drowsy. She has had an interview with her husband ; 
 neither of them appeared to be aware of their situation. V. S. et fluant sang. ^xvj. Syn- 
 cope followed blood of loose consistence ; the bleeding relieved her. From this time she 
 continued occasionally with pain in the head, attended with increased pulsation of the qaro- 
 tid and temporal arteries, and a renewal of her restlessness and maniacal symptoms, which 
 were generally relieved for the time by the application of leeches to the head, blisters to the 
 nape of the neck ; her bowels were constantly kept open, and she generally used the 
 shower-bath . 
 
 About the 2d of January, 1818, she had a slight attack of contagious fever, which subsided 
 in about a week. From that time she gradually recovered, and was discharged, cured, on 
 the 26th of the following June. Full diet was allowed her from the time of her becoming 
 convalescent from fever. 
 
 Observations. This was evidently a case of inflammatory congestion of the head. It was 
 excited by dram-drinking, and relieved by local depletion; but not cured, until a new disease 
 took place, which altered the determination of the vascular system, and overcame the tend- 
 ency to congestion in the head. 
 
 Purgatives and mercury are our most valuable allies in combating in- 
 flammatory disease of the brain. Dr. Abercrombie says, " In all the 
 forms of the disease, active purging appears to be the remedy from 
 which we find the most satisfactory results ; and although blood-letting 
 is never to be neglected in the earlier stages of the disease, my own ex- 
 perience is, that more recoveries from head affections of the most alarm- 
 ing aspect take place under the use of very strong purging than any 
 other mode of treatment." Dr. Abercrombie preferred croton oil as the 
 most convenient. I generally give calomel in five-grain doses, as we 
 'thus obtain the benefit of the specific powers of this mineral in restrain- 
 ing inflammation, as well as its purgative effects. 
 
 The following case, from Dr. Abercrombie, illustrates the power of 
 purgative medicines in these diseases : 
 
 Case48.j- A gentleman, aged 17, 1st February, 1810, had symptoms of continued fever 
 for a week; the skin then became cool, and the tongue clean ; but he had severe headache, 
 with considerable stupor; pulse 100. General bleeding was then employed, foil owed 1 by 
 purging and mercurial frictions, and after a few days the symptoms were alleviated ; but 
 there was still much headache, with oppression, and considerable slowness of speech. On 
 the 14th there was increase of stupor; pulse 86; the tongue clean; the skin cool. On the 
 
 Op. cit, p. 72. ., f Op. cit, n. 160, Duodecimo. 
 
TREATMENT OF INFLAMMATION OF THE BRAIN. 355 
 
 16th there was much incoherent talking and unmanageable delirium; after which the 
 stupor again increased, the pulse continuing at 84. On the 19th, there was partial relief, 
 after smart purging ; but on the 20th the stupor had returned as before, and by the 22d had 
 increased to perfect coma ; the pulse about 100. He now lay in a state of perfect coma for 
 four days, during which time various medicines were given with difficulty, and with little 
 effect upon his bowels. On the 27th, purging was produced to the extent of fourteen evacua- 
 tions in the day, with complete relief of all his symptoms. On the 28th there was some 
 delirium, which subsided in another day. For a week he continued to complain of some 
 headache, and a feeling of weight in his head, but by the 10th of March he was free from 
 complaint. 
 
 Cold applications to the head are invaluable; on the whole, pounded 
 ice in a large bladder is perhaps the best. If this cannot be procured, 
 then any evaporating lotion, such as spirit of wine and water, but this 
 must be constantly changed ; and the effect is very much increased by a 
 current of air thrown upon it with the bellows. 
 
 The best refrigerator, after all, is the cold douche, but then the patient 
 should be in a warm bath ; or, if this is not possible, his feet should be 
 placed in warm water. It can always be administered by pouring water 
 from a height of about five or six feet out of a common washing-stand 
 jug. It is so powerful a remedy that it must be used with caution. The 
 writer, to whom I last referred, says that he has seen, under the opera- 
 tion of it, a strong man thrown, in a very few minutes, into a state 
 approaching to asphyxia, who immediately before had been in the 
 highest state of maniacal excitement, with morbid increase of strength, 
 defeating every attempt of four or five men to hold him. 
 
 Regarding the use of cold to the head, Dr. Henry Holland makes the 
 following excellent practical observations :* 
 
 " There are one or two lesser points in the treatment of affections of 
 the brain deserving more discrimination than they usually obtain. One 
 of these is the general use of ice, or other cold applications, to the head. 
 Any influence of cold, through its effect on the capillary vessels of the 
 head, is at least ambiguous in such cases ; and though its direct sedative 
 effects on the nervous system may afford more certain warranty for the 
 practice, yet these require to be distinguished and watched over in their 
 progress. For, even where relief is distinctly obtained from cold sud- 
 denly applied after embrocation, it by no means follows that this appli- 
 cation, long continued, will produce or maintain a like benefit. It is 
 well known in various parts of practice how far it is otherwise ; and 
 that the effect of cold upon the circulation and nervous system is some- 
 times even reversed, according to the amount and manner in which it is 
 applied. Or allowing, as I readily do, that there may be a distinct 
 sedative effect from cold, beneficial in cases of inflammation of the brain 
 or its membranes, will this equally apply to apoplectic cases, where 
 pressure occurs from fullness of vessels or extravasation? If the relief 
 to some kinds of headache be alleged, it must be remembered that 
 other headaches are increased by this means. The same disparity, 
 doubtless, exists as to the more serious affections of this organ requiring 
 discrimination wherever we can exercise it. Unfortunately these are 
 cases in which, generally, patients can render least aid. Sometimes they 
 are manifestly uneasy under the application of cold. Their feeling, 
 whenever it can be ascertained, is better than any other test." 
 
 * P. 47, op. dt. 
 
356 HUMAN BRAIN. 
 
 I have found aconite, antimony, and digitalis, each and all most use- 
 ful medicines in subduing inflammation of the brain. 
 
 The value of aconite is well shown in the case of Betsey Rankin 
 Meningitis from fracture of the skull. Antimony I have not used much, 
 as I have considered it too depressing in its operation. Digitalis is more 
 useful in chronic cases than in the acute. 
 
 I have long felt convinced that much of the obscurity, which envelops 
 these diseases, and those of other parts of the brain, mi^ht be removed 
 by comparing them with diseases of the eye ; viewing them through the 
 light which the observation of this interesting class of affections affords 
 us. I do not refer so much to acute disease as chronic, though both are 
 useful as instructors. One great reason why these affections of the eye 
 ought to guide us in our treatment and prognosis of inflammation, both 
 chronic and acute in other organs, is the facility with which we can ob- 
 serve the action of remedies, medicines, topical applications, general 
 stimulants, and diet, upon an organ so open to observation. I believe 
 that every form of mental derangement is dependent on some change, 
 though often very slight and temporary, of the vital condition of the 
 hemispherical ganglion. 
 
 I arn convinced that the reason why physicians, to whom the treatment 
 of the insane has been entrusted, believe in the existence of mental dis- 
 ease unattended with disease of the instrument which the mind employs 
 in its communications with the world, is because the medicine, both 
 constitutional and local, has so little control over these diseases, and the 
 great good to be derived from moral treatment. A knowledge of the 
 treatment of diseases of the eye would teach them a different lesson. 
 Let any man ignorant of the treatment of ophthalmic diseases attempt 
 the cure of a case of strumous ophthalmia; he would, in all probability, 
 seeing the red, inflamed conjunctiva, the pain suffered by the patient, 
 and the distress occasioned by the presence of light, employ all the most 
 approved antiphlogistic measures. He would bleed from the arm, purge 
 violently, and then possibly put his patient under the influence of mer- 
 cury. What would be the consequence? Why, most assuredly the loss 
 of the eye, total blindness. And the same sad results followed the treat- 
 ment of insanity when it was considered to be an inflammation of the 
 brain, except in very acute cases occurring in subjects with much con- 
 stitutional power; injudicious treatment being attended in the one case 
 with the loss of sight, in the other with the loss of intellect. But sup- 
 pose a judicious surgeon, one bred in the school of Farre, Travers, 
 Lawrence, and my late respected colleague, Frederic Tyrrell, called 
 upon to treat this strumous inflammation of the eye. He would support 
 his patient's general health with a tonic plan of treatment ; he would 
 improve the condition of the circulating fluid and the instruments which 
 circulate it. He would endeavor to arrest local inflammation by small 
 local blood-lettings, counter-irritants, and astringent lotions, by remov- 
 ing him from all those atmospheric influences and moral circumstances 
 which would stimulate the organ. And thus he might ultimately suc- 
 ceed; but what care, what patience, and what confidence in the reme- 
 dial agents employed, does it require on the part of the surgeon who 
 Jtreats these cases, to effect a cure ! 
 
TREATMENT OF INFLAMMATION OF THE BRAIN. 357 
 
 If, then, it is so difficult to subdue an inflammation in an organ, the 
 actual condition of whose blood-vessels we can view, to which we can 
 actually apply local remedies, and from which we can withdraw the in- 
 jurious agents which have produced this inflammation, and exclude the 
 natural stimulus of the organ, and see, in the whole course of our reme- 
 dial measures, the progress or the failure of each particular plan of treat- 
 ment, is it astonishing that men should have failed so much in the treat- 
 ment of chronic and strumous inflammation of the arachnoid, pia mater, 
 and hemispherical ganglion, when they have all these difficulties to con- 
 tend with, and want many of the adjuncts? 
 
 Mr. Tyrrell, in his lectures, used to relate, in illustration of the im- 
 portance of a generous diet and tonic medicine in the cure of chronic 
 asthenic ophthalmia, the case of a young gentleman who was brought to 
 him by his father, an intelligent medical man, on account of the obstinacy 
 of the ophthalmia from which he was suffering. The father had been 
 employing antiphlogistic measures. Mr. Tyrrell said, " Before I pre- 
 scribe for your boy, go and give him a good dinner, and a pint of porter." 
 The father was thunderstruck, the boy delighted, for he had had nothing 
 but water-gruel, &c., for the previous week. The father did as he was 
 told, the same principle was extended to the prescriptions, and the boy 
 soon got well. 
 
 Now, supposing that this inflammation, instead of being of the eye, 
 where it could be seen, had been an inflammation of the brain, where it 
 could not be seen, the existence of which could only be conjectured from 
 symptoms, and the physician had prescribed the same phlogistic treat- 
 ment, with the same success, he would adduce it as a proof that there 
 had been no inflammation at all. 
 
 Again, the cures that are effected by moral treatment alone, are often 
 brought forward as a proof that mental diseases are unconnected with, 
 and independent of, corporeal diseases. It would be just as correct to 
 say an inflammation of the eye was no inflammation of the eye, because 
 such inflammation is sometimes cured by placing a patient in a dark 
 room, and removing the part from the injurious stimulus of light and 
 atmospheric influences. 
 
 The moral treatment of the insane is no more. It essentially consists 
 in the removal of injurious stimuli, soothing and tranquilizing the organ. 
 
 Strumous ophthalmia has been alone adverted to in illustration of this 
 view, but there are many other ophthalmic affections which are equally 
 in point, and the consideration of which will, I think, be found equally 
 instructive: iritis, choroiditis, and amaurosis, but especially the last. 
 
 The treatment of iritis is chiefly instructive in demonstrating the 
 superiority of mercury over blood-letting in subduing a deep-seated 
 inflammation, and the necessity of bringing your patient rapidly under 
 its influence, to prevent the consequence of adhesive inflammation. 
 
 Amaurosis, consequent on chronic choroiditis, is, I believe, almost 
 pathologically identical with mental imbecility, consequent on chronic 
 meningitis. 
 
 In the first case, the delicate structure of the retina, the vesicular 
 neurine which expanded on the optic nerve, has been pressed upon by 
 
358 HUMAN BRAIN. 
 
 its vascular and serous membrane, the choroid and membrana Jacobi, 
 thickened by morbid deposit. 
 
 In the second, the vesicular neurine of the hemispherical ganglion is 
 pressed on by the thickened pia mater and arachnoid. 
 
 And most certainly the success which attends perseverance in the 
 treatment of chronic choroiditis and amaurosis ought to encourage us to 
 similar patience and perseverance in the treatment of chronic menin- 
 gitis. 
 
 I have known Mr. Tyrrell cure most obstinate cases of amaurosis by 
 persevering in the administration of small doses of mercury, generally 
 two grains of gray powder every night, or every other night, for twelve 
 months, taking care never to affect the mouth. Indeed, he used to say 
 that he has often seen the cure of such a case arrested, sometimes en- 
 tirely prevented, by rapid salivation, in consequence of the impatience 
 of the invalid, or want of judgment on the part of the practitioner. 
 Mr. Tyrrell told me that he had often given mercury in small doses for 
 two months without any improvement in vision, but this has not dis- 
 couraged him, and that, by proceeding with the plan, he has ultimately 
 restored many a poor fellow to sight, whose case had been abandoned 
 as hopeless. Mercury is in disrepute in the treatment of insanity, be- 
 cause, as I believe, it has not always been judiciously administered. 
 
 Mercury will often restore the sight in amaurosis, even where the 
 perception of light is destroyed. Mr. Tyrrell used to consider that a 
 case was not entirely hopeless, if the globe retained its natural consist- 
 ency; neither abnormally hard, or soft and shrunken: for when the disease 
 is of very long continuance, then the retina and vitreous humor become 
 sometimes implicated in the morbid action, and partial atrophy ensues. 
 
 If we could apply the same test in our diagnosis and prognosis of 
 cerebral affections, we should administer our remedies with more con- 
 fidence, as it is almost impossible to say when the ganglion has become 
 atrophied, and when it is still unchanged in structure. In these amau- 
 rotic cases it is not merely necessary to sustain the mercurial action for 
 months, but at the same time the power and tone of the patient's con- 
 stitution must be sustained by a good nutritious diet and a moderate quan- 
 tity of stimulus. Mr. Tyrrell's words are,* U I consider that the safety 
 of the treatment, and its efficacy, depend very greatly upon the support 
 of the general power; for whilst this is properly sustained, I believe 
 that the remedy cannot produce any general injurious effect, though its 
 operation upon the local disease may proceed most beneficially. Unless 
 the general power be maintained, the effects of the mercurial action on 
 the system are extremely distressing and injurious; and it can rarely be 
 continued long enough to remedy the amaurosis." These observations 
 result from great practical experience ; not only in ophthalmic diseases, 
 but in other surgical affections, in which the continued and free use of 
 mercury is of the greatest use in arresting and subduing diseased action. 
 
 Case 49. Mr. T. relates the case of a man about thirty-eight years of age, who had been 
 amaurotic for seven years, and had lost the perception of light; but the globes possessed 
 their natural firmness and elasticity; the pupils were clear, but irregular, from many points 
 
 * Cyclopaedia of Surgery > L p. 91. 
 
TREATMENT OF INFLAMMATION OF THE BRAIN. 359 
 
 of adhesion between the pupillary margin of the iris, and the anterior capsule of the lens ; 
 the irides were discolored and dull, and he had the vacant aspect of a blind person. I ad- 
 mitted him into the infirmary, then in Charter-House-square, and put him under mercurial 
 treatment, with a nutritious diet; as soon as the mouth became tender, a considerable degree 
 of s^Ierotitis occurred, with pain and tenderness of the eyeballs; the plan was, however, 
 steadily continued, and some belladonna was applied, night and morning, to each eyebrow; 
 he soon became sensible of light, and gradually acquired the power of discerning objects, 
 and, at the same time, the adhesions between the iris and the capsule of the lens began to 
 give way, and the pupils to re-assume their natural figures; by degrees the vision improved, 
 all appearance of inflammatory action subsided, the pupils became nearly regular, and the 
 irides brilliant; the full mercurial action was kept up for above sixteen weeks, when the 
 amaurosis was completely subdued, and his vision perfect. For about sixteen weeks he dis- 
 charged alxmt a pint and a half of saliva daily, but in spite of the severity of the treatment, 
 he came out of the course improved in appearance and evidently increased in bulk. 
 
 The more I see of these affections of the brain, the more am I con- 
 vinced that the same rules ought to guide us in the treatment of these 
 cases and ophthalmic affections. The great indisposition to the use of 
 medicine on the part of those to whom the medical treatment of the in- 
 sane is entrusted impels me to strengthen my position by such authority 
 as Mr. Tyrrell's. I know many medical men who decidedly avow that 
 medicine has no control over insanity, and that they never think of giving 
 medicine unless the secretions are at fault, and there is general fever. 
 Mr. Tyrrell's observations on choroiditis so exactly accord with my 
 ideas regarding meningitis, that I shall quote them.* The italics are my 
 own. 
 
 " The commencement of organic disease of the choroid, although 
 unattended by any marked symptoms of inflammatory action, demands 
 serious attention and careful management ; the patient being otherwise 
 constantly liable to a sudden burst of inflammation and its consequences. 
 
 " The existence, then, of a network or gauze, or the appearance of 
 large spots in the field of vision, unaccompanied by pain or uneasiness, 
 or any other evidence of increased action in the vessels of the conjunc- 
 tiva or sclerotic, should meet with prompt attention and careful treat- 
 ment, by which the integrity of the organ may be in most instances 
 restored, and, at all events, useful vision preserved. 
 
 " The organ should be perfectly rested, and kept from exposure to 
 bright light. Counter irritation, by means of blister or tartar emetic 
 ointment, should be created upon the forehead or temple ; the diet should 
 be adapted to the power of the patient, but he should avoid stimulating 
 food or drink, (beyond that which habit may have rendered necessary,) 
 and such matter as is not easy of digestion, or is incompatible with the 
 medicine employed. 
 
 u Medicinal treatment should first be directed to correct errors in 
 secretion, and restore the disordered functions, the accomplishment of 
 which is frequently sufficient to subdue the ocular disease ; but should 
 the vision continue disturbed, the alterative mercurial course should be 
 adopted and the local remedies continued. It is very rarely necessary 
 to produce mercurial action in the system." 
 
 He directs that blood should always be taken away in moderation, and 
 only in sufficient quantity to relieve congestion, but not to nffect the general 
 circulation; that in " many cases, when the disease is apparently acute, but 
 
 * P. 90. 
 
360 HUMAN BRAIN. 
 
 the power feeble, the loss of blood aggravates rather than benefits the affec- 
 tion; this 1 have observed most frequently in young and delicate females. 
 I have known the continuance of depletory treatment prove most injurious 
 in augmenting the morbid action and hastening disorganizing process ." 
 
 " Unfortunately, as relief frequently follows the local abstraction of 
 blood, the patient in every fresh attack or relapse is desirous of resorting 
 to the same treatment again, and the medical attendant, unacquainted 
 with its injurious effects, readily adopts it; the relief is, however, of 
 short duration, and this burst of acute symptoms in a few days occurs. 
 The same remedies are again resorted to with similar effect, but the 
 patient is further reduced in power, and the local disease has made some 
 progress in disorganization. Under continuance of this treatment the 
 patient suffers from repeated attacks of the acute kind, each of which 
 produces an increase in the amaurosis, and eventually vision is com- 
 pletely destroyed, while at the same time the general health is materially 
 deranged, if not permanently injured. I have seen several very dis- 
 tressing cases of permanent araaurosis resulting from such treatment ; 
 and I have also known many instances in which the disease has been 
 arrested and vision preserved, by raising and maintaining the general 
 power, and pursuing the medical treatment which I have recommended, 
 after many weeks of depletion had failed to produce the desired effect." 
 
 The following case shows the value of this plan of treatment in chro- 
 nic meningitis with some serous effusion : 
 
 Case 50. A lady, aged 48, a married woman, but without any children, consulted me on 
 the 8th of December, 1841, for drooping of the right eyelid and violent pain in the head. 
 The right eyelid droops over the eyeball, and she can only raise it half way. The left she 
 has complete command over. There is a quivering motion in both eyelids and eyeballs. 
 When she closes the left eye, and attempts to look at anything with the right, she finds her 
 vision very imperfect and misty. 
 
 She complains of a shooting, pricking pain in the ball of the right eye, with a feeling of 
 great pressure and pain on the left side of the head and face. 
 
 She says she sometimes has feelings as if she was not right in her mind, as if she were 
 going delirious. These feelings existed previous to the eye being affected. Her countenance 
 is rather wild and anxious ; the eyes staring and unnatural. 
 
 She complains of sensations in the body and extremities, which she calls "live blood," or 
 " pins and needles," as if there was something fluttering underneath the skin ; sometimes the 
 right eyeball flutters so violently that it feels to her as if it would jump out of her head. 
 The right arm and leg sometimes are numb, but the left never feels so 
 
 She passes, per anum, from piles, nearly a pint of blood during the week, which she con- 
 siders gives great relief in the head. 
 
 I found, on inquiry, that she had been much harassed latterly, and suffered much anxiety 
 of mind. 
 
 About six years ago she had a bad miscarriage, since which the womb has been displaced, 
 and it has become hard and shrunken, and prevented all connection for two years. She has 
 only menstruated once during the last two years, and that occurred about two months ago, 
 and she felt relieved by their appearance. Pulse quick and irritable; tongue rather pale, 
 but not furred ; appetite pretty good ; sleeps tolerably ; feels very weak. 
 
 Ordered Hyd. c. Greta gr. ij. nocte maneque. Emp. Lyttse fronti. 
 
 After using the mercury in doses varying according to its effect, and never so as to sali- 
 vate, with various counter-irritants, issues, &c.,at the same time supporting the general health 
 for two months and a half, the paralysis of the eyelid was entirely cured, and the pain in 
 the head left her, and, as she felt nearly well, she left off her medicine, and I lost sight of her 
 for above two months, after which time she came to me again. 
 
 Her countenance is worse; the right eyelid again droops. She says that all her sufferings 
 are returned as bad as ever, though her general health has improved. The pain at the back 
 of the head is most violent, and the burning sensation at the top of the neck so severe that she 
 can scarcely contain herself; at times something seems to pass over the eyes so as to make 
 her blind. Sometimes the sensations are so horrible that she feels as if she were going mad. 
 
TREATMENT OF INFLAMMATION OF THE BRAIN. 361 
 
 She has some loss of power on the right side, across the right leg it feels numb and heavy. 
 Moral causes appear to have produced this relapse, though she says that soon after the mouth 
 became well from the mercury, she began to feel uncomfortable. This time I was obliged 
 to cup her three or four times, as well as employ mercury in full doses. She came under 
 my care, on this occasion, on the 13th of April, and it was not till the 22d of June, that I 
 could report any decided improvement; by this time she was able to walk pretty well, her 
 head felt easy, and she says she can now use her reason. 
 
 I continued the mercury for four months, at the end of which time she was quite well. 
 Her sight was quite restored; no f>ain in her head; feels strong and hearty; spirits good; 
 mind equable and placid. Her countenance is entirely changed ; instead of a staring, wild, 
 unnatural expression, she looks composed and comfortable. She expresses herself grateful 
 for her recovery. 
 
 I have been gratified in finding the following observations on the use 
 of mercury in such cases from the pen of that admirable surgeon, the 
 late Mr. Colles,* of Dublin, whose work on the treatment of syphilis is 
 one of the best in the English language. 
 
 "I now merely wish to report the result of my own experience, as to 
 the efficacy of mercury in some classes of disease, in which, as far as I 
 know, it has hitherto been but seldom, and even then but sparingly, 
 employed. I allude to certain derangements of the brain and nervous 
 system, sometimes accompanied with more or less of paralysis of the 
 voluntary muscles. In these diseases I consider mercury, when actively, 
 and at the same time judiciously, administered, to be a most invaluable 
 medicine. 
 
 " This position, I think, I can best establish by a brief statement of 
 a few cases, which I have selected out of several that have fallen under 
 my own immediate observation." 
 
 Colles gives eight cases, all of which are interesting and instructive, 
 but I must refrain from quoting more than one. This I have selected 
 because it is of that class which I believe ultimately terminates in mental 
 imbecility. 
 
 Case 51. Oct. 3d, 1836. Mrs. B., of Rathmines, set. 50. For nearly the two last years, 
 this woman has suffered many severe family afflictions, and considerable loss of property, 
 in consequence of which, as she thinks, she has become subject to what she terms "great con- 
 fusion in the back of the head," which of late has extended to the right side of the head also. 
 She has latterly avoided all society, and has sought for solitude. At the same time she ob- 
 served a failure of memory, which, within the last six weeks, has increased considerably, 
 so that now she cannot find words to express her ideas. If she chance to lay a key or any- 
 thing out of her hand, she cannot, in a minute after, recollect where she had placed it. She 
 is unable to read, as the attempt instantly brings on the "confusion in the head ; if she attempt 
 to recollect anything, it all ends in the same confusion ; nor can she even attempt to do any 
 needlework, as this would be followed by the same distressing sensation. Her temper has 
 become extremely peevish and irritable ; she suffers from a constant sickness of stomach like 
 sea-sickness. When she attempts to walk, she staggers, as she says, in consequence of a 
 dizziness in her head, yet she can walk in a dark room ; nor is she alarmed by looking down 
 from a height. Her appetite is good; the bowels are very costive; she sleeps very heavily; 
 there is no emaciation; pulse 96. I determined, in this case, to try the effect of ptyalism ; 
 and having prescribed a strong purging draught, directed calomel gr. iij. bis in die. 
 
 Oct. 7th. She has had a slight attack of mercurial dysentery yesterday, with some sore- 
 ness of the mouth and gums; she describes what she terms the confusion in the back of the 
 head as being much less; there is a decided improvement in her memory; she can now 
 much more readily and more constantly find words to express her ideas. She has some 
 sickness of stomach, but different from that kind of sickness she has so long suffered. 
 
 Oct. 10th. She can now read and attend to figures, and can even cast up an account, 
 which she could not previously attempt to do ; but still she feels she would become confused 
 
 * On the Use of Mercury in Affections of the Nervous System. By Abraham Colles, 1837, 
 p. 328. 
 
362 HUMAN BRAIN. 
 
 if she attended to them beyond a very short time. Habeat Haust. c. Quinae. Sulph. gr. ij. 
 bis in die. 
 
 Oct. 18th. Whenever she stoops or turns about her head suddenly, she feels a sense of 
 confusion, and then a pain in the head. Her sleep is less heavy, and much more refreshing ; 
 she can now read as much as twenty pages of a book at once. She takes an interest in it, 
 and can recollect what she has read. Says she feels as if some great weight had been lifted 
 off her ; ptyalism was still maintained by occasional doses of mercury. Habeat Urigt. Ant. 
 Tart. Vertici capitis. 
 
 Oct. 24th. Pustules have been produced by eleven applications of ointment. She can 
 now stoop, and look up suddenly, without any unpleasant sensations; her memory and spirits 
 are improving; she can now attend to her household affairs, and can recollect what she has 
 to do. 
 
 Nov. 3d. She now reads with interest, and recollects what she has read a week before ; 
 her temper is still very irritable, especially if hurried; her spirits are much better in the 
 latter part of the day in the morning she feels very nervous ; jolting of the car makes her 
 head still feel a little giddy. 
 
 Nov. 13th. She feels much improved in every respect; she becomes fidgetty and uneasy 
 at 10 P.M. before she goes to bed; this is the principal nervous uneasiness she now experi- 
 ences. She feels her temper much improved since the scalp has healed. 
 
 Nov. 16th. She walked from Rathmines to my house, upwards of a mile, this day, and 
 feels no inconvenience except a very slight giddiness. Her sleep is now refreshing and 
 natural, her temper much improved ; she does not now suffer from confusion when she is 
 hurried. 
 
 I observed, that during the entire treatment, her bowels required very active aperients, 
 the uneasy feelings in her head uniformly becoming aggravated by costiveness. 
 
 Dr. Alison,* in speaking of the symptoms which mark those " cases 
 of active inflammation within the cranium, such as bear evacuations 
 best, and are most generally and decidedly benefitted by them when used 
 early and carried to a due degree," after mentioning the ordinary symp- 
 toms, such as pain, impatience of light and sound, sickness and vomit- 
 ing, adds, " great aggravation of the uneasy feelings in assuming the 
 erect posture." As a general rule, I find the contrary: that the recum- 
 bent posture is the most comfortable in anaemia, the erect in hypersemia. 
 It is possible that all he means is, that every kind of motion is painful ; 
 and there I agree with him, but not that it is limited to the inflammatory 
 affections. He agrees with most pathologists in objecting to the use of 
 opium in these affections. He is strongly in favor of general bleeding 
 in all well-marked cases of inflammation of the brain and its membranes. 
 He says : " The bleeding should be general and local, but the former is 
 by far the most important ; and it may be laid down as a general rule, to 
 trust no case to the local bleeding only beyond the age of five years. 
 There are some cases, particularly in adults, in which the inflammation 
 lasts very long, or returns very frequently, and ultimately abates com- 
 pletely, under repeated local or even general bleeding, without stupor, 
 delirium, or spasms, ever supervening ; while in others, those results of 
 the disease show themselves within a few days."f 
 
 Dr. H. Holland makes some excellent observations on the use of 
 mercury, particularly the bichloride, in affections of the nervous system, 
 especially supporting my opinion of the value of its continuance. He 
 says *4 " Perseverance in the use of bichloride of mercury is of singular 
 avail in certain cerebral or spinal disorders to obtain the full benefit, 
 we must be patient as well as decided in its use." He refers to one 
 very interesting case. 
 
 * Outlines of Pathology, &c., 1844. t P - 344 > P- cit - 
 
 J P. 250, op. cit. 
 
APOPLEXY. 363 
 
 Treatment. Recapitulation. In the treatment of all inflammatory 
 affections of the brain, the following broad principles must always be 
 attended to: 
 
 1st. There is no time to be lost even minutes are of value. 
 
 2dly. That inflammation of the brain is a depressing disease, and 
 that, as a general rule, general blood-letting is not often admissible. 
 
 3dly. That, though general blood-letting may sometimes be attended 
 with benefit at the time, the good derived from it is seldom permanent. 
 
 4thly. That local blood-letting, by leeches and cupping, is generally 
 useful, and especially in cases of insomnolence, arising from abnormal 
 action of the brain. 
 
 5thly. In cases of insanity, where opium has failed to produce sleep, 
 leeches and cold applications frequently will ; and if they do, it is strong 
 evidence that the excitement arises from hyperasmia, and not from ana> 
 mia, as in that of delirium tremens. 
 
 6thly. That aconite and digitalis are the best sedatives, especially 
 when combined with mercury. 
 
 7thly. When it is advisable to salivate rapidly, raise the cuticle by 
 boiling water, or a similar escharotic, and dress the surface with the 
 strong mercurial ointment. 
 
 Sthly. Always commence the treatment with a brisk mercurial pur- 
 gative. 
 
 9thly. Soothe the patient's feelings in every way. 
 
 lOthly Never leave anything that is disagreeable to the patient to be 
 done by a nurse or attendant, such as the application of leeches, &c., 
 but persuade him to have them applied. 
 
 llthly. Never lose your patience in the treatment of a chronic case, 
 or try to hasten the cure by increasing the doses. 
 
 12thly. When it is considered necessary to continue the use of mer- 
 cury for a lengthened period, combine tonics with it. 
 
 Apoplexy. The term is derived from the Greek word artojt^lw, to 
 strike; hence the common appellation, an apoplectic stroke, or a stroke 
 of the palsy. 
 
 Apoplexy, Jong as this term has been familiar to the profession, still 
 conveys a very indefinite meaning. Some authors use it to distinguish 
 a particular class of symptoms and effects of disease ; others to desig- 
 nate the pathological condition which gives rise to those symptoms. 
 
 I thinkthat.it is applied too generally to the effects of disease, instead 
 of the cause. The classification of diseases of the brain which I have 
 adopted is founded on pathology*, not on symptomatology. I propose 
 using it to designate pressure on the brain, or encephalon, produced by 
 extravasation of blood or serum, or by distension of the vessels without 
 extravasation, such extravasation not being the result of direct violence, 
 as a blow upon the head. Wherever I employ the term apoplexy, I use 
 it as synonymous with cerebral pressure, and I believe that all its varieties 
 depend on the amount of the effusion and the part of encephalon injured. 
 
 This view of the subject will be exposed more clearly as we proceed. 
 
 Apoplexy, in its most aggravated form, is an awful disease to suffer 
 from, to witness, or administer to. 
 
 A man, in apparently good health, suddenly falls down deprived of 
 
364 HUMAN BRAIN. 
 
 all his senses, wholly unconscious of surrounding objects. The coun- 
 tenance livid, the vessels of the face and head turgid with blood, the 
 breathing stertorous, slow, and laboring; the limbs lie powerless; the 
 pulse is full, slow, and intermittent: from this state he never rallies, 
 sinks without any change, and dies in the course of forty-eight hours. 
 His brain, when examined after death, is found to have been more or 
 less torn and destroyed by extravasated blood. 
 
 This may be considered as a typical case of apoplexy, but this de- 
 scription of it will no more include all the varieties of this disease, all 
 the aberrant forms of the complaint, if we may so speak, than the de- 
 scription of the characteristics of the eagle would include that of the 
 whole class of rapacious birds. 
 
 It is typical, because the extravasation is so severe that all the effects 
 of extravasation are produced all the centres of nervous power with- 
 in the cranium are affected. The aberrant forms are merely slighter 
 effects, from a slighter but a common cause. 
 
 It is said that apoplexy may be confounded with syncope, ordinary 
 sleep, and epilepsy; but when we consider the above phenomena which, 
 in a greater or less degree, always attend the apoplectic seizure, we must 
 allow that they are peculiar to the disease. 
 
 In such a case as the above it could not be mistaken for syncope, for 
 the patient is not pale and cold, the pulse is not feeble. It could not 
 be mistaken for sleep it occurred too suddenly, and the patient could 
 not be awakened. It could not be mistaken for epilepsy, for there was 
 no cry and no convulsions. 
 
 But there are some cases of apoplexy which might be mistaken for 
 syncope, and others which might be mistaken for epilepsy. 
 
 Abercrombie arranges apoplexy under three forms of apoplectic attack, 
 and very admirable are his descriptions. The first are those which are 
 immediately and primarily apoplectic, using the term as synonymous 
 with coma ; the second are those which begin with a sudden attack of 
 headache, and pass gradually into apoplexy; and the third are those 
 which are characterized by palsy and loss of speech, without coma : 
 classifying them according to the symptoms. If we reverse the order, 
 we find that the first form depends upon such a sudden and extensive 
 effusion into the hemispheres, that the powers of the hemispherical gan- 
 glion are at once arrested, as in a case of severe concussion of the brain. 
 The second form of apoplexy, which might be mistaken for syncope, is 
 thus described by Abercrombie: 
 
 "The patient becomes pale, sick, and faint, generally vomits, and 
 frequently, though not always, falls down in a state resembling syncope ; 
 the face pale, the body cold, and the pulse very feeble : this sometimes 
 accompanied by slight convulsion. In other cases, he does not fall 
 down ; the sudden attacks of pain being only accompanied by slight 
 and transient loss of recollection. In both cases he generally recovers 
 in a few minutes, from the first effects of the attack, is quite sensible 
 and able to walk, but continues to complain of headache after a certain 
 interval, which may vary from a few minutes to several hours; he be- 
 comes oppressed, forgetful and incoherent, and then sinks into coma, from 
 which he never recovers. In some cases paralysis of one side occurs; 
 
APOPLEXY. 365 
 
 but in others, and I think the greater proportion o-f this class, no para- 
 lysis is observed. "* 
 
 This form will be pathologically described as menirvgeal apoplexy. 
 The effusion taking place on the surface of the vertex of the brain, and 
 giving rise to headache, the effusion taking place in such small quantity, 
 and so slowly that, the powers of the sensorium not being at once anni- 
 hilated, the patient is cognizant of pain; the effusion continuing, till at 
 last all the cerebral ganglia are compressed, and the patient dies coma- 
 tose. Dr. Abercrombie remarks on the similarity of these cases to those 
 extravasations from external injury, where the patient recovers from the 
 first effect of such effusion, and is even able to walk home. The fol- 
 lowing illustrates this in a striking way : 
 
 Case 52. Laceration of brain, from a blow on the head without fracture of the skull. 
 May 7th, 1845. I was this day, at nine o'clock, A. M. T called in by Mr. Maybury. of Little 
 Tower Street, to see Mr. T. F. C., Love Lane, Eastcheap, who was suffering from injury 
 to the head. 
 
 He was about fifty years of age, and, as I learned from his daughter, generally of temper- 
 ate habits. It appeared that, between five and six in the afternoon, he had been struck about 
 the face and chest by another man, and that in falling he hit the back of his head against the 
 pavement; he was rendered insensible by the fall, but became conscious on arriving at the 
 London Hospital, whither he was conveyed. His wound was dressed, and the dresser ad- 
 vised him to remain at the Hospital; he, however, refused, saying that his wife would be 
 rendered anxious by his absence. From Mr. Maybury I learned the following particulars, 
 viz , that he was sent for on the same evening, and, on arriving at the house, found C. sit- 
 ting in a chair near the fire, relating with all his usual reason the circumstances which led 
 to the fall above mentioned. Mr. M.'s attention was immediately called to the profuse haa- 
 morrhage issuing from the dressings on the head, on the removal of which dressings, two 
 large incised wounds on the left side of the occipital bone were exposed. These wounds 
 penetrated to the cranium, and were distant from each other about a quarter of an inch, each 
 being an inch in length. Several small arteries were pouring out blood profusely. This 
 Weeding being suppressed, the wounds were dressed simply with lint soaked in cold water. 
 The patient was put to bed, when he was attacked with rigors. He was ordered a mixture 
 of aromatic spirits of ammonia ; camphor mixture and spirits of lavender. On the following 
 morning, the 7th, Mr. Maybury called, and found him laboring under difficult and stertorous 
 breathing, and presenting all the worst symptoms of compression ; the pupils remaining fixed 
 beibre the glaring light of a candle, the right dilated, the left contracted. These symptoms, 
 preceded by a short attack of shivering, commenced immediately after Mr. Maybury 's de- 
 parture on the foregoing evening. Mr. Maybury bled him, and immediately afterwards 
 called upon me. I found the patient breathing stertorously, and with great difficulty; in 
 fact, he appeared almost moribund ; his pulse varied, never full or strong, but every now 
 and then gradually stopping altogether, and then going on again; it was not merely inter- 
 mittent. Both pupils were fixed, the left contracted, the right dilated. There was a small 
 wound, about one inch in length, behind the left ear. I put my little finger into it, but could 
 not feel any fracture. This operation was evidently felt by him, for he moved his head 
 about, and his stertorous breathing was altered, so as almost to amount to a groan. I tried 
 if he could swallow a little water; but he was nearly suffocated by the attempt. 
 
 I ordered a turpentine enema !|j. to the Ibj. A blister to the side of the neck, to be 
 dressed with mercurial ointment; and we agreed to see him again at about one, if he was 
 alive. His head was shaved, and a cold spirituous lotion kept constantly applied. Mr. May- 
 bury visited him several times during the day: he continued to grow worse, and died about 
 five o'clock the following morning. 
 
 We examined the head, and lound the following appearances, viz. 
 
 Extravasation under 'the scalp on the left side extending to and through the left temporal 
 muscle. Laceration of the under surface of the middle lobe of the brain on the right, with 
 coagulated bloo 1 on the same side, amounting in quantity to about three or four ourn-e, be- 
 tween the dura mater and the brain. No fracture of the skull. Strong adhesions of the 
 dura mater to the cranium. Brain otherwise healthy. 
 
 In this case death endued from pressure, as in apoplexy, though the active external hae- 
 morrhage delayed the fatal event. 
 
 * Op. cit^ p. 204. 
 
HUMAN BRAIN. 
 
 The pallor and faintness which attend the class of apoplectic cases 
 before spoken of, and which appear to remove them from true apoplexy, 
 arise from the sudden loss of blood occurring from the vessels of an im- 
 portant organ. It is well known that a very small loss of blood from 
 the vessels of the intestinal canal, the lungs, and other viscera, will 
 cause great vital depression, while a much larger quantity may be re- 
 moved from the extremities without the constitution taking the alarm. 
 And thus it is with the brain, if its normal sensibility is not interrupted 
 by the pressure of the extravasated blood. Again ; the reason that this 
 form of apoplexy differs from the typical form, in absence of congestion 
 of those vessels of the head which are apparent to the eye, as shown by 
 the red or purple countenance, is, that the proximate cause of the ex- 
 travasation is not over-distension of the blood-vessels of the brain, but 
 disease in their coats, which then suddenly break under the heart's 
 action. If the patient recover his senses quickly, it is because the 
 opening is very small, and the quantity extravasated in accordance with 
 the aperture. 
 
 Abercrombie observes, and I believe truly, that these cases are gene- 
 rally fatal. This may be thus explained. We cannot by any remedial 
 measures with which we are at present acquainted, alter this diseased 
 condition of the coats of the blood-vessels, and it is seldom, if ever, that 
 a rent in a diseased vessel is closed by that adhesive action by which 
 nature repairs similar lesions in healthier tissues. We can moderate, 
 for a time at least, the inordinate action of a diseased heart we can 
 relieve a vascular system, unnaturally distended with blood we can 
 prevent mental and cerebral excitement by judicious moral treatment 
 we can promote the absorption of extravasated blood, and thus it is that 
 all cases of apoplexy are not fatal, and not irremediable ; but in these 
 cases of pallid, fainting apoplexy, such measures are of little use. These 
 observations touching the treatment of apoplexy may appear premature, 
 but I have thought them necessary in order to account for such different 
 symptoms arising from pathological states so nearly similar and requiring 
 nearly similar treatment. 
 
 In the third class the effusion takes place near the base of the brain, 
 or in the motor tract near the anterior and posterior cerebral ganglia, 
 and is so limited that it does not affect either the hemispherical the 
 intellectual ganglia or the respiratory ganglia; and hence the absence 
 of coma and stertor. 
 
 This class includes many cases which will be considered seriatim 
 when we investigate the peculiar effect of effusion according to the 
 portion of the encephalon injured. 
 
 Apoplexy may be again divided into three groups, in accordance with 
 the matter which produces the pressure from which the apoplectic symp- 
 toms result namely, extravasated blood, sanguinous apoplexy; extra- 
 vasated serum, serous apoplexy; abnormally distended blood-vessels, 
 simple apoplexy. In these latter cases there are no post-mortem appear- 
 ances. 
 
 There is a state of brain that may be advantageously adverted to here 
 which closely resembles the apoplectic condition, but which requires a 
 very different line of treatment. I cannot pretend to say exactly what 
 
APOPLEXY. 367 
 
 the pathological condition is but not anaemia ; I suspect it is one of 
 very partial congestion, limited, simple apoplexy. The following case 
 illustrates it : 
 
 Case 53. 1847. I was called to visit a gentleman in the city, who had been suddenly 
 attacked with paralysis. I found him sitting on a stool in his office, perfectly conscious, but 
 unable to articulate a word ; he endeavored by signs to call my attention to his having lost 
 the use of the whole of the right side of the body and extremities. On asking him his age, 
 he made signs for pen and ink and paper, and wrote with the left hand, tolerably legibly, 
 "49 or 50, also a bad cough." I found his pulse very variable in both strength and quick- 
 ness, but not positively intermittent, nor laboring or jerking, soft and compressible. On my 
 calling for a basin, he became excessively agitated, which I afterwards found arose from 
 his being afraid I was going to bleed him. As soon as I got the basin, I poured cold water 
 over his head with a jug, which operation I had scarcely commenced before he spoke quite 
 distinctly, saying I am all right again : he then told me that the first uncomfortable symp- 
 tom he had, took place about an hour previous ; he wanted to put "clown on paper 108, but 
 found his hand fail him, and he could not write more than 10 : this annoyed him, and he made 
 some excuse ; the uncomfortable sensations were sufficient to frighten him, and induce him 
 to send off immediately for medical assistance, but they passed off so quickly that he soon sent 
 another messenger to say he was quite well, and left his counting-house to return home to 
 Greenwich ; but he had not proceeded far before they all returned, though to a much greater 
 extent, reducing him to the state in which I found him. 
 
 Previous history. A man of highly nervous temperament, exceedingly active in business, 
 in which he has been a good deal harassed lately, leaving him scarcely any time for his 
 meals, and giving him a great deal of anxiety : he had been -repeatedly warned by his wife 
 and friends that if he did not pay more attention to his health, he would have some serious 
 illness; this they said from seeing him every now and then in a state of great exhaustion : 
 he had also been suffering lately from hooping-cough. 
 
 It was very clear that stimulants were the only things indicated here in the first in- 
 stance. I therefore gave him a small quantity of brandy and water, and some sal- volatile : 
 in a few minutes after he had recovered his speech he recovered the whole use of his right 
 side, declaring that he felt perfectly well, and determined to return home ; we therefore put 
 his things on and sent for a cab, but when he got up to go down stairs, he said, " I am afraid 
 I am going to be ill again," and I asked him why he thought so : he answered, because I 
 am losing the power over my hand and leg ; and his speech began to falter ; he then told 
 me where he wished to be taken, lest in a few minutes he should not be able to speak. I 
 gave him some more sal-volatile and brandy : in a few minutes more, all these unpleasant 
 symptoms had again passed away, and we were enabled to proceed safely without any re- 
 turn of them, to his own house at Greenwich. On his way down he several times declared 
 he never felt better in his life, and said it was very strange he should have been so ill such 
 a short time before. At Greenwich, I left him in the hands of his own medical man, Mr. 
 Watsford, recommending a warm bed, hot water to the feet, mustard poultices to the legs, 
 and a mild aperient. 
 
 I have learnt since from Mr. Watsford, under whose care he remained, that he had one or 
 two threatenings of a return of his illness, but that they were averted by the same general 
 plan of treatment, and that he is now quite recovered. 
 
 The predisposing causes of apoplexy, though uncertain, still deserve 
 consideration. A peculiar conformation may be mentioned ; a full florid 
 countenance, short neck. Advanced age is also a predisposing cause of 
 apoplexy. Individuals seem to inherit from their ancestors a predispo- 
 sition to this disease, occasioned, most probably, by a similar morbid 
 condition of the coats of the cerebral vessels, or of the heart and its 
 valves. 
 
 Other predisposing causes exist, but these are secondary, being de- 
 pendent on disease of other organs, as organic disease of the heart and 
 arteries, diseases of the lungs, sudden changes in the system, cessation 
 of the menses or drying up of pus-secreting surfaces. Drunken habits 
 may also be reckoned as a predisposing cause. 
 
 The profession have long been aware of the concomitance of diseases 
 of the heart and diseases of the brain. When it was my duty to conduct 
 
368 HUMAN BRAIN. 
 
 the post-mortem examinations at St. Thomas's Hospital, I scarcely ever 
 examined a case of apoplexy without finding some disease of the heart 
 and arteries, generally hypertrophy of the left ventricle, with atheroma- 
 tous deposit in the coats of the vessels of the brain; and of course I 
 pointed out to the students how both these diseases would in themselves 
 and unconnected, facilitate sanguineous effusion; the first giving to the 
 forcing pump undue power, which the vessels nearest to it would feel 
 the most, and the second making that tube brittle, which in a state of 
 health is elastic, though firm. I was therefore surprised to find from Dr. 
 Burrowes' researches that so many writers on diseases of the brain, and 
 among the number Dr. Abercrombie, should have omitted all mention 
 of the influence of diseases of the heart in producing cerebral diseases. 
 Dr. Burrowes says,* u ln opposition to the opinions entertained by many 
 respectable authorities that the quantity of blood within the cranium is 
 at all times nearly the same, and that the heart does not influence the 
 cerebral circulation, ray own observations, supported by facts already 
 detailed, convince me that in many, perhaps the majority of cases of 
 apoplexy and hemiplegia, the primary disease is not situated within the 
 cranium. 
 
 u I would go further, and affirm, that in many cerebral affections ap- 
 parently depending on effusions of serum or blood, there is no further 
 primary disease of the brain than there is of the cellular tissue in ana- 
 sarca, or of the peritoneum in ascites, or of the skin in purpura, or of 
 the stomach in ha3matemesis. There is, indeed, a palpable morbid con- 
 dition of these several tissues and organs where the effusion or ecchy- 
 mosis takes place ; but it is generally dependent upon a morbid state of 
 some other viscus which generally interferes with the circulation in the 
 parts where the effusions are detected. An hypertrophied left ventricle, 
 or valvular obstruction in the heart, will lead to lesions within the cra- 
 nium, similar to those observed in the stomach and peritoneum when 
 there is obstruction to the circulation through the portal veins in the 
 liver. 
 
 " If the pathology of the brain in apoplexy and hemiplegia be analo- 
 gous to that of other organs which suffer from effusions of serum and 
 blood, how much must this knowledge improve the routine treatment of 
 apoplexy, which has so extensively prevailed. 
 
 "Does not the view of the pathology of apoplexy render more intelli- 
 gible those different varieties of the disease which are described by an- 
 cient writers, although they could not account for the differences?' 7 
 
 We must all, I think, accord with Dr. Burrowes in these opinions. 
 It is very clear, that if Abercrombie's judgment had not been warped by 
 his peculiar views regarding the cerebral circulation, he would have 
 seen more distinctly than he did the relation between the various cere- 
 bral lesions, and their vital effects. 
 
 As a general observation, attacks of apoplexy are apparently sudden 
 and unexpected, but on inquiry we frequently find that the subjects of 
 the attack have been indisposed and out of health for a shorter or longer 
 time ; it is, therefore, important to consider the premonitory symptoms, 
 
 Op. cit., p. 124, 
 
APOPLEXY. 369 
 
 -which, if not attended to, would usher in an apoplectic fit. The patient 
 will sometimes exhibit an unusual tendency to sleep, will sleep long 
 and heavily, with laborious breathing, sometimes almost amounting to 
 stertor; a constant dull pain in the head, and this, when the patient has 
 not been previously subject to headache, should put us on our guard. 
 
 Vertigo, or swimming in the head, after stooping for a short time, the 
 countenance exhibiting a livid hue, the veins on the forehead turgid, 
 the carotids and temporals pulsating forcibly. Sometimes there is tinnitus 
 aurium, partial deafness or blindness ; double vision is also a common 
 and very suspicious symptom. The mental faculties are more or less 
 impaired, memory is lost, but more frequently only partially so. The 
 most common terms and occurrences are forgotten, while the memory of 
 uncommon words and circumstances is perfect; sometimes one word, of 
 a totally different meaning, is substituted for another. The patient ap- 
 pears at times quite imbecile, temper irritable; at other times he remains 
 in an apathetic condition, from which it is very difficult to rouse him. 
 There is also generally a tendency to paralysis, which exhibits itself in 
 various ways. Ptosis is not uncommon as a precursory symptom; or the 
 patient may be unable to articulate his words from partial paralysis of 
 the muscles of the tongue. Drawing of the corner of the mouth from 
 palsy of the opposite muscles, an unsteadiness of gait, tripping over 
 slight impediments, are one and all occasionally observed. Frequent 
 cramps and numbness of the limbs, toes, or fingers, all exhibit a tendency 
 to paralysis, and are consequently deserving of serious consideration. 
 
 Now although the above is a tolerably correct outline of the premoni- 
 tory symptoms of apoplexy, it must not be supposed that such phenome- 
 na never present themselves except as the precursors of that disease. 
 All of them will arise from a disturbed state of the digestive organs; it 
 is, therefore, of the greatest importance to investigate the state of these 
 organs before taking so serious a view of the case. Generally speaking, 
 if we ask a patient whose brain evidently sympathizes easily with his 
 stomach, whether he suffers from indigestion, he says, "Oh no, I do not 
 know what it is." He has never been in the habit of connecting his 
 uncomfortable feelings with his stomach. But we perhaps find, on a lit- 
 tle inquiry, that he is very irregular in his diet, not resting quietly after 
 his meals, and paying no attention to his bowels ; that he has a foul 
 tongue, stinking breath, and all the usual signs of dyspepsia. In doubt- 
 ful cases an active aperient is the best medicine, and a little careful 
 watching will soon decide as to the danger of an apoplectic attack; 
 always bearing in mind that aggravated dyspepsia is itself a cause of 
 apoplexy. 
 
 Mental excitement has already been considered as an important 
 pathognomonic symptom of incipient meningitis ; it must also be remem- 
 bered as a possible forerunner of apoplexy. Dr. Conolly* says that he 
 knew a very corpulent woman subject to hysteria, with some threaten- 
 ings of paralysis of the left side, who described herself as feeling so well 
 and lively before her worst attacks that she " could not always refrain 
 
 * An Inquiry concerning the Indications of Insanity. By John Conolly, M.D., 1S3(X 
 London. Pp. 248. 
 
 24 
 
370 HUMAN BRAIN. 
 
 from singing," showing that the capillary system of the hemispherical 
 ganglion was at that time in a state of hypersemia. In the consideration 
 of such excitement, for the guidance of our diagnosis, \ve must, of 
 course, attend particularly to the general character of the constitution, 
 and the moral circumstances which have been lately influencing the pa- 
 tient. Case 35 is a good illustration of apoplexy induced by moral 
 causes. 
 
 Sanguineous apoplexy presents many interesting points for our con- 
 sideration, both in a practical, pathological, and physiological point of 
 view. To some of these our attention shall next be directed. 
 
 In some cases of apoplexy the effusion takes place so slowly, and in 
 such small quantity, that the real pathological character of the disease 
 is easily passed over ; especially with patients among the lower orders, 
 who are not generally very clear in the accounts of their ailments. 
 
 The following case is very instructive from its insidious character, and 
 as illustrative of the value of blood-letting and mercury in the treatment 
 of this disease. 
 
 It is true that we happily had no autopsy to demonstrate the exact 
 seat of the effusion, but I have very little doubt that it was in the right 
 crus cerebri, and that the quantity was effused so slowly that the conduct- 
 ing fibres were not ruptured, only pressed on by the blood effused be- 
 tween them. If they had been ruptured, I think there would have been 
 more or less spasm or convulsion. 
 
 Case 54. Wm. Green, set. 42, shoemaker, a married man, temperate in his general habits, 
 but occasionally taking a little too much, but not so as to get drunk ; leuco-phlegmatic tem- 
 perament; no apparent hereditary predisposition to apoplexy. 
 
 July 5th, 1846. Applied to me at the Dispensary for partial loss of power of the left leg 
 and foot. On this occasion he merely complained of a pain in his loins, in addition to the 
 loss of power; but said nothing to call my attention to his head. I ordered him to be cupped 
 on the loins, and to take Pulv. Jalap, c. Cal. gr. xv. h. n. Haust. purgans eras mane. Cal. 
 gr. ij. Opii gr. , n. et m., low diet. 
 
 On the 8th, he complained of some numbness in the face and arm, and his speech was 
 slightly affected. It was now evident to me that there had been some sanguineous extra- 
 vasation into some portion of the cerebral mass, and most probably in the region of the right 
 crus cerebri. I made further inquiries, and obtained from him the following account: 
 About four days previous to his first visit to me, he was attacked under the following cir- 
 cumstances : His wife returned unexpectedly from the country with some friends about 
 eleven o'clock; he welcomed them with a little extra beer and gin. After that he had his 
 dinner, about one; and then went to sleep on his bed, as was his usual custom in the mid- 
 dle of the day. On waking, he found that he had lost the use of his foot, and it felt numb 
 and pricking, but still he went on with his work as usual. Since the loss of power in his 
 leg, but not before, he has had occasional sharp pains across his forehead, but they did not con- 
 tinue; he felt occasionally stupid in his head, but this went off again. He never lost his 
 senses. As there was no great power in the pulse, or evidence of general plethora, I or- 
 dered him to continue the calomel. 
 
 15th. His mouth is tender from the mercury; decidedly better. Ordered Mist. lodin. et 
 dec. Sarsaparillse b. d. 
 
 19th. Complains of his head. Ordered the Tinct. lodinii Comp. to the neck and* back 
 of the head, as a counter-irritant. 
 
 22d. He now complains of some feeling of giddiness, and great pain in his head; bowel 
 confined. Ordered C. Cruenta pone aures. ad ^xij. Cal. gr. ij. nocte maneque. Leave off 
 the Sarsaparilla. 
 
 Aug. 5th. Much relieved: can walk better; in his head there is less pain, and this is 
 confined to a spot about the size of half-a-crown. Ordered, C. Cruentae Ocdpiti ad ^viij. 
 
 Aug. 15th. Much better; free from pain in the head; he can move his arm; face better 
 can move his toes a little, which he has not been able to do before this time since his seizure. 
 Continue the calomel. 
 
APOPLEXY. 371 
 
 Sept. 29th. Has continued the mercury, and he has been gradually improving in health 
 and strength since the last report. He is now able to walk nearly as well as ever ; all the 
 signs of paralysis have nearly disappeared in the face and arm, both as regards the numb- 
 ness and the expression of the countenance. After this, I lost sight of him until the 20th of 
 November, 1846. About four years since the loss of power in the leg, but not before, he 
 has had occasional sharp pains across the forehead, but they did not continue. He felt occa- 
 sionally stupid in his head, but this went off again. He never lost his senses. When he 
 first applied he did not complain at all of his head, but only of his leg. He was ordered 
 an active aperient. Pulv. Jalap, gr. xv. Calomel gr. v. statim sumendus M. S. C. mane. C. C. 
 lumbis ad ^vi. Cal, gr. ij. Opii. i n. et m. 
 
 The effects of sanguineous apoplexy are very varied, depending on 
 the extent and the seat of the effusion. 
 
 Beginning with the medulla oblongata, effusion into this part is more 
 suddenly fatal than any other. It is the only form of fatal apoplexy that 
 resembles and is liable to be mistaken for death from disease of the heart. 
 It very seldom occurs, for this part is not very vascular ; the vessels are 
 not large, and they are well supported. Effusion more frequently takes 
 place o?i the surface of this part than into its substance, and then it proves 
 equally fatal, only not so suddenly. The reason of effusion into this re- 
 spiratory centre proving so rapidly destructive to life, must be obvious 
 to every physiologist. It is from this centre that the nerves of respira- 
 tion and the muscles which they command receive their power of action. 
 When blood is effused into the third ventricle from rupture of the ves- 
 sels of the thalami or corpora striata, it gradually finds its way down to 
 the medulla oblongata, and this is a very frequent termination of such 
 cases. 
 
 When the effusion is first into the transverse commissure of the cere- 
 bellum (pons Varolii), and secondarily into the medulla oblongata, the 
 effects are often most interesting and instructive to the physiologist ; and, 
 vice versa, the symptoms are so characteristic that the lesion may be 
 easily recognized by the practitioner. Effusion into the pons Varolii pro- 
 duces paralysis of one or both limbs, according to its extent ; but after 
 the first effect of the effusion is over, it does not affect the intellect, as 
 the hemispherical ganglion is left intact. As the blood advances to the 
 medulla, so are the respiratory organs affected ; first, the muscles of re- 
 spiration are unnaturally and irregularly stimulated, and the sensibility 
 of the respiratory passages abnormally exalted, until the excitation is 
 succeeded by paralysis, and the patient dies suffocated. This next case, 
 related by Ollivier,* is peculiarly instructive. The following, from Aber- 
 crombie, is equally so, showing the absence of all symptoms of injury 
 to the respiratory system, and the confinement of the extravasation to a 
 small portion of the pons. 
 
 Case 55. Spontaneous hemorrhage and rupture of the cephalic bulb of the spinal marrow and 
 of the annular protuberance. Convulsive contractions of the limbs. Stertorous respiration. Death 
 at the end of five hours. M. D., a middle-sized man, large head, short neck, broad shoulders, 
 and large abdomen, very muscular, being at work in open air, complained suddenly of a ring- 
 ing in the ears; some minutes after he screamed from acute pain; he arose, commenced to 
 run, as if to escape the danger which threatened him. After having run for a short distance 
 he fell, and presented the following symptoms: Complete loss of consciousness; face pale; 
 immobility of the pupil, which is not dilated, and is of the same diameter on both sides ; 
 eyelids at first half closed, and completely approximated (the upper lid of the right side fell 
 a little subsequently to the left); immobility of the globe of the eye; mouth half open- 
 
 * Ollivier, torn. ii. p. 511. 
 
372 HUMAN BRAIN. 
 
 tongue covered with arterial blood, and occasionally protruded, but without permanent de- 
 viation of its point ; lips covered with frothy saliva ; no perceptible tension of the mouth. 
 
 Respiratory movements frequent, irregular, accompanied occasionally with stertor, and 
 almost continually with a sound similar to that which is frequent in attacks of epilepsy. 
 The alas nasi contract convulsively with the muscles of respiration; twice there was vio- 
 lent sneezing, during which the patient, who lay on his back, bent forward. The limbs in 
 a state of rigidity, which is easily overcome. This contraction, besides, is not entirely per- 
 manent; it ceases for some moments, and then the limbs are pliant enough, particularly the 
 arm of the right side; the contraction then manifested itself suddenly, and lasted some time. 
 In a word, these contractions seemed to hold a medium between tonic and clonic convulsions, 
 though they approached nearer to the latter. The contraction of the muscles of the neck 
 was not strong enough to prevent the head, in obedience to the laws of gravity, from in- 
 clining to the right or to the left, forwards or backwards, according to the position given to 
 the patient. With respect to the sensibility, it was hard to determine whether it was abolished 
 pr not. There was observed a convulsive movement of the right arm, when its skin was 
 pinched, and a similar movement when the integuments were cut in bleeding him. Were 
 these movements owing to pain experienced by the patient ? 
 
 In considering the almost convulsive contractions of the limbs, during which the arms 
 were rotated inwards, and the strongly-flexed state of the thumbs, and the froth with which 
 the mouth was covered, one would have thought it a fit of epilepsy ; but the patient never 
 presented any other symptom of this disease. He died five hours after the first appearance 
 of the disease. He was not observed for the last two hours. On examining the body, the pons 
 Varolii was found changed into a pouch, filled with blood partly coagulated, and mixed with 
 some fragments of nervous substance, softened and colored by this liquid. This effusion made 
 its way laterally by a small opening, but the principal rupture existed in the fourth ventricle, 
 the floor of which, divided transversely, had given issue to the blood which distended the 
 parietes of this ventricle. 
 
 It is to be regretted that this patient was not watched closely up to the time he died, be- 
 cause the general paralysis which must have preceded it might have been ascertained. It 
 cannot be doubted but that the spontaneous. hemorrhage produced the cessation of motion 
 and sensibility when it occasioned the laceration of the entire substance of the spinal bulb. 
 But if this case be incomplete in this respect, it is still very important, in its establishing the 
 diagnosis of the effusion from its commencement in this portion of the cerebro-spinal sys- 
 tem. These symptoms are truly characteristic, and present no analogy to those which are 
 peculiar to other cerebral hemorrhages. I have since had several opportunities of observing 
 this apoplexy at the moment of the attack, and I have always remarked convulsive contrac- 
 tions in the upper extremities with alternating movements of rotation inwards. The open- 
 ing of the mouth underwent no change. These spasmodic convulsions, observed at the 
 commencement of the attacks of apoplexy in general, seem to me to depend on the irrita- 
 tion which the blood produces on the extremities of the torn medullary fibres, with which 
 it remains in contact, and on which it must act as an irritant. 
 
 With respect to the general paralysis of the upper and lower extremities, it has been 
 uniformly observed in all cases where, at the post-mortem, there has been found an apoplectic 
 cavity in the substance of the protuberance and peduncles. M. Serres saw several instances 
 of this hemorrhage, and always, he says, complete immobility of the trunk and upper and 
 lower extremities took place at the same moment when the apoplectic attack showed itself. 
 Thus I hesitate not to assert, that paralysis existed during the last hours before the death of 
 the person who is the subject of the preceding case. 
 
 In the first moments we saw that the respiratory movements were executed freely enough, 
 and were even voluntary, since the patient sneezed twice, in doing which he flexed the trunk 
 forwards, and we know that this movement of respiration requires an effort of expulsion 
 which is impossible when the action of the respiratory nerves is abolished. It is probable 
 that the hemorrhage, confined to the protuberance, and to some fibres of the corresponding 
 portion of the peduncles, did but lacerate them progressively, whilst it extended itself 
 towards the cephalic bulb, a point where the rupture was soon followed by death. The mani- 
 fest movements made by the patient when pinched, and when his skin was cut in vene- 
 section, show that at the commencement the sensibility was not extinguished ; and this cir- 
 cumstance is precisely conformable to the seat of the hemorrhage, when it first occupied, as 
 we have seen, only the anterior fasciculi of the spinal marrow. 
 
 Death is so much the more rapid, according as the hemorrhage is more abundant, and the 
 more it involves the cephalic bulb of the spinal marrow. The respiration becomes more 
 difficult and stertorous also ; it becomes progressively retarded, and the patient dies of real 
 asphyxia; sometimes, too, the lungs are found emphysematous. M. Serres quotes two facts 
 which prove that life may still continue a long time, notwithstanding the paralysis of the 
 upper and lower extremities, consecutive on hemorrhage of the protuberance. He met in 
 
APOPLEXY. 373 
 
 two subjects, even in the midst of the pons Varolii, a cavity containing a yellowish fluid ; 
 there was an induration of the surrounding cerebral substance. The numerous excoriations 
 on the posterior parts of the body in both subjects, evident marks of a long-continued lying 
 on those parts ; the atrophy of the upper and lower extremities, equal on both sides, were 
 evident proofs of a paralysis of long standing, consecutive on the effusion into the protuberance, 
 which was partly absorbed. 
 
 Case 56. A gentleman, aged 37, had been for several months in bad health, being affected 
 with occasional tightness of the chest and difficulty of breathing. He had also severe dys- 
 peptic complaints, with occasional vomiting, and yellow tinge of the skin, and considerable 
 uneasiness in the region of the liver. For these complaints he had been advised by his 
 medical attendants in the north to go to Cheltenham, and arrived in Edinburgh with that 
 intention on the 22d March, 1828. I saw him on the following day with Mr. Wishart. 
 We found his pulse frequent ; his countenance sallow, and his expression febrile and anxious. 
 He complained chiefly of tightness across his chest, with some pain in the region of the 
 liver. Respiration was very imperfect along the right side of the thorax, and there was 
 some cedema of the legs. By topical bleeding, purging, &c., he was considerably relieved ; 
 and on the 24th, he expressed himself as feeling much better, but his pulse continued fre- 
 quent. On the morning of the 25th he was suddenly seized with giddiness, noise and con- 
 fusion in his head, and numbness of the whole right side. He was oppressed, but not 
 comatose ; answered questions distinctly, but in a loud voice, and with a peculiar manner. 
 He complained chiefly of noise in his head, of a tight and cramped feeling of his right arm 
 and leg, with much pricking and loss of command of the parts ; but when desired to grasp 
 another person's hand with his, the muscular power did not seem to be diminished. Th<? 
 expression of his countenance was vacant and fatuous ; the eye was natural. The face was 
 slightly distorted, and the speech was in some degree embarrassed. The pulse was 120. 
 
 After blood-letting and the other usual remedies, the symptoms gradually assumed a more 
 favorable aspect, and, after four or five days, he was considered as being out of any imme- 
 diate danger, though the effects of the attack were by no means removed. His pulse was 
 now natural, his speech was distinct, and his mind entire ; his sight was good, and the ap- 
 pearance of the eye natural, except a slight degree of paralysis of the upper eyelid of the 
 light side. His breathing was easy, and he made no complaint, except of the tight and 
 cramped feeling, with numbness of the right arm and leg. His look, however, continued 
 vacant and peculiar. His appetite and digestion were good, and his bowels easily regulated. 
 He was improving in strength, and was able to be out of bed part of the day. This favor- 
 able state continued till the 14th of April, on which day he was found with a very frequent 
 pulse, without any other change in the symptoms. This febrile state continued on the two 
 following days with rapid failure of strength, and he died on the evening of the 16th. He 
 continued sensible to the last, and during this febrile attack he seemed to have acquired an 
 increased command over the limbs of the affected side. 
 
 About the commencement of his illness, on the 25th March, he complained of considera- 
 ble uneasiness in passing his urine ; for a day or two it was bloody, and there was a good 
 deal of tenderness in the region of the bladder. After a few days this subsided, and he 
 began to pass considerable quantities of puriform fluid of remarkable fetor, which subsided 
 to the bottom of the chamber-pot after the urine had stood for a short time. This continued 
 during the remainder of his life, though it had greatly diminished in quantity for several days 
 preceding the last febrile attack. The urine was in sufficient quantity, and passed without 
 difficulty. 
 
 Inspection. The brain and cerebellum were found in every respect in the most healthy 
 state, and no vestige of disease was discovered until the cerebellum was separated from the 
 tuber annulare. In doing so, a cavity was exposed about the size of a large hazel nut, 
 lined by a soft cyst, and full of dark grumous blood of a firm consistence. This remarka- 
 ble cavity was formed partly in the substance of the tuber and partly betwixt it and the 
 base of the cerebellum. It was decidedly more to the left side than the right, and the sur- 
 rounding substance was softened, and tinged with dark red points, as if from injection of 
 dark blood. There was effusion in the thorax to the amount of at least Ib. ij. The right 
 lung was contracted, and extensively hepaiized ; the left was much loaded with sero-puru- 
 lent fluid. The liver was very considerably enlarged, and of a pale ash color and granu- 
 lar texture. The left kidney was pale, indurated, and tubercular. The inner surface of the 
 bladder was deeply injected, and in several places showed distinct round ulcers about a 
 quarter of an inch in diameter. 
 
 Effusion into, or on to, the crus cerebri will produce paralysis of the 
 extremities on the opposite side of the body, and often of the opposite eye, 
 from its affecting the optic nerve, without interfering with the sensoriuin. 
 
 fci& u ^ ,r*i'-* .i * t \ v zwl; titirt.u.v muh>> 
 
 Jlvnls il liOM* 
 
374 HUMAN BRAIN. 
 
 The following case, though happily we have no post-mortem examina- 
 tion to produce in confirmation of the opinion, is most probably of this 
 kind. It shows also the value of temperate and judicious treatment. 
 
 Case 57. May 12th, 1847. Mr. W., aet. 50, called upon me in the evening, complaining 
 that he had lost the use of his right side. I found that the paralysis, though not complete, 
 was unequivocal ; he was able to move his arm and leg but very imperfectly, and com- 
 plained of slight numbness. 
 
 History. I learnt from him, that for some time past he has all day been occupied in a go- 
 vernment office, after which he was engaged till ten at night in further mental labor. At this 
 time he generally sat down to enjoy himself, frequently taking three or four glasses of brandy 
 and water before going to bed, which was seldom before twelve o'clock. He has occasion- 
 ally suffered from dyspepsia, and within the last two days has had two attacks of bilious 
 vomiting, but had not previously applied for medical advice. He states mat he has suffered 
 from headache during the last few days, which was confined almost entirely to the right 
 side. His intellect is quite perfect; the left pupil is dilated; pulse deficient in power, and 
 irregular both in force and frequency. His first feeling of illness was an inability to walk 
 as strong and as well as usual. This he experienced about three days ago. His speech is 
 not affected, and he protrudes his tongue quite straight ; there is a very slight appearance to 
 dragging of the right side of the face ; he complains of severe pain shooting down the right 
 side of the face; head rather hot. 
 ^ Ordered Calomel gr. iiij. 4 tis - horae. Hirudines xx. dextri. lat. cup. Emp. Lyttae nuchae. 
 
 May 13th, 2 P.M. Has passed a tolerable night, slept at intervals; bowels opened, rather 
 purged ; thinks that he has rather more numbness of the left leg ; this was decidedly in- 
 creased on his attempting to get out of bed, but is less numb now than it was an hour ago ; 
 finds his head easier when placed high ; cannot incline it at all to the left side ; is more 
 comfortable while lying on the right side : states that the leeches relieved his pain, but he 
 thinks that they made him feel more stupid ; pulse same as yesterday. 
 
 Ordered R. Inf. Buchu ^i. Liq. Hyd. Bichlor. Ji. Tinct. Lyttse IT^x. sextis. hor. sum. 
 Hirud. rept. Blister dressed with strong mercurial ointment, cold lotion to the head. Calo- 
 mel omitted. 
 
 14th. Has passed a quiet, comfortable night ; says he is much better; says he is free 
 from pain in his head, but that he still suffers from a sense of weight and difficulty of mov- 
 ing it off the pillow. 
 
 Bowels not open to-day ; urine high colored. 
 
 The left pupil is still slightly more dilated than the right, but it acts quite naturally to the 
 light. The right eyelid is oedematous, from the irritation of the blister. He can move his 
 arm and leg perfectly. The numbness has quite passed away; pulse 18-20, soft and regu- 
 lar; mouth tender. 
 
 Pil. aloes co. gr. x. adde. potas. acet. gfs. singulae dosi misturae. 
 
 15th. Better; can retain his water ; head free from pain, but feels light. Mouth sore, 
 pulse 76, regular. 
 
 19th. Better; allowed to get up for a short time during the day. Countenance cheerful 
 and natural ; pulse soft and quiet; pupil of the left eye still a little larger than the right ; boil 
 on one of the leech bites. 
 
 24th. Both pupils nearly alike ; all symptoms of paralysis have disappeared, but he has 
 a true carbuncle on the upper part of the forehead, on the seat of one of the leech bites. 
 Incised the carbuncle. 
 
 Ordered Decoct. Sarsa. Ibfs. Ext. ejus. gj. bis in die allowed a glass of bitter ale with 
 his dinner. 
 
 26th. Carbuncle spreading; but in other respects well; no headache; thinks the ale 
 agrees with him. Incised the carbuncle again. 
 
 28th. Much better; the carbuncle diminished in size; sloughing stopped. In other 
 respects quite well. Gave him leave to go down to the Isle of Wight. 
 
 Remarks. Whatever may have been the seat of the effusion, the case is one of great 
 practical interest. In the first place, it shows the value of early attention to any symptoms 
 of paralysis. It was a case which required great caution in the employment of blood-letting. 
 I doubt if he would have recovered without some; but I am quite sure if it had been 
 pushed further, he would have had either delirium tremens or sunk exhausted. The appear- 
 ance of the carbuncle shows that he would not have borne depletion. I believe that mer- 
 cury here, as in all apoplectic cases, was invaluable ; it arrested inflammation, and it pro- 
 moted the absorption of the clot. With regard to the cause of the disease, I believe that 
 may be sought alone in the over-mental exertion with which he taxed himself; there was 
 no indication of diseased heart: of the exact condition of the cerebral arteries we were of 
 course ignorant there was no general plethora, or physical conformation, tending to the 
 disease, such as short, thick neck. 
 
LESIONS OF THE CORPUS STRIATUM. 375 
 
 Lesions of the Corpus Striatum. I believe it is an invariable fact that 
 extravasation into the corpus striatum is followed by paralysis ; and con- 
 sequently that there is no portion of the brain that pathology has so 
 clearly indicated the function of, as the corpus striatum, in so far as its 
 connection with volition and the production of voluntary motion is con- 
 sidered. Morgagni, with his usual acumen, was among the first to 
 observe that disease or injury from extravasation into the substance of 
 this body was followed by paralysis. In the eleventh letter of this 
 writer, we find the following passage: "But whatever was the cause of 
 this separation of the corpus striatum, I have already shown you, in the 
 third letter which I sent you, how often a hemiplegia is wont to happen 
 from an injury in one or other of these bodies or their neighborhood. 
 Add to this what the sepulchretum teaches, that Willis also having some- 
 times examined the bodies of those who died after a long palsy, and a 
 very grievous resolution of the nerves, had always found these bodies 
 less firm than others in the brain, being discolored like lees of oil, and 
 having their striae greatly obliterated." But I think it will appear, from, 
 several facts I shall bring forward hereafter, that some physiologists have 
 advanced too rapidly in theory when they assigned to this body the 
 office of conducting and producing the action of the muscles of the 
 lower extremities, while the thalamus presides over and superintends 
 those of the upper. 
 
 Andral, in referring to this subject, makes the following judicious 
 remark: u Among the cases of softening which we have detailed, there 
 are several which seem to us to form a strong objection to the opinion 
 of those who thought they had discovered in the brain the particular 
 parts which preside over the motions of the upper and lower extremi- 
 ties. Very probably these particular parts do exist, since each limb 
 may be separately convulsed, paralyzed, &c.; but it appears to us that 
 these particular parts are yet to be found out, and we know nothing 
 which can be so fatal to the sound doctrine of the localization of the 
 cerebral functions as those premature localizations which some persons 
 have been inclined to establish in latter times." 
 
 In opposition to what has been said of the special function of the 
 corpus striatum as presiding over the motions of the lower extremity, 
 the succeeding case may be quoted, in which lesion of the part in ques- 
 tion was accompanied with paralysis not of the lower but of the upper 
 extremity.* 
 
 Case 58. Effusion of blood into the corpus striatum of the right side ; sudden loss of conscious- 
 ness ; hemiplegia on the left; death on the fifteenth day. A woman, 48 years old, addicted to 
 wine, fell suddenly deprived of consciousness on the 16th of March, 1823. A little time 
 after, she was bled; at the end of two hours ghe came to herself; she entered the hospital 
 of La Charite the same evening. On the next morning we found the two extremities of the 
 left side completely deprived of motion and sensation. The right commissure of the lips 
 was drawn upwards ; intellect perfect : pulse hard, vibrating, a little frequent. (She had 
 blisters to the legs, and purgatives.) On the following day a visible amendment; sensibility 
 restored in the paralyzed side; the left lower extremity begins to perform some movements ; 
 the left upper extremity as much paralyzed as on the preceding day. The 19th, she moves 
 the leg and thigh of the left side with ease; pulse not frequent. (A blister between the 
 ehoulders.) From this period to the 1st of April, symptoms of gastro-intestinal irritation 
 manifested themselves; tongue red and dry; great thirst; tension of the abdomen; diar- 
 
 * Andral, op. cit, p. 102. 
 
376 HUMAN BRAIN. 
 
 rhoea ; delirium soon came on ; the patient died in what is called the adynamic state. The 
 paralysis of the lower extremity of the left side had been completely removed ; not so that 
 of the upper. 
 
 Post-mortem examination. Cranium. The only lesion presented by the encephalon was in 
 the right corpus striatum. Towards the middle part of this substance, some lines beneath 
 its upper surface, was found a small cavity filled with blood. Around them the cerebral 
 pulp was very soft for the space of three or four lines. 
 
 Thorax. Hypertrophy of the walls of the left ventricle of the heart, with contraction of 
 its cavity. 
 
 Abdomen. Gastric mucous membrane very soft and red through the entire splenic portion. 
 Intense redness, and, as it were, granular appearance of the inner surface of the ileum 
 through a great portion of its extent. 
 
 Remarks. It is rare to find hemorrhage so exactly limited to the corpus striatum as in the 
 above case. The commencement of the affection was similar to that of the generality of 
 cerebral haemorrhages, whatever be their seat. The sanguineous effusion being inconsidera- 
 ble, the patient soon recovered the use of her senses, and her intelligence continued quite 
 perfect, which in this case may be referred to the seat of the haemorrhage, the effusion having 
 taken place far from the substance of the convolutions. At first the two extremities of the 
 side opposite to that of the sanguineous effusion were equally paralyzed, which already in- 
 validates the opinion according to which isolated lesions of the corpus striatum should modify 
 motion only in the inferior extremity. But this is not all; one of the paralyzed limbs soon 
 recovers the power of moving, and that is the lower extremity; that is to say, the limb 
 which, according to the opinion just now mentioned, should alone have continued deprived 
 of motion. Thus, the more we advance the more will facts tend to destroy, or at least to 
 stagger, assertions too hastily made. There was no appearance in this case of any curative 
 process having been set up around the haemorrhagic cavity. The most alarming cerebral 
 symptoms had, however, ceased, and it was under a complication of gastro intestinal inflam- 
 mation that the patient sank. She had also hypertrophy of the heart. 
 
 The following case appears to prove that the tract of neurine \vhich 
 conveys the dictates of the will to the lower extremities as well as that 
 which leads it to the upper extremities, partly passes through the corpus 
 striatum ; it also teaches us that partial recovery occasionally takes place 
 after apoplexy. 
 
 Case 59. Traces of an old effusion of blood into the right corpus striatum; hemipkgia, pre- 
 ceded by loss of consciousness: death thirteen months after the attack of apoplexy* A hair- 
 dresser, 46 years of age, entered La Charite the 27th of January, 1822. He told us, that on 
 the 21st of February, 1821, he had had an attack of apoplexy, during which he said he had 
 entirely lost all consciousness. On coming to himself he was paralyzed in the two extre- 
 mities of the left side. By degrees this paralysis diminished, and when we saw him he 
 merely felt some debility in the left extremities. The arm of this side appeared to him not 
 so strong as the other, and in walking he dragged the leg a little. He presented all the signs 
 of pulmonary phthisis, of which he died, the 14th day of April, 1822. 
 
 Post-mortem examination. In the posterior part of the right corpus striatum, nearer its ex- 
 ternal than its internal part, about an inch and a half below its upper surface, a cavity was 
 found, an inch in length and an inch and a half in breadth. It was filled with a substance 
 similar in color and consistence to thick chocolate. No false membrane extended over the 
 parietes of this cavity. Around it, for the extent of about half an inch, the substance of the 
 corpus striatum was transformed into a yellowish pulp. Caverns and tubercles in the lungs ; 
 heart normal; ulceration in the intestines. 
 
 Remarks. Here again the lesion was confined to the corpus striatum, and still there was 
 hemiplegia. Observe, however, that it was in the posterior part of the corpus striatum that 
 the haemorrhage took place. The paralysis, though considerably diminished, existed how- 
 ever, in a slight degree, at the time of death. We saw what was the state of the corpus 
 striatum after the lapse of more than a year since the haemorrhage. There was yet no or- 
 ganized membrane on the parietes of the cavity, and around it the cerebral substance had 
 neither the natural consistence nor color. 
 
 Thalamus Nervi Optici. Extravasation into the thalamus nervi optici 
 is not accompanied by any unequivocal lesion of sensibility, as might be 
 -supposed if the theory that it is the ganglion of the sensory column were 
 
 * Andral, p. 103. 
 
THALAMI NERVI OPTICI. 377 
 
 correct. It is indeed true that morbid anatomy has not yet shed any 
 clear light on the functions of this part, beyond the facts that volition 
 appears to flow through it ; for it is seldom injured without paralysis of 
 some part or other being the result. If it is in any way connected with 
 the phenomena of sensation, as its communication with the posterior 
 columns would induce us to believe, it is not entirely devoted to this 
 purpose, for there are many cases on record, in which its lesions have 
 been accompanied with paralysis, while the sensibility of the parts para- 
 lyzed has remained intact. In truth, I believe with Andral,* that though 
 sensation is perhaps more frequently affected by cerebral hemorrhage 
 than motion, " it has been impossible up to the present time to detect, 
 in the nature or in the seat of the alterations of the brain, the cause 
 which sometimes suffers sensibility to be intact, and sometimes occasions 
 its more or less complete abolition." 
 
 In the following casef the lesion was so entirely confined to the tha- 
 lami that it cannot but prove interesting. 
 
 Case 60. A man, 60 years of age, was admitted, towards the commencement of No- 
 vember, into the Maison de Sante, with a disease of the heart of long standing. The two 
 extremities of the left side were also paralyzed ; the intelligence was perfect. About three 
 weeks before his admission, he told us that he felt his left leg fail him, and he fell, not how- 
 ever deprived of consciousness. A little after, he found the upper extremity of the left side 
 also deprived of motion; the sensibility of the paralyzed limbs remained. His dyspnoea in- 
 creased, as also his dropsy, and he died on the 25th of November, the hemiplegia continuing 
 to the last moment. 
 
 Post-mortem examination. In the centre of the right optic thalamus there was found a 
 cavity filled with black blood of some consistence. The cavity was capable of containing a 
 large cherry. 
 
 Thorax. Lungs infarcted ; hypertrophy of the parietes of the heart and dilatation of its 
 cavities, which were filled with blood ; cartilaginous incrustation at the base of the mitral 
 valve ; serous effusion into the left pleura ; close adhesions between the heart and pericar- 
 dium. Two bony concretions developed between this membrane and the proper substance 
 of the heart. 
 
 Abdomen. Considerable injection of the intestinal mucous membrane in different parts ; 
 spleen very large, dense, and black ; liver gorged with blood. 
 
 Remarks. This case differs from all the preceding, in this, that no loss of consciousness 
 occurred when the haemorrhage came on. The two extremities of the left side were equally 
 affected with paralysis, though the lesion existed but in one optic thalamus. 
 
 From the corpora striata and thalami, we may proceed to consider 
 those cases of effusion where the blood is confined to the tubular sub- 
 stance of the hemispheres. It is in these cases that we find, after the 
 first effect of the effusion is passed, that the intellect remains intact, or 
 only slightly disturbed. I have selected the following case from Andral 
 in illustration. It also demonstrates the way in which a false membrane 
 is sometimes thrown round a clot of blood. | 
 
 Case 61. Effusion of blood into the middle part of the right hemisphere. Some softening of 
 the cerebral substance around this effusion. Death the seventh month A periwig-maker, se- 
 venty-one years of age, of a good constitution, fell suddenly, deprived of consciousness, on 
 the 15th of May, 1820. This loss of consciousness lasted but for some hours. When he 
 came to himself, he found that he was paralyzed in all the left side of the body. He en- 
 tered La Charite, June 28, and presented the following state: Pain towards the summit 
 of the head, particularly on the right side; sight and hearing weaker on the left than on the 
 right; left buccal commissure immovable, the right drawn out; tongue inclined to the left 
 side ; complete loss of motion in the upper and lower extremities of the left side ; sensibility 
 of these same members very much impaired, but not quite extinct ; obstinate constipation ; 
 
 * Andral, p. 103. f Ibid., p. 113. J Ibid., op cit., p. 100. 
 
 *' ' ' 
 
378 HUMAN BRAIN. 
 
 pulse full, a little frequent; intellect perfect. On the 4th of July, it was observed that the 
 left side of the thoracic parietes was covered with an enormous anthrax. A crucial incision 
 was made into it a considerable depth; whitish eschars were detached from it by degrees; 
 towards the end of August it was scarcely cicatrized. During the month of September ano- 
 ther anthrax, still larger than the former, appeared in the supra-spinous fossa of the left 
 scapula. Other small ones appeared in succession in the vicinity of this latter one, always 
 on the left. At this time, the paralyzed limb became atrophied, and permanently contracted, 
 the forearm on the arm, and the leg on the thigh. He complained when we attempted to 
 move his limbs. He passed his urine and faeces involuntarily. Towards the month of Oc- 
 tober he became very feeble; scarcely ever spoke ; large eschars formed on the sacrum; the 
 contraction of the left upper extremity ceased, whilst it& immobility remained. He died the 
 21st of November, without his respiration having become stertorous. 
 
 Post-mortem. Complete marasmus ; extremities rigid ; broad ulcers on saorum and tro- 
 chanters. 
 
 Cranium. Its walls very brittle ; dura mater strongly adherent to the vault of the cra- 
 nium ; arachnoid of the convexity a little opaque ; right hemisphere of the brain presented 
 a cavity capable of containing a middle-sized apple ; this cavity at an equal distance from, 
 the two extremities of the hemispheres, near the circumvolutions of the upper surface, exter- 
 nal, superior and posterior to the corpus striatum. Its parietes were lined by a cellular 
 membrane, dense, very resisting, in the tissue of which numerous' vessels were ramified. 
 By its inner surface, this membrane adhered closely to the cerebral substance, which is re- 
 moved along with it. The cavity is filled with a softish substance having the color of iron 
 rust. The surrounding cerebral substance is softened to the extent of four or five lines. 
 The softened portion has a slightly yellow tinge. Some little serum in the ventricles and at 
 the base. 
 
 Extravasations on the surface of the brain have sometimes been de- 
 scribed as meningeal apoplexy. This is divisible into two kinds, one 
 into the cavity of the arachnoid, the other into the sub-arachnoid tissue. 
 Effusion in the arachnoid cavity is never the result of such a decided 
 rupture of the vessels, as is visible to the naked eye, and hence it has 
 been called an exhalation ; but wherever there are blood-discs extrava- 
 sated, there are also openings in the sides of the vessels. The blood 
 coagulates in this situation, and is frequently invested with a false mem- 
 brane, which adheres to the arachnoid. This subject has been well in- 
 vestigated by the French writers, Rostan, Bayle, Cruveilhier, Durant 
 Fardel, and Dr. Pruss. There is a good abstract of the paper* of this 
 last-mentioned author in the British and Foreign Quarterly Medical Re- 
 view. 
 
 The disease has been described by Carswell and Dr. Burrowes in the 
 Croonian Lectures, and more lately by Mr. Prescott Hewett, in the tenth 
 volume of the Medico-Chirurgical Transactions. This careful patholo- 
 gist brings forward many good instances of the investment of the coagula 
 with a false membrane. He says, " The pathological investigations 
 carried on within the last few years by Messrs. Longet, Baillarger, Cal- 
 meil, Ernest Boudet, and others, have all shown that the fine, delicate 
 membrane which covers these extravasations of blood, and which pre- 
 sents to the naked eye all the characters of a serous tissue, is a newly- 
 formed membrane, so beautifully adapted to the original serous membrane, 
 that it is only with the utmost care that the exact limits of each can be 
 defined. The cases of this nature which I have examined have afforded 
 me an opportunity of verifying the accuracy of this opinion ; and in 
 speaking of the formation of this membrane, I shall bring forward seve- 
 ral examples, which will, I trust, prove that it is much more frequently 
 and much more rapidly formed than is usually supposed. " 
 
 * M6moire de 1'Academie Royale de Medecine, tome xi. Paris, 1845. 
 
MENINGEAL APOPLEXY. 379 
 
 Mr. Hewett considers that this membrane is wholly formed by the 
 coagulated fibrine ofcthe extravasated blood, not by a secretion of lymph. 
 
 Pain in the head always marks this form of apoplexy. 
 
 Paralysis follows this effusion, though not so invariably as that into 
 the cerebral substance. One of the most important occasional charac- 
 teristics of this disease is the intermission of the symptoms, and the 
 consequent masking of the disease. The following case from Mr. 
 Hewett is very instructive, though I cannot help saying that I think the 
 existence of the mental excitement ought to have warned the prac- 
 titioner as to the possible nature of the case, and forbade the use of 
 quinine. 
 
 Case 62. In the early part of 1841, Mrs. , aet. 65, after having for several days 
 
 suffered from great mental excitement, was suddenly seized with violent pain confined to the 
 right eyebrow, which lasted for two or three hours, and then disappeared. This pain con- 
 tinued for several days to recur twice in the twenty-four hours, presenting all the characters 
 of brow ague ; it was apparently relieved by quinine, but it was followed by a train of 
 low symptoms, accompanied by a dry brown tongue, wandering and impairment of the 
 intellectual faculties, terminating in coma. There never was any paralysis, neither were 
 any contractions of the limbs observed. The patient died twelve days after the first attack 
 of pain. 
 
 The body was examined about twenty-four hours after death. The veins of the scalp 
 were gorged with blood. The dura mater, on the right side, appeared to be somewhat 
 thicker than natural. A large quantity of blood was found extravasated in the cavity of 
 the arachnoid ; it corresponded both to the upper and to the inferior surfaces of the right 
 hemisphere, and a small quantity of it had even made its way into the corresponding cere- 
 bellic fossa, where it was lying on the margin of the foramen magnum; the whole of this 
 extravasated blood was of a dark fawn color. At the base of the skull, the extravasa- 
 tion at first sight appeared to have taken place between the dura mater and its arachnoid 
 lining, for the blood was covered by a thin, smooth, and polished membrane, presenting to 
 the naked eye all the characters of the serous tissue, with which it was perfectly continuous, 
 at the margins of the extravasation ; but this membrane, and the clot, were easily removed, 
 and the arachnoid was then found slightly roughened, but uninterrupted throughout in its 
 continuity. The substance of the brain was healthy, but its ventricles contained some fluid. 
 The source of the haemorrhage was not discovered. No marks of external violence existed 
 about the cranium. 
 
 This form of apoplexy is not so invariably fatal as that into the sub- 
 arachnoid tissue. Its duration is certainly longer; Dr. Prus says that 
 it may extend a month, and upwards, and as a proof that recovery does 
 sometimes take place, cites the discovery of cysts in the serous cavity. 
 I was present at the inspection of a case of this kind at Bethlem, April, 
 1842. The patient had had symptoms of an apoplectic seizure two 
 years previous to his death, from which he recovered. On the internal 
 surface of the parietal, or reflected portion of the arachnoid, there was 
 a false membrane of a brown yellowish color, about as thick as a piece 
 of stout writing paper, near the mesial line, but gradually diminishing 
 in thickness to that of a mere cobweb, at the base of the skull. The 
 visceral arachnoid was thick and milky, the cerebro-spinal fluid abund- 
 ant beneath. 
 
 The symptoms which mark extravasation on the surface of the brain 
 into the sub-arachnoid tissue depend very much on the seat and rapidity 
 of the effusion. When injuries of the skull give rise to effusion of 
 blood, I oftentimes remarked that, as long as the blood was confined to 
 the base of the brain, the mind was little affected, but as the blood rose 
 upwards and reached the upper part of the hemispheres, that then coma 
 and insensibility would come on. The proof, that the effusion com- 
 
380 HUMAN BRAIN. 
 
 menced at the base, was the discovery of the ruptured vessel, generally 
 the middle meningeal artery. I have not had the opportunity of observ- 
 ing whether the same applies to apoplectic effusion, but I can see no 
 reason to doubt it. Hemiplegia seldom follows this form of effusion, 
 and this most probably arises from the blood being poured into the cavity 
 of the cerebro-spinal fluid, which readily makes way for it. 
 
 Dr. Prus sets down the cephalalgia, redness, and heat of the integu- 
 ments of the face, as premonitory symptoms, rather than evidences of 
 the actual occurrence of the haemorrhage. I do not agree with him, as 
 I am convinced that in many cases the haemorrhage goes on very slowly 
 at first. It is very true, as stated by this author, that the intellectual 
 faculties are scarcely ever perverted , but weakened. The reason is, that 
 the hemispherical ganglion is not usually inflamed in these cases, it is 
 only compressed, and hence the most constant effect is coma. 
 
 Apoplectic effusions on the surface generally arise from the rupture of 
 small vessels: sometimes no rupture whatever can be found, and some- 
 times they are the consequence of ulceration. When the effusion takes 
 place slowly, the pain experienced is excessive, it is excruciating, there 
 is blood enough to irritate the membranes and elicit that sensibility which, 
 like the peculiar sensibility of every tissue, is a warning, protective 
 sensibility, but not enough to smother the instrument whose office it is 
 to receive impressions and recognize pain. Sometimes this suffering 
 may last for some days, but generally coma comes on rapidly and re- 
 lieves the pain. One of the most striking cases I ever saw of this kind, 
 occurred in the person of an old servant. On the morning she was 
 about to quit the service of a family where she had lived many years 
 most happily, she awoke with severe pain in the head ; she got up, and 
 attempted to pack her boxes, and do other little things as usual, but she 
 soon felt too ill to do anything, and she was obliged to go to bed again. 
 Medical treatment had no power over the attack, and she died comatose 
 on the fifth day, without any appearance of hemiplegia. The only lesion 
 discovered was an effusion of blood over the whole of the upper part of 
 the brain ; it was smeared with blood. No ruptured blood-vessel could 
 be discovered. 
 
 The following case is peculiarly interesting and instructive, from the 
 obscurity of its symptoms and the insidious character of its onset : 
 
 Case 63. Sanguineous Apoplexy very obscure symptoms. M. C , set. 38, pale, and of 
 
 fair complexion, short stature, robust, energetic and muscular appearance, and of well-ordered 
 habits, has been married, and has had five children, the last of whom is five months old. 
 She was nursing at the time of seizure, on the evening of the 15th of November, having 
 been perfectly well and active to the period of attack ; she was suddenly, and without 
 cognizable cause, seized with severe and repeated vomiting, with partial loss of conscious- 
 ness. 
 
 I saw her about twenty minutes after the commencement of vomiting, and found her sit- 
 ting in a chair; the pulse was very small and feeble, about 105; the surface of the body cool 
 and clammy; the eyes natural in their appearance; the pupils perfectly sensible, and con- 
 sciousness much restored. She knew every body and everything, but had some hesitation in 
 replying to questions ; but the answers were all perfectly correct ; muscular power appeared 
 very weak, but under control ; she complained of headache, and said she felt very ill ; retch- 
 ing continued very troublesome. The contents of the stomach having been previously ex- 
 pelled, small quantities of mucus were ejected. Bowels constipated. Ordered to be put to 
 bed, her head raised, and cold lotion applied ; hot bottles to the feet and legs, Hyd. Chlorid. 
 gr. viij. stat. Magn. Sulph. Jfs. ex. aquae Cinnamomi gifs. post horam dimidiara. 
 
 1- ,.:'"> *.?JIO9 ^IffUfW^tM ..!: 
 
MENINGEAL APOPLEXY. 381 
 
 Saw her again in forty minutes ; had thrown up the powder and draught ; pulse quite 
 small and feeble ; sensibility rather more obtuse ; she still answered all questions correctly, 
 and the pupils were sensible ; but she took very little notice without cause to do so. Head 
 to be shaved, and cold lotions applied; large mustard poultices to the scrobiculus cordis and 
 calves of the legs. Calomel gr. v. 4 ta hora. H. Salinus. post sing. dos. 
 
 I visited her again in three hours. Pulse, intellect, and other symptoms the same; the 
 surface of the body had become warmer. She had had the mustard poultices on for about 
 two hours; the skin was much inflamed under them; but when questioned, said they pained 
 her only slightly. Muscular power and sensation very much depressed, though not paralyzed. 
 Contin. gruel only, for sustenance. 
 
 16th. Pulse rather rallied still small and weak; retching not quite so troublesome, but 
 was still continuing, and the medicine had been ejected; head was still painful; pupils sen- 
 sible, intellect obtuse, but her replies more correct; the mammae were secreting, and the 
 child was ordered to be put to the breast. A purgative enema administered immediately. 
 Calomel gr. ij. 3 fia - hora. Hs. Aper. 6 ti8< horis. Blister to the scrobiculus cordis, and behind 
 the ears. Continue the cold lotion to the head. 
 
 17th, mane. Intellect rather more obtuse; other symptoms same as yesterday; bowels 
 had been freely acted upon by the enema yesterday. Cont. Cal. et Hs. Sal. Emp. Lyttse 
 capiti. 
 
 Vespwe. Consciousness and sensibility much more blunted and impaired; when excited 
 to do so, answered questions, but irrationally ; did not generally identify persons around her, 
 and when questioned as to how she was, answered Quite well; pupils still contract, but 
 not so sensitive. When I saw the patient she was still asleep. Her manner was rational, 
 and not peculiar ; but when asked who Mr. W., her medical attendant, was, said he was 
 somebody else evidently did not know him. When left to herself, she soon dozed off 
 again, from which state she was roused again with difficulty, though it was unaccompanied' 
 by stertor. When roused, she answered the 'inquiry how she was distinctly, though slowly ; 
 that she felt very well that she had no pain anywhere. I examined the pupils before she 
 awoke, and they then contracted decidedly and forcibly to the light; after she awoke, they 
 also contracted to the light, though not so much, but both acted equally. The pulse was 
 100, and rather jerking, not very easily compressed, but still not giving the idea of much 
 power. The head was rather hot, but not decidedly so. There were, in fact, no decided 
 symptoms. However, taking into consideration the progress of the disease, and the fact 
 that she was hourly getting more stupid and sleepy, and there was a jerking character of 
 pulse, I thought it right to abstract a little blood from the arm, taking care to watch its 
 effects. The blood flowed from a free opening, and the pulse, after the abstraction of three 
 or four. ounces, became a little feebler, but when there were six taken, it became slightly 
 intermittent, and this became more decided. I stopped the bleeding, taking only seven 
 ounces. She was a little more sensible after the bleeding, but the change was very slight. 
 Ordered Hyd. Chlorid. gr. ij. tertia hora. Hyd. Bichlorid. gr. ij. Syrup. Croci Tinct. Lyttas 
 ifs. aq. Menth. viij. 6 tara - part ra - omni hora. R. Olei Tereb. if i. Tinct. Assafetid. gi. 
 aq. J viij. fiat enema. 
 
 During the night, and after I left her, I understand she was a little more conscious, but 
 it did not last long, for she sank about ten the next morning. 
 
 Post-mortem 44 hours. Head. Vessels of pia mater very full, arachnoid natural. Be- 
 fore removing the brain from the skull, we observed a slight sanguineous effusion extending 
 over the upper surface of the anterior lobes, below and before, backwards, forming a very 
 thin layer a mere smearing of the brain. On removing the brain from the skull, I found 
 the under part of the right anterior lobe so soft that it gave way to the finger, and when the 
 brain was removed, we found the anterior portion of the corpus callosum also torn and evi- 
 dently softened. The layer of effused blood was thicker between the two hemispheres 
 than at the upper part, and was gradually thickened as we traced it from above downwards, 
 round the front of the brain to the base ; it evidently proceeded from a vessel which had 
 given way close to the fissura Sylvii; in the substance of the brain opposite the fissure, 
 there was a clot about the size of a hazelnut the brain softened and discolored around it. 
 This effusion had just penetrated the wall of the anterior cornu of the lateral ventricle, for 
 in it there was a small quantity of liquid blood smearing its floor, also the posterior cornu; 
 all the rest of the brain was healthy. 
 
 Chest. Lungs sound. Concentric hypertrophy of left ventricle, with diminution of the 
 cavity. The walls were double their normal thickness; the cavity about half its natural 
 size. The aortic opening was narrow; and along the attached edges of the semilunar valves 
 there was a slight, narrow, cartilaginous thickening, also some deposit of cartilaginous matter 
 in the mitral valve. Right ventricle a little dilated. The rest of the viscera healthy. 
 
 This case was one of the most obscure I ever met with. There were 
 
HUMAN BRAIN. 
 
 none of the ordinary signs of sanguineous apoplexy no paralysis of 
 either motion or sensation no morbid impression on the retina no 
 stertor no suffusion of the eyes, no congestion of the head neither 
 were there any signs of inflammation of the membranes of the brain or 
 hemispherical ganglia. The condition of the patient seemed to point 
 more to serous effusion at the base of the brain, and there -was nothing 
 in either the history of the case or appearance of the patient to make 
 me regard it as asthenic in its character and the danger of the patient 
 as imminent. I ventured on the abstraction of blood, and I^am now 
 sorry we did not carry it further. 
 
 The following case from Ducrot, (Essai sur la Cephalite, 1812, Obs. 
 2,) quoted by Lallemand, illustrates the progressive effects of extrava- 
 sation of blood in exciting inflammatory action of the tubular substance, 
 and with it convulsive movements ; these being followed by paralysis, 
 as the brain becomes softened, and the conducting instruments destroyed. 
 
 Case 64. Mr. A., about 60 years of age, had a fracture with a depression into the left 
 frontal region by a stone thrown with violence; he lost much blood, but was able to return 
 home. The next day, throbbing pains came on, with confusion of memory and inability to 
 give proper answers to questions; power of speech not much impaired, but incapability of 
 putting the tongue out. The pulse was feeble; oppression. (A liquid emetic.) The third 
 day deglutition difficult, thirst, skin hot, pulse frequent. The fourth day, drowsiness, answers 
 always correct. (A large blister to the nape of the neck.) Fifth day, drowsiness increases, 
 loss of speech: he understands what is said to him, but can only answer by cries; the faeces 
 and urine pass involuntarily. Sixth day, drowsiness still more increassd, symptoms the 
 same. Seventh day, no alteration. Eighth day, delirium, loss of sense, convulsive motions 
 of the trunk and limbs, with distortion of the mouth and eyes; he had attacks every quarter 
 of an hour. In the interval respiration difficult, snoring, eye fixed, gaping mouth. The 
 ninth, at midnight, the convulsions cease, the drowsiness diminishes, his senses return, but 
 the alteration of memory and judgment continue; slight delirium, the left limbs begin to be 
 paralyzed. The tenth, complete paralysis of these limbs, with rigidity and slight pain when 
 they were raised from the trunk ; the countenance idiotic, answers not correct, optical illu- 
 sions, convulsive jerkings during the night. The following day same state. The eleventh 
 day, loss of sense, aphonia, immobility and general insensibility, coma, respiration loud and 
 difficult, &c. ; death at eleven in the evening. 
 
 Autop. cadav. Depression two lines in depth for about two inches on the frontal region. 
 At the internal and posterior part of the right lobe of the brain, inflammation an inch and 
 a half in extent from above to below, and half an inch in the other direction, extending 
 on one side as far as the corpus callosum, and on the other to the base of the brain. This 
 inflammation was marked with a bright redness, sprinkled as it were through the substance 
 of the brain. The arachnoid, which covered the convexity of the brain, was opaque, white, 
 very thick, and smeared upon its internal surface by a thin layer of albuminous matter. 
 
 Our attention may next be directed to the effect, and, consequently, 
 the symptoms of apoplectic effusion on or into the Cerebellum. These 
 lesions are always more or less followed by hemiplegia, and this is, I 
 believe, invariably, as in the instance of brain, on the opposite side of 
 the body. Sight and hearing are generally secondarily affected from the 
 propinquity of the optic ganglia and auditory nerves. 
 
 In many cases, though not in all, we find decided disturbance, ge- 
 nerally excitement of the generative organs. 
 
 The following case is interesting in many points of view ; first, it is 
 an instance of a moral cause fright so exciting the cerebral circulation 
 as to give rise to effusion ; secondly, the gradual loss of power, the 
 effusion, in all probability, being very small ; thirdly, the effect on the 
 organs of vision ; fourthly, the supervention of inflammation in the 
 cerebellum, and its effect convulsive movements ; fifthly, the super- 
 
APOPLEXY OF THE CEREBELLUM. 383 
 
 vention of inflammation of the hemispherical ganglion and its effect 
 delirium ; sixthly, effusion into the ventricles, and its effect coma. 
 
 Case 65. Considerable softening of the right lobe of the cerebellum,- with hemiplegia* A 
 seamstress, thirty-one years old, who had hitherto enjoyed good health, about six weeks 
 before entering the hospital of La Charit, had a fright whilst menstruating : the menses 
 were suppressed, and, immediately after their disappearance, she was seized with dizziness, 
 and an acute pain in the back part of the head, towards the right side. The dizziness 
 disappeared after a bleeding, but the pain of head remained ; it was unconnected with any 
 other symptom for eight days ; subsequently the patient began to experience an annoying 
 sense of formication at the ends of the fingers of the left hand ; she could use this hand but 
 awkwardly, and was astonished at seeing what she handled with it fall continually from 
 her grasp : she soon became unable to work with it at all ; the entire arm seemed very 
 heavy. After some time the lower extremity of the left side became weaker, and in about 
 a month the patient had complete hemiplegia of the left side. At the same time that the 
 patient thus lost the power of motion of one of the sides of the body, her sight, till then 
 extremely good, became very weak, and five weeks after the invasion of the first symptoms, 
 she became completely blind. 
 
 This was the state in which we first saw her ; deprived of sight, and of the power of 
 moving the limbs of the left side; the pain of head had then become less acute; the patient, 
 however, still felt it, and referred it to the lower part of the occipital region of the right side. 
 
 The paralyzed limbs were flaccid, and could be moved in all directions ; the skin covering 
 them still retained its sensibility; no trace of paralysis of the face; the pupils, moderately 
 dilated, still contracted on the sudden approach of light; the appearance of the eyes was 
 natural ; there was, however, all but complete blindness, the patient being scarcely able to 
 distinguish day from night; the intellect was perfect, the pulse natural; the catamenia 
 had not reappeared since they were suppressed by the fright. Leeches were first applied 
 to the nape of the neck, then to the genital organs ; aloetic pills were frequently given, and 
 subsequently the back of the head was covered with a blister. 
 
 No change appeared for the first three weeks of her stay in the hospital ; then, without 
 any known cause, the pain of head suddenly became more violent, and extended to the 
 entire cranium ; the extremities of the left side, which till then had remained entirely im- 
 movable, were several times agitated with convulsive movements, which were slight in the 
 lower extremity, but very violent and almost continual in the upper limb ; acute pains ac- 
 companied these convulsions ; the intelligence soon became disturbed ; complete delirium 
 set in ; for twenty-four hours the patient spoke, and was agitated incessantly ; she then fell 
 into a profound coma, in which state she died. 
 
 Postmortem examination. The pia mater extending over the convexity of the cerebral 
 hemispheres was very much injected, as was also that covering the cerebellum. The sub- 
 stance of the brain, properly so called, was marked with a considerable number of red 
 points, and presented no other lesion ; lateral ventricles distended with a great quantity of 
 limpid serum ; the fornix and septum lucidum natural. Externally the cerebellum appeared 
 healthy ; but we had scarcely removed some layers of the substance of its right hemisphere, 
 proceeding from above downwards, when we found an immense cavity, where this sub- 
 stance, deprived of its normal consistence, was changed into a grayish bouillie; this softening 
 occupied at least two-thirds of the right hemisphere of the cerebellum ; it partly implicated 
 the prolongations which go from the cerebellum, either to the spinal marrow, or to the 
 tubercula quadrigemina, or to the annular protuberance : it did not extend as far as the lower 
 surface ; in no part of its extent was there either injection or infiltration. 
 
 Case 66. Effusion of blood into the right hemisphere of the cerebellum,' hemiplegia of the left side, 
 accompanied with loss of consciousness. Death 50 hours after the appearance of the first apoplectic 
 symptoms.^ A female, 22 years of age, was treated at the hospital of La Charite for a chronic 
 gastritis; she had evinced symptoms of this affection for the last two years. One evening 
 at six o'clock, a short time after having eaten, and before going to bed, she fell, suddenly de- 
 prived of consciousness and motion. After about an hour she recovered the use of her 
 senses, but could not move the extremities of the left side. On seeing her the next morning 
 her state was as follows: face injected equally on both sides, contraction of the pupils, vision 
 unimpaired, air of stupor ; she answers questions with correctness, no embarrassment of 
 speech. The two extremities of the left side completely deprived of voluntary motion ; they 
 presented no trace of contraction ; sensibility of the skin covering them impaired. Pulse 75, 
 and full; heat of skin natural; respiration hurried, 30 to 34 every minute. 
 
 * Andral's Clinique Medicale, sect. ii. Case I. p. 202. 
 f Andral, op. cit, p. 195. 
 
384 HUMAN BRAIN. 
 
 This girl seemed to us to have been struck with cerebral haemorrhage ; she was bled to 
 sixteen ounces. This produced no amendment, and the symptoms going on from bad to 
 worse, the patient expired on the evening of the day on which she was first seen. 
 
 Post-mortem examination. Cranium. Sub-arachnoid cellular tissue of the convexity of the 
 cerebral hemispheres very much injected. The latter present no appreciable alteration, ex- 
 cept considerable sandiness of their tissue. In the central part of the right hemisphere of 
 the cerebellum was found an effusion of blood, which formed in the nervous substance a 
 cavity large enough to hold a pullet's egg. Around this cavity the tissue of the cerebellum 
 was red and softened for the space of three or four lines. 
 
 A man mentioned by Serres,* after a blow on the back and lateral 
 part of the head, which stunned him at the time, had a certain unsteadi- 
 ness in walking, which made him always anxious to take the arm of a 
 friend ; and he had a weakness of his head, which made him liable to 
 be much affected by a small quantity of wine. This state continued 
 about eighteen months, when he became low spirited and irritable, and 
 was affected with trembling of the limbs. Soon after, the left leg be- 
 came paralytic, and the arm of the same side felt benumbed and weak- 
 ened. After the insertion of a seton in the neck, the arm recovered. 
 Three months after this the patient died, with fever, delirium, and an 
 affection of the bowels. 
 
 There was found disease in the right lobe of the cerebellum, with an 
 abscess and extensive softening. 
 
 In another man, mentioned by the same writer, who died in forty days, 
 there was palsy of the right leg, with wasting of the limb, but without 
 loss of sensibility, the arm of the same side being little, if at all, 
 affected. 
 
 There was found ramollissement of the left lobe of the cerebellum, 
 occupying chiefly the centre of the left peduncle. 
 
 The cases above referred to prove that lesions of the cerebellum, like 
 those of the cerebrum, generally produce paralysis of the side of the 
 body opposite to the seat of injury. In some cases the sensibility was 
 decidedly impaired, but in others this function scarcely presented any 
 signs of implication. 
 
 One of the most interesting and extraordinary circumstances connected 
 with injuries of the cerebellum with which I am acquainted, I give on 
 the authority of Andral.f 
 
 " When the hemorrhage of the cerebellum occurs simultaneously 
 with that of the cerebrum, or a little time after it, but so that the blood 
 is effused on the right into the cerebellum, and on the left into the cere- 
 brum, or vice versa, there is paralysis only on the side of the body oppo- 
 site to the hemisphere of the brain where the haemorrhage has taken 
 place ; that is, on the same side as the haemorrhage of the cerebellum. 
 How then does it come to pass, that whereas the movements of the ex- 
 tremities of the right side are abolished when there is an effusion of 
 blood into the left hemisphere of the cerebrum, the effusion which takes 
 place simultaneously into the right hemisphere of the cerebellum should 
 no longer have the power of paralyzing the extremities of the left side? 
 It had this power, however, in the cases where the cerebrum remained 
 uninjured : is not that a fact worthy of attention ?" Any comment upon 
 this circumstance in the present state of our knowledge would be pre- 
 
 Journal de Physiologic, 1822-23. f Op. cit., Part I. p. 201. 
 
SANGUINEOUS APOPLEXY. 385 
 
 mature. We would only beseech pathologists to pay particular atten- 
 tion to the fact, and in the first instance endeavor to ascertain whether 
 matters invariably fall out as they are reported to have done in the cases 
 related by the learned and very candid author above quoted. 
 
 Abercrombie* quotes a curious case from Morgagni, in which scirrhus 
 of the left lobe of the cerebellum was followed by paralysis of the lower 
 extremities, the upper being left perfectly sound. 
 
 Portal, when treating of paralysis produced by lesions of the cerebel- 
 lum, says: " In some cases of injuries of the cerebellum, the paralysis 
 and the convulsions have happened on the wounded, and riot on the 
 opposite side, as is usually the case in patients whose cerebrum has been 
 wounded ; but still this is not sufficiently proved to be received as a 
 demonstrated point of doctrine." 
 
 Among the anomalous instances of disease of the cerebellum produc- 
 ing no symptoms of paralysis, I may relate one mentioned by Douglas. f 
 The patient had been for three months affected with pain in the fore- 
 head, which generally obliged him to sit with his head leaning forward ; 
 he had little appetite, and his sleep was disturbed ; but no other symp- 
 tom of disease. He died suddenly from an attack resembling syncope, 
 having been for a day much better, with a good appetite, and enjoying 
 quiet sleep. An encysted abscess was found in the middle of the cere- 
 bellum, and a rupture of the left lateral sinus, which probably was the 
 immediate cause of death. 
 
 I will conclude these observations on sanguineous apoplexy with a 
 quotation from Dr. Bright's admirable work. 
 
 Dr. Bright^ says : " When the decided attack has taken place, it 
 varies greatly in extent and severity ; sometimes it is attended with 
 violent pain in the head ; sometimes there is not the slightest pain ; 
 sometimes it assumes the form of complete apoplexy, the annihilation of 
 all consciousness, the extinction of all sensation, the loss of all voluntary 
 motion ; for a few minutes, or a few hours, the retarded pulse bespeaks 
 the difficulty with which the heart and arteries maintain, by their volun- 
 tary actions, the labor of circulation, and the stertorous sound of impeded 
 breathing betrays the inactive condition of those muscular parts through 
 which the involuntary powers are called upon to force the air in the pro- 
 cess of respiration, and these soon prove insufficient to maintain life. At 
 other times, the apoplectic condition, though well marked, gradually 
 subsides, or frequently the state of insensibility continues for a few mi- 
 nutes only; while in some attacks the consciousness is never destroyed. 
 
 " But though the apoplectic state should not exist, or though the con- 
 sciousness should have returned, yet, if effusion of blood have taken 
 place, paralysis will generally remain. The extent of this paralysis will 
 vary almost indefinitely; it frequently affects both the motion and the 
 sensation of the same part; sometimes, however, the motion, and some- 
 times the sensation, suffers in the greatest degree; and, occasionally, 
 the sensation of one part and the motion of another are more strikingly 
 influenced. 
 
 " Hemiplegia is by far the most common form which paralysis assumes 
 
 * P. 470. t Quoted by Abercrombie, 129. $ Op. cit., p. 37. . 
 
 25 
 
386 HUMAN BRAIN. 
 
 from effusion of blood within the cranium. I ha.ve, indeed, never met 
 with a decided instance of paraplegia from this cause ; occasionally one 
 leg or arm will be affected, without the other limb on the same side 
 suffering materially ; but those forms of paralysis which occupy, almost 
 exclusively, the two upper or two lower extremities very rarely result 
 from the sudden effusion of blood in the brain. Cases occur, where 
 paralysis of the two lower extremities has appeared to depend on other 
 disease or injury in the brain; but of these we should always be some- 
 what skeptical, from the obvious sources of error to which they are lia- 
 ble, amongst which the unobserved or the unsought diseases of the spinal 
 cord and its membranes are the most to be suspected. Defective articu- 
 lation and deglutition, either alone or as attendants upon hemiplegia, 
 are likewise common results of apoplectic seizures. Occasionally great 
 pain is experienced in the affected limbs, while at other times a sense of 
 numbness alone is felt. The powers of the mind generally suffer in some 
 degree, but this varies greatly ; sometimes the mind evinces great irrita- 
 bility, and sometimes a childish tendency to excitement, and a trifling 
 turn quite inconsistent with the former disposition, or with the present 
 situation, of the sufferer: at other times, the patient falls into a dull 
 state of imbecility while cases occur in which the affection of the mind 
 is so slight, that it is only by close examination it can be detected." 
 
 " The successive changes," says Dr. Bright,* " which take place in 
 the effused blood, and in the portion of the brain injured by the effusion, 
 will of course depend in a great degree upon the concomitant circum- 
 stances of the patient. In some cases no effort at repair or restoration 
 will be made, but the surrounding parts will gradually soften down ; 
 and even though there is no tendency to continued haemorrhage, the 
 mischief will increase, till, some more extensive effusion occurring, the 
 disease proves fatal. In other cases, the mingled mass of blood and 
 comminuted brain will remain for many months, forming a soft mass, 
 -without there being apparently sufficient power in the constitution to 
 produce either absorption or repair. In other cases, it seems as if all 
 the injured portions of brain separated, and a smooth surface formed, 
 with more or less vascularity, derived partly from the natural vessels of 
 the brain, and partly from newly-formed vessels, and thus gradually a 
 kind of cyst is generated as a lining to the cavity produced by the clot. 
 Then a process of contraction and absorption goes on, till, according 
 probably to the greater or less powers of the constitution and the admix- 
 ture of cerebral matter with the blood effused, either a small quantity of 
 watery fluid remains, and, this diminishing, the walls of the cavity at 
 length coalesce, or a more solid yellowish-white substance interposes, 
 forming a permanent cicatrix in the brain. 
 
 " The period of time which these different changes require for their 
 completion seems to vary considerably. In a case which proved fatal 
 on the sixth day, a commencement was already made ; the greater part 
 of the injured brain appeared to have separated from that which had 
 suffered less ; a smooth and polished surface presented itself on many 
 parts of the cavity, and the natural vessels of the brain appeared to have 
 
 * Op. cit., p. 332. 
 
SEROUS APOPLEXY. 387 
 
 become enlarged. In another case, on the tenth day the clot had under- 
 gone considerable change in its color, and with the broken cerebral 
 matter was separating from the more sound brain. But \in Case 138, 
 though twelve days had elapsed, no such favorable change had taken 
 place; the broken surface was still soft, and the surrounding brain was 
 ready to yield on every side. In Case 140, where death occurred after 
 twenty-three days, considerable change had taken place in the surface 
 of the cavity ; but in some parts the proce'ss by which the injured brain 
 is detached was not completed. In Case 139 seven weeks had passed 
 between the effusion and the death ; and here a very distinct lining 
 membrane had formed of an opaque white color, and so solid as to allow 
 of being detached from the surrounding brain. In this case it was pecu- 
 liar that this fine membrane should have formed, though the brain im- 
 mediately exterior to it was decidedly unhealthy and discolored ; but it 
 is possible that this might in part have depended on subsequent mischief. 
 In the same case a cavity was discovered of a date much prior, no doubt, 
 to that I have been mentioning, containing a clear fluid, and lined with 
 a fine membrane, the opposite surfaces of which were beginning to form 
 vascular adhesions; and very similar cavities were found in the case of 
 Saunders; but the date of these formations was likewise doubtful. In 
 the case of one after a lapse of eleven months, the small cysts were formed 
 of opaque white substance, and did not seem so far advanced as in Saun- 
 ders. In case 145, after about a year, a cicatrix was formed, a little 
 soft in the centre, but apparently contracted, round its whole circum- 
 ference, a-nd proceeding to the obliteration of the cavity. But in Case 
 144, after an equal period, the soft and disorganized mass still showed 
 no tendency to undergo a favorable change." 
 
 In many cases it is extremely difficult to distinguish between apoplexy 
 from congestion and epilepsy at the period of the attack. Dr. Bright* 
 remarks on the " difficulty of drawing a correct diagnosis between apo- 
 plexy from congestion and certain epileptic attacks. There is in truth 
 scarcely any precise distinction to be recognized ; the same state of ves- 
 sels apparently inducing both, and the one passing imperceptibly into 
 the other. The convulsive nature of the symptoms marks the chief 
 difference, and this probably depends rather on some original irritability 
 of the brain, or on the part which chiefly suffers from congestion, than 
 on difference of the exciting cause." 
 
 Serous Apoplexy. Serous apoplexy, though not the result of any single 
 condition of the vascular system of the brain, nevertheless is always more 
 or less dependent on general debility, with local vascular excitement and 
 congestion of an asthenic character. For instance, a man of intemperate 
 habits may get a blow on his head, producing concussion ;/ if this is 
 judiciously treated, he recovers in the course of a few days. But sup- 
 pose that he is bled largely from the arm, and purged freely, the accident 
 being treated without reference to the habits and constitution of the 
 patient, the result will almost certainly be serous apoplexy. On the 
 other hand, suppose that he is stimulated, under the impression that he 
 is sinking from exhaustion, then inflammation of the brain would ensue. 
 
 * Reports of Medical Cases, vol. ii. p. 198. 
 
The exact treatment in such a case must, of course, depend on the state 
 of the pulse, skin, head, intellect, bowels, &c., but most probably a pur- 
 gative with a cold lotion to the head would be all that were required. 
 
 The most unequivocal cases of asthenic serous apoplexy are those 
 -which occur from suppresion of urine, the result of destructive disease 
 of the kidneys. The following case is a good illustration of this form 
 of the disease. 
 
 Case 67. Frederic Smith, set. 29, boot-blacker by trade, was admitted into St. Thomas's 
 Hospital, January 25, 1842, under my care. On admission, he was suffering from suppura- 
 tive erysipelas, of a low, slow, sluggish character. His countenance indicated organic dis- 
 ease. He complained of great pain in the bladder and inability to retain his urine for many 
 minutes. The urine was pale, with a whitish sediment, and alkaline, albuminous, and con- 
 taining phosphatic acid. This disease of the urinary organs was traced to an injury of the 
 loins, received on board a ship, at the age of fourteen. Up to this time he had been a fine 
 hearty boy; but from the period of the accident he suffered more or less from disease of these 
 organs. On his admission, I ordered him Decoct. Pareiraebravae^ifs. ; Acid. Muriat. dil. TT^x. 
 Gin ^iv. daily beef-tea, fish. Two incisions and poultices to the limb; in a fortnight the 
 erysipelatous inflammation was entirely subdued, and the wounds on the limb nearly healed. 
 After a few more days, suppuration commenced suddenly in the opposite thigh ; the follow- 
 ing day, the 13th of February, this abscess was opened, and a large quantity of thin, ichorous 
 discharge evacuated. From this day up to the second of April, about six weeks, the dis- 
 charge varied a little from day to day, but never ceased altogether. 
 
 On this day, a little before midnight, a sudden change took place. He had been talking 
 to his mother, quite rationally, and, as he seemed inclined to go to sleep, she left him to go 
 to the fire, when he suddenly screamed out Oh, mother, mother ! what have you done to 
 my head 1 ? and he continued screaming violently for four hours, that was until four in the 
 morning ; he then suddenly became quiet, and remained in one position until his death, which 
 took place at 12 o'clock, that was exactly twelve hours from the seizure. 
 Sectio cadaveris. Post-mortem twenty-two hours. 
 
 Head. Calvarium, natural ; dura mater, idem. On removing the dura mater, we found, 
 instead of the usual appearance of the pia mater, the whole surface of the brain presenting 
 a pale yellow or whitish color, scarcely broken by even the larger vessels of the pia mater, 
 which, instead of being distended with blood, contained only a narrow line in their centre. 
 The smaller ones were quite empty. In three or four places there was a dotted appearance, 
 caused by the effusion of blood in minute points, about the size of a pin's head This pallor 
 of the brain was partly owing to the empty state of the vessels, and partly to a layer of 
 serum containing a few flakes of lymph effused beneath the tunica arachnoidea investiens. 
 This layer of serum was found in equal quantity at the base of the brain. Beneath the pia 
 mater there was a small deposit of ill-formed curdy pus. This membrane separated very 
 readily from the brain. Cerebrum not quite so firm as in health. Cerebellum softer than 
 cerebrum. Hemispherical ganglion pale. Fibrous neurine beautifully bright and distinct; 
 more fluid than usual in the ventricles. 
 
 The connection of the tenia semicircularis and anterior extremity of the peduncles of the 
 pineal gland, with the anterior pillar of the fornix, was beautifully distinct, also the longi- 
 tudinal fibres of the septum lucidum. Some imperfectly-formed pus in the pia mater, as it 
 passed under the fornix to form the velum interpositum. 
 
 Thorax. Pleural adhesions on the left side of old standing. Gray hepatization of the 
 lower lobe of the same lung: a small abscess, about the size of a walnut, in the same. The 
 rest of both lungs healthy ; no tubercular deposit. 
 
 jUbdomen. Liver, nutmeg color, no tubercles, colon very low down, nearly in the pelvis ; 
 mesenteric glands large. Chyle vessels very distinct. 
 
 Right kidney. Only about half the cortical substance remaining, and this presented the 
 appearance described by Dr. Bright. The rest of the kidney was occupied with small cavi- 
 ties, lined by a distinct membrane, and containing more or less tuberculous matter. "Renal 
 pelvis enormously distended, and also the ureter, which resembled in appearance and size a 
 portion of contracted small intestine. There was extensive tuberculous deposit in the coats 
 of this tube, within half an inch of its termination in the bladder, which must have rendered 
 it almost impervious. 
 
 Left kidney was entirely disorganized, not a fraction of its proper substance remaining; it 
 consisted of cysts or cells of various sizes, lined by a membrane, the smaller containing 
 tuberculous matter, and the larger thick serum, with flakes of lymph and pus. Ureter and 
 pelvis natural size. Bladder contracted j lining membrane, dark grayish color, but not rough 
 
SEROUS APOPLEXY. 389 
 
 or thickened; openings of the prostatic ducts extremely large, about the size of swan shot, 
 or small peas. The right lobe of the prostate entirely disorganized, converted into a series 
 of cells, communicating freely, about the size of peas; the left natural. 
 
 I have no doubt that severe mental exertion carried on in an exhausted 
 system will sometimes lead to sudden serous effusion. In these cases 
 very decided treatment is required to arrest it. Premonitory symptoms 
 always exist in these cases, but they are not observed by unprofessional 
 friends, and the medical attendant is frequently not called in until it is 
 too late. 
 
 The following case, to which I was called by my colleague, Dr. Brodie 
 Sewell, and which I give in his own words, illustrates what I mean ; and 
 though I have no post-mortem appearance to adduce in proof of the posi- 
 tive pathological condition in this case, I think no one will dispute the 
 existence of serous effusion. My chief reasons for considering the attack 
 inflammatory, though accompanied with great want of power, were, 1st. 
 The exciting cause, excessive use of the organ, and therefore neces- 
 sarily excessive sanguineous stimulation; 2d. The heat of the head. 
 Nevertheless, if this patient had been bled to any extent in the first 
 instance, he would have sunk immediately. The diffusible stimulus 
 which was given was the best thing, and it kept the flame in until the 
 mercury arrested the asthenic inflammatory action, and caused the ab- 
 sorption of the fluid. 
 
 Case 68. J. B., set. 20, of an excitable disposition, spare habit, ordinary good health, though 
 suffering occasionally from severe headache, was seized on the llth of November, 1844, 
 under the following circumstances : 
 
 He had for many weeks been studying very closely, without attention to the regularity of 
 the animal functions; returning after a long abstinence to a hearty meal, and applying closely 
 during the greater part of the night. He had not been to bed on the night of the 10th. 
 
 Complaining of headache after dinner on the llth, he was persuaded to go out for a little 
 time instead of reading. He left home for this purpose, and was brought back in about ten 
 minutes by a gentleman, who saw him stagger and fall. He was tlfen sufficiently sensible 
 to state somewhat unconnected I y, that he had previously felt dizzy, and that he recollected 
 falling. This amount of intelligence was, however, quickly annihilated, as, when I saw 
 him, he was in a state of complete coma. The pulse scarcely perceptible, the extremities 
 cold, and, the pupils perfectly insensible to light. The breathing regular, without noise; no 
 vomiting. I ordered him a mixture of ether and ammonia, with hot applications to the 
 extremities. 
 
 Three hours afterwards, a slight reaction had taken place, there being fuller and quicker 
 pulse ; the extremities had recovered their natural temperature, but the symptoms of pres- 
 sure on the brain still continued undiminished, and the head was very hot. I then ordered 
 the head to be shaved, two leeches to be applied to the temples, and a blister to the neck, 
 with three grains of calomel laid on the tongue every three hours. 
 
 Nov. 12. No improvement has taken place; the patient lies in the same state; the blister 
 rose without exciting any apparent sensation ; he passed water once in the bed ; no action 
 of the bowels; the extremities become rapidly cold if exposed. This morning Mr. Solly 
 saw him with me. He approved of the general plan of treatment, but thought it had not 
 been carried out sufficiently. 
 
 Ordered gr. v. of Cal. every hour; cold application to the head. This was continued 
 without intermission, until the morning of the 13th, when Mr. Solly saw him again. A slight 
 improvement was evident ; the pupils were somewhat contracted ; he evinced impatience 
 when the powder was placed in his mouth, and he swallowed a little beef-tea. The same 
 treatment was continued, and, towards evening, he was more restless and uneasy, and be- 
 came conscious of the soreness of his gums and neck; at least, he frequently raised his 
 hands to his mouth, and moved his neck upon the pillow. 
 
 Nov. 14. Mr. Solly saw him again with rne, and pronounced him much better: slight 
 consciousness of person and place; sight impaired, and eye wild, but pupil much more 
 active. Gums touched, but no great amount of salivation. Calomel every four hours, and 
 a dose of castor oil as the bowels had not acted. During the night of the 13th, first cognizant 
 of desire to pass water. 
 
390 HUMAN BRAIN. 
 
 Nov. 15. Mr. Solly saw him for the last time; nearly all the symptoms of pressure 
 having been removed. As most probably, however, some effusion might remain, he was 
 ordered five minims of Tinct. Canth. in a mixture, with some Liq. potasses. This was 
 continued, with such modification as circumstances required, vintil he was perfectly con 
 valescent; and he was able to resume his studies after the Christmas vacation. 
 
 Simple Apoplexy. Dr. Abercrombie classifies under a distinct head, 
 that of simple apoplexy, those cases which occur and terminate fatally, 
 without leaving any morbid appearance in the brain. These cases are 
 peculiarly interesting and instructive, but I think not so inexplicable as 
 some have supposed. I quite agree with Dr. Burrowes in attributing 
 the fatal result to pressure on the brain from distended vessels, brought 
 on by determination of blood to the part, or by detention of blood there. 
 u But, if this be the correct explanation of the production of these cases," 
 says the same author, u why does the coma persist, and death so speedily 
 ensue, although the vascular distention, the supposed cause of pressure, 
 is removed by abstraction of blood, or other remedies, and, as we ascer- 
 tain after death, the brain has sustained no structural lesion ?" 
 
 He ascribes the fatal event to another cause. He considers that from 
 the partial arrest of the respiratory function, the substance of the brain 
 is gradually saturated with undecarbonized blood. The apoplectic per- 
 son remains in a condition analogous to that of one whose rima glottidis 
 is constricted, or who has been suffering from asphyxia for some time. 
 The apoplectic patient dying, not simply from pressure on the brain, but 
 from the effects of imperfect respiration, the presence of undecarbonized 
 blood in the brain and other organs. 
 
 Even in those cases which terminate fatally, and serum or blood are 
 found effused within the cranium, Dr. Burrows attributes the coma to 
 the state of congestion which precedes the effusion, and not to the effu- 
 sion itself. " I am of opinion, that apoplectic coma is rarely dependent 
 upon the extravasation of blood, although the concomitant paralysis un- 
 doubtedly is. Upon the examination of the brains of apoplectic patients, 
 we sometimes find large extravasations of blood, which, from peculiar 
 appearances in the clot, we feel assured have existed there for many 
 days, or even weeks, and yet, during the greater part of that period, 
 there has been no coma. Upon other occasions we discover small ex- 
 travasations of blood within the brain, which, from their ^appearance, 
 we can decide have only been effused a short time prior to death, and, 
 nevertheless, there has been a well-marked coma in these cases. Hence, 
 if pressure be regarded as the physical cause of apoplectic coma, and 
 that pressure is supposed to be occasioned by the extravasated blood, 
 then we must account for the paradox of a small extravasation producing 
 a coma which terminates fatally, and a large effusion of blood having no 
 such effect."* 
 
 Dr. Alisonf considers that the cause of simple apoplexy " is the pres- 
 sure exerted on the brain by an increased propulsion of blood upon it, 
 or transmission of blood through it." 
 
 The following case, for which I am indebted to Mr. Adams, Curator 
 of the Museum at St. Thomas's Hospital, illustrates well the form of 
 simple apoplexy, and it confirms the opinion that the symptoms arise 
 from pressure, occasioned by turgid vessels. 
 
 * P. 92, op. cit. t P- 692 - 
 
SIMPLE APOPLEXY. 391 
 
 Case 69. James Bibby, set. 38, a man of intemperate habits, thoush generally enjoying 
 good health ; for twenty-three years in the service of Mr. Whitfield. He had had two slight 
 apoplectic fits; one about two years, and the other a few months, previous to his last illness. 
 On the morning of the 7th December, 1845, he complained of fullness arid pain in his head, 
 and appeared dull and heavy; about 10 A. M. he suddenly fell down in a fit, his head came 
 in contact with a piece of stone, by which the temporal artery was wounded, and he lost a 
 large quantity of blood before any assistance was rendered; when picked up, he was per- 
 fectly insensible, with extremely labored and slightly stertorous breathing; he remained in 
 this condition for about twenty minutes, when consciousness began to return, and he after- 
 wards completely regained his senses; no paralysis followed this fit. A purgative dose of 
 calomel and colocynth was given ; head shaved, and counter irritation applied. 
 
 On the following day, the 8th December, he became restless and wandering, and was 
 allowed a small quantity of gin. 
 
 On the 9th December, fte restlessness and wandering were increased, and he became 
 extremely violent; his symptoms resembling those of delirium tremens ; gin, morphia, and 
 ammonia, with sulphuric ether, were given. He continued in the same state till 6 p. M., 
 when he suddenly became perfectly quiet, the pupils fixed, breathing stertorous, pulse slow, 
 full, and labored, and had the ordinary appearance of a man in an apoplectic fit; in this 
 condition he remained till 11 p. M., when he died; five hours from the appearance of the 
 apoplectic symptoms. 
 
 At the post-mortem inspection, on the 10th December, the only morbid appearance found, 
 was an extremely congested condition of the vessels of the membranes and substance of the 
 brain, with a slight serous effusion beneath the arachnoid over either hemisphere. The tho- 
 racic and abdominal viscera were generally healthy. 
 
 Andral believes in the existence of this congestive apoplexy, and re- 
 lates the following very interesting case, which also throws some light 
 on the pathology of serous apoplexy :* 
 
 Case 70. A woman, fifty one years old, of a sanguine temperament, and strong constitu- 
 tion, ceased to menstruate about her forty-ninth year; during the six months following she 
 was subject to numbness in the right arm. In her fifty-first year she suddenly lost con- 
 sciousness, fell, and retained, when she came to herself, some difficulty in her speech, with 
 some falling of the commissure of the lips arid tongue on the right side; considerable dimi- 
 nution of motion and sensation of this side, nausea and bilious vomiting. Under proper 
 treatment this state disappeared at the end of four weeks. After this the patient returned 
 to a perfect state of health, when, towards the middle of March, 1819, she again began to 
 feel a little weakness in the right arm; slight pains of head in the frontal region soon super- 
 vened, and on the 20th of April, without any obvious cause, there came on in the night, 
 during sleep, a new attack, more violent than the former, and of the same side, total loss of 
 speech, considerable diminution of sensibility, but particularly of motion of extremities of 
 right side; features not altered; tongue fell a little on right side. This new attack disap- 
 peared, however, more promptly than the preceding; and at the end of three days, the 
 patient having entered the hospital, presented the following state : She had slept well the 
 previous night; some weight of head; tongue unsteady when she put it out; some numb- 
 ness and weakness on the right side of the body; speaks distinctly; pulse full, strong, and 
 slow; habitual constipation (lemonade, with cream of tartar) ; fifteen leeches to each foot; 
 warm pediluvium, purgative lavement. In the morning she took some soup, and was seized 
 with vomiting in the course of the day, when she threw up some bile; the vomiting brought 
 on a new attack, followed by hemiplegia on the right side, and greater embarrassment of 
 speech. She was bled to ten ounces; new attacks of a slight nature appeared in the night, 
 upon which sinapisms were applied to the feet ; after this the fteces passed involuntarily. On 
 the 30th, hemiplegia more developed ; articulation nearly impossible ; pulse less full, less 
 hard, and more accelerated; paralysis of the bladder (lemonade, with one ounce of soluble 
 tartar, bleeding from the jugular vein, purgative lavement; introduction of the catheter.) 
 Immediately after the bleeding (ten ounces) a new attack, followed by total loss of speech, 
 and of motion in the right extremities, frothing at the mouth, dilatation of the pupil, counte- 
 nance quite vacant. On the following morning these symptoms were all aggravated ; trismus 
 supervened, which prevented her from drinking, and constant drowsiness. On the 1st of 
 May, pupils immovable, blindness, trismus, frothing at the mouth at each expiration, con- 
 tractility abolished on the right side, almost none on the left, a little sensibility on both sides, 
 rather more on the left: pulse full, hard, irregular for the number of pulsations (twenty- 
 leeches to the neck, blister to legs, purg. lavements). She died a little after the visit. 
 
 * Andral, op. cit., p. 24. 
 
392 HUMAN BRAIN. 
 
 Post-mortem. Cranium. The lateral ventricles contained nearly four ounces of limpid 
 serum; no lesion in the thoracic or abdominal viscera. 
 
 Remarks. The apoplectic attacks in this case seem to have been caused by simple san- 
 guineous congestions in the brain. It would appear that here the hemiplegia was the re- 
 sult of a sanguineous congestion, greater in one hemisphere than in the other, whereby thia 
 hemisphere lost its influence over the muscular contractility, even when the congestion 
 ceased to exist. The first time, the hemiplegia was preceded by a total loss of conscious- 
 ness ; the second time, it was gradual, and not announced by any symptom of apoplectic 
 attack. The more alarming symptoms observed for the last two days were the resvflt of 
 serous effusion into the ventricles ; of which the habitual sanguineous congestion had been 
 probably a predisposing cause. We should not forget to notice here the influence of the 
 vomiting on increasing the hemiplegia. 
 
 The following graphic account, derived from^he Madras Journal, 
 edited by my old fellow-apprentice, Samuel Rogers, is interesting in 
 many points of view ; and while it strikingly illustrates the value of cold 
 effusion as a therapeutical agent in cerebral affections, it presents many 
 facts highly instructive both physiologically and practically. After de- 
 scribing the circumstances under which the march was undertaken, and 
 their exposure to the sun, the report goes on to say,* " About eight 
 o'clock a most melancholy scene commenced ; men were seen to drop 
 down and instantly expire ; others less severely attacked were saved by 
 timely and copious bleeding. Every hour added to our melancholy 
 situation; for notwithstanding our utmost exertions the day ended, I 
 regret to say, with no less a loss than eighteen, and left us with sixty- 
 three sick in the hospital. Our loss on this occasion, with one excep- 
 tion, was entirely confined to the recruits, and the chief part of the sick- 
 ness that followed was also confined to them. The troops halted one 
 day, and on the following day they lost three more. 
 
 " When warning of the attack was given to the patients, they usually 
 complained of difficult breathing, with a sense of tightness and oppres- 
 sion about the chest, followed by giddiness, burning heat of the eyes, 
 and a sense of general fullness about the head, in many amounting to 
 excruciating pain, succeeded by loss of sense and motion, faltering of 
 the tongue on attempting to speak, fullness of the eyes, dilated and fixed 
 pupils, violent twitching of the muscles of the face, particularly those 
 about the mouth, subsultus tendinum, and involuntary stools. Along 
 with these symptoms, the patients also had a strong, full, and frequent 
 pulse, tremendous throbbing of the carotid and temporal arteries, flushed, 
 swollen, and sometimes livid countenance, and, throughout, a parched 
 and burning skin. 
 
 " In so severe a form of disease, I could only look for success from 
 immediate and profuse depletion ; blood was accordingly abstracted 
 from different assailable points, viz., the arm, the jugular vein, and the 
 temporal artery. Cold was applied to the head, and at the same time 
 the feet were immersed in hot water. Blisters were applied to the head, 
 neck, and lower extremities; brisk purgatives were administered, and 
 their operation assisted by purgative injections. When the disease 
 terminated in fever, the rest of the treatment consisted chiefly in small 
 doses of calomel and antimony. In several of the cases spontaneous 
 vomiting took place, without producing any marked effect. No case of 
 paralysis supervened. 
 
 * Madras Journal, vol. ii. p. 326. 
 
TREATMENT OF PREMONITORY SYMPTOMS. 393 
 
 " I have to regret that the situation of the corps at the time, and the 
 severe duties I had to perform, rendered it impossible for me to examine 
 any of the bodies after death. 
 
 " Considering the foregoing details of this affection, the full, quick 
 pulse, the great heat of skin, the violence, suddenness, and urgency of 
 the symptoms, venas sectio seemed at once indicated, and it was carried 
 ad deliquium, or to the relieving the patient. It was found that it some- 
 times required fifty, sixty, nay, even one hundred ounces of blood to 
 produce this effect ; and that the remedy sometimes was worse than the 
 malady; for, though the first attack might be relieved, yet the subsequent 
 symptoms required the same profuse evacuation for their relief; and from 
 the previous loss of blood the patient was not in a state to bear such 
 depletion. In fact, two individuals became convulsed, and, shortly 
 after they were bled, died; and after death it was found, that although 
 the heart was empty, the vessels of the head were loaded with blood. 
 This clearly indicated that whatever it was that excited the heart's inor- 
 dinate action, blood-letting would not subdue it; for as long as a drop 
 of blood remained it was sent to the head. How lucky for us, and 
 truly so for our patients, that we found in the cold effusion a most effect- 
 ual remedy! Just as one man had expired, I might almost say under 
 the lancet, another was brought into hospital. He was put into the 
 bathing tub, and a constant stream of cold water poured on his head till 
 he felt relieved. He was then put into bed, calomel 9i. given to him, 
 his head shaved, and cold wet cloths kept to it; and, in a few minutes 
 after, as the heat returned, and the pulse rose, forty ounces of blood 
 were taken from his arm. He was by these means perfectly relieved, 
 and fell asleep ; and as often as the pain and heat returned was the cold 
 effusion had recourse to. This, with purgatives, leeches to the tem- 
 ples, and cold cloths to the head, cured him, as well as all the subse- 
 quent cases, when the men came into hospital in proper time, and the 
 disease had not advanced too far. 
 
 " The history of the first person in whom the cold effusion was had 
 recourse to as the principal remedial agent, would be but the history of 
 all the subsequent cases. Some men required two or three bleedings, 
 but they were not large, and we now found convalescence speedy ; 
 whereas, in the former cases that recovered, it was imperfect, uncertain, 
 and protracted. The benefit of the cold effusion has brought to my re- 
 collection the advantages I formerly derived on the line of march with 
 the left wing of H. M. 13th Light Infantry, from frequently pouring 
 water on the men's heads when they felt oppressed ; than which, nothing 
 seemed to allay arterial action and nervous excitement so well ; and so 
 grateful was it to the men's feelings, that they used to get it two or three 
 times in the course of the hour, at their own solicitation. It allayed the 
 heat and thirst, and procured sleep." 
 
 Treatment of the Premonitory Syntptoms. Though it is not possible to 
 say a great deal on this subject, inasmuch as each individual case will 
 vapy more or less, and must be treated on its own merits, or according 
 to the circumstances which arise, and for the very reason that it is im- 
 possible to lay down very precise rules to guide the practitioner in all 
 instances, it behoves him to bring all his powers of mind to judge and 
 
394 HUMAN BRAIN. 
 
 discriminate between those symptoms which really threaten a coming 
 storm, and those which arise from some temporary disturbing cause. 
 There is no disease in which judicious medical advice may be of more 
 service than in threatened apoplexy. It is the duty of every medical 
 man to warn the friends of a patient rather than the patient himself, of 
 those circumstances which might induce a fit of apoplexy in a form pre- 
 disposed by disease to its occurrence. It is true that in many cases this 
 is not possible ; but when an attack has once occurred, then the medical 
 man has it in his power to speak officially. In all cases the condition 
 of the digestive organs must be attended to, especially the state of the 
 hepatic circulation. All tendency to obesity should be corrected. A 
 fat belly encroaches on the chest and interferes with the organs of res- 
 piration and circulation. But this must not be attempted rudely ; habits 
 that have been long established must not be suddenly changed. Violent 
 exercise must be especially avoided. Moderate exercise, but plenty of 
 it moderate quantity of food, and that very simple moderation in the 
 use of stimulants, if they have been freely used habitually. The entire 
 abandonment ought to be ultimately aimed at. If the tendency is very 
 decided, and the threatening of an attack very strong, then all mental 
 occupation should be abstained from, and the patient live a completely 
 vegetative life. I sometimes say to my patients, " You must be con- 
 tented to live the life of a cabbage." A mild aperient should be given 
 every night to prevent any straining at stool, which is in itself most dan- 
 gerous, and all patients should be warned against it. If there is the 
 least appearance of bronchial disease, it should be treated decidedly 
 and promptly by counter-irritation to the chest, and expectorants and 
 mild sedatives. Congested lungs delay the blood on the right side of 
 the heart, and this affects more or less the whole venous system, but 
 especially the jugular veins and cranial sinuses. But the very act of 
 coughing affects the cerebral circulation, and apoplectic effusion has 
 occurred during its paroxysms. Dr. Watson mentions that a patient of 
 his died from an apoplectic fit induced by straining in pulling on a wet 
 boot. Loud talking, playing on wind instruments, singing, intemperance, 
 venereal excess, the depending posture, and severe cold, are all referred 
 to by this physician as occasionally exciting causes of apoplexy. If any 
 discharge has been suppressed, either it must be re-established, or a fresh 
 artificial one made. 
 
 Apoplexy. Treatment. In the treatment of apoplexy, the first thing 
 to determine is not so much whether the effusion is serous or sanguineous, 
 but whether it is of a sthenic or asthenic character, whether our patient 
 will bear depletion, or whether he is depressed, and whether the dis- 
 ease itself is the result of exhaustion. With regard to our diagnosis of 
 the seat and nature of the effusion, this is more important in relation to 
 our prognosis of this disease than our treatment. I do not mean to 
 undervalue careful diagnosis in thes^ cases; on the contrary, I consider 
 it of the greatest importance, and no pains can be too great which will 
 assist us in coming to a right conclusion. In these cases the friends 
 are of course extremely anxious, and our prognosis, whether favorable 
 or otherwise, must depend on the conclusions we arrive at regarding 
 the cause, the seat, and the nature of the effusion. If the cause of the 
 
TREATMENT OF APOPLEXY. 395 
 
 effusion be extreme plethora, and some accidental circumstance, such 
 as posture, or straining at stool, without any disease of heart and ves- 
 sels, then our prognosis might be favorable. If the seat of the effusion 
 appears to be at the base of the brain, but not near the medulla oblon- 
 gata, then it may possibly be remedial. These are merely illustrations 
 of the fact, that though our treatment may be the same wheresoever the 
 effusion may have occurred, and, in many instances, howsoever it may 
 have been produced, our diagnosis ought yet to be made with the same 
 care, and is of nearly the same value, as if the whole plan of our treat- 
 ment depended upon it. 
 
 Our remedies in all cases are few and simple. First in the list stands 
 blood-letting, the most valuable remedial agent in some cases, the most 
 dangerous in others. Many a valuable life has been saved by the prompt 
 and free use of the lancet: more have been hastened into eternity by its 
 indiscriminate employment. 
 
 Dr. Abercrombie, whose opinion on these cases is so valuable, scarcely 
 allows that there are any cases in which bleeding is not desirable. He 
 says,* " In the extent of our evacuations, indeed, a due regard is cer- 
 tainly to be had to the age and constitution of the patient, and the 
 strength of the pulse; but I think we have sufficient ground for saying, 
 that there are no symptoms which characterize a distinct class of apo- 
 plectic affections, requiring any important distinction in the treatment; 
 or, in other words, a class which in their nature do not admit of blood- 
 letting. On this important point we may refer with some confidence to 
 the facts which have been related. Weakness of the pulse and paleness 
 of the countenance we have seen to be frequent symptoms of the worst 
 forms of sanguineous apoplexy, and on the other hand we have seen 
 cases terminate by serous effusion which were accompanied by strong 
 pulse and flushing of the countenance. Finally, we have seen one 
 remarkable case in which there existed every circumstance that could 
 lead us to consider the disease as serous apoplexy, but which was fatal 
 without any effusion ; and another in which there was most extensive 
 effusion, without any apoplectic symptom. It is likewise to be kept in 
 mind that in apoplectic affections the strength of the pulse is a very un- 
 certain guide, for nothing is more common than to find it, upon the first 
 attack of apoplexy, weak, languid, and compressible, and becoming 
 strong and full after the brain has become in some degree relieved by 
 large blood-letting. 
 
 u It would be quite superfluous to detail common apoplectic cases 
 treated successfully upon these principles. But it may be of use, in 
 connection with this part of the subject, to select a few cases, which, 
 occurring in old and infirm people, might have been considered either 
 examples of serous apoplexy, or modifications of the disease not admit- 
 ting of active treatment, yet under such treatment terminating favorably. 
 
 Case. 71. "A woman, aged 70, of a spare habit, and thin, withered aspect, having walked 
 out in her usual health, fell down in the street, speechless and paralytic on the right side. 
 I saw her four or five hours after the attack. She was then much oppressed, but not en- 
 tirely comatose. She was completely speechless and paralytic: her pulse about 90, and of 
 tolerable strength. She was bled to 15 ounces; purgative medicine was ordered, with col(J 
 
 * P. 288. 
 
396 HUMAN BRAIN. 
 
 applications to her head. On the following day she was considerably improved, both in 
 speech and in the motion of the right side; but having become rather worse towards night, 
 she was again largely bled, and purgative medicine was continued. From this time she 
 improved rapidly. At the end of the week she was able to walk with little assistance, and 
 in a few days more was restored to perfect health." 
 
 At one time, this opinion of the imperative necessity for blood-letting 
 in apoplexy was almost universal, but it has lately been much modified. 
 
 The deservedly high reputation of Abercrombie gave too much value 
 to the use of the lancet in apoplexy, and it will therefore be well to turn 
 to the opinions of other observing practitioners, and see if we may not 
 find a safe middle path. 
 
 Dr. Bright's opinion is decidedly in favor of blood-letting as the gene- 
 ral rule, and the omission of it should be the exception. He concurs 
 with others in considering it our duty to bleed, and bleed largely, even 
 when the pulse is slow and laboring. He is opposed to small bleedings, 
 as they only relieve the heart of its load, and enable it to do more mis- 
 chief, increasing the force of the circulation instead of diminishing it. 
 If, after bleeding, the pulse increases in rapidity and volume, the lancet 
 must be used again. But if, after the abstraction of forty or fifty ounces, 
 no decided benefit is gained, then we must desist. 
 
 Dr. Watson, who considers blood-letting our sheet-anchor in certain 
 forms of apoplexy, carefully distinguishing between those which require 
 it and those in which it would be injurious, also advises, after one full 
 and sufficient bleeding from the arm, to abstain from further use of the 
 lancet. 
 
 Dr. Copland advises a full blood-letting, thirty or forty ounces at 
 once, particularly when the attack has proceeded from exciting causes, 
 and paralysis is not present. 
 
 The pulse is generally more or less intermittent and irregular on the 
 first onset of apoplexy, so that this character by itself must not deter us 
 from blood-letting, if at the same time it is not feeble, and thin, and 
 quick, and the patient does not show other signs of general depression, 
 such as pallid countenance and cold skin. 
 
 The same observations which I made regarding the treatment of in- 
 flammatory affections of the brain, apply to the treatment of apoplexy. 
 The disease itself is most depressing, and in its treatment we must not 
 consider simply the present moment we must look also to the future. 
 
 We must not be satisfied in arresting the cerebral extravasation, but 
 consider the possible condition of the brain afterwards. I am convinced, 
 from observation, of what occurs in cases of injury of the brain as well 
 as in true apoplexy, that large abstraction of blood gives rise to serous 
 effusion. And every man engaged extensively in practice in London 
 will bear witness to the frequent occurrence of delirium tremens, in either 
 a slight or severe form, after the apoplectic symptoms have been subdued. 
 
 The next case exhibits those circumstances which indicate the neces- 
 sity of immediate and decided blood-letting, and I think it illustrates 
 the value of prompt treatment on the very onset of the apoplectic attack. 
 I have no doubt that in this case all the vessels of the brain, especially 
 the venous system, were excessively distended by blood rushing into 
 them in the stooping posture, and that if she had not been bled freely at 
 first, extravasation must have inevitably occurred. 
 
TREATMENT OF APOPLEXY. 397 
 
 I suppose that the sudden distention gave rise to some inflammatory 
 action which the mercury and the leeches arrested, for it was not until 
 the mouth became sore that her sufferings were put an end to. The 
 endermic mode of exhibiting this mineral is the best in such cases where 
 it is desirable to obtain its influence rapidly. 
 
 Case 72. May 15th, 1846. I waS requested by Mr. Wildbore, of Shoreditch, to see a lady 
 who was said to have fallen down in a- fit of apoplexy. 
 
 The patient, Mrs. T., 40 years of age, stout, and rather full habit, temperate, and in com- 
 fortable circumstances ; she has had seven children, the youngest 13 months old. She has 
 been under Mr. Wildbore's care occasionally for the last five years, with symptoms of cerebral 
 disease, but of so doubtful a character that a physician of high character who saw her about 
 two years ago, pronounced them merely functional. The symptoms were varied ; sometimes 
 she expressed a feeling of numbness in her limbs ; sometimes shooting pains in her head, 
 and a feeling of swelling of the lips, lowness of spirits, and feeling of weakness. 
 
 The present attack came on when she was stooping to show her servant how to clean the 
 fire-place. When she recovered her consciousness she stated that she felt a terrific pain in 
 the head, and she said, U O Caroline, I am dying, take me up stairs." When she was laid 
 down on the bed, she vomited, and almost immediately afterwards lost her consciousness; 
 she did not remain wholly insensible for a long period, but seemed to be in a dreamy state 
 for four or five hours, not able to speak, but evidently suffering pain, as evinced by putting 
 her hand to her head. 
 
 Present state. I found her lying on the bed, countenance slightly flushed. In answer to 
 my question, whether she felt any pain, she said. " Yes, violent pain in the back part of the 
 head." She had previously answered quite rationally some questions from one of her 
 friends ; her head was hot, but her feet cold ; her pupils were rather contracted, but not ex- 
 tremely so; they acted freely to the light; no paralysis of either the face or the limbs. Pulse 
 56. and soft. She had been bled to about 16 oz. : this I was informed had not produced any 
 material effect on the pulse; which certainly had not risen in frequency with it. 
 
 Ordered a blister to be made with a hot, metal plate at the back of the neck, to be dressed 
 with mercurial ointment. Turpentine enema immediately. Liq. hyd. bjchlorid. Jj. tinct. 
 lyttge, ^ifs. aq. cinnamon, ^vfs. sumat. cochl. duo magna. 6 tis . horis. 
 
 16th, 4 P.M. Rather better quite conscious, but cannot move her head without suffering 
 most violent pain: she feels, she says, as if her head were being split open; the light from 
 the window distresses her. Her stomach is extremely irritable ; vomits almost everything 
 she eats; countenance flushed. She says that the cold lotion is very grateful to her, that 
 without it her head would be intolerable; pulse 80. Ord. Cal. gr. . om. hora. Hirudines 
 xxx. capiti. Leave off the hyd. biehlorid. 
 
 17th, 10 A.M. Has passed a quiet night, slightly better, stomach still very irritable, cannot 
 keep anything down but a little milk, pain in the head not quite so severe. The leeches have 
 not bled well or freely; the mouth slightly affected with mercury. Ordered Rep. hirudines. 
 Hyd. c. creta gr. ij. 6 tis . horis. 
 
 18th. Decidedly better bowels relieved, free from sickness, much less pain in her head; 
 says she found decided relief from the leeches; mouth sore from mercury. Ordered Leave 
 off the mercury, and take Inf. armoracce ^j. Acid hydrocyanic dil. TT^iv. 
 
 19th. She says she is not so well to-day; more pain in the head; which is hotter to the 
 touch; she feels very sinking, she says, and that her eyeballs are painful ; her countenance 
 is flushed. The Inf armoraca? seems to have been too stimulating; ordered to be cupped to 
 ^vj. and to take a saline draught. 
 
 20th, 9 A.M. She says she is better that her head is easy when she is quite quiet, but 
 that if she moves, it then swims ; the leeches bled pretty well, and gave her great relief; 
 countenance is still flushed, pulse 72, soft, tongue furred, mouth tender from the mercury, 
 menses have appeared very profusely, a good deal of pain in the lower part of the belly, 
 bowels purged. Ordered Omit the last medicine, and take a simple effervescing mixture. 
 
 23d. Going on well, head much more comfortable. 
 
 She recovered perfectly in about a week. 
 
 I have since seen this patient repeatedly, and she has had no return of the apoplectic attack. 
 Though always a temperate person, I have made her abstain from all stimulating liquors, 
 and take nothing stronger than water. She says that she has been decidedly more comfort- 
 able ever since she adopted this regime. 
 
 On being called to an alleged case of apoplexy it is well to accompany 
 your messenger. In cases of emergency this is frequently one of the 
 family, and much valuable information touching the history of the patient 
 
398 HUMAN BRAIN. 
 
 and the advent of the attack may often be gained before seeing him. 
 Inquiry should be made as to his age, and whether triere is any hereditary 
 predisposition to the disease; whether he is subject to fits, what are his 
 habits of life, what his circumstances, whether he has had cause for 
 anxiety lately, whether he has been harassed in business. The period 
 of day at which the attack may have occurred will also of course suggest 
 questions. As soon as the patient is in our hands, the neckcloth and 
 collar should be loosened, the head raised, hot water ordered for the 
 feet, and the pulse felt; as the first question which the medical man has 
 to decide is to bleed or not to bleed, and on his correct decision hangs 
 the momentous issue of the case. 
 
 Enough has been said to show that this cannot be decided by the 
 pulse alone, nor by the countenance, the breathing, or indeed by the 
 condition of any one organ or any one set of organs, but by evidence 
 derived from them all conjointly, and the history obtained of the patient. 
 
 The broad features of those cases in which bleeding is desirable may 
 thus be drawn, but the minuter details must be left to the discrimina- 
 tion of the practitioner at the time. The countenance may be either 
 pale or flushed, if the pulse be strong, slow, full, or wiry. Whatever 
 the state of the pulse is, if the face is flushed and the head hot, feet cold, 
 patient under 60, and robust, and active; and the attack induced by ex- 
 citement, whether of a psychical or physical nature, whether the result of 
 mental disturbance or stimulating liquor. 
 
 Bleeding is contra-indicated if the countenance is pale, the head cool, 
 the skin generally cold, the pulse soft, quick, and variable as to force 
 and frequency, the patient old, his habits intemperate, or his diet sud- 
 denly changed from a stimulating to an abstemious one, or his having 
 been exhausted by want of food and hurry in business. 
 
 If we decide to use the lancet, it is imperative for us to keep our 
 finger on the pulse, and regulate the quantity of blood taken by its effects. 
 
 " The peculiarities of the pulse," says Dr. Burrowes,* " in apoplexy 
 and other cerebral affections must, indeed, be noticed, but they are often 
 very perplexing, especially when we are looking to the state of the cir- 
 culation as an indication for treatment. But suppose a careful exami- 
 nation of the apoplectic or hemiplegic patient's heart discloses the ex- 
 istence of valvular disease to the extent of obstructing the circulation 
 through its cavities, here the pulse will be a most deceptive guide as 
 to the propriety or impropriety of abstraction of blood. If the mitral 
 valve be principally implicated, and allow of regurgitation from the left 
 ventricle, the small and irregular pulse so commonly observed with that 
 lesion would probably dissuade from that free abstraction of blood which 
 the cerebral symptoms might require. If in another case of apoplexy 
 or hemiplegia, the aortic valves be found diseased to the extent of not 
 only obstructing the onward current of blood, but also of allowing regur- 
 gitation into the ventricles, during its diastole, there will probably be 
 associated with this lesion considerable hypertrophy of the left ventricle. 
 There will be observed a full and vibrating or thrilling pulse, but a 
 pulse of increased action without real power, and hence a deceptive 
 
 * Burrowes, op. cit, p. 143-0. 
 
TREATMENT OF APOPLEXY. 399 
 
 pulse; and one which, if it be regarded without reference to the struc- 
 tural changes of the heart, would invite to a more copious abstraction 
 of blood than was called for by the general symptoms. In each of these 
 last-mentioned cases greater relief to the symptoms will be obtained by 
 a free local abstraction of blood from the vicinity of the heart (either by 
 cupping from beneath the left mamma or between the left scapula and 
 spine) than by a much larger depletion by venesection. 
 
 " Again, there are other instances of apoplexy and hemiplegia, where, 
 from an examination of the heart by auscultation, we feel assured there 
 is serious valvular disease; and, from the character of the cardiac mur- 
 murs, and other physical signs, we arrive at a well-grounded suspicion 
 that there is osseous deposit about the valves of the left ventricle, in 
 the coats of the ascending aorta, and, in all probability, in the tunics of 
 the arteries within the cranium. In such a condition of the arterial sys- 
 tem an accidental cerebral congestion may have been followed by extra- 
 vasation of blood, and thus have arisen the most common symptoms 
 of apoplexy. The knowledge obtained through auscultation in such 
 cases would properly dissuade from large losses of blood, although the 
 fullness and hardness of the radial pulse might at first have invited such 
 depletion. 
 
 " There are other cases of apoplexy and hemiplegia where we dis- 
 cover dilatation of the cavities of the heart and extensive emphysema of 
 the lungs; the latter lesion is, indeed, a more common cause of cere- 
 bral congestions and hemiplegia among the laboring classes than is com- 
 monly supposed. In such cases the appearance of extreme congestion 
 and dyspnoaa might tempt to practice large depletions, and thus the very 
 symptoms of the heart which have induced the cerebral congestion and 
 apoplectic symptoms would be aggravated. I should here suggest the 
 employment of cupping-glasses to the nape of the neck, or between the 
 scapulas, with the internal administration of stimulating diuretics, diffu- 
 sible stimulants, and the application of rubefacients to the sternum. 
 Many mistakes arising from the causes I have now adverted to may cer- 
 tainly be obviated if a careful examination of the heart and lungs be 
 made with the stethoscope in the first or congestive stage of apoplexy, 
 or immediately after an attack of hemiplegia." 
 
 Though I think 'at the present time there is some danger of the pro- 
 fession falling into the opposite extreme of allowing their patients to die 
 from a want of the lancet, it must be allowed that we are much indebted 
 to Dr. Henry Holland and some others, who have pointed out in forcible 
 language the mischief which accrues from indiscriminate blood-letting. 
 
 In the treatment of apoplexy, especially after the first serious symp- 
 toms are subdued, it is often much more important to do nothing than 
 do anything. It often requires great moral courage on the part of the 
 practitioner to combat popular prejudices, and it is often absolutely 
 necessary to prescribe medicines which are inert, in order to prevent 
 mischief being done by others. In such cases we can do no harm, and 
 may do some good, by prescribing very mild diuretics. 
 
 Dr. Holland, in his most interesting and valuable work, entitled, 
 " Medical Notes and Reflections," has a chapter, headed u Bleeding in 
 Affections of the Brain," which he thus begins : " Is not depletion by 
 
400 HUMAN BRAIN. 
 
 bleeding, a practice still too general and indiscriminate in affections of 
 the brain, and especially in the different forms of paralysis? I believe 
 that the soundest medical experience will warrant this opinion." He 
 then points out a variety of cases where there is diminished nervous 
 power, but which, from their resemblance to those in which there is an 
 excess of arterial action, there is danger of their being confounded, as 
 we have already considered under the head of anaemic affections. 
 
 The following observations bear so directly on the question before us, 
 that I shall not hesitate to quote them.* "Even where the tendency to 
 paralytic seizure is generally lessened by bleeding, as common practice 
 would imply, it does not thence follow that abstraction of blood from 
 the brain should be needful or desirable in immediate sequel to such 
 attack. In many cases, it is undoubtedly otherwise. The paralysis, 
 when depending on apoplexy, with extravasation of blood or serum, or 
 on other cause of continued pressure, may come on by degrees, and 
 admit of relief in its progress by emptying the vessels of the head. But 
 often it occurs as an instant shock to a portion of the brain or spinal 
 marrow, without any proof of extravasation or obvious cause of pressure ; 
 the shock itself being of momentary duration, though it leaves lasting 
 effects on parts of the nervous system thereon depending. In these 
 cases (and they are frequent) the physical causes of the change are little 
 known to us. There are reasons for supposing that the nervous sub- 
 stance itself is often primarily affected. We have certainly no proof of 
 mere pressure from fullness of vessels being concerned, to warrant large 
 bleeding, especially after the stroke of palsy has actually occurred. The 
 degree of coma attending and following these seizures is not alone suf- 
 ficient cause for the practice, and will usually subside without it, where 
 the original attack is not such as to endanger life. 
 
 " Looking, indeed, to the magnitude of the event which has occurred 
 between, common reason would suggest a doubt whether the same treat- 
 ment can be desirable immediately before and after a stroke of palsy. I 
 do not mean to give this the weight of an argument. From the nature 
 of the circumstances, it is extremely difficult to bring unequivocal proofs 
 on the subject; but there is much cause to believe that the practice of 
 bleeding in the latter case is often injuriously pursued. The risk, I 
 believe, will generally be less from waiting a certain time, to observe 
 the effect of what has occurred upon the circulation, the breathing, and 
 the sensibility, than from hastily taking away blood at the moment of a 
 great shock to the brain, and before we can rightly appreciate its con- 
 sequences. This effect upon the greater functions of life, gives us, in 
 fact, the best information we can have in guidance of further practice. 
 But this we forfeit in great part by the disturbance any large depletion 
 makes in the system, and particularly in the organs upon which these 
 functions depend. The importance of this consideration may be readily- 
 understood. It is a point constantly before us in practice. 
 
 " Even where evidence is obtained of the fitness of bleeding soon 
 after one paralytic attack, for the prevention of another, the question 
 still remains as to the manner of this; whether, by copious depletion at 
 once, or by smaller bleedings, repeated as observation may suggest. 
 
 * Op. cit., p. 45. 
 
TREATMENT OF APOPLEXY. 401 
 
 And this question the practitioner, while prepared for boldness in all fit 
 and urgent cases, is bound always to keep before him ; seeing, espe- 
 cially, that any great excess in the remedy may hurry on the very mis- 
 chief it is sought to prevent. I believe that in most cases the latter 
 method is to be preferred. It accords better with the state of our know- 
 ledge of these disorders; involves no irretrievable step; and in its pro- 
 gress affords the information most requisite to decide how far it should 
 be carried into effect. Paralytic cases there presumably are of such a 
 nature, that a few ounces of blood taken away at regular intervals will 
 ward off a recurrence of the attack, which any large or sudden deple- 
 tion would probably hurry on. The proof here can seldom be explicit, 
 but the presumption is one I have often been led to entertain. These 
 remarks, and the cautions they suggest, are familiar to many, and to such 
 needless. But I feel assured, from what I have seen, that they ought to 
 be carried further into general practice. The use of the lancet is easy, 
 and gives a show of activity in the practitioner at moments when there 
 appears peculiar need of this promptitude. Current opinions and pre- 
 judices are wholly on the side of bleeding; and the complexity and 
 danger of the cases tend to obscure the results of the treatment pursued. 
 The physician needs all his firmness to decline a practice thus called 
 for, where the event is so doubtful, and where death may be charged 
 upon his presumed feebleness or neglect." 
 
 " While making these remarks, however, I must be understood as 
 recognizing, in the fullest sense, the value and need of this remedy, 
 promptly and vigorously used, in various cerebral diseases, or ^"pre- 
 vention of such, where well-marked symptoms lead to their anticipation. 
 And I dwell upon this the more earnestly, lest, while merely inculcating 
 a cautious discrimination as to the cases for its use, I may seem to be 
 seeking reasons against the practice altogether. In active inflammation 
 of the brain or its membranes in many states of pressure from conges- 
 tion in the head, topical or general, without inflammation in cases 
 where extravasation may be presumed to be going on and even in 
 other conditions of cerebral irritation less definite than these, we have 
 no method of treatment equally effectual; and safety often depends 
 solely on the speed and sufficiency of its employment. But almost in 
 the same ratio with the necessity of the remedy in the above cases is 
 the importance of refraining from depletion in other instances, often with 
 difficulty to be distinguished from the former. And in the right direc- 
 tion of diagnosis and treatment here, we have the best proof that the 
 mind of a practitioner is equal to the most difficult exigencies of his 
 profession." 
 
 Mr. Copeman has published an interesting series of cases to illustrate 
 the dangers of bleeding in apoplexy, which are worthy of perusal. 
 
 After the practitioner has relieved the immediate effects of the apo- 
 plectic seizure by blood-letting, carried as far as the circumstances of 
 the case admit, he has still much to do. Mercury must be his sheet- 
 anchor in every case, though the mode of administration may vary 
 according to the constitutional powers of the patient, the amount of 
 plethora, and the state of the bowels. The best plan is to raise the 
 cuticle immediately, either by means of the liq. ammon. fort, or boiling 
 26 
 
402 HUMAN BRAIN. 
 
 water, and dress the raw surface with the strong mercurial ointment. 
 Calomel should be given internally in doses of two grains every hour, 
 or five grains every four hours if the patient is plethoric, for twelve or 
 twenty hours, watching the effect closely. If there is much debility the 
 hydrargyrus c. creta in two or five grain doses is better. Emetics have 
 been recommended, but they are dangerous. 
 
 The value of purgatives in the treatment of apoplexy, especially the 
 croton oil, is acknowledged by every experienced practitioner. With 
 respect to mercury, Dr. Bright gives the following practical hint : " We 
 should be careful not to administer calomel before the powers of deglu- 
 tition are sufficient to insure its being swallowed. I once saw most 
 serious consequences result from this ; for having put five grains of 
 calomel on the tongue, and attempted to wash it down with a cathartic 
 draught, the calomel, instead of passing into the stomach, remained, 
 moved about by the tongue, and produced, in a few hours, a most 
 alarming ptyalism, in which the tongue was forced out of the mouth, and 
 it was necessary to scarify it deeply before it could be returned within 
 the teeth." 
 
 In the treatment of apoplexy, after the first effect of the fit is subdued, 
 the practitioner must always bear in mind that there is still remaining in 
 or on the brain, extravasated blood, which has a tendency, like an ex- 
 traneous body, to excite inflammation. After a day or two, when con- 
 sciousness has been more or less restored, the patient may be observed 
 raising his hand to his head, and showing, by his movements, that he is 
 suffering in that direction. The head will be found unnaturally hot, and 
 more so on the side opposite the paralyzed lirnbs, in a case of hemi- 
 plegia. 
 
 It is in this stage that leeches to the scalp and cold applications will 
 be found especially useful, followed by blisters to the nape of the neck. 
 
 Diuretics may be employed with benefit, and the inf. digitalis with 
 the bichlorid. of mercury is one of the best : the inf. armoracae with 
 spirit, aeth. nit., or the inf. buchu, with tincture of squills, are also very 
 useful and less active. 
 
 In the convalescent stage of apoplexy, after all the active symptoms 
 have been subdued, but a certain amount of paralysis still remains, it is 
 often a very difficult question as to what tonics may be employed with 
 advantage. I believe that of the mineral tonics there are only two at all 
 admissible : these are zinc and silver, and they may only be given in 
 very small doses. 
 
 The power of nux vomica in stimulating the nervous system has in- 
 duced some practitioners to employ it, but I am convinced it is a very 
 dangerous remedy. I have seen it do much harm, and whenever there 
 is any indication of either existing or latent inflammatory action, it must 
 not be thought of. Dr. Bright says,* " In a case of local paralysis, I 
 have applied this powerful remedy in doses of the ^th, ^th, and ^ a 
 grain to a blistered surface, with the effect of producing spasmodic 
 action through the paralyzed muscle, and I have sometimes adminis- 
 tered it internally with advantage. But cases of hemiplegia from rup- 
 
 P. 338. 
 
 
TREATMENT OF APOPLEXY. 403 
 
 ture of vessels are not those in which this remedy holds out the greatest 
 prospect of success, though with caution it may be employed in the ad- 
 vanced stages of convalescence, with safety, at least, and sometimes 
 with benefit." 
 
 Dr. Burrows does not recommend strychnia in these cases. He says : 
 " My opinion as to the effects of strychnia as a direct stimulus to the 
 nerves in hemiplegia is even less favorable than that which I have ex- 
 pressed respecting electricity. In some cases strychnia does much harm 
 by aggravating the wearing pains in the affected limbs to a much more 
 acute suffering." He recommends friction as very beneficial. 
 
 After the acute symptoms have been removed, but paralysis remains, 
 the bichlorid. of mercury will be found useful : thus, Liq. hyd. bichlo- 
 rid. 3i., Tinct. lyttae, ^Ix., Decoct, sarsaparill. 3iv. ter. in die. 
 
 I have also seen decided benefit from the tincture of iodine, as a lo- 
 cal application to the head. This was very evident in the following 
 case, which is interesting in many other respects. 
 
 Case 73. On the 9th of March, 1842, I was consulted by a Miss P., of Skinner Street, 
 Holborn, for paralysis. When I first saw her she could scarcely articulate a word which 
 was intelligible to me, though her sister, who accompanied her, was able to explain what 
 she meant to say. 
 
 The right arm was quite paralyzed, much smaller than the left, the fingers contracted, the 
 nails clenched in the hand, and very hard. The right leg not wholly useless, but she has 
 very little power over it, and walks with the greatest difficulty. The motion of a carriage 
 on the stones affects hef head so much that she is obliged to walk as well as she can. I 
 learn that she had lately been twice electrified at Guy's Hospital, but without any benefit, 
 and that they subsequently refused to admit her as an in-patient, stating they considered her 
 case incurable. 
 
 9th. I prescribed for her hydr. c. creta gr. ij. Ext. Q. S. ut fiat Pil. om. nocte sumend., 
 and the tinct. of iodine, to be painted on the back of the head, where she complains of most 
 pain. 
 
 I learnt from her sister that she was first attacked on the 18th of May, 1840; that is, 
 one year and nine months previous to my first seeing her. 
 
 Considers that she has always had a tendency to the rushing of blood to her head, feeling 
 it in her face and head ; had suffered more or less for years with headaches, but they had 
 been much worse for about a month previous to this seizure, which she has since described 
 to me as coming on with at first a loss of power in the arm and a difficulty of speech, but 
 she was perfectly sensible, and immediately sent one of the family for the doctor ; but 
 in ten minutes from the occurrence of the first symptom she had lost all power of speech. 
 
 For the following details I am indebted to Mr. Fisher, of King Street, Snow Hill, who 
 attended her at that time. 
 
 Miss P., aged 40, of spare habit, but previously healthy, sanguine nervous temperament, 
 active, industrious habits. On the 18th of May, 1840, had ridden to Camberwell and back, 
 arrived at home in the evening, and suddenly became hemiplegic, with complete loss of 
 speech, intellect otherwise quite unaffected, pulse strong, full, and rather frequent. Vene- 
 sectio ad deliquium, Hab. 01. Tiglii gtt. iij. in pil. ij. quarurn st. j. statim et rep. in hor. duobus. 
 
 19th. Symptoms unaltered, bowels not acted on, a powerful purgative enema adminis- 
 tered, and a purgative mixture given. Evening, cupped, and blister to nape of neck. 
 
 20th. Bowels acted on freely no alteration, cannot take medicine. 
 
 21st. Strength sinking rapidly, dark thick typhoid fur on tongue, and other signs of ex- 
 treme collapse. Small doses of Amm. Sesquicarb. every hour. 
 
 24th. A little food at length taken, but no medicine; health improving, but the paralysis 
 continues unmitigated. To take an occasional mild aperient, and small doses of Inf. CahunbEe, 
 with tinct. Aurantii gj. every four hours. 
 
 June 7th. Health has continued to improve under the above treatment, but only very 
 slight improvement in the nervous symptoms; some motion in the leg; able to say yes and 
 no; but although she evidently uses them as negative and affirmative, she uses them indis- 
 criminately, very expressively nodding her assent, and saying at the same time, " no, no," 
 and vice versa, as often as using them correctly. She has also once been heard to pronounce 
 the word Father. She has been requested to write, but cannot accomplish anything having 
 
404 HUMAN BRAIN. 
 
 the least resemblance to a letter, although she could before write. She has never, from the 
 first, had the least difficulty in understanding everything said to her, nor in making herself 
 understood, so far as can be accomplished by signs, and by expression of countenance, 
 which is not so much impaired, as the paralysis is not so complete in the face as in the 
 limbs. 
 
 17th. Able, with difficulty, to sit up ; motion of lower limb somewhat improved; more 
 command of speech, which is extremely imperfect. But the following facts have been with 
 difficulty elicited. She had lost entirely the power of remembering all words, and of course 
 the names of all letters ; therefore, she could not read, although she perfectly recollected the 
 purport of every word addressed to her viva voce. About this time I put her to the test by 
 writing the word shell with another word, and showing her a shell, asked which word was 
 the name of the object shown; after an effort she selected the wrong word, although it had 
 no resemblance to the right one. : In addition to the former treatment a stimulating lini- 
 ment was now prescribed. 
 
 20th. Seen to-day by Dr. Farre, who ordered her to take every four hours Tinct. Aurantii 
 gfs. Spt. Amm. Arom. TT^iv. in Inf. Valerian* ^j. and to continue the liniment. 
 
 July 1st. Removed to Camberwell, and was advised to continue the medicines with an 
 occasional Aloetic aperient.- The catamenia were during the whole time regular. The 
 sphincters also performed their office efficiently. 
 
 20th. Mouth becoming tender; first moved her arm slightly to day. 
 23d. Can raise her arm to touch her forehead; feeling has partially returned; bowels 
 confined. Pil. Rhei. co. gr. v. o. n. alvus constricta sit. 
 
 29. Has gained more power in her arm and leg. Speech improving. 
 April 1st. Not quite so well; appetite failing a little; to go on with the gray powder, in 
 the dose of one grain, and take Inf. Aurant. co. ^j. Tinct. Calumb. 3J. Soda? Carbon, gr. x. 
 tres die. 
 
 6th. Better again; more power of moving her leg; can now feel a little in her leg and 
 toe the sensation of pins and needles ; speech improved. 
 
 8th. Complains of continual aching pains in the leg; speaks much better; can nearly 
 say anything she wants, and the names of things which she could not before remember 
 during her illnes she now remembers, and can say them ; can raise the arm higher; finger 
 nails softer; mouth very sore: to take only one grain of the gray powder at night, and use 
 the chlorate of soda gargle. 
 
 13th. Can raise the arm to the head; speech much the same ; pains in the limbs less; 
 sensation so much returned in the leg that she can now feel with it, whether it is hot or cold, 
 which she has not been able to do before. Can read the newspaper to herself, and under- 
 stand it, which she has not been able to do since her first attack. 
 
 25th. Mouth and throat exceedingly sore; to discontinue all medicine, and use the gargle, 
 and take Olii Ricini ^j. 
 
 29th. Better; occasional shooting pains in the limbs, and a sensation of scalding on that 
 side generally, both in the limbs and face. 
 
 May 5th. Improving; can now turn in bed, which she has not before been able to do; 
 taking the Iodine and Gent. t. d. 
 
 22d. When sitting up in bed reading, she felt a curious sensation down the affected side, 
 and almost immediately afterwards lost all consciousness. She was found by her sister on 
 the floor perfectly insensible, very pale and cold. A Mr. Cooke, the nearest medical man, 
 was sent for, who sent her a draught, and said that nothing else could be done for her. She 
 recovered her senses gradually. 
 
 23d. I visited her this day, and found her much the same as usual, only that her speech 
 was not quite so clear, and her power of walking less than before the attack. Her pulse 
 was quick and exceedingly feeble ; she said she had a little headache, but not much. 
 I ordered, Quin. gr. i. Pil. Aloes co. gr. ij. bis. in die. 
 
 24th. The report of her sister is, that she is rather better, and does not complain of 
 headache. 
 
 25th. Very weak; no headache; bowels confined. Quin. gr. ij. Pil. Rhei. co. gr. ij. t. d. 
 
 July 22d. She has remained out of town until a few days ago, and without any material 
 
 change taking place. When I saw her to-day, I foynd her looking much the same as usual. 
 
 the speech very imperfect. She complained of pain in her head, and I ordered her two 
 
 leeches and a purge. 
 
 25th. She did not apply the leeches when ordered, but the following day she suffered so 
 much from her head, and felt as if she was going to have a fit, that she applied them, and 
 found much relief. 
 
 Sept. 12. Has not been taking any medicine for fourteen days, but she has continued the 
 Iodine to the head ; she is much better, both as regards her speech, and she can walk better, 
 and feels her arm and foot much better, and is stronger in her general health. 
 
CONVULSIVE AFFECTIONS. 405 
 
 26th. Has continued to apply the tincture of Iodine to the head, and is improving : has 
 more feeling in her side, and her speech is improving, and she is gaining strength. 
 
 Oct. 7th. Considers that she is not so strong as she was. 
 
 Ordered her, Mist. Iodine ex Gent. 
 
 29th. Had a fit this morning, which was considered by Mr. Fisher, who saw her at the 
 time, to be a fainting fit; the sister says that she does not perceive anymore paralysis in the 
 arm or leg ; a little more difficulty of speech ; she got up with a headache, and felt sick ; it 
 occurred at eight o'clock ; she has been suffering from headache. 
 
 Ordered Cal. gr. ij. Pil. Rhei. co. gr. viij. h. n. haust. p. eras mane. 
 
 31st. Better 5 but still feels a weight in the back of her head. 
 
 Ordered Hirud. j. regioni cerebelli. 
 
 Nov. 4th. Relieved by the leech from pain ever since. Her sister reports to me to-day 
 that she is exceedingly weak, and that she is so excessively sleepy that she falls asleep as 
 soon as she sits down in her chair, however great the noise. This symptom has only 
 existed for the last two or three days. Bowels opened with the Conf. Sen. : appetite very 
 good. 
 
 1 843, January 2d. Has been stopping at Hampstead,and is much better in every respect. 
 
 July 14th. I lost sight of this patient since the last date, but I now learn that she is 
 much better, can walk three or four miles, and her speech is better 5 she does not take any 
 medicine, but continues the Tinct. lod. to the head, and she finds if she leaves it off her 
 speech becomes worse. 
 
 Convulsive Affections. Convulsions, from convellere, " to tear or pluck 
 up." The terra is now confirmed pathologically to sudden, spasmodic, 
 involuntary action of muscles. Convulsions are most frequently the 
 effect of disease, either functional or organic, of the cerebro-spinal axis, 
 sometimes the effect of injury. I do not purpose, in this place, to attempt 
 an account of convulsive diseases generally, but only those which appear 
 dependent on derangement of the circulation of blood in the brain, or 
 lesion of its substance. 
 
 Let us first direct our attention to those convulsions which appear the 
 result of direct violence done to the brain. In doing this, it will be 
 found instructive to combine physiological inferences with those patho- 
 logical deductions which are to direct the diagnosis and guide the treat- 
 ment. 
 
 In considering the pathology of convulsions, I think it will be found 
 that the same law holds good as in inflammatory affections. In inflam- 
 matory affections, we have already observed that mental excitement is 
 an indication of inflammation or irritation of the hemispherical ganglion, 
 and, I believe, it will be found that convulsions are indications of irri- 
 tation or inflammation of the tubular neurine, either where it is in con- 
 tact with the vesicular neurine, or in its course to the muscles, or of the 
 vesicular neurine, from whence the power, which excites the muscles, 
 emanates; thus confirming the truth of the law we have already investi- 
 gated, that irritation of the cerebral substance, either by inflammation or 
 mechanical means, first excites its normal action, though it may lead to 
 its ultimate destruction. 
 
 I have quoted a case from OHiviep,* of "spontaneous hemorrhage and 
 rupture of the cephalic bulb of the spinal marrow and of the annular 
 protuberance, accompanied with convulsive contractions of the limbs." 
 This author says, " I have since had several opportunities of observing 
 this apoplexy at the moment of the attack, and I have always remarked 
 convulsive contractions in the upper extremities, with alternating move- 
 ments of rotation inwards. The opening of the mouth underwent no 
 
 * P. 500. 
 
406 HUMAN BRAIN. 
 
 change. The spasmodic convulsions observed at the commencement of 
 the attacks of apoplexy in general, seem to me to depend on the irrita- 
 tion which the blood produces on the extremities of the torn medullary 
 fibres, with which it remains in contact, and on which it must act as an 
 irritant. 
 
 The following case, from Mayo's Outlines of Pathology,* seems to 
 be highly instructive, though the narrator does not appear to have duly 
 appreciated its important bearing on the physiology of convulsions. 
 
 Case 74. W. Tucker, setat. 42, brought into the Middlesex Hospital, and supposed to be 
 intoxicated. He was drowsy, heavy, stupid, not insensible; answered some questions; the 
 pulse small and slow. The left arm and leg powerless; face drawn to right side. When 
 put to bed, he was seized with rigor, and complained of pain in the right side of occiput ; 
 in an hour afterwards the pulse rose, and the right side of the body became convulsed : v. s. 
 Sjxviij.: the convulsions ceased for a time, then returned with extreme violence, threatening 
 to suffocate him: v. s. ^xl.: the respiration became more free, but the convulsions remained: 
 he then became comatose. He continued insensible during the night, the breathing stertorous, 
 right pupil dilated, left contracted, no pulse at the wrist: he died at 11 A. M. A large cavity 
 filled with blood, partly clotted, occupied the centre of the right hemisphere of the brain : 
 it did not communicate with the lateral ventricle, but opened between the sulci of the con- 
 volutions, which for a large extent were lined with it; between their summits streaks of 
 clotted blood lay. resembling veins. There was slight sanguineous effusion on the surface 
 of the anterior lobe of the left hemisphere. It is possible, but very unlikely, that this may 
 have caused the convulsions of the right side of the body. 
 
 I confess I am surprised at Mr. Mayo's concluding observations, 
 when cases like the following, related by Abercrombie, are to be met 
 with so frequently.! 
 
 Case 75. A man aged about 35, keeper of a tavern, and addicted to the constant use of 
 ardent spirits, had been drinking to intoxication during the night betwixt the 12th and 13th 
 of July 1816; and, about seven o'clock in the morning, was found lying in a state of violent 
 convulsion. No account could be obtained of his previous state, except that during the 
 evening he had drunk a very large quantity of whisky, and that when he was last seen, 
 about three o'clock in the morning, he was walking about his house, but unable to speak. 
 He was seen by Dr. Hunter at a quarter before eight. He was then lying on his left side, 
 in a state of perfect insensibility, with laborious breathing; saliva was flowing from his 
 mouth ; his eyes were much diffused and greatly distorted, the cornea of both being com- 
 pletely concealed below the upper eyelid; pulse 120, full and soft. While Dr. Hunter stood 
 by him he was again seized with convulsion ; it began in the muscles of the jaw, which 
 was drawn from side to side with great violence, producing a loud jarring sound from the 
 grinding of the teeth. The spasms then extended to the body and extremities, which were 
 first thrown into a state of violent extension and then convulsed for one or two minutes; 
 they then subsided, and left him as before in a state of perfect insensibility. Similar attacks 
 took place four times while Dr. Hunter was in the house, which was about half an hour ; 
 and he expired in another attack of the same kind about two minutes after. Blood-letting 
 and every other remedy that the time admitted of were employed in the most judicious 
 manner. 
 
 Inspection On removing the skull-cap an appearance was observed on the surface of the 
 dura mater of coagulated blood in small detached portions. These appeared to have been 
 discharged from small glandular-looking elevations on the outer surface of the dura mater, 
 which were very vascular and highly gorged with blood. There were depressions on the 
 inner surface of the bone which corresponded with these bodies. On raising the dura mater 
 there came into view a coagulum of blood, covering and completely concealing the ri^ht 
 hemisphere of the brain; it was about two lines in thickness over the middle lobe and be- 
 came gradually thinner as it spread over the anterior and posterior lobes, and dipped down 
 below the base of the brain. The coagulum being removed weighed about 3-v. On the 
 surface of the left hemisphere the veins were turgid with blood, on the surface of the right 
 they were entirely empty ; but the source of the haemorrhage could not be discovered. 
 There was no fluid in the ventricles, and no other disease was discovered. The stomach 
 being carefully examined, was found to contain nothing but air and healthy mucus. 
 
 * Part I. p. 208. t Abercrombie, c. x. p. 243. 
 
CONVULSIVE AFFECTIONS. 407 
 
 Lallemand's observations on the opinions which used to prevail on 
 the subject of convulsions on one side of the body, and paralysis on the 
 opposite, in connection with wounds of the head, are so extremely ap- 
 posite that I cannot resist quoting them.* 
 
 " You have just heard many different opinions founded on observa- 
 tions more or less incomplete concerning injuries of the head: thus some 
 have admitted that inflammation of the brain produced convulsions on 
 the opposite side, others that it produced paralysis, and others that it 
 sometimes occasioned convulsions and sometimes paralysis; so that the 
 convulsions (always of the opposite side) were produced by inflamma- 
 tion, and paralysis by suppuration ; that is to say, by compression of the 
 brain. Another series of observations brings forth other opinions. 
 
 "Salmuthiusf found in a patient who had had paralysis on one side 
 and convulsions on the other, an abscess in the hemisphere opposite to 
 the paralyzed side. 
 
 " Daniel Hoffman (Dissert, de Sanatione rariss.) relates the case of a 
 child who, having had a fracture of the skull on the left side, with con- 
 siderable destruction of the brain, had paralysis on the right and con- 
 vulsive motions on the left side. These facts, after all, are very 
 common ; there are few practitioners who have not observed them. 
 
 "BerengerJ says that he has most frequently seen convulsions on the 
 sound side and paralysis on the opposite. 
 
 " 'It is to be observed,' says Dr. Hennequin, * that when on one side 
 of the body there are convulsions and on the other paralysis, the con- 
 vulsions attack the side corresponding to the injured brain; but when 
 convulsions alone are present, and on one side only, it is generally op- 
 posite to the injury.' 
 
 u You will find these facts described by various authors, very nearly 
 in the same manner, among the most recent of which I will cite one to 
 which the author's name attaches an imposing authority. This is what 
 Boyer says: 
 
 " ' Paralysis is not the only disorder produced by compression of the 
 brain arid alteration of its substance. Convulsions are also sometimes 
 caused by these affections. The greater number of observers who have 
 remarked that paralysis always attacked the side opposite to that which 
 was injured, have at the same time observed that when in this case 
 convulsions occurred, they attacked the side opposite to that paralyzed, 
 that is to say, the injured side, whilst the convulsive motions affected 
 the side of the body opposed to the injury, when no paralysis existed.' 
 
 "Amongst the authors who have spoken of these facts, some have 
 contented themselves by relating them, without endeavoring to explain 
 them ; others have thought that the same affection could at the same 
 time produce convulsions on the injured side, and paralysis on the op- 
 posite. Boyer seems to be of this number, when he says * paralysis is 
 not the only disorder, &c.' And others, persuaded that the convulsions 
 were produced by inflammation, and the paralysis by the mechanical 
 
 Op. cit., p. 500. 
 
 t Obs. Medtoor. Centyriae tres, 4to, Bruns. 1648. 
 j Tract, de Fractura Cranii, 4to, Venet, 1535. 
 Traite des Mai. Chirurg., &c., torn. v. p. 109. 
 
408 HUMAN BRAIN. 
 
 compression of the brain, have thought that in this case the hemisphere 
 corresponding to the injury was at the same time inflamed, and com- 
 pressed by blood, serum, or pus. But thus to explain these two orders 
 of symptoms, required that the opinions of the ancients, generally re- 
 ceived, should be rejected ; and this is what is done. It is pretended 
 that the symptoms of convulsions are quite different from those of para- 
 lysis; that the one manifested themselves on the injured and the other 
 on the opposite side. So, inflammation and compression of the same 
 hemisphere of the brain would show symptoms in the first case on the 
 same side of the body, and in the other on the opposite. Although the 
 mere relation of this suffices to show its absurdity, the notion has had 
 a great many supporters. 
 
 " It appears that in Morgagni's time it was much accredited, for he 
 speaks of it at great length, and combats it in many parts of his works.* 
 After having called to mind the decussation of the fibres of the brain, 
 admitted to explain the cause of paralysis on the opposite side, he 
 finishes with this judicious reflection, which naturally presents itself to 
 the mind: 'Igitur quam decussationem ad paralysim in latere opposito 
 explicandam agnoscere debeamus quare ad convulsionem non agnos- 
 cemus.' 
 
 "Morgagni's argument, very plausible at that period, fell the moment 
 that we were able to demonstrate, by the scalpel, the interlacing of the 
 fibres of the brain, which was then but a hypothesis more or less pro- 
 bable. That even has not hindered this opinion from being propagated 
 to us, and I have heard distinguished practitioners defend it warmly. 
 Others, always after the same observations of injuries of the head, have 
 admitted that convulsions could occur on the side of the inflamed 
 hemisphere, or on the opposite side, whether this last was free or para- 
 lyzed a circumstance much more difficult to be conceived. 
 
 " It has, indeed, been imagined that convulsions only occurred on 
 one side, because the antagonist muscles were paralyzed, so that the 
 healthy ones drew the others to their own side ; for example, pulled the 
 mouth towards one or the other ear, bent the body laterally, &c. But, 
 without considering whether this action of the healthy muscles can be 
 assimilated to the permanent contractions or tonic convulsions produced 
 by inflammation of the brain, it is evident that paralysis of the muscles 
 of the arm or leg of one side can have no influence over the limbs of 
 the opposite side. Of all these explanations, the most reasonable, the 
 nearest to truth, is that which was adopted by Mus, Donatus, Cesalpinus, 
 P. Martian, Morgagni, &c. ; they thought that in these injuries of the 
 head the cause of the two orders of symptoms had equally its seat in 
 the cerebral hemisphere which was opposite to the side of the body 
 affected with paralysis or convulsions ; but that this cause was of a dif- 
 ferent nature, that is to say, that it was a compression or a mechanical 
 lesion of the one hemisphere which produced paralysis on the opposite 
 side, and an inflammation of the other which produced convulsions on 
 the other side. They were in that consequent with themselves, and they 
 
 * See Epist. Anat., xiii., Nos. 14, 17, 18, & 22. De Sed. et Caus. Morb. Epist., Nos. 40, 
 47, & 48. 
 
CONVULSIVE AFFECTIONS. 409 
 
 explained in a very simple manner contradictory facts ; yet this opinion 
 did not prevail generally, and for this reason : 
 
 " In many cases they indeed found on the injured side an effusion of 
 blood, pus, or serum, on the surface of the arachnoid, or an abscess in 
 the brain, alterations which explained the paralysis of the opposite side : 
 but they sometimes only found the dura mater and arachnoid injected, 
 with softening of the subjacent brain : nothing then proved that there 
 had been compression of the brain. There existed the great difficulty: 
 they did not find in the hemisphere of the side opposite to that convulsed, 
 evident traces of inflammation of the brain, and the state of the arach- 
 noid was thought of no importance, for two reasons : the first, as you 
 have seen, is, that it is much more inflamed on the injured side than on 
 the other ; so that by comparison they thought it healthy when red, in- 
 jected and opaque, &c. ; the second is, that they did not think that in- 
 flammation of the arachnoid was more likely to produce convulsions than 
 delirium. 
 
 " Some facts, certainly rather rare, threw into confusion the opinions 
 of authors concerning convulsions and paralysis after injuries of the head. 
 Paralysis was observed to take place on the side injured, and convul- 
 sions on the side opposite to it ; and even Avicenna, who probably had 
 seen many similar cases, thought (De Fract. Cran.) that these were more 
 common 'than the reverse. They were for a long time very much em- 
 barrassed how to explain this singular phenomenon, which overthrew 
 the received ideas ; but when they opened the skulls of individuals who 
 had died, they in a short time perceived that the lesion of the brain was 
 opposite to that of the skull, and consequently opposite to the paralysis.* 
 
 u These two series of symptoms, then, explain themselves in the same 
 manner as in the preceding case. I have seen no other means of ex- 
 hibiting to you in the most simple and clear manner possible, this rapid 
 sketch of all these opinions, and of the facts upon which they are founded, 
 than by reducing them to their most simple expression, by depriving 
 them of that vain parade of erudition, which is very easily abused, and 
 amid which it is so difficult to see one's way. 
 
 " Yet with this precaution you will perhaps find that the labor which 
 such an extent of reading requires is not compensated by the benefit 
 reaped from it ; but I have thought that if others began to demolish 
 before they build, or simply to pull down without leaving anything in 
 the place of that which they destroy, I could, and I even ought, after 
 endeavoring to build upon bases more extended and more solid than 
 have up to this time been assumed, to try to make everything disappear 
 that might oppose your progress.' 
 
 "After all, you see that the cause of the errors which have reigned 
 concerning symptoms of inflammation of the brain is, that they have been 
 studied in surgical observations; that great importance has always been 
 
 * Amongst others, see the case of Paillot, continued by M. Ant. Petit, in his collection of 
 Clinic. Observ., p. 223. He received over the left coronal suture a sword cut; the eighteenth 
 day the left arm was paralyzed, the paralysis increasing by degrees, and he died the 26th 
 day. Under the wound the dura mater and brain were healthy ; on the anterior lobe of the 
 opposite hemisphere was a vast abscess which had penetrated many lines in its substance. 
 See also Morgagni, Epist. LI., No. 42 : and the Observ. of M. Dan de la Vauterie, Letter I. 
 No. 19. 
 
410 I HUMAN BRAIN. 
 
 attached to the external wound, and little attention paid to the symp- 
 toms ; and this in considering pathological observations, which are so 
 much more complicated than cases of spontaneous inflammation. 
 
 " You also see that all these opinions were founded upon facts which 
 have been reproduced in our own days, because nature does not change ; 
 although so very contradictory, it is easy to explain them, and even to 
 reconcile them one with another." 
 
 Injuries of the head often give rise to convulsions. This fact is im- 
 portant, both in a surgical and physiological point of view. The ap- 
 pearance of convulsions after injury of the head is a most serious symp- 
 tom. If it occurs within a few hours after the accident, it is generally 
 indicative of laceration of the brain ; if it does not supervene for some 
 days, it is then dependent on subsequent inflammation. 
 
 The next case illustrates the fact that the convulsive fits sometimes 
 occur after a blow on the head without fracture, and that the injury 
 which gives rise to them is riot always irremediable. 
 
 I have no doubt that the convulsive twitchings in this case were occa- 
 sioned by some injury to the brain produced by the contre-coup, and the 
 case is instructive from its showing how gradually serious symptoms will 
 sometimes arise some days after the receipt of injury. The result of the 
 local depletion and counter-irritation bear out this view of it, and the 
 general tonic plan which was indicated by the previous habits of the 
 man, and his state of constitution, is important to attend to, from the 
 success which followed its adoption. 
 
 Case 76. Injury to the head William Pearson, set. about 40, a pot-boy at a public-house, 
 was admitted into George's Ward under my care, May 16th, 1842, with a small lacerated, 
 wound on the left side of the head; he was intoxicated at the time of admission. The ac- 
 cident was caused by his being knocked down or run over by a cart, I could not learn 
 which. 
 
 The case was regarded by the dresser as one of intoxication, and I did. not see him until 
 the following morning. 
 
 17th. He now complains much of pain in his head; but, with this exception, there were 
 no^symptoms indicative of cerebral mischief, and the headache I considered more character- 
 istic of disordered stomach than brain. There was no drowsiness, and his manner was na- 
 tural ; he referred the pain to his forehead, and not to the seat of injury ; his pupils acted 
 naturally. 
 
 I ordered Pulv. Jalapse c. Cal. J. stat. M. S. C. 6ta. hor. post. 
 
 In the evening, finding that, though his bowels had been relieved, the pain in the head 
 continued, I ordered him Calomel, gr. v. 4ta. hora. 
 
 18th. Symptoms much the same. 
 
 Ordered Opium, gr. j. at night, and repeat the Cal. and Jalap, as a purge. 
 
 19th. Has had convulsive movements of the left side of the face, of an epileptic charac- 
 ter. Tongue drawn to the left side. Constantly spitting a large quantity of frothy saliva. 
 Both pupils are alike, and slightly contracted, but act freely to the light. Pulse 116, weak. 
 He is quite conscious, and answers all questions naturally, though he has not perfect power 
 of speech. I again examined the head, and, for the first time, perceived that there was 
 some tenderness on pressure on the right of the head, opposite the wound. 
 
 Ordered Hirudines xx. to the right side of the head; to be followed by a blister. 
 
 Opii Tinctura, TT^xxx. ; Spirit. Ammon. Arom. gfs. ; Mist. Camphor. ^ j. hac nocte. 
 
 20th. Says he found relief from the leeches, and his head is much better, though still 
 very .bad. Pulse soft. 
 
 22d. No appearance of twitching, but tongue still drawn to the left side. Has vomited 
 some greenish bile. Pulse soft. 
 
 Ordered Hirudines xxx. to the right side. Port wine ^vj. in arrowroot. 
 
 23d. Says his head is much better, though not quite free from pain. Has only had one 
 fit of convulsive twitching since the last report Pulse still weak. 
 
 Ordered Quinine, gr. ij. b.d. 
 
CONVULSIVE AFFECTIONS. 411 
 
 24th. Much better; free from headache; no twitching since yesterday; appetite return- 
 ing. Pulse weak, 80. 
 
 Quinine and a pint of porter daily, in addition to the wine. 
 
 This man perfectly recovered, arid left the hospital quite well soon after the last report. 
 
 In fractures of the skull, the brain is sometimes lacerated, and it is 
 interesting to contrast the effects of this form of lesion, when it is very 
 limited, with the effects of concussion and compression.- 
 
 The following case is interesting and instructive in many points of 
 view. As bearing on convulsive affections of the brain, it is interesting 
 inasmuch as the convulsive attacks did not appear until fourteen days 
 after the receipt of the injury ; the convulsions being most probably the 
 result of the subsequent disorganization and irritation of the tubular sub- 
 stance of the hemispheres. The serious nature of the injury was masked 
 by its small extent : this and other points will be adverted to when the 
 case has been detailed, which is peculiarly instructive, surgically, as 
 bearing on the use of the trephine (and to this subject our attention must 
 also be directed) ; pathologically and physiologically, inasmuch as it 
 shows that convulsions result, in some cases, from lesion of tjie cere- 
 brum, and that they are not solely pathognomonic of spinal irritation and 
 disease, as stated by Dr. Marshall Hall. 
 
 Case 77. John Wingrove, set. 33, a stone sawyer, of healthy appearance, was admitted 
 into St. Thomas's Hospital, at a quarter before 8 A.M., on April 13th, 1843, with a compound 
 fracture of the skull. The wound was about two inches and a half in length on the right 
 side of the head, near the posterior extremity of the vertex. The scalp was completely divided, 
 and the bone perfectly bare. The parietal bone was fractured in a fissured form ; a portion 
 of the outer table being depressed so that the fractured edge of the skull was distinct above 
 it. Some blood flowed from the bone, but not much. A portion of the leather lining of 
 his cap had been driven into the wound, and was nipped so closely by edges of the bone 
 that it was not easily removed. A small artery was bleeding on the divided edge of the 
 scalp. I saw this man at a quarter before 9, about one hour and a quarter after the acci- 
 dent had happened. He was quite sensible ; both pupils acted perfectly naturally to the light ; 
 he complained of pain in his head, but referred it principally to the forehead. There was 
 no paralysis of any kind ; pulse small, only 60 in the minute. The accident occurred at the 
 New Royal Exchange, and was occasioned by a blow from the head of a mason's hammer 
 which flew oft' from the handle, and falling about 30 feet struck him on the head and glanced 
 off. He was completely stunned by the blow, and had no recollection of being put into the 
 cab by which he was conveyed to the hospital, but he recovered his senses before he ar- 
 rived there. 
 
 I ordered Cat. Lini. to the wound. Calomel gr. v. 3tia bora, 
 
 \ past 12 P.M. No change. 
 
 \ past 10 P.M. Pulse 80, but not strong; says his head is much better, but he feels very 
 tired, and cannot sleep ; but this he is not surprised at, as he never can sleep well if he has 
 not had his usual day's work. 
 
 He has taken five doses of the calomel, and the bowels have been copiously relieved ; 
 as he has no untoward symptoms, I have discontinued the calomel. Not more than two 
 or three ounces of blood have been lost from the wound. 
 
 14th. Going on well in every respect; no bad symptoms ; almost free from pain in his 
 head ; pulse 64 ; suffers a little from cough. Linct. pro tussi. 
 
 15th. Has had a good deal of pain in the forehead, which he attributes to the shaking 
 of his head from the cough. His pulse 86, but not strong ; loud respiration over the whole 
 chest. No pain in the wound or neighborhood ; bowels not open to-day. 
 
 Ordered Calomel, gr. v. 4ta hora; Hirud. xxx. lateri capitis dextro. Head shaved. Pil. 
 Ipecac, c. Conio. gr. v. 6ta hora. Emplast. Lytt. pectori. 
 
 16th. Much better ; his cough very much relieved ; free from pain in his head ; bowels 
 not open to day ; mouth tender. 
 
 Ordered M. S. C. stat. To omit the Cal.till to-night A poultice to the blistered surface. 
 
 17th, 9 A.M. Has had a bad night; head very painful in the frontal region ; pulse small, 
 80; looks uncomfortable; wound healthy, suppurating. 
 
 Ordered Hirud. xxx. stat. 
 
412 HUMAN BRAIN. 
 
 12 P.M. better ; very little cough. 
 
 To omit the Pil. Ipecac, c. Conio, and to rep. Hirud. h. n. 
 
 18th. Much better as regards his head, but the cough still troublesome. 
 
 To repeat the Ipec. c. Conio, the blister on the chest not having risen well; to paint the 
 throat and chest with tincture of iodine. Pulv. Rhei. c. Cal. gr. xv. h. n. 
 
 19th. Much better in every respect. 
 
 20th. Free from pain in his head, and the cough nearly gone. 
 
 21st and 22d. I flid not see him. 
 
 23d. Going on well in every respect. 
 
 24th. Apparently going on well, but as he still had pain in the head, I ordered twenty 
 leeches, and Pil. Hydrar. gr. v. bis in die. 
 
 25th. The same. Thus it appears, that for thirteen days after his admission, he had not 
 a bad symptom. 
 
 26th. I received a message from the dresser, saying that the man had passed a bad night 
 and was in a good deal of pain in his head, for which he had applied twenty leeches. I 
 saw him at 1 P.M. His head has been relieved by the leeches, but he complains of pain 
 at the external angle of the right orbit, which pain appears to him to rise upwards from the 
 jaw, and to shoot over the head. He states that he is free from pain in the neighborhood 
 of the wound ; his mouth is tender from the mercury. As the pain has so much of a neu- 
 ralgic character, and possibly connected with this salivation, I ordered the mercury to be 
 omitted, and the face to be fomented, after which an ointment containing aconite to be rubbed 
 into the side of the face. At 5 P.M., when I saw him again, he had been relieved by the 
 fomentation, but had not had the ointment, as there was not any aconite in the hospital. I 
 ordered instead of it equal parts of the extract of belladonna and lard, to be made into an 
 ointment and rubbed into the face. 
 
 Pulv. Jalap, co. ^j- hac nocte. M. S. C. eras mane. 
 
 27th, 12 A.M. Pulse 80, soft, and rather -weak; complains of his forehead and the side of 
 the head, but no pain in the neighborhood of the wound. His countenance was anxious 
 and distressed ; the right pupil was dilated ; the left natural. I thought at first that this 
 might possibly arise from the application of the belladonna, but he complained of having 
 lost the feeling in his left hand, and that he could not lay hold of things so readily with it. 
 I need hardly say I regarded this circumstance with the greatest concern, as I feared the 
 worst from it. He had another very serious symptom, viz. that on lying down he corn- 
 plained of his head throbbing violently. 
 
 I ordered the twenty leeches to be repeated, and five grains of blue pill twice a day; the 
 head to be raised in bed. Immediately I quitted the ward I called the attention of the pupils 
 who were with me to the serious character of his symptoms, and gave an unfavorable prog- 
 nosis. 
 
 At 8 P.M. I received a message from the dresser, informing me that he had had a fit, and 
 when I arrived I found him just recovering from a third fit. The fits were not preceded by any 
 scream, but in every other respect they were all of a true epileptic character. As soon as 
 he began to recover his senses he went off again, and just previous to this he became very 
 violent, and was with difficulty retained in bed. I inquired of his wife whether he had 
 ever been subject to epilepsy : she said no, but that she had heard from his mother that 
 when a child he had been subject to fits. Coupling the invasion of these fits with the in- 
 cipient paralysis observed in the morning, I considered it not impossible that there was some 
 irritation from the internal surface of the fractured bone. I therefore determined to trephine. 
 This was accomplished by making first a crucial incision of the integuments, and then, by 
 the application of the trephine on the lower edge of the fissure in the parietal bone. After 
 the removal of the portion cut by the trephine, I removed with the dressing forceps a small 
 portion of bone with a sharp edge, about the size of a thumb nail, from under the superior 
 edge of the fissure in the internal surface, which evidently pressed on the dura mater, 
 About eight ounces of blood were lost at the operation, but very little afterwards. I per- 
 formed it just after the commencement of the fourth fit, as I found he was too excited after 
 he recovered from one to permit any operation willingly. He had one fit shortly after it 
 was completed, but no more during the night. The dresser, Mr. Fixot, sat up with him, 
 and he tells rne that the patient complained of a good deal of pain in his head, referring it 
 principally to the forehead and eyebrow, but sometimes to the back part, near the wound; 
 he dozed at intervals, and then awoke with pain; pulse very variable, sometimes thready, 
 and sometimes a little fuller ; cough occasionally occurred, always causing violent pain in the 
 head. 
 
 28th, 9 A.M. He has now paralysis of the whole of the left side of the head, body, and 
 left extremity. 
 
 He knows me : complains of pain in his head, and wishes to sit up in bed: we raised him, 
 
CONVULSIVE AFFECTIONS. 413 
 
 and then he complained of being faint. I gave him a very little weak brandy and water, 
 and ordered some sal volatile occasionally. His pulse is weak : 100. 
 
 28th, 10 P.M. Has had nine fits at intervals during the day, the last about half an hour 
 before I came down; he is quite sensible between the attacks ; the sister thinks that he has 
 lost some power in the right arm. As he was now dozing I would not disturb him ; pulse 
 80, small, but not very feeble ; skin hot. In one of the fits the convulsions were very 
 slight, and confined to the left side of the body, and he seemed scarcely to lose his con- 
 sciousness. 1 learned from the sister that she had observed twitchings of the muscles on the 
 left side during the afternoon of yesterday. 
 
 On Saturday he continued sensible, and did not appear to lose his consciousness even dur- 
 ing the fits, for as soon as the convulsions ceased he would take up his handkerchief and wipe 
 his mouth. He had fits every half hour, which began at 9 in the morning and continued 
 till 4 in the afternoon, when twelve leeches were applied to his head, and he had no more 
 till 11 o'clock at night, when he had a very slight one ; but at 12 he had a very severe one, 
 which continued one hour: he was perfectly conscious, and breathing natural; scarcely ever 
 complained of his head, and then referred the pain to the right brow. 
 
 Sunday, 30th. He had no decided fits, only twitching of the muscles; remained sensible 
 till about 4 o'clock in the afternoon, when a great change took place ; he turned very pale, 
 and had more twitching of the muscles, and at twenty minutes after four had a fit, 
 which lasted an hour and a half. After this he totally lost the use of his inferior extremi- 
 ties; all consciousness left him; he did not have another fit, but merely twitching of the 
 muscles, and died at twenty minutes after 3, on the 1st of May, moaning a great deal and 
 making a great noise, but for one hour before he died he never spoke. 
 
 Post-mortem, May 1st, 1 P.M. Head. After the cranium was sawn through, about half an 
 ounce of yellow pus escaped, while endeavoring to detach it from the dura mater. When 
 this was done we found the internal table of the skull fractured more extensively than the 
 outer table, split inward from the upper edge of the fracture. A portion of this table which 
 was thus split I had removed with the dressing forceps after using the trephine. The por- 
 tions which remained could not have been removed without some force, as they were only 
 partially separated from the surrounding bone. 
 
 At the time of the operation I did not detect this further depression, from a fear of sepa- 
 rating the dura mater more than was absolutely necessary. But the appearance of this bone 
 certainly teaches us that we are warranted in such cases (even in the absence of'depression 
 of the outer table, and the removal of the portions which are found at the edge of the open- 
 ing made by the trephine), in searching carefully for any further portions that may have 
 been separated. 
 
 Opposite this fracture there was a small opening in the dura mater of the size and shape 
 of the extremity of the nail of the little finger, through which some softened brownish-co- 
 lored brain was exuding, On turning back the dura mater, we found on the same side the 
 whole surface of the arachnoidea investiens covered with healthy yellow pus. The arach- 
 noidea reflexa lining the dura mater was coated with a thick layer of pus, so tenacious that 
 it almost amounted to a false membrane. 
 
 The brain, corresponding to the seat of fracture, was much discolored. The centre of 
 discoloration was of a dark, dirty-brownish hue, of a semi-liquid consistency, gradually be- 
 coming firmer, and shaded off to a dingy pinkish color towards the circumference, which 
 was spotted with deep bloody points : a horizontal section of the brain about half an inch 
 from the surface showed this very distinctly. The disorganization extended downwards into 
 the lateral ventricle at the commencement of the descending and posterior cornua, involving 
 a portion of the transverse commissure, but not either the thalamus or corpus striatum. The 
 surface of the brain, where the arachnoidea had been covered with pus, was slightly softened 
 in many places, but most so over the inferior edge of the anterior lobes of the right hemi- 
 sphere. 
 
 The hemispherical ganglion was scarcely, if at all, altered in its condition: its color was 
 healthy, neither paler nor deeper than usual ; the edge, in some situations, was converted 
 into a grayish-greenish tint, which Dr. Hodgkin attributed to a post-mortem action of sulphuretted 
 hydrogen. 
 
 The pia mater and arachnoid on the left hemisphere were both perfectly healthy, and 
 also on the surface of both hemispheres, where they are in contact with the falx major. 
 
 If the nature of the fracture in this case, and the injury inflicted on 
 the brain and its membranes, as demonstrated by this post-mortem ex- 
 amination, could have been ascertained at the time of his admission, no 
 one could have hesitated to use the trephine. Some fifty or sixty years 
 ago the trephine would have been immediately applied with the view of 
 
414 HUMAN BRAIN. 
 
 elevating the depressed portion. This operation, however, in the pre- 
 sent da) 7 , is not as a general rule considered justifiable in the absence of 
 symptoms of compression, or direct irritation of the brain. It is, then, 
 a question for consideration why this condition was not detected, and 
 how far it would be desirable to adopt a different course when a similar 
 case comes before us. 
 
 As a post-mortem examination does not demonstrate the amount of 
 lesion of the brain at the time of his admission, for much that we now 
 observe is the result of subsequent inflammation and gangrene, let us 
 endeavor, reasoning from other cases and the physiology of the subject, 
 to establish this point. 
 
 In the examination of a case of this kind, during life, it is extremely 
 important to enter minutely into all those signs which indicate any injury 
 to the brain. First, the mental condition this was perfectly normal ; 
 he was quite sensible, and his manner natural. Next, the state of the 
 pupils the iris is placed before that expanded surface of the optic nerve, 
 the retina, as an intelligent curtain to guard it from injury. The vital 
 contrivances by which it acts, and by which its action is directed, are 
 so beautifully perfect, that the extent of the opening of the curtain is in- 
 dicative of the state of the nervous apparatus it is destined to protect, 
 by preventing such an amount of light impinging upon it as would be 
 liable to injure it. In disease of the globe of the eye, the dilated pupil 
 indicates more or less pressure on the retina by some cause in the globe 
 itself, such as a permanently turgid choroid, &c. But if with a healthy 
 eye, and in connection with a blow on the head, we find a dilated pupil, 
 then we have the sign of some pressure or injury to the nerve in its 
 course within the skull, or the ganglia in which it terminates. 
 
 The dilated pupil, then, indicates very serious injury to the optic 
 nerve, or the nervous centres with which it is connected, though it may 
 happen, as in the case of very severe concussion, that the injury is re- 
 mediable. The contracted pupil, on the contrary, indicates an irrita- 
 bility of the nervous instruments, an undue excitement of their natural 
 function, not an obliteration of it. You will sometimes see, in the case 
 of injury of the brain, dilatation of one pupil and contraction of the other; 
 where this is the case you will find the most severe injury of the brain 
 on the side opposite the dilated pupil, as occurred in this case from sub- 
 sequent inflammation and softening. 
 
 The next point to which ray attention was directed in reference to the 
 prognosis of the case, was the state of the wound, and the blood which 
 flowed into it. Now the blood which flowed into the depression might 
 be from a wounded artery of the dura mater, or simply from the bone. 
 If from the dura mater, the injury was of course very serious: this I 
 hoped, and believed, from its extent at the time, was not the case. It 
 soon ceased, which gave me reason to hope that the inner table was not 
 fractured. That the outer table may be fractured without the inner, has 
 long been known. We have a very good preparation in the Museum at 
 St. Thomas's, where there is considerable depression of the outer with- 
 out any whatever of the inner table. But the post-mortem examination 
 proved that at the time of his admission, the internal table of the skull 
 was more extensively fractured than the outer, and that the fractured 
 
CONVULSIVE AFFECTIONS. 415 
 
 portions were partially depressed, notwithstanding the entire absence of 
 all symptoms of compression. These symptoms, as almost universally 
 agreed to by surgeons, consist of an entire loss of consciousness; the 
 mental faculties are smothered, and they cannot be roused. Many of the 
 functions of vegetative life are also interfered with the breathing is 
 laborious and stertorous, not unfrequently the sphincters are relaxed, and 
 the excretions are evacuated involuntarily. There are sometimes other 
 symptoms, but these are the most common. 
 
 It may be said, if such are the symptoms of compression, why were 
 they entirely absent in this case, where the inner table was depressed 
 and driven in upon the brain ? I am inclined to believe that the acknow- 
 ledged symptoms of compression depend upon the extent of the hemi- 
 spherical ganglion which is pressed upon suddenly, and that if only a 
 very small portion of this ganglion is pressed upon, then its functions 
 are not naturally impaired, in this case, and many others that might be 
 quoted : nevertheless, you must not consider it more than an hypothesis 
 of ray own, and not as an established principle, but I conceive this is 
 the only truly physiological explanation of this apparent anomaly. 
 
 The splintered portion of the skull lacerated the dura mater to a very 
 small extent, and to about the same extent, but no more, was the hemi- 
 spherical ganglion originally injured. The medullary or fibrous sub- 
 stance beneath was so shaken that blood was effused in small points, as 
 may sometimes be observed in cases of simple concussion without frac- 
 ture. On referring to treatises on injuries of the head, I have been sur- 
 prised to find so many cases recorded in which very serious injuries to 
 the brain have been unattended by serious symptoms of disturbed intel- 
 lect ; but, as far as I can judge from the loose mode in which post-mor- 
 tem appearances are almost invariably detailed, they are all cases in 
 which the injury is confined to the base of the brain, or the hemispheri- 
 cal ganglion has been but slightly injured in the first instance. It is a 
 pity that surgeons who have written on this subject should have neglected 
 to state the exact extent of the surface injured, for this fact is equally 
 important in its physiological as it is in its pathological bearing ; the 
 ignorance of it having induced some well-meaning but foolish people to 
 quote such uses in proof of their theory that the brain is not the organ 
 of the mind not distinguishing between the ganglion which is connected 
 with the mind, and those which are not. The following case, quoted 
 by Mr. Guthrie from Dupuytren, illustrates my view of this subject. 
 
 A young man had received a wound in the head from a knife, which 
 healed in the usual way, leaving only a little pain which occurred occa- 
 sionally round the cicatrix. Some years after, he was brought to the 
 Hotel Dieu in a state of stupefaction, with which he had been suddenly 
 seized. An incision having been made through the cicatrix, the point 
 of a knife was seen sticking in the bone, the removal of which gave no 
 relief. The trephine was then applied without any result. The para- 
 lysis continuing on the opposite side to that on which the wound had 
 been received, it was thought right to open the dura mater, arid then to 
 plunge the knife into the brain, when a large quantity of pus escaped. 
 The paralysis ceased that night ; he recovered his speech, became sen- 
 sible, and entirely, though gradually, recovered. 
 
416 HUMAN BRAIN. 
 
 In this case we may conclude, from the account, that the ganglion was 
 only injured to the extent of the breadth and thickness of the knife, and 
 no disturbance of the mind followed until an abscess formed, which, 
 pressing on the ganglion from within, indicated its presence by the stupe- 
 faction and paralysis that followed. 
 
 The evacuation of the matter relieved the pressure, the senses re- 
 turned, and the paralysis ceased. 
 
 Whether this explanation of the fact that we meet with cases of de- 
 pression of the table of the skull without the ordinary signs of compres- 
 sion of the brain, be true in its physiology or not, the fact itself is a most 
 important one to be remembered for its practical bearings. 
 
 On referring back to its progress, it will be seen that on the 8th, 9th, 
 and 10th days after the accident, he was almost free from untoward 
 symptoms : so well indeed had the case gone on, that my friend Mr. 
 Travers, who had watched it with some interest, congratulated me on 
 the favorable result of the anticipatory treatment which I had adopted. 
 It may be fairly considered that these antiphlogistic measures, which 
 were practised so early, stayed for the time the invasion of inflammatory 
 action, though they did not entirely arrest it. His system was brought 
 under the influence of mercury within 24 hours of the occurrence of the 
 injury, and though he was not bled from the arm, for he never had a pulse 
 exhibiting sufficient vascular action to justify it, 148 leeches were applied 
 to the head. 
 
 The cough was much subdued by the ipecacuanha and conium pill, a 
 blister, and the tincture of iodine to the chest. 
 
 But still the mischief went on, and thus I believe the fibrous medulla 
 beneath the hemispherical ganglion became softened, as indicated on the 
 eleventh day, by slight loss of sensation in the left hand. If the medulla 
 had been materially altered in its texture, at the time of his admission, 
 by the blow, there must have been paralysis at that time, and the fact 
 of its not appearing till the eleventh day shows how slowly the softening 
 and disorganization must have proceeded. The softening increased, and 
 then an epileptic fit takes place, quickly succeeded by another, and 
 another, and another, until, by means of openings made with the trephine, 
 a splinter of bone was removed. 
 
 The principal cause of irritation is removed, and one more fit occurs 
 immediately, and then they cease for about twelve hours, when they 
 again recur, and though occasionally stopped for a short period by local 
 blood-letting, they return at intervals, until the patient becomes quite 
 insensible, remaining so for twelve hours previous to his death. This 
 loss of consciousness I attribute to the pus we found effused on the sur- 
 face of the brain, for until the pus was effused there was nothing to in- 
 terfere with the hemispherical ganglion, and therefore nothing to affect the 
 intellect ; and neither the quantity nor quality of the pus was such as might 
 not have been effused in the course of twelve or fifteen hours at the 
 longest. I think the inflammatory action which caused it was occasioned 
 by the epileptic fits, and not the cause of them. The cause of the fits 
 I believe is to be found in the softening and gangrene of the fibrous or 
 conducting substance of the brain. 
 
 Taking this view of the progress of the case, I cannot avoid the con- 
 
CONVULSIVE AFFECTIONS. 417 
 
 elusion (hat if this patient had been trephined when he was first admitted, 
 he would have had a better chance of recovery than by postponing it; 
 and though it is impossible to say whether the brain was or was not so 
 much injured at first as to have been irremediable, I candidly confess that 
 I do not believe it was ; for if such had been the case there must have 
 been some symptoms of such a lesion, though it is astonishing from what 
 serious lesion, both primary and secondary, the brain will recover. I 
 believe that almost all the disorganization which the post-mortem exami- 
 nation exhibited in the right hemisphere of the brain was the result of 
 inflammatory action, excited by the irritation of the fractured skull, and 
 partly kept up and aggravated by the concussions occasioned by the 
 cough. The number of cases on record in which patients have recovered 
 whose brains have been seriously wounded, when the cause of irritation 
 has been removed, should encourage us to make the attempt as early as 
 possible to remove, if we can discover on what it depends. The dif- 
 ficulty in the present case was to ascertain the fact of depression of the 
 internal table. 
 
 There is no point in surgical practice regarding which there is and 
 has been so much difference of opinion as the use of the trephine. Mr. 
 Abernethy's Treatise on Injuries of the Head was called forth in con- 
 sequence of the difference of opinion regarding the line of practice that 
 ought to be followed in particular cases. He relates seven cases of 
 fracture, with depression, which occurred within one twelvemonth at 
 St. Bartholomew's, that recovered without any operation, " showing that 
 a slight degree of pressure does not derange the functions of the brain, 
 for a limited period at any rate, after its application." After relating 
 other cases, he goes on to say " Such cases ought to deter surgeons 
 from elevating the bone in every instance of slight depression, since by 
 the operation they must inflict a further injury upon their patients, the 
 consequence of which it is impossible to estimate. From all, therefore, 
 that I have learned from books, as well as from the observations I have 
 made in practice and from reasoning upon the subject, I am disposed to 
 join in opinion with those surgeons who are against trephining in slight 
 depressions of the skull, or small extravasations of the dura mater." 
 
 Benjamin Bell, whose System of Surgery was published in 1801, 
 says, " Hitherto it has been a general rule to consider the application of 
 the trepan as necessary in every fissure, whether any symptoms of a com- 
 pressed brain have occurred or not ; but due attention to the real na- 
 ture of the fissure, and to the effects most likely to result from perforating 
 the skull, will show, that although fissures may be frequently combined 
 with such symptoms as require the trepan, yet they are not always, 
 or necessarily so ; and, unless when such symptoms actually exist, that 
 this operation, instead of affording relief, must frequently do harm ; for 
 it is by no means calculated for, or in any respect adequate to, the pre- 
 vention of these symptoms, and I have already endeavored to show that 
 laying the brain bare is never to be considered as harmless, and, there- 
 fore, that it should never be advised but where it is probable that some 
 advantage may be derived from it." In the present day these observa- 
 tions of Mr. Bell seem almost superfluous, but when we find such pre- 
 cepts as the following inculcated by John Hunter in his Surgical Lec- 
 27 
 
418 HUMAN BRAIN. 
 
 tures, we need not be surprised that subsequent teachers of surgery 
 should have felt the necessity of warning their pupils against the too free 
 use of the trephine. " As we cannot tell for certain at the time," says 
 Mr. Hunter, u whether the symptoms arise from concussion, compres- 
 sion, or from extravasation of blood, it may be more advisable to trepan, 
 as the operation can do no harm" 
 
 Mr. Lawrence relates an interesting case in a clinical lecture, pub- 
 lished in the Medical Gazette, vol. xxi. p. 345, of a boy who recovered 
 without operation, in whom the skull was fractured and depressed, the 
 brain wounded, and portions of it extravasated through a laceration of 
 the scalp. "In this case," Mr. Lawrence says, " as the bone was here 
 evidently and considerably depressed, and as it was also probably driven 
 in upon the brain, it would, I believe, have accorded with the princi- 
 ples of treatment generally admitted, to have performed an operation for 
 the purpose of elevating and removing depressed and detached portions 
 of the bone." 
 
 " The considerations which determined me to do this were, the favor- 
 able state of the patient generally, and in particular the absence of all 
 symptoms indicating compression of the brain ; the specimens in patho- 
 logical collections, of very extensive injuries of the skull repaired by a 
 natural process ; the smallness of the external wound, which brought 
 this case nearly into the state of simple fracture ; the extensive incision 
 of the integuments, and exposure of the bone, dura mater, and brain, 
 which an operation would have involved ; and the almost invariably 
 fatal termination of such proceedings within my own experience in hos- 
 pital practice." 
 
 Dr. Hennen, in his admirable work on Military Surgery, relates many 
 cases to show that, in the absence of symptoms, the trephine should not 
 be used, even when the bone is evidently depressed. He says, p. 288 : 
 " We have here sufficient proof that there is no absolute necessity for 
 trepanning merely for depressed bones from gunshot, although few would 
 be so hardy as not to remove all fragments that came easily and readily 
 away." 
 
 All the cases which Dr. Hennen relates are well worthy of perusal, 
 but I have only room to quote one short history in connection with the 
 present case. " A soldier was shot in the head in the Canadian cam- 
 paign. A fracture was the consequence, with a depression of not less 
 than an inch and a half; but as no untoward symptom occurred, no ope- 
 ration was had recourse to. The man recovered, and went to the rear, 
 where, at a distance of several weeks afterwards, he got an attack of 
 phrenitis from excessive drinking, and died. As the existence of the 
 ball in the brain was strongly suspected, an inquiry was made after 
 death, and on dissection it was found lodged in the corpus callosum." 
 
 Mr. Gtithrie, in his interesting and valuable work on Injuries of the 
 Head, lately published, makes some excellent remarks on the best mode 
 of proceeding in these obscure cases. ** The inner table (says Mr. 
 Guthrie) is sometimes broken in a peculiar manner, to which I believe 
 attention has only been drawn by myself in my lectures, since trepanning 
 has ceased to be the rule in all cases of fracture. In these cases the 
 skull is cut rather than broken by a sharp cutting instrument, such as an 
 
CONVULSIVE AFFECTIONS. 419 
 
 axe, sword, "&c., just in fact as a piece of wood might be, while the in- 
 ner table, like a piece of glass or brittle steel, is broken and splintered 
 inwards. u These cases should be examined carefully. The length of 
 the wound on the top, or side, or any part of the head which is curved 
 and not flat, will readily show to what depth the sword or axe has pene- 
 trated. A blunt or flat ended probe should in such cases be carefully 
 passed into the wound, and being gently pressed against one of the cut 
 edges of the bone, its thickness may be measured, and the presence or 
 absence of the inner table may thus be ascertained. If it should be 
 separated from the diploe, the continued but careful insertion of the 
 probe will detect it deeper in the wound ; a further careful investigation 
 will show the extent in length of this separation, although not in width, 
 and will, in all probability, satisfy the surgeon that those portions of 
 bone which have thus been broken and driven in are sticking in or irri- 
 tating the brain. In many such cases there has not been more than a 
 momentary stunning felt by the patient ; he says he is free from symp- 
 toms, that he is not much hurt, and is satisfied he shall be well in a few 
 days." 
 
 " An officer was struck on the head in Halifax, Nova Scotia, by a drunken 
 woman with a tomahawk or small Indian hatchet, which made a per- 
 pendicular cut into his left parietal bone and knocked him down. As 
 he soon recovered from the blow, and suffered nothing but the ordinary 
 symptoms of a common wound of the head with fracture, it was con- 
 sidered to be a favorable case, and was treated simply, although with 
 sufficient precaution. He sat up and shaved himself until the fourteenth 
 day, when he observed that the corner of his mouth on the opposite 
 side to that on which he had been wounded was fixed, and the other 
 drawn aside, and that he had not the free use of the right arm, so as to 
 enable him to shave. He was bled largely, but the symptoms increased 
 until he lost the use of the right side, became comatose, and died. On 
 examination the inner table was found broken, separated from the diploe, 
 and driven into the brain, which was at that part soft, yellow, and in a 
 state of suppuration." After relating several other instructive cases 
 bearing on this point, he says: " The principle being laid down that it is 
 right and proper to examine all such wounds with a blunt flat probe, in 
 order to ascertain, if possible, whether the inner table is depressed or 
 broken, the question necessarily arises, what is to be done when such 
 depression and breaking down of the inner table are ascertained to have 
 taken place? There can be no hesitation in answering that in all such 
 cases the trephine should be applied, although no symptoms should exist, 
 with the view of anticipating them." 
 
 1 The old doctrine, it may be said, in regard to fractures generally, 
 is revived in these cases, but on a principle with which our predecessors 
 were not sufficiently acquainted. A patient very often survives a mere 
 depression of the skull ; he may, and occasionally does, survive a greater 
 depression of the inner than the outer table; but I do not believe that 
 he ever does survive and remain in tolerable health, after a depression 
 with fracture of the inner table, when portions of it have been driven 
 into the dura mater. If cases could be advanced of complete recovery 
 after such injuries, I should not consider them as superseding the prac- 
 
420 HUMAN BRAIN. 
 
 tice recommended, unless they were so numerous as to establish the 
 fact that wounds of the dura mater and brain are not extremely dangerous. 
 I have referred purposely to many cases in which a cure was effected 
 after a lapse of time by the bone being removed ; but they rather sup- 
 port than invalidate the principle I have inculcated. There are great 
 objections, I admit, to the trephine being applied in ordinary cases of 
 fracture, which are not attended by symptoms of further mischief; but 
 the nature of the cases which I have particularly referred to having been 
 ascertained, I maintain that the practice should be promp and decisive 
 in every instance in w r hich the surgeon is satisfied that there is not merely 
 a slight depression or separation of the inner table, but that several points 
 of it are driven into the dura mater.'' 
 
 I have thought it incumbent on me to dwell very fully on the justifi- 
 ableness of the use of the trephine in such fractures of the skull where 
 there is an absence of cerebral symptoms. Nevertheless, I cannot re- 
 commend the use of the trephine in any case, unless there ia*very de- 
 cided evidence of a wounded dura mater from splintered portions of the 
 inner table. " If there be any doubt," says the same authority, u on 
 the mind of the surgeon whether there are, or are not, any portions de- 
 pressed and irritating the brain or its membranes, he should wait ; and 
 in this it is that the real difference between modern surgery and that of 
 the olden time exists, with respect to adults." 
 
 The nature of the fracture in this case rendered it almost impossible 
 to ascertain the fact of fracture of the inner table by means of the probe, 
 as recommended by Mr. Guthrie. 
 
 It will be perceived, from these few quotations, that there is still con- 
 siderable difference of opinion as to any general rule for the use of the 
 trephine in fracture of the skull. It must, indeed, be admitted that no 
 general rule can be laid down, but that every surgeon must be guided 
 by the peculiar circumstances of each particular case, bearing in mind 
 that there are cases of injury of the brain in which the trephine may be 
 required, though all the symptoms of compression are absent. Such 
 cases, it is true, are rare, and their diagnosis difficult, but it is only by 
 the remembrance of their occasional existence that we ever detect them. 
 
 And, on the other hand, scarcely any extent of wound of the skull, 
 the brain, and its membranes, accompanied with unequivocal depression 
 of bone, should dissuade from the operation, if the functions of vegeta- 
 tive life are not so seriously interfered with as to make a fatal result in- 
 evitable ; for the records of surgery teem with cases showing/rom what 
 serious injury of the brain some patients will recover. 
 
 The next practical point which the consideration of this case suggests, 
 is, whether we are justified in opening the dura mater when it has been 
 exposed by the trephine, in those cases in which there are symptoms of 
 pus beneath its surface. 
 
 The dura mater, when exposed by the removal of a portion of the 
 skull, will be seen to rise and fall wilh the pulsations of the brain, if it 
 is not separated from the dura mater by anything else than the other in- 
 vesting 'membranes. It is true that in a tranquil state, and with a small 
 opening, the motion is very slight. The absence of this motion is stated 
 by Mr. Guthrie as diagnostic of fluid beneath. "I have seen," says 
 
CONVULSIVE AFFECTIONS. 421 
 
 this author, " on the removal of a portion of bone, the dura mater rapidly 
 rises up into the opening, so as to attain nearly the level of the surface of 
 the skull, totally devoid, however, of that pulsatory motion which usually 
 marks its healthy state ; and an opening into it under these circumstances 
 has allowed a quantity of purulent matter to escape, proving that the 
 unnatural elevation of the dura mater was caused by the resiliency of the 
 brain, when the opposing pressure of the cranium was removed. I con- 
 sider this tense elevation, and the absence of pulsation, to be positive 
 signs of there being a fluid beneath requiring an incision into the dura 
 mater for its evacuation. It is a point scarcely, if at all, noticed in 
 English surgery, although much insisted on in France. It was not in 
 the slightest degree understood till the commencement of the war in the 
 Peninsula, and was one of those points which particularly attracted my 
 attention." 
 
 In Wingrove's case, no such phenomena were exhibited at the time 
 of the operation, nor did I perceive it when I examined the wound at 
 my daily visits, which would rather confirm the opinion that the pus 
 was not effused until about twelve or fifteen hours before death. 
 
 If I had observed this sign of the presence of matter under the dura 
 mater, I confess that I should have punctured it, though I cannot believe, 
 from the post-mortem examination, that the operation would have altered 
 the result, as nothing could have changed the gangrenous condition of 
 the brain. There are many other points of interest connected with in- 
 juries of the skull, and the use of the trephine, not bearing upon the 
 present subject, which I shall notice in another place. 
 
 I cannot conclude these remarks without again adverting to the im- 
 portance of making a very careful diagnosis and prognosis in all injuries 
 of the skull ; and that while we value the trephine and elevator as most 
 useful instruments for the relief of a compressed and irritated brain, we, 
 must never be tempted by the prospect of performing what, if successful, 
 is certainly a brilliant operation, but blamefully mischievous if the con- 
 dition of the parts should not absolutely require it, without having first 
 a well-grounded conviction that its use can alone save the life of our 
 patient ; remembering that in all such injuries the great danger to be 
 apprehended is inflammation of the brain and its membranes, and that 
 nothing is so likely to produce it as their exposure to the air, and the 
 forcible removal of their natural protectors. 
 
 The next case is one of great interest in every point of view. I have 
 never seen convulsions following injury to the brain of such frequencv 
 and severity which have been survived. That the cerebral lesion must 
 have been very serious, is proved by the paralysis of the arm and leg. 
 In a therapeutical point of view, it is important to observe how obsti- 
 nate the symptoms were until the system was influenced by the mer- 
 cury. I have no doubt but that the blood-letting arrested the inflamma- 
 tory action until the mercury performed its work, but it did not appear 
 as if the blood-letting alone could control the disease. 
 
 Case 78. Thomas Smith, a boy set. 14, residing at Woolwich, was admitted into George's 
 Ward, May 1 1th, 1846, under the care of Mr. Solly, with a severe injury of the head. 
 
 It was stated that he had fallen from a scaffolding twenty feet, or upwards, in height, 
 pitching upon his head; when picked up, was quite insensible, and there was bleeding 
 from the right ear. 
 
422 HUMAN BRAIN. 
 
 The accident occurred at 7 A. M., and he was at once sent to the Hospital. 
 
 Mr. Solly saw him at half-past 9, when he was still insensible, and evidently suffering 
 from a severe concussion of the brain. His head was directed to be shaved, a cold lotion 
 to be applied, and warmth to the extremities; and five grains of calomel were given im- 
 mediately. 
 
 At half-past 1 he was again seen by Mr. S., when he had recovered his senses, but was very 
 drowsy, and complained of pain in his head ; the pulse was somewhat slow and laboring, 
 the pupils dilated, particularly the left, but contracted upon the admission of light. He was 
 ordered to take two grains of calomel every two hours, and to have twenty leeches applied 
 to the head. 
 
 At 9 p. M. was much the same as in the middle of the day. Was bled from the arm to 
 
 3 vii J- 
 
 May 12th, half-past 8 A.M. He complained still of pain in the head, continued drowsy; 
 pulse 72; bowels not opened, although he had taken eight doses of mercury. Ordered 
 Calomel gr. v. every hour until the bowels were relieved. Leeches to be repeated, but 
 thirty in place of twenty. 
 
 I p. M . To continue treatment. 
 
 II P.M. Was sleeping; sensible when roused, but complained of pain, particularly on 
 the left side of the head. Bowels still confined; had taken nine 5 gr. doses of Calomel. 
 Ordered an enema to be administered immediately, and repeated, if necessary. The Calo- 
 mel to be omitted until the morning. 
 
 13th. Sleeps a good deal, and he is not easily roused, but quite sensible, when awakened. 
 Said, " I have got the headache, sir," and then dozed otf again ; pulse 64 ; bowels opened 
 twice by the enema, stool lumpy, and dark brown. Ordered Calomel gr. v. 
 
 I P.M. Rather more drowsy; becoming forgetful; leeches to be repeated, thirty in 
 number. 
 
 7 p. M. The sister observed that he had slight grating of the teeth, and almost immedi- 
 ately thrust his tongue from his mouth, and it remained out; at the same time, the right 
 arm was drawn up, and there was rolling of the eyes. The sister thought he was con- 
 scious, but he could not speak. She then sent for Mr. S., which was at 
 
 8 P.M. His countenance had become more anxious; he was not so readily roused, and 
 answered less perfectly questions put to him, speaking in a drawling way ; pulse 76, not so 
 full. A vein was opened in the arm, but the blood, which was very dark, flowed so slowly, 
 that the temporal artery was opened. He was raised from the pillow, and as soon as little 
 more than an ounce had flowed, he had a convulsive fit; the struggle was slight, and ac- 
 companied with a slight moan. The artery was then completely divided, which stopped 
 the bleeding, and he was again laid on the pillow; he almost immediately recovered his 
 consciousness; his countenance was pale, and covered with cold sweat; pulse 56, irregular. 
 In a few minutes he seemed better, and said, in answer to a question, that he was easier. 
 Ordered Hydr. c. Greta gr. ij. 4ta hor. 
 
 14th mane primo. Said he was very bad; quite conscious; has had no more convulsions ; 
 complained of his head. Pulse 72, soft ; mouth rather tender. 
 
 9 P. M. Countenance more cheerful ; head cooler ; pulse 80. Said he was better. Con- 
 tinue treatment. 
 
 II P.M. Had another convulsive fit, which was very short; foaming from the mouth, 
 which was drawn somewhat to the right side ; no scream. A few minutes before this, he 
 had started up in the bed, and would have fallen out, but for the attendant. 
 
 15th. Several fits of short duration have occurred during the night. 
 
 Half past 8. Countenance very heavy and dull; scarcely any answer given to questions; 
 right side of face and arm partially paralyzed, but can feel somewhat when pinched ; 
 bowels not open. Continue the Hydr. c. Greta. 
 
 Half-past 7 p. M. Has had several fits, but not of great length, nor severe ; countenance 
 much the same; answers slowly, but rationally. Bowels relieved; motions loose and green ; 
 pulse 80. Continue the Hydr. c. Greta. Empl. Lytta? to chest. Acet. Lyttae et Ungt. Hy- 
 drarg. ad eundem. 
 
 16th. Not so conscious, nor so well in other respects; pulse 80. Continue treatment. 
 
 17th. Very drowsy; has frequent fits, some of longer duration than before; countenance 
 heavy and bad; pulse 140; cannot get him to take food; is not aware when it is offered 
 him. 
 
 18th. Much worse; countenance continues anxious; can scarcely answer any question; 
 pulse 156, small. Says he wants his breakfast; always expressing a feeling of hunger. 
 Convulsions occur very frequently. 
 
 19th. Countenance more anxious. Says he is better, and that the pain in the head is 
 less ; has greater difficulty in speaking, and is certainly worse. Continue Mercury. 
 
EPILEPSY. 423 
 
 20th. Appears much the same; says he feels better; pupils both act to light; the right 
 arm is paralyzed, but not the leg; the convulsions continue. 
 
 21st. Convulsions not so frequent in occurrence, but continue fora greater length of time, 
 and are more violent; he is not so drowsy; his countenance has improved, and he says there 
 is less pain in the head; pulse 130; bowels open. Continue treatment. 
 
 22d. The convulsions continue very violent, but occur less frequently even than yester- 
 day ; his countenance has much improved ; pupils act; pulse 120; bowels open. Says he 
 is better, but complains of his head. 
 
 23d. There is little alteration as regards the frequency and violence of the convulsions. 
 He has the power of moving his arm, which was paralyzed on Wednesday ; countenance 
 continues good ; pulse 120 ; bowels open ; mouth beginning to get a little tender. Continue 
 treatment. 
 
 24th. Has had no fit since last night ; appears much relieved ; the pain in the head 
 diminished; countenance good; bowels open; tongue cleaning; pulse 112; complains of 
 his gums. Continue treatment. Apply cold lotion to head. 
 
 25th. Mouth sore ; continues free from fits ; complains less of pain in the head ; has 
 quite recovered the power of his arm; pulse 108; bowels open ; appetite good.. Continue 
 the pills night and morning, instead of every sixth hour. Discontinue the application of the 
 ointment. 
 
 26th. Has passed a good night; no recurrence of the fits; pain in the head slight, 
 and confined to the frontal region ; bowels open; pulse 108. 
 
 27th. Says he is better; has but little pain in the head; tongue cleaning; pulse 112; 
 bowels confined. Ordered Comp d> Colocynth pill, gr. x., to be repeated, if necessary. His 
 bowels were relieved before the Colocynth was given, therefore no purgative required. 
 
 28th. Is progressing favorably. 
 
 June 3d. His gums are still tender, and he is generally much better. Ordered Hydr. c. 
 Creta every other night, instead of night and morning. 
 
 7th. Is much improved ; has no pain in the head, or elsewhere ; bowels regular ; tongue 
 clean ; appetite good ; pulse 90. 
 
 13th. Appears and describes himself as feeling quite well; is rapidly gaining strength. 
 To discontinue the pills altogether. 
 
 This lad recovered perfectly. 
 
 Epilepsy. E^a^ij, from Ertaappdvu, "to invade, attack, oppress." 
 Of all the various ills that flesh is heir to, this is the most distressing to 
 witness. It is no wonder that, in ancient times, the poor afflicted mor- 
 tals who suffered from its influence were supposed to be possessed of a 
 devil. For there is no doubt that the Demoniacs of Scripture were 
 epileptic patients. 
 
 As soon as medicine was cultivated as a science, epilepsy was treated 
 as a disease, and recorded by medical writers. 
 
 Hippocrates described it under the title of Morbus sacer, and scouted 
 the idea of demoniacal possession; and we learn from the able translator 
 of the works of Paulus ^Egineta, (Mr. Adams,) that Galen, Oribasius, 
 ^Etius, Aretasus, Pseudo-Dioscorides, Alexander Leo, and a host of 
 others, including Rhases, have devoted their attention to the complaint. 
 Dr. Copland, whose learned article on this subject ought to be perused 
 by every member of the profession, says, that by none has it been no- 
 ticed so fully and accurately as by AretaBus. 
 
 The outward signs of the disease, when fully developed, consist in 
 the occurrence of convulsive fits, so striking, so frightful, and so peculiar, 
 that, when once seen, they can never be mistaken, either by physician 
 or layman, for any other disease. I say when fully developed, because, 
 as a general rule, the fits do not attain their characteristic peculiarities 
 all at once. The disease is usually progressive. In a practical point of 
 view this is most important. For the time to combat the disease with 
 most chance of victory, is, as in apoplexy, during the occurrence of the 
 premonitory symptoms, when the disease is only in embryo. 
 
424 
 
 HUMAN BRAIN. 
 
 The following is the usual order of phenomena which constitute an 
 epileptic Jit. The patient may be sitting at the dinner-table, or in a gig, 
 or anywhere, in the apparent enjoyment of perfect health, and his face 
 will become suddenly flushed, there will be a slight convulsive action of 
 the lips, and then a scream, more unearthly and horrible than any sound 
 uttered by living creature. The railway whistle makes some approach 
 to it. The whole body now becomes convulsed, and the patient, if sit- 
 ting, is generally thrown from his seat by the convulsive action of the 
 flexor muscles, and he falls forwards. If he is standing, he generally 
 falls in the same way. Sometimes, it is true, there is a short, slight 
 warning, which enables him to lay himself on the ground, and save the 
 violent concussion of the face. 
 
 By the convulsive paroxysm, the jaws are fixed, and in the sudden- 
 ness of their closure, the tongue is usually severely bitten. The ex- 
 pression of suffering is agonizing. Bloody, frothy saliva issues from the 
 month. The head is drawn down upon the chest, the body curved for- 
 wards, the thighs flexed upon the pelvis, the hands violently clenched. 
 The convulsions are usually more on one side than the other, and the 
 same side always affected. The countenance is livid and distorted. In 
 the neck the carotid arteries may be seen distended, and pulsating vio- 
 lently. The seminal fluid is generally ejected during the paroxysms by 
 the violent convulsive action of the ejaculator muscles. Gradually the 
 muscles relax, the eyes open bloodshot, and are turned upwards with 
 the ghastly expression of death. The breathing is slow, gasping and 
 stertorous, and the poor sufferer presents all the appearance of one about 
 to quit this earthly scene. In a few minutes more the countenance be- 
 comes natural, and the breathing gradually less stertorous, and now, if 
 he is undisturbed, he will fall into a deep and tranquil sleep, from which 
 he wakes in about half an hour, or an hour, wholly unconscious, until 
 some minor circumstance acquaints him with the fact that he has passed 
 through this fearful ordeal. 
 
 The consequences of the severer paroxysms vary very much. In 
 some cases, the patient opens his eyes a few minutes after the attack, 
 and looks about him as if nothing had happened, but generally there is 
 complete coma. If the fits come very close together, and in any number, 
 the coma will last some time for days, and even a week. 
 
 Sometimes it is succeeded by complete mania. I was consulted, a 
 few days ago, by a gentleman, who told me he was always raving mad 
 for a few days after a series of fits. The effect of the fits depends a 
 good deal, also, on whether the patient is kept quiet or not. If he is 
 disturbed or annoyed by seeing strange faces around him, he is generally 
 much worse. On one occasion I saw a gentleman who usually had 
 only five or six fits at a time, and these spread over a period of a week, 
 with intervals of six weeks or a fortnight ; but on this occasion he had 
 twenty-four in forty-eight hours, occurring regularly every two hours, 
 almost to a minute. The unusual number appeared to have been pro- 
 duced by mental excitement, for after the first fit he wanted to get up, 
 and leave the house, which was new to him, and the servants prevented 
 him; this rendered him very violent, and as he was a strong, powerful 
 man, a great deal of force was used to restrain him. After this long 
 
EPILEPSY. 425 
 
 series of attacks, he was insensible for four days, and did not entirely 
 recover his intellect for more than a fortnight. 
 
 Such, then, are the general features of a true and complete epileptic 
 paroxysm, or fit. The disease does not always exhibit itself in pre- 
 cisely this form ; there are many modifications of it, particularly in its 
 commencement. It is very necessary to be aware of these varieties, 
 especially as their serious nature is sometimes overlooked, until a true 
 epileptic fit occurs, which draws a veil from the disease, painfully ex- 
 posing its hideous form to the horror-stricken friends and astonished 
 medical adviser. 
 
 The milder attacks, or half-attacks, as many patients call them, also 
 vary in their intensity. Sometimes there is a momentary unconscious- 
 ness : if the patient is walking, he will stop suddenly, and gaze for a 
 few seconds quite vacantly, or he will turn round and look on the ground, 
 as if he were looking for something that he had lost. See Case 79. 
 
 Patients are generally aware of having had these attacks, and they 
 will tell you how many they have had in the day. 
 
 These half-attacks are sometimes more severe the petit mal, as it 
 is called by the French. There may be a slight convulsive movement 
 of the face or lips, and the state of unconsciousness last longer. 
 
 In one case, they used always to prove the finale of the series of fits, 
 and until the half-attack came, the patient and his friends felt insecure 
 as to the occurrence of more fits. 
 
 It is curious that sometimes these half-attacks derange the intellect 
 more than the complete attack. It was decidedly so in the last case 
 referred to. 
 
 Foville observed that the petit mal was attended with more disturb- 
 ance of the intellect than the complete attacks. 
 
 Warnings. These vary considerably, both as regards the disease 
 generally, and individuals in particular. Some patients that I know have 
 a warning at night, and not in the day. Others say that they used to 
 have a warning when the disease first came on, but that they do Jiot now ; 
 some have headaches, and feel fullness of the head; others experience a 
 most disagreeable odor for a day or two ; others, again, are particularly 
 well, cheerful, and clear-headed. One boy is always excessively mis- 
 chievous and high-spirited just previous to an attack, and his thumbs 
 are drawn into the palm of his hand, as in children affected with crow- 
 ing convulsions. This-turning in of the thumbs is a very common sign 
 of the approach of the attack. Some patients are always found lying 
 on their tace a night or two previous to an attack. In many cases there 
 is sufficient warning to enable the patient to lie down, if walking in the 
 road, on a bank, out of danger, and place a handkerchief in the mouth, 
 to prevent the tongue being bitten. Sometimes patients will attempt to 
 speak, to call the attention of a friend, but they can seldom articulate 
 distinctly. One patient has always convulsive catchings or twitchings 
 in the right leg for a night or two previous to the fits. I have others who 
 always have a violent pain in the stomach previous to an attack. An- 
 other, who says she always knows when an attack is coming on by every- 
 thing looking different; she cannot define the appearance, though she 
 says she has often attempted. One gentleman I knew had sufficient 
 
426 HUMAN BRAIN. 
 
 warning, which was a singing in the ears, to enable him to get off his 
 horse. On one occasion, he did so in Shoreditch, and reached a shop 
 before he fell. I have a young lady under ray care, in whom the fit has 
 more than once been averted by pinching the nose, and sometimes she 
 has sufficient warning to cry out, "My nose, ray nose." 
 
 The most curious warning is the aura epileptica ; this term is applied 
 to designate a sensation which originates in one of the extremities, and 
 passes upwards, in the course of a nerve, to the head. It precedes the 
 fit, and patients who have experienced it say, that they feel it distinctly 
 until it reaches the head, and then they lose all consciousness. They 
 sometimes describe it as a cold, sometimes as a warm, feeling, but 
 always as a creeping sensation like " pins and needles." It is not com- 
 mon ; out of between forty and fifty cases of epilepsy that I have seen, 
 I have only met with it once. 
 
 Sir Astley Cooper used to relate, in his lectures, a curious instance in 
 which he cured a case of epilepsy by the removal of a portion of the ra- 
 dial nerve. He said, u A man was sent to me, by a surgeon of Wat- 
 ford, having this disease; he would occasionally be seized by a severe 
 pain in the thumb, which gradually extended up the arm, in the course 
 of the radial and brachial nerves, through the axilla to the neck ; his 
 head would then become twisted, and in a moment he would drop on 
 the floor in a fit ; shortly afterwards he would get up, and appear as well 
 as ever. I cut down upon the radial nerve by the side of the flexor 
 carpi radialis longus, exposed about an inch, and removed five-eighths 
 of it. After this the pain entirely left him, and he returned to Watford, 
 where he remained completely cured." 
 
 Sauvages is of opinion, that the sensation has its origin in the brain, 
 though it is referred to the limb, just as a man who has lost his limb 
 still thinks he feels his toes. 
 
 There is no period of life at which these fits have not been known to 
 occur ; they are not frequent in infancy., or in extreme old age ; but I 
 once knew an old gentleman who was attacked at the age of eighty, and, 
 recovering from them, lived to above ninety, in good health, and in per- 
 fect possession of his faculties. 
 
 The convulsions which attend dentition in infancy have been classed 
 by some authors with epilepsy ; but I think it very doubtful whether 
 they depend" on the same pathological condition ; and at any rate a 
 medical man who thus designated such fits would give a great deal of 
 unnecessary pain in a family. But whatever the immediate cause of 
 the convulsions may be, they depend on a very different state of health 
 generally. They require a very different line of treatment. The cause 
 is one which is acting without intermission. It is more decidedly in- 
 flammatory, and the antiphlogistic measures which will permanently re- 
 move the convulsions of infancy, would, in true epilepsy, render the 
 patient more liable to a recurrence. 
 
 Georget* considers the disease more frequent among women than 
 among men ; but this does not accord with my own experience. 
 
 Many of the higher animals are subject to epilepsy ; for instance, the 
 
 * Dict.de Medecine, 21 vols., tome viii. 1823, p. 207. 
 
EPILEPSY. 
 
 dog, cow, horse and pig. The fits that puppies are subject to are true 
 epileptic fits. 
 
 Georget,* though he does not deny the possibility of sympathetic epi- 
 lepsy, says he has never seen such a case; he avows frankly that he 
 knows nothing of the nature of epilepsy. 
 
 Post-mortem examinations have failed to show that epilepsy is depend- 
 ent on any single morbid condition of either the membranes or the brain. 
 
 In most instances, where the disease has existed some time, some 
 morbid alterations have been discovered after death, which may be di- 
 vided into two classes those which would act as irritants to the brain, 
 such as osseous deposits on the dura mater, and those which there is 
 more reason to believe have been occasioned by the paroxysms, than that 
 they are the cause of them, such as thickening of the membranes, &c. 
 
 Esquirol says,f " Of all these researches, particularly of those of 
 Bonet, Morgagni, Baillie, Greding, Meckel, Sprengel, what are we to 
 consider? Nothing. Wepfer and Lorry have drawn this sad conclu- 
 sion. Let us avow frankly that pathological anatomy has at present 
 shed but little light on the immediate seat of epilepsy. However, we 
 must not be discouraged ; nature will not always be so rebellious to the 
 efforts of her investigators." 
 
 In many cases bony deposits have been found on the dura mater, and 
 in some instances even a spiculum of bone has been found projecting 
 from the internal table of the skull. But such morbid growths cannot 
 be considered the proximate cause, as these are always there, whereas 
 the fits come in paroxysms, and leave the patient in the interval quite 
 well. 
 
 I quite agree with Dr. Watson when he says, " Dr. Marshall Hall's 
 doctrine, that all convulsive diseases of the spinal marrow cannot be 
 properly applied to this convulsive disease of epilepsy." It is very clear 
 that the brain is always more or less affected in epilepsy ; and the milder 
 forms, where there is interruption to the mental operations, but without 
 any convulsion, affords a strong argument in favor of this opinion. All 
 that Dr. Hall has written is worthy of attention ; but the more I have 
 seen of epilepsy, the more I am convinced that the brain, and not the 
 spinal cord, is primarily affected. 
 
 Dr. Marshall Hall divides epilepsy into two forms,]: " Centric con- 
 vulsions, or epilepsy," and " Centripetal epilepsy." Both forms he 
 considers true spinal, not cerebral, diseases; but I will quote his exact 
 words, that I may not misinterpret his meaning, and thus unintention- 
 ally do injustice to this able physiologist. 
 
 " Jlny disease within the cranium or spine, whether effusion, tumor, 
 exostosis, &c., may induce convulsions or epilepsy. 
 
 " Fright, or other sudden mental emotion, has induced convulsion, 
 and this convulsion has been repeated, affording one of the most de- 
 plorable cases of epilepsy. I have already suggested, indeed, that all 
 convulsive diseases are affections of the true spinal marrow (I refer my 
 readers to previous observations). 
 
 * P. 214. ' -J- Des Maladies du Cerveau, tome i. p. 313, 1838. 
 
 J Page 319, op. cit 
 
428 HUMAN BRAIN. 
 
 " The cerebrum is obviously the seat of the mind ; it is neither sen- 
 tient itself, nor the originator of motions in itself. The true spinal 
 marrow, on the contrary, is the term of certain excitements and the com- 
 biner of certain motions the centre, in a word, of a peculiar series of 
 excito-motory phenomena, physiological and pathological. Unlike the 
 cerebrum, it induces, if stimulated, convulsive movements in the organs 
 appropriated to ingestion and egestion, and in the limbs. 
 
 " Diseases within the cranium, by irritating excitor nerves, or the 
 medulla oblongata, induce convulsions or epilepsy, too frequently, alas, 
 of an incurable kind. Disease within the spinal canal may prove the 
 source of convulsion or epilepsy still more immediately. This form of 
 epilepsy is, also, for the most part, incurable. These cases are, for ob- 
 vious reasons, frequently met with in hospitals, asylums, and work- 
 houses. Hence the idea that epilepsy is not to be subdued by medi- 
 cine, prevalent amongst those who draw their conclusions from obser- 
 vations made in these establishments.'" 1 
 
 Epilepsy induced by external causes, not internal disease, he denomi- 
 nates Centripetal epilepsy. 
 
 u This form of epilepsy takes its origin in the excitor nerves of the 
 true spinal system, involving the axis of this system and its motor nerves 
 in their turn ; functionally, not organically. It is for this reason that I 
 have denominated this form of epilepsy centripetal. This form of epi- 
 lepsy is to be viewed as curable, however difficult of cure. By avoiding 
 the exciting causes, its attacks are avoided ; the susceptibility to returns 
 subsides; these returns become less frequent and less severe, and, at 
 length, frequently cease altogether. Everything depends upon rigid 
 rules proposed by the physician, and most strictly and perseveringly ob- 
 served by the patient. 
 
 " In describing the causes, symptoms and treatment of centripetal 
 epilepsy, I must refer to all that I have said respecting the anatomy and 
 physiology of the true spinal system. Every part of this system is dis- 
 tinctly but exclusively involved in the circumstances of the disease ; if 
 the encephalon suffers, it is only as an effect of the convulsive attacks."! 
 
 He then proceeds to speak of the causes, detailing, 1, "the presence 
 of indigestible food in the stomach; 2, the presence of morbid matters 
 in the intestines; 3, uterine irritation. The first of these acts through 
 the medium of the pneumogastric, the second and third through the 
 true spinal system." 
 
 The following facts illustrate many points in the history of this curious 
 disease, which are of importance and interest to the practitioner. The 
 mother of the patient was a particularly intelligent woman for her sta- 
 tion in life, and always gave me a very clear account of her daughter's 
 illness. She was a pale, delicate looking girl, intelligent, nervous, and 
 excitable ; has suffered from epilepsy for some years. She was a seven- 
 months child, born in 1829, very small and feeble ; she was unable to 
 walk by herself till she was two years old, though at that time her arti- 
 culation was perfectly distinct, and she had abundant power of express- 
 ing herself. Her excitability was so great, that any over-amusement or 
 
 .Mi! ,l * 
 * Page 319. t P. 322, op. cit 
 
EPILEPSY. 429 
 
 emotion produced sleeplessness. This, after the first difficulties were 
 overcome, was the great enemy the parents had to contend with. At 
 the age of sixteen months something like a dizziness, quite momentary, 
 appeared. The eye became fixed, with a quick vibration of the head, 
 and a tendency to fall forward, so that at that time if she could have 
 been unsupported she must have overbalanced herself. This, which 
 was for some time only apparent to the mother, increased in degree and 
 duration so much that, at the age of three years, when she was a very 
 lively, talkative child, it became evident to all, for in the midst of her 
 prattle she would frequently stop short, the head would nod forward 
 several times, and sometimes she would fall. The lapse in conscious- 
 ness was so complete that, though she always recovered herself in a 
 minute with a deep sigh, she never regained the thread of her story, but 
 passed to something else, having forgotten it. These little effects were 
 considerably augmented by emotion, fatigue, or excitement; and this 
 appeared to be the first stage of the complaint. 
 
 The second stage arose when she was five years old. The nodding 
 had much increased lately, and now came on what the parents called the 
 seizures, which were an odd state of semi-consciousness, with a great 
 deal of spasmodic motion of the body, inability to direct the eyes to any 
 particular object, or even to fix both on the same thing; a rambling con- 
 versation, with a hesitating, tremulous voice, accompanied with many 
 ocular delusions. This state, w 7 hich came on every few 7 days on first 
 waking, generally lasted about half an hour, though sometimes through 
 the day, and often ended without any fit or crisis. In the second year 
 it assumed a periodical character, returning on the third, and then on 
 the fifth morning. At these times water was passed unconsciously, and 
 the bowels generally moved, before she could give warning. No notice 
 was ever taken to her of these attacks, and great attention was paid to 
 remove from her objects of excitement, and to keep her brain in repose, 
 and so we come to the third stage. 
 
 At the age of seven, the nurserymaid, who was dressing her, sud- 
 denly fell back in a strong epileptic fit, which it was impossible to con- 
 ceal from the child, who appeared deeply affected by it, and on the 
 following morning (which was the day for the seizure) having continued 
 the usual time in her semi-conscious state, instead of recovering from it, 
 she stretched herself, and went off into a fit of the ordinary epileptic 
 character. These fits have now continued for nearly nine years, being 
 always ushered in by the semi-conscious spasmodic state on first waking. 
 Most of the usual remedies employed in cases of epilepsy have been 
 tried, such as Valerian, Copper, Indigo, Musk, and Oil of Turpentine, 
 all with some good effect for a time ; Indigo and Oil of Turpentine with 
 great success, particularly the latter, till she became quite accustomed 
 to it, when its efficacy gradually wore away. The symptoms which in- 
 dicate the fit generally appear on the preceding day, consisting chiefly 
 of a rapid quivering of the eyelids, nodding of the head, with lapse in 
 conversation, sometimes pain in the forehead ; but if this last increases 
 to a real headache, so as to end in sleep or in vomiting, the next day's 
 fit is generally averted for three or four days at least, sometimes for a 
 longer period ; she has, in consequence, frequently had given her an 
 
430 HUMAN BRAIN. 
 
 emetic under these threatening signs, and with success. Four or five 
 weeks may perhaps be considered as a fair average duration for the in- 
 terval between the fits ; towards the latter part of that time the irritation 
 has been very visibly accumulating, though often disappointed, as it were, 
 by the emetic or blister behind the ear, till it has become uncontrollable, 
 and has ended in a fit. The fit leaves no cloud on the mind, but a great 
 languor of body for one or two days, after which all nervous suscepti- 
 bility seems^uite gone. For a week, at least, all vibration of the eye- 
 lids is quite suspended, and the mind appears to be perfectly calm and 
 free from excitation. On eight different occasions she has lain in con- 
 vulsions for three hours. These attacks have not begun like the common 
 fit, which is with a scream, and struggle to turn on the face ; they have 
 generally set in with strong movement in one arm, which is lifted above 
 the head ; they have been preceded by the usual semi-conscious state, 
 and, during the last half hour before the convulsion began, by an appa- 
 rent insensibility, when the saliva has bubbled from the mouth, and the 
 hearing has seemed quite gone. During the whole time that these con- 
 vulsions have lasted, the heart has beat violently, the face has been suf- 
 fused with red, and the lips purple ; during the three hours the convulsive 
 agitation has been incessant, growing fainter, till the poor child has at 
 last sunk exhausted to sleep, but not till the struggle for breath and the 
 apparent thread of suffocation were frightful to see. She has had no 
 such severe attack for four years. 
 
 On eight other occasions she has lain in the semi-conscious state 
 through two successive days; sometimes the fit has closed it, and some- 
 times natural sleep. It is also a long time since she has had an affection 
 of this kind. 
 
 The pulse always increases steadily in frequency from its ordinary 
 rate, about 70 in the minute, up to 90 or a 100, previous to the attack 
 occurring. I ordered the digitalis in this case with apparently some 
 benefit, but I have since lost sight of the case. 
 
 In the treatment of all disease, we ought to have some distinct idea of 
 the pathological condition on which it depends. In many diseases it is 
 extremely difficult to come to any satisfactory conclusion, but still it is 
 our duty to attempt it. Before we consider the treatment of this disease, 
 I will theorize a little on its pathology. In detailing the following 
 theory, I am too well aware that it does not deserve a higher title than 
 a theory; I do not pretend that it has originated with me, though I know 
 not on whom to father it. 
 
 The first morbid action is a sudden determination of blood to the 
 brain, which expends itself, in the secretion of that nervous power which, 
 in a state of health, is employed by the brain to convey volition to the 
 muscles, and which power is, I have no doubt, identical with electricity. 
 This excessive secretion is carried off by the motor nerves, like a dis- 
 charge from an electric battery, and. from its quantity and excess, pro- 
 duces excessive action of the muscles. It is another illustration of a 
 law that vre had occasion to decide upon already, namely, that the first 
 effect of arterial excitement in every secreting organ is to excite to an 
 unnatural degree the natural function of the organ. We know that 
 mental emotion will cause a sudden determination of blood to other 
 
EPILEPSY. 431 
 
 organs, which, according to the nature of the part, will be followed or 
 not by secretion. 
 
 Blushing and erection of the penis are instances of sudden determina- 
 tion of blood to a particular part. And the lachrymal glands, salivary 
 glands, testicles, prostate gland, gastric glands, and even the kidneys, 
 often pour fourth their secretions so abundantly and so suddenly that the 
 formative fluid, the blood, must have circulated through their capillaries 
 in greater quantity and with greater rapidity than when the glands were 
 at rest, and their secretions suspended. I think that the periodic attacks 
 of mania, with which many of the insane are afflicted, may be regarded 
 in this light. 
 
 Since writing the above, I have met with the following observations 
 of that excellent physician, Dr. Alison, which I am delighted to quote in 
 support of my views, though it may deprive me of any credit of originality.* 
 
 11 There are hardly any chronic local diseases in which local determina- 
 tions and congestions of blood do not occur; and we are not sufficiently 
 informed of the cases in which such irregularity in the distribution of the 
 blood may be regarded as the primary or fundamental morbid change. 
 Probably these cases are in reality few, but it is important briefly to 
 enumerate the principal diseased states in which morbid determinations 
 of blood certainly occur, and in a great measure determine their extent 
 and intensity, and injurious results. Thus, very various derangements 
 of the functions of the nervous system, headaches, giddiness, transient 
 imperfections of sense, or of memory, fits of epilepsy, of hysteria, or 
 other spasms, even of mania, in those predisposed to these diseases. 
 Some cases of transient paralytic affections, and many of apoplexy, ap- 
 pear to result from simply increased afflux of blood to the brain, without 
 rupture of its vessels, disorganization of its texture, or even increased 
 effusion of its serous fluid." 
 
 The vessels, which are especially the seat of this morbid action, I 
 suspect, are those of the choroid plexus, and one of the layers of the 
 cortical substance. The choroid plexus is frequently found hypertro- 
 phied in the brain of epileptics, assuming an almost fleshy appearance. 
 This hypertrophy would, very probably, be the effect of repeated action. 
 It is also the seat of small tumors, generally like hydatids. 
 
 The expression " determination of blood to the head" is often made 
 use of, but without any explanation of the manner in which this takes 
 place. I doubt whether the profession generally have any distinct idea 
 as to the exact condition of the vascular system which produces it. I 
 would venture to offer the following theory, the first idea of which I 
 certainly derived many years ago from that most truly philosophical work, 
 the Elements of Physics, of Dr. Arnott. It applies not merely to the 
 head, but everywhere else. The middle or muscular coat of the arteries 
 in a state of health, contracts with each systole of the ventricles just 
 sufficiently to give a solidity to the wall of the pipe, so that the force of 
 the contraction is not lost on a yielding surface. A much greater force 
 is required to drive water through a leather hose than through a leaden 
 tube. The middle coat contracts just sufficient to assimilate the artery 
 
 Alison's Pathol., p. 554, op. cit 
 
432 HUMAN BRAIN. 
 
 physically and temporally to the leaden tube. Arteries with permanently 
 rigid walls, like leaden tubes, would have interfered by their rigidity 
 with the motions of the limbs; and hence this beautiful contrivance. 
 When this middle coat does not contract, or only contracts imperfectly, 
 then the force of the heart dilates the tubes, and produces congestion. 
 
 I believe, then, that determination of blood to the head arises simply 
 from deficient contraction of the muscular coat of the capillaries of the 
 brain, preceded by excitement of the heart's action. 
 
 The throbbing of the carotid arteries may be considered as corrobora- 
 tive evidence in favor of this opinion. The throbbing cannot arise from 
 action of the vessel ; it is the action of the heart felt strongly, and seen 
 distinctly, because the tube yields to the impulse of the left ventricle, 
 instead of resisting it, like a solid leaden pipe. If the throbbing arose 
 from the action of the artery, it would not be synchronous with the heart, 
 which it is. It is the same yielding of the coat of the capillaries in an 
 inflamed limb which gives rise to the throbbing sensation, which all of 
 us have felt in some small spot or another. 
 
 I think it not at all improbable that the reason why these capillaries 
 of the brain thus suddenly and unnaturally neglect to perform their duty, 
 is some defective innervation from the sympathetic nerves, whose office 
 I hold to be the regulation of the coat of the arteries, so as to produce 
 secretions, &c. ; and so for, I can see much probability in the opinion 
 of the Wenzels, that the pituitary gland is in fault in epilepsy believ- 
 ing, as I do, with Dr. Copland, that this gland is the cerebral ganglion 
 of this nervous system. 
 
 The following are Dr. Copland's words in reference to apoplexy :* 
 " Upon tracing the relation subsisting between the various causes of the 
 disease, the symptoms, and the appearances on dissection upon remark- 
 ing as far as my own observation has gone, the frequency of change in 
 the pineal and pituitary glands of apoplectic patients I am induced to 
 infer that functional lesion, or organic change, often commences in that 
 portion of the ganglial system which supplies the encephalon and its 
 blood-vessels ; and that, owing to exhaustion of its influence, the capil- 
 laries lose their vital tone, have their circulating functions impaired, 
 become more or less dilated, and are disposed to rupture." 
 
 The invaluable researches of Dr. Burrows have shown that the ves- 
 sels of the brain may contain^a larger quantity of blood at one time than 
 another, just as the vessels in any other part of the body may be so af- 
 fected. 
 
 Dr. Bright says,f " There is no organ of the body liable to such rapid, 
 violent, or frequent changes in the state of its circulation, as the brain ; 
 and while the excitement to which other organs are exposed is in some 
 degree limited, those which act on the brain seem to be almost unlimit- 
 ed, augmenting with every increase of luxury and civilization." " It 
 is impossible for us not to feel admiration at the wonderful power of 
 resistance by which the brain is daily preserved from disorganization, 
 when we consider the intensity of mental application to which it is ex- 
 posed, the violence of internal strife by which it is agitated, the heed- 
 
 * Diet., vol. i. p. 97. t Op. t> p. 653. 
 
EPILEPSY. 433 
 
 less stimulation to which its vessels are subjected, and the rapid vicis- 
 situdes of temperature, and the severe and neglected external injuries 
 to which it is liable." 
 
 There are many circumstances attending organic disease of the brain, 
 which I think can only be accounted for on the supposition that the 
 quantity of blood in the brain varies very much at different times. One 
 of the most striking of these is the remission of pain, and accession 
 being produced by anything that would tend to accelerate the circu- 
 lation. In the following quotation from Dr. Abercrombie, I have put 
 in italics those phenomena which appear to me to support this view of 
 the subject.* 
 
 " The pain is in some cases acute and lancinating, in others obtuse ; and 
 it is sometimes referred to a particular spot, as the crown of the head 
 or the occiput. In many cases it is accompanied by a violent throbbing, 
 and this also may be general, or it may be referred to a particular part 
 of the head, as the occiput, or one temple. In the more violent parox- 
 ysms the pain is intense, obliging the patient to remain for a considerable 
 time in one position, the slightest motion aggravating it to perfect tor- 
 ture; but the remissions from this severe suffering are often so remark- 
 able as to lead a superficial observer into the belief that it is merely 
 periodical headache, or headache connected with dyspepsia. This lat- 
 ter supposition is also countenanced by the stomach being frequently 
 much disordered, and by the more violent attacks being often accom- 
 panied by vomiting. The diagnosis, indeed, is sometimes difficult, 
 but, by attention, it will be found that the duration and violence of the 
 pain must lead to a suspicion that the complaint is something more than 
 common headache, and that though the stomach is at times disordered, 
 yet that the headache is often most severe when no disorder exists in 
 the stomach that can account for it. The patient generally cannot bear 
 a warm room, the noise of company, or even the exertion of cheerful con- 
 versation, without becoming distressed and his headache increased; and 
 the same effects are produced by wine and bodily exertion. He seeks quiet- 
 ness, coolness, and darkness; and in these respects the disease differs re- 
 markably from dyspeptic headache, which is commonly dissipated by ex- 
 ercise and cheerful company. Sometimes the paroxysms are accompa- 
 nied by vomiting, and sometimes by violent throbbing in the head" 
 
 Most authors who have written on epilepsy agree in stating that the 
 brain is in a state of congestion during the fit. 
 
 Esquirol says,f " Sanguineous plethora has been admitted by all authors 
 as a cause of essential epilepsy." Foville states that the brain of patients 
 who have died in the fit is always found congested ; but he attributes it 
 to the mode of death, which he considers from suffocation ; and that the 
 same appearances are found in persons who have died by hanging; that 
 they are not peculiar to epilepsy ; and that they do not explain the attack, 
 but only point out the way in which it has been fatal. Upon this Dr. 
 Watson remarks,! " It is, I fancy, a very common notion, both that such 
 congestion does take place, and that it is the cause of the paroxysm." 
 
 * Abercrombie, op. cit., p. 317. f Op. cit., tome i. p. 307, 1838. 
 
 J Lectures, 2d edit., 1845, vol. i. p. 617. 
 
 28 
 
434 HUMAN BRAIN. 
 
 Dr. Watson does not agree in this view, and for the following reason : 
 " In the first place, it is not easy to conceive that the congestion could 
 so suddenly arise and subside again, as it must sometimes do, if it be the 
 immediate determining cause of the fit, within the space of a single 
 minute, for example. In the second place, the signs of external con- 
 gestion and plethora, by which signs we measure the amount of the 
 internal or most marked, just when the symptoms of the paroxysm begin 
 to subside and disappear, so that we cannot look on the congestion as a 
 cause of the convulsive symptoms." In answer to the first, I would 
 suggest that, as it is not owing to venous congestion, but to arterial, it is 
 quite possible that this should subside suddenly, supposing the blood to 
 be employed in the arterial capillaries in the secretion of the power 
 (whether the electric fluid or not) which is suddenly discharged by the 
 nerves into the muscles; and in regard to the second, I think that the 
 congested state of the venous system, after the convulsive explosion has 
 taken place, can only be caused by the flow of blood from the arterial or 
 secerning system. Dr. Holland considers this condition of the arteries, 
 which I believe to be the immediate cause of determinations of blood, 
 dependent on nervous influence. He says, " I find among my notes 
 many instances of partial change in the arterial circulation ; some in which 
 the effect was manifest even in the larger arteries, leading to a part under 
 this influence." 5 "An example has recently occurred to me of slight 
 hemiplegia evidently connected with cerebral disease, where the beat 
 of the arteries on one side of the head was wholly different in character 
 from that on the other, as shown even in the carotid itself; and similar 
 differences probably exist in many cases of this nature. The strong 
 beatings which sometimes occur in the course of particular arteries are 
 well known ; and though we may hesitate to describe them, with Laen- 
 nec, as neuralgic spasms of the artery, yet it is difficult to attribute them 
 to any other than nervous influence, of some kind, on the coats of the 
 vessels so affected."! 
 
 With regard to the cause of epilepsy, Dr. Copland thus expresses 
 himself :J 
 
 " That in the simple and early disease it is not dependent upon any 
 lesion cognizable by our unassisted senses, unless such lesion be seated 
 in the medulla oblongata or pituitary and pineal glands parts not yet suffi- 
 ciently examined in this malady, and which may be dangerously affected, 
 without manifesting any material change. That the appearances found 
 in old or complicated cases are to be referred rather to the repeated de- 
 rangements the circulation of the brain has suffered in the paroxysm, and 
 to the nature of the associated disease, than to the lesions detected in 
 fatal cases; such lesions, however, when induced in the course of other 
 disorders, being occasionally exciting or concurrent causes of the epi- 
 leptic attacks. That general congestion of the encephalic vessels evi- 
 dently exists in the second or convulsive stage of the fit ; but it is not 
 so manifest that this state is present from the commencement of the 
 seizure, as cases have presented, at this period, symptoms of a very op- 
 posite condition. This congestion is only a passing phenomenon, evi- 
 
 
 
 * Med. Notes and Reflec., 533. f P- ciL > P- 54 - t Med - Dict - P- 797 - 
 
 ' 
 
EPILEPSY. 435 
 
 dently caused by interruption to the respiratory actions, impeded circu- 
 lation through the heart, and to the spasmodic action of the muscular 
 system, and is not the cause of the seizure ; the principal phenomena 
 of the fit even ceasing at the very moment when the congestion is at its 
 height. The paroxysms of epilepsy cannot, therefore, be imputed to the 
 congestion, which is evidently an advanced or consecutive phenomenon 
 produced as now stated, but must be referred to the parts on which sen- 
 sibility depends, and which actuate the respiratory and muscular organs." 
 
 "Congestions of blood do not occur; and we are not sufficiently in- 
 formed of the cases in which such irregularity in the distribution of the 
 blood may be regarded as the primary or fundamental morbid change. 
 Probably these cases are in reality few, but it is important briefly to 
 enumerate the principal diseased states in which morbid determinations 
 of blood certainly occur, and in a great measure determine their extent 
 and intensity and injurious results. Thus very various derangements of 
 the functions of the nervous system, headaches, giddiness, transient im- 
 perfections of sense or of memory, fits of epilepsy, of hysteria or other 
 spasms, even of mania, in those predisposed to these diseases, some 
 cases of transient paralytic affections, and many of apoplexy, appear to 
 result from simply increased afflux of blood to the brain, without rupture 
 of its vessels, disorganization of its texture, or even increased effusion of 
 its serous fluid." 
 
 My own observations do not accord with Dr. Copland, in so far as I 
 have always witnessed a flushing of the face previous to convulsive 
 paroxysm, previous, as I believe, to the discharge of the electric fluid 
 in those epileptics who were full blooded and plethoric. In the very 
 feeble and asthenic, I suppose that the surplus quantity of blood has not 
 been sufficient to overcharge the brain and flush the cheeks at the same 
 moment. 
 
 The amazing benefit which I have seen derived from the use of digi- 
 talis, as described under the head of " Treatment," is strongly corrobo- 
 rative of this theory. This powerful medicine was most serviceable 
 when it kept the pulse down even below the standard of health. 
 
 The following case I have selected, as most illustrative of this view 
 of the subject, inasmuch as our patient had only two complete fits after 
 commencing the digitalis, though previously he had two or three dur- 
 ing one day in each week. The half attacks gradually disappeared also. 
 The pulse, which, previous to the exhibition of the digitalis, was quick 
 and very irritable, was kept down by this medicine to 54 in the minute ; 
 seldom above this, sometimes below. 
 
 Case 79. C. S. G., set. 19. Fresh complexion, healthy looking, steady habits, neither ad- 
 dicted to masturbation nor venery. Consulted me February 3d. 1845, for epilepsy. About 
 June, 1843, he had a severe mental impression from reading "Diary of a Physician" de- 
 pressed. In Oct. 1843, he lost consciousness when playing at Loto, but without any fit: this 
 half attack occurred nearly every day until he had bis first fit, which happened on the 27th 
 February, 1844, between one and five in the afternoon. He had another on the 10th May, 
 another on .the llth November, one on the 9th December, and on the 20th January he had 
 two, between one and five in the afternoon. His father had been dead some years : two or 
 three years previous to his decease his powers of mind became weakened so much as at 
 last to incapacitate him for business: he had two or three attacks of fainting, attended with 
 partial paralysis; his last and fatal attack lasted only for two or three days. Post-mortem 
 showed a colorless state of the brain, with softening, and a few ounces of fluid in the ven- 
 
436 HUMAN BRAIN. 
 
 tricles : his symptoms during life were attributed by his medical attendants to ramollisse- 
 ment. 
 
 February 3d. The attacks have lately come on more frequently, generally exhibiting a 
 sudden loss of consciousness and memory for a short time, then recovering also suddenly. 
 He generally turns pale, his lips blue, and his hands sometimes slightly convulsed; some- 
 times one, sometimes two, attacks of this kind in the day. I ordered him to take Argent 
 Oxyd. gr. j.b. d. Ext. Col. co. gr. v. o. n. ; and on the 3d of March to take it three times a 
 day with gr. ij. of Ext. Col. co. ; also Liq. Potass, ijifs Tinct. lodinei co. gj. Sp. ^Ether. Nit. 
 ^ifs. Capt. coch. min. ex aqua. b. d. 
 
 March 1st. Had a decided fit while walking with his mother was in a state of uncon- 
 sciousness for several minutes previous to the fit. There was no flushing of the counte- 
 nance, no cry, countenance blue during the fit, but soon recovered its color, the struggle was 
 not severe, and did not last long. He remembered everything before it occurred, does not 
 believe it was so severe as usual, slept for an hour on his arrival at home. 
 
 April 7th. Has been going on much the same, the attacks increasing rather in frequency 
 than otherwise. Ordered continue Argent. Oxyd. The attacks still increased rather in 
 frequency, if not in severity, till the 27th June, 1845, on which day he went to stay with 
 Mr. B. in the country. To take Argent. Oxyd. gr. j. Ext. Col. co. Ext. Gentian, co. gr. iifs. ft. 
 Pil. ij. t. d., and an aloetic- pill at bed-time. The imperfect attacks generally occur three times, 
 sometimes four or five times a day. 
 
 August 14th. Had a complete attack at 1 P.M. lasted a quarter of an hour, attended with 
 great frothing at the mouth, with considerable congestion of the head and face, not followed 
 by any coma. Has always three partial attacks in a day. 
 
 23d. Has had no fits for four days; this morning at 10 A.M. he had an attack, limbs rigid 
 and strongly convulsed lasted about ten minutes. Had another attack of the same dura- 
 tion at 6 P M. soon after dinner, strong convulsions, lividity of features, intense action of 
 carotids. Was yesterday subjected to a little excitement from a visit home. A leech was 
 applied to the nostrils. Pil. Hydrarg. Ext. Col. co. 
 
 August 25th. Argent. Oxyd. Zinci. Oxyd. gr. j. Ext. Col. co. gr. iifs. ft. Pil. t. d. s. App. 
 Lin. Tinct. lodinei. c. Liq. Potassae. 
 
 31st. Has had three half attacks daily, but they are less severe; at the present time he 
 is rarely insensible during their continuance, and is conscious of their existence. 
 
 September 5th. Five attacks yesterday, with symptoms of indigestion. 
 
 1 5th. Better : attacks slighter and less frequent. 
 
 29th. Heavy and low spirited: a leech has been applied to the nostril occasionally, and 
 with benefit. 
 
 November 2d. Still has four attacks daily, though not so severe. 
 
 6th. A complete attack with convulsions, but short. Two half attacks in the evening. 
 
 llth. Three half attacks daily. Zinci Sulph. gr. ij. Conf. Rosae. q. s. 
 
 29th. He continues much the same, general health pretty good, sometimes three, some- 
 times even five, half attacks per day; three every Sunday. To-day he was ordered to omit 
 the pills and commence taking Inf. Digitalis 3J. every night. 
 
 Jan. 4th, 1846. Four half attacks daily, two complete to-day. These two are the last he 
 has bad. 
 
 6th. Dose increased to gifs. 
 
 9th. Three half attacks, pulse 84. 
 
 10th. But one half attack. 
 
 15th. Has had three per day lately, to-day but one, silent and depressed, pulse 78. Omit 
 for two days. 
 
 16th. No half attack. 
 
 19th. Dose has been reduced to ^i. ; no attack. 
 
 27th. Has had no attacks at all since last report, but has had four half attacks to day. 
 
 28th. Five; x. 
 
 February 1st. None; pulse 58. Has had some sickness, which has gone off. 
 
 6th. None. 
 
 7th. None : very sick : omit medicine two days. 
 
 30th. Three half attacks. 
 
 18th. None; has had one daily for the last few days. 
 
 27th. None; pulse 84. Irregular. Dose ^ifs. 
 
 March 1st. No attack, general health excellent. 
 
 6th. Has had one yesterday and to-day. 
 
 24th. Has had some days one attack, on others none during the day. Had a half attack 
 to-day. Pulse averaged from this date 54 in the minute until he left off the digitalis. 
 
 June 13th. Has left the country; has not had any attack since the last report : takes ^fij. o. n. 
 
 June 1847. Continues perfectly well; has not had any more attacks, nor taken any of the 
 
EPILEPSY. 437 
 
 medicine since the 15th of Axigust; having occasionally previously intermitted its use. Is now 
 regularly occupied in business, active, and healthy in mind and body. 
 
 In another case, the subject also being fresh complexioned and of 
 sanguineous temperament, the fits were arrested for six months by the 
 action of the digitalis. Previous to its use he had suffered generally 
 every ten or fourteen days, then having four or five fits in forty-eight 
 hours. After the commencement of the medicine, he only had one, and 
 that very slight. This young gentleman had a constant redness of the 
 skin above the eyebrows, which always became more vascular at the 
 period of the attacks. When the attacks were arrested by the digitalis, 
 this redness disappeared. He left town, and when away, the medicine 
 was not continued so regularly, and the redness returned, and with it 
 the attacks, though they carne singly, and only two in number the 
 digitalis again controlling them. 
 
 I believe that in all cases of fatal epilepsy, where there has been an 
 autopsy, the vessels of the brain and membranes have been found enor- 
 mously distended, and in some there has been extravasation. 
 
 The (Enanthe crocata, or hemlock water-drop-wort, when taken in 
 any quantity, produces epileptic convulsions. I was present at ihe post- 
 mortem examination of four convicts, who died at Woolwich from eat- 
 ing it. The progressive amount of sanguineous effusion on the brain 
 was in proportion to the length of time they survived. The seizure was 
 most striking and instructive. 
 
 In all there was great congestion and some sanguineous effusion on 
 the surface of the brain : in those that lived the longest, the quantity 
 was in proportion to length of time they survived the seizure. The 
 first man died in about an hour, and the last in about two hours. 
 
 The following case appears to corroborate this idea, that the proximate 
 cause of the convulsions is a rush of blood to the brain, if it may be 
 so expressed. 
 
 Case 80 Ligature of the common carotid in epilepsy. Michael Cox, pensioner, set. 25, san- 
 guineous temperament, and muscular. This man has for the last five years been subject to 
 very severe epileptic fits, recurring generally about once a fortnight. He was first attacked 
 whilst on duty at Burmah, but without any previous warning, and without having experi- 
 enced any attacks of illness. He had, however, for some time been much exposed to the 
 sun, arid undergone great fatigue. He had lived generally temperately. Since the first 
 seizure, the epileptic fits have generally recurred without any assignable exciting cause, but 
 have been also occasionally induced by intemperance. He has not been able, however, to 
 take by any means the same quantity of spirits or other intoxicating liquor as European, 
 soldiers generally do; a very small quantity comparatively completely overpowering him, 
 inducing extreme giddiness, and violent throbbing headache. He had been frequently bled 
 during the paroxysms, but subjected to no other treatment. The first time the fits were par- 
 ticularly brought to my notice, was whilst he was attending a hospital as orderly over one 
 of the sick. The attack was extremely violent, and his efforts so powerful, that it was with 
 difficulty he was restrained by several persons. There was great cerebral congestion, a 
 feature which I conceive essential to every attack of epilepsy, and by preventing which (an 
 object I believe attainable by tying one or both carotids) I hope to cure the disease. Still 
 my expectations of success did not rest entirely upon the correctness of this view of its na- 
 ture, which might, I was aware, be erroneous, but yet the epileptic tendency be removed by 
 the operation, although in a manner different from that expected by me. 
 
 The operation was performed on the 4th February; the ligature came away on the 5th 
 March. 
 
 April 13th. Since the operation was performed, there has been no return of the epileptic 
 attacks, nor any tendency to them. He has experienced also, since that time, a great im- 
 provement in his general health and feelings. His spirits have been good before almost 
 
438 HUMAN BRAIN. 
 
 constantly depressed, and he could not stoop for any time without giddiness and consequent 
 danger of falling. On this account he was not able to work at his trade that of a shoe- 
 maker and was obliged to abandon it. Since the operation, he has again resumed his 
 work, and has not experienced the least return of these disagreeable feelings. He has also 
 proved the efficacy of the remedy that has been employed by very hard drinking, which he 
 and his friends considered a test; it required a large quantity of spirits to make him drunk, 
 and he did not afterwards experience the headache, and gloomy and even horrible feelings, 
 which had previously always followed such an excess. He suffered, as he told me, scarcely 
 at all. His whole feelings have undergone a complete revolution, and he is now as happy 
 as he was before miserable and wretched. > 
 
 The warning which I have already adverted to, which many epilep- 
 tics have, viz., a singing noise in the ears, I believe arises from the 
 dilated carotid artery vibrating in the carotid canal close to the vestibule 
 of the internal ear. I regard it as analogous to the throbbing produced 
 by the dilated artery in an inflamed part. If this hypothesis is correct, 
 it may be considered an additional argument in favor of this theory. 
 
 Dr. Conolly* observes that epileptic patients are occasionally warned 
 of the approach of a paroxysm by mental excitement, their high spirits 
 becoming to their friends the well-known precursors of their sufferings. 
 This must arise from arterial action. It is analogous to the mental ex- 
 citement induced by spirituous liquors ; no one doubts that this psychical 
 effect is produced by a physical cause. 
 
 In reference to a theory which was broached by the Wenzels, that the 
 pituitary gland is always diseased in this complaint, Dr. Bright says,f 
 " Much importance had been ascribed to that organ as connected with 
 epilepsy ; I have not, however, as yet succeeded in tracing this connec- 
 tion. Indeed, the structure of the gland is very apt to deceive us as to 
 its changes; for in its healthy state it is a firm, fleshy body, so sunk in 
 the sella turcica, that often, in attempting to bring it into view, we lace- 
 rate or injure it. Still, however, there is no doubt that it is sometimes 
 out of proportion, small and compressed ; at other times larger than we 
 should suppose healthy ; sometimes the seat of small excavations, and 
 even of suppuration ; and in one case mentioned in the present volume, 
 it was supposed to be altogether wanting. It is by no means impos- 
 sible that it may want some peculiar influence in epilepsy ; but I have 
 undoubtedly seen epilepsy where no obvious disease existed in the pitu- 
 itary gland; and I have seen cases where it might be well supposed 
 to be small and dwindled, but this depending entirely on that frequent 
 occurrence in epilepsy the thickening and morbid growth of the pro- 
 cesses of the basis of the skull." 
 
 Dr. Bright says, " I believe that almost always during the epileptic 
 paroxysm either as a cause or an effect, sanguineous congestion takes 
 place within the brain." 
 
 Continued cold weather sometimes induces epilepsy in old and feeble 
 constitutions. I suppose it is by disturbing the circulation that it pro- 
 duces the fit. I believe that the severity of the weather last winter 
 brought on several severe forms of cerebral disturbance. 
 
 Case 81. February 1st, 1847, I was called in great haste to visit a gentleman, aged 56 
 years, though in appearance much older. I found him standing in his counting-house with 
 
 * An Inquiry concerning the Indications of Insanity, by John Conolly, M. D. London, 
 1830, p. 241. 
 t Op. cit., vol. ii. p. 696. 
 
EPILEPSY. 439 
 
 a vacant look, and apparently lost to all surrounding objects ; his eyes were opened, and pu- 
 pils quite natural; he was unable to answer any questions; his face and hands were cold, 
 and head rather hot; the pulse was small, feeble, and about severity. I then heard the fol- 
 lowing history : Shortly after coming to town in the morning, his partner observed he did not 
 seem quite so clear-headed as usual. This dullness of intellect gradually increased, until his 
 partner became alarmed, and thought it necessary to have medical advice. I learnt that his 
 general habits were quiet and penurious, living rather below par than above : it was very 
 clear to me he would not bear any depletion. I was anxious, therefore, to put his feet in hot 
 water, and to get him to bed as soon as possible ; but before I could get him into a cab he 
 was seized with an epileptic fit ; it was preceded by a short cry and accompanied by the 
 usual convulsions, which did not affect one side of the body more than the other : he remained 
 quite insensible about a quarter of an hour, and then very slowly recovered his conscious- 
 ness ; but before this took place he was lifted into a cab, and I proceeded to his home, in the 
 neighborhood of London ; by the time he had arrived there, he had so far recovered himself, 
 that he soon recognized his own house, and he said something, though very indistinctly, to 
 that effect : as soon as I got him into the house, I ordered his bed to be warmed, and mustard 
 poultices to the calves of his legs, his feet to be immersed in hot water. 
 
 I sent for his usual medical attendant, who agreed in the view I had taken of the treat- 
 ment required. Our patient soon recovered his entire consciousness, after the general warmth 
 of his body was restored. We gave him some cal. and rhubarb that night, followed by a 
 purgative draught: he gradually recovered, but for some weeks suffered much from, great 
 debility of the lower extremities. He is now pretty well, though he does not feel his mind 
 capable of much attention to business. The rest of our treatment consisted at first in simple, 
 bitter infusions, until the tone of the stomach seemed restored ; afterwards we gave him the 
 bichlorid. of mercury in sarsaparilla. The latter medicine was given in consequence of the 
 partial paralysis of (he lower limbs. He has had no more fits. 
 
 The remote causes of epilepsy are very uncertain ; but there is one to 
 which our attention should be directed I mean the venereal disease. 
 Every practical surgeon knows how often this poison puts its paw upon 
 the dura mater. We have already had occasion to consider this. 
 Syphilitic inflammation in the fibrous tissue not unfrequently produces 
 deposits and thickening; and more than once have I seen epileptic fits 
 apparently result from the irritation which this disease occasions. My 
 attention was first called to this fact by my friend Mr. Thomas Copeland, 
 a surgeon, who related to me a case of the kind which was cured by 
 active salivation. The following case occurred in my own practice, and 
 was clearly dependent on periosteal mischief, though its syphilitic origin 
 was not so clear. It is another case in illustration of the value of the 
 tincture of iodine in cerebral affections. 
 
 Case 82. Affection of the periosteum of the skull and membranes of the brain. May, 1843, 
 A. B., a married gentleman, set. 27, consulted me with the following symptoms: deafness in 
 both ears, occasional feeling of giddiness, more in the morning than in the evening ; but he soon 
 feels tired from exercise, and then he has a throbbing in his head, and feeling as if he was 
 going to be giddy. He has no decided pain in his head, but he feels very uncomfortable, has 
 occasional retching, but does not bring anything off his stomach. 
 
 Complexion yellow ; pulse 100, weak and irregular; tongue rather pale, but not furred ; 
 fauces slightly injected ; he has occasionally twitchings of the arms on dropping off to sleep, 
 but not more on one side than the other. He showed me four periosteal swellings on the 
 head, two on the left side of the forehead, another on the right side, and a fourth over the 
 mastoid process of the temporal bone on the right side: all these contain fluid. 
 
 History. Had syphilis seven years and a half ago; took a little mercury, but neglected 
 himself; had secondary symptoms, which were efficiently treated by an intelligent practi- 
 tioner with the oxymuriate of mercury and sarsaparilla ; he got quite well, and is quite cer- 
 tain that he has not had any symptom, of any kind, of this disease since. About three years 
 ago he was thrown out of his gig and pitched upon his head, by which he was rendered 
 insensible, and on recovery found himself deaf, from which he has suffered ever since. 
 
 Ordered him a little blue pill and rhubarb at night, and draught in morning. 
 
 7th. Potass. lodidi gr. iv. bis die. Sarsa. bis t. d. Hydr. c. Greta gr. ij. Pulv. Rhei gr. j. o. n. 
 
 ]3th. Head shaved, Tinct. Iodine to the head. 
 
 18th. Decidedly better, and went out of town. 
 
440 
 
 HUMAN BRAIN. 
 
 24th. Ditto, less giddiness, no sickness, appetite good. 
 
 June 13th. Complains of some heat in his head: to leave off the Iodine, and use a cool- 
 ing lotion. 
 
 20th. He feels so perfectly well that he determined to go back again to his business ; he 
 can walk six or seven miles without inconvenience. 
 
 Ordered to take the Iodine and Sarsa. once a-day and the pill at night. 
 
 His place of business is hot, and he feels the writing so much that he is obliged to give 
 it up again: he remained a week sleeping out of town, but he found it was of no use. 
 
 July 3d. When he returned to me, he complained much of pain in his head, and twitch- 
 ings at night. I ordered him an active purge, three leeches to the head over a spot where 
 he has a fixed pain. Afterwards Hydr. c. Greta gr. iv. o. n. With this plan he soon got 
 much better again. 
 
 13th. Feeling much better, but weak weaker in the morning than after he has been 
 walking. 
 
 August 17th. Has been down in Kent, living very quietly, continuing his medicine, Dec. 
 Sarsa. c. lod. and Hydr. c. Greta. Says he is decidedly better ; walked up to town from 
 Blackheath, and will walk back again : applied some more Tincture of Iodine to the head. 
 
 September 5th. Much the same, feels pretty well, but says there is a certain feeling in 
 his head which is not quite right : ordered him to resume the use of the Tincture of Iodine 
 to the head. 
 
 22d. Says he is decidedly better, that his hearing has improved wonderfully, and very 
 little feeling of weight in his head. 
 
 October 12th. Says he is perfectly well when he keeps quite quiet, but with any extra 
 exertion he feels a slight uncomfortable sensation about his head. He continued the Tinc- 
 ture of Iodine till within a few days ago, when he thought there was a little heat in his 
 head; he continues the Hydr. c. Greta gr. ij. alt. n. Mist. lodin. and Sarsa. once a-day. Orel. 
 Hirud. ij. vertici appl. alt die. Hydr. c. Greta om. nocte. 
 
 17th. Much better: he has been applying two leeches every other night to the upper 
 part of his forehead by my advice, on account of a slightly uncomfortable feeling, occasion- 
 ally at the vertex, when he attempted to read. This feeling he says seems to come on from 
 any slight annoyance which irritates him. 
 
 November 6th. Better, but has still a slight feeling at the top of the head if he reads; it 
 extends, in a zigzag line, as if there had been a cut there-, but not over a large surface as 
 before. Ordered to apply Hirud. ij. alt. nocte. 
 
 24th. Has lost everything like pain or uncomfortable feeling in his head, but he had a 
 sensation of giddiness on the 22d, on getting off the coach and walking down the hill ; he 
 was rather exhausted, not having had his regular meal in the middle of the day ; had a 
 slight tremulous and faint feeling yesterday. 
 
 Ordered to leave off his Sarsa. arid Hyd. c. Greta, and take Zinci Sulph. gr. ij t. d. 
 
 29th. Still uncomfortable in his head from a feeling of weakness and giddiness. Or- 
 dered Pil. Rhei Gal. gr. x. H. S. 
 
 December 1st. Has acted very powerfully, his head is more comfortable, but a feeling 
 of great weakness; the hearing has never retrograded at all. Ordered Mist. Camph. c. 
 Quin. Pil. Hydr. gr. ij. o. n. 
 
 8th. Better, but not well ; to return to the Iodine Potass. lodjn. ex. Sarsa. bis in die, and 
 to go for a fortnight to the sea. 
 
 28th. Says he is now quite well, that after being two days at the sea, he felt all his un- 
 comfortable feelings leave him. He has been stopping a week at Blackheath, and has con- 
 tinued well. 
 
 1845, June 15th. I was sent for during the night to see Mr. . When I arrived at 3 
 
 A.M., I learnt that he had had nine fits close one after the other, the first occurring about ten 
 o'clock in the evening: he was sensible, and knew me when I came in. I learnt that he had 
 been free from all attacks for twelve months, and had been in very good health, and getting stout; 
 that he had been very regular in his habits, and very strict in his diet; but taking bitter ale every 
 
 day. That latterly Mrs. had thought him not quite so well ; that he had been restless 
 
 at night, and his nose inclined to bleed. The weather has been very hot lately, and the day 
 before he went down to Gravesend with his brother ; on this occasion he drank a pint and 
 a half of bitter ale that is, about half a pint more than usual. I found his head hot, but 
 he did not complain of pain except when he raised it from the pillow. I put his head over 
 a basin, and poured cold water upon it, gave him five grains of calomel, ditto of Rhei and 
 Jalap, and a draught in the morning: he had had a mustard emetic. 
 
 l(jth. Going on well. I ordered Liq. Am. acetatis and Tinct. Lyttee, &c. No beer or 
 other stimulus. 
 
 18th. Going on well: to take the Argent. Oxyd. gr. j. t. d. 
 
 23d. Free from all pain, and is quite comfortable j he came to see me. 
 
EPILEPSY. 441 
 
 When epileptic fits once occur in the adult, they are seldom checked 
 at once, generally recurring after a short interval, and our prognosis 
 ought to be very guarded and on the whole unfavorable. But some- 
 times they occur singly, or limited to two or three, and never reappear; 
 but this is the exception to the rule. 
 
 Case 83. In the month of February, 1843, I was sent for, suddenly, to visit a gentleman 
 who was reported to have had a fit. I was at his house within an hour from its occurrence, 
 and I found him quite sensible and free from pain, both in the head and elsewhere. His 
 brother, who was with him, then informed me that he had been complaining that he was 
 not quite well, having a good deal of pain in the lumbar portion of his back, which he sug- 
 gested might be disease of the spine, and begged his brother to feel it ; on doing so, he 
 winced when I touched a particular spot which gave rise, as it were, to a sensation which 
 ran up from this spot to the back part of the head, arid thus extended over the head to 
 lose all consciousness, and would have fallen, if his brother had not caught him. 
 
 His brother described his condition as exactly the same as an ordinary epileptic attack, of 
 which he had seen many, as Mr. H.'s father had suffered from them for years. He was 
 slightly convulsed, but not much. Before he quite recovered, he opened his eyes with a 
 stupid stare, looking quite unconscious. This attack was soon followed by another exactly 
 similar to that he had two hours before I saw him. Ordered A draught to be taken at 
 once: Sp. Amm. Ar. fs. Tinct. Rhei gj. Inf. Aur. ^j. and two pills at night; Pil. Rhei co. 
 gr. v. Pil. Hyoscy. gr. v., and to keep in bed till I see him next day. 
 
 18th. Motion full of bile, and healthy; says he feels comfortable; pulse 80, regular, of 
 fair power ; examined the spine could not detect any symptoms whatever of disease. 
 Ordered Inf. Aurant. co. gvfs. Sp. Amm. Ar. gfs. Sodee Carbon j. Tr. Rhei gij. Mf. 
 Mist, cujus cap. sextam partem bis in die. 
 
 I attended him for about a month, prescribing for him, after I got the digestive organs into 
 order, the Sulphate of Zinc : this he took for about a month, and then left it off. He has 
 been very careful in his diet, and abstemious in regard to wine, almost abstaining from the 
 latter, which he used to indulge in before, though never to intoxication. He was living, at 
 the time, in rather a low and damp situation, which I persuaded him to quit. He has since 
 lived in a high and dry spot, and has remained perfectly well ever since. 
 
 Cases of epilepsy combined with hysteria are generally more tractable 
 than other forms, and yield frequently to very simple treatment ; the fol- 
 lowing was one of this class. 
 
 Case 84. Eliza Tittensor, set. 20, lives at home domestic occupation ; healthy appear- 
 ance. 
 
 First fit last Christmas, occasioned by fright from a tipsy man, lasted four hours; health 
 previously very good, not subject to headache or any other ailment. 
 
 March. Fit about two months after the first, occasioned at chapel by a man praying very 
 loud near her. 
 
 September 23d. Third fit today; no particular cause; complains of her head never hav- 
 ing been comfortable since the first fit. Made an issue with Potassa Fusa in the neck. Pil. 
 Rhei c. Cal. gr. x. H.P. mane. 
 
 October 16th. Argent. Oxyd. gr. ij. 
 
 23d. She complained of her head so much, and as I felt it arose from the stomach, or- 
 dered Inf. Cinchon. gvj. Tinct. Rhei 3jj. Pot. Carb.^ij. Acid Hydrocyan. dil.^j.Sp. Menth. 
 Pip. 3J. Coch. Magn. ij. bis die. 
 
 November 29th. Much better, free from fits, head easy. 
 
 December 18th. Has continued the mixture regularly, free from headache, feels well, 
 pulse rather small and quick, excitable. She says that on the 14th she sat up all night with 
 her aunt's baby, and that on the Sunday evening she felt as if a fit were coming on, the 
 sensation being a rising in the throat, but she went to sleep and no fit occurred. 
 
 January 27th. Not quite free from headache, but always finds the medicine relieves her 
 head ; had not had any fit since the 23d. 
 
 February 8th. Complains much of her head, has not had any fits since. Ordered Zinci 
 Sulph. gr. ij Ext. Aconite, gr. j. t. d. This produced sickness, but relieved the head : to take 
 gr. j. Zinci Sulph. 
 
 20th. To leave off the pills and take the mixture again, which she continued till March 
 15th; left off all medicine, and dried up the issue: continues quite well. 
 
 I received a letter from the medical man of the family, stating that these fits were epilep- 
 tic, complicated with hysteria. 
 
442 HUMAN BRAIN. 
 
 The various forms of epilepsy have thus been classified by Esquirol, 
 who has seen as much of this disease as most men : essential, sympa- 
 thetic, and symptomatic. 
 
 Essential idiopathic epilepsy has its seat in the brain and its append- 
 ages. It may be divided into three varieties : 
 
 1. Idiopathic epilepsy, produced by external causes, such as forcible 
 compression on the cranium, contusions, fractures, coup de soleil. 
 
 2. Idiopathic epilepsy, depending on defective organization of the 
 cranium, on lesion of the meninges or of the brain, or serous or sangui- 
 neous extravasations into the cavity of the skull. 
 
 3. Idiopathic epilepsy, which may be termed nervous, produced by 
 moral affections either of the mother, the nurse, or the patient himself: 
 among the moral causes, anger, fright, irritation, are the most to be 
 feared. He describes sympathetic epilepsy as presenting five varieties. 
 
 The first, he says, is connected with the digestive organs, and de- 
 pends on the presence of indigestible matter in the alimentary canal 
 intestinal worms. I have certainly known an attack of epilepsy brought 
 on in a patient who had been free from fits for twelve months, by indi- 
 gestion consequent on a supper of cheese and radishes. Still it must 
 not be supposed that these derangements of the stomach are the ultimate 
 cause of epilepsy ; they are merely the exciting causes acting on an 
 irritable brain. 
 
 The second still less deserves the name of sympathetic. He desig- 
 nates it angiotenique, from its seat being in the arterial system. The 
 suppression of menses, haemorrhoids, habitual haemorrhages, digression 
 from regime, abuse of liquors, provoke these. 
 
 The third has its seat in the system of white vessels, humoral epilepsy. 
 Pale, chlorotic, rachitic, and scrofulous persons, are predisposed to it ; 
 the retrocession of porrigo, itch, ulcers, syphilis, and gout, causes this 
 species. 
 
 The fourth has its seat in the organs of reproduction epilepsia geni- 
 talis, epilepsia uterina, the abuse of venereal pleasures, onanism, conti- 
 nence, pregnancy, accouchement, are the ultimate or proximate causes. 
 
 The fifth has its seat in the external organs epilepsia sympathica of 
 authors. Every cause, apparent or hidden, which irritates some of the 
 external parts, and of which the secondary effect radiates towards the 
 brain, produces this variety of epilepsy. 
 
 But, with all due deference to this distinguished author, I doubt the 
 correctness of this classification; and for these reasons that all the causes 
 he enumerates as productive of sympathetic epilepsy, are causes which 
 are capable of disturbing the circulation, and that it is much more pro- 
 bable that this disturbance of the circulation is the cause of the epilepsy 
 than this stalking-horse called sympathy. It is possible that our differ- 
 ence may be one of words merely, and that what he would call sympa- 
 thetic I should call functional. 
 
 Esquirol's prognosis of epilepsy is as unfavorable as that of our own 
 countrymen. He says 
 
 " Sympathetic epilepsy is more easily cured than that kind which 
 arises from constitutional causes, yet the latter is not always incurable. 
 
 " Epilepsy seldom attacks those children who have humors on the head. 
 
EPILEPSY. 443 
 
 c< Sometimes this disease disappears for several years, and then recurs, 
 without any assignable cause. 
 
 "Those who are attacked shortly after birth seldom recover; if they 
 do not get well at puberty, they remain incurable. 
 
 " Those who become epileptic between the ages of three or four often 
 are curable, if the disease be treated in time. 
 
 "Those who become epileptic a little before puberty, recover at the 
 end of this crisis. 
 
 " Those who become epileptic after puberty, are sometimes cured, 
 although Hippocrates thought otherwise. 
 
 " Marriage merely cures genital epilepsy; it is hurtful in the other 
 forms of this disease. A pregnant woman who becomes epileptic is 
 exposed to great dangers. 
 
 " When the fits occur at shorter intervals, and become more violent, 
 death is to be feared. 
 
 "Death takes place during the prostration after the violent convul- 
 sions, not during the fit. Epilepsy, complicated with mania, is incur- 
 able." 
 
 Dr. Prichard* supports the doctrine of particular determinations of 
 blood to distinct parts. He says we often find a patient laboring under 
 intense and oppressive pain in the head, with vertigo, flushed and heated 
 in the face, the pulse in the carotid and temporal arteries bounding, while 
 the extremities are at the same time cold, the pulse small, and the ves- 
 sels on the surface generally constricted. If the feet are plunged in hot 
 water, and rubbed, hjood taken from the head, and cold applied there, 
 the pulse at the wrist and the carotid soon becomes equalized, and the 
 headache is relieved. 
 
 Dr. Prichard believes in a power of active dilatation in the artery. 
 He says, " This property of the arteries is precisely that which Dr. Parry 
 has described under the term Tonicity." He states distinctly! that he 
 considers u the immediate cause of an attack of epilepsy, or that physical 
 change which, in a constitution prepared by natural predisposition, or 
 by the action of morbid circumstances, is the immediate precursor and 
 occasion of the fit, appears to him to be a preternatural influx of blood 
 into the vessels of the encephalon, or an unusual fullness in some part 
 of the vascular system of that organ." Dr. Prichard then goes very 
 fully and ably into his reasons for this opinion. 
 
 The following case illustrates one of the forms somtimes assumed 
 by this Protean disease. It is only by a knowledge of all its various 
 shapes that we can understand its nature, or give a correct prognosis 
 when consulted on the first appearance of it. 
 
 Case 85. Nov. 6th, 1846. I was consulted by Mrs. W., for her daughter, C. W., aet. 12, 
 on account of the following ailment. She suddenly loses her consciousness ; her hands fall, 
 and she drops anything that may be in them ; her eyes become fixed and staring ; her face 
 very red. This is followed by a sucking or convulsive motion of the lips, but not elsewhere. 
 No cry or noise. This lasts, at the most, about three or four minutes, then she turns pale, 
 and falls off heavily to sleep, and wakes again in about half an hour. 
 
 She first suffered in this way about two years and a half ago, and the attacks have gra- 
 dually increased in frequency since : they now sometimes occur three or four times in the 
 day. She seldom passes a day without one or two; not more liable at one period of the 
 
 * Op. cit., p. 82. 
 
444 HUMAN BRAIN. 
 
 day than another. She suffers very much from headache, which is especially over the fore- 
 head. She is now very nervous, and very timid, but was not so as a young child. She is 
 intelligent, and is very clever at school. Her countenance is, on the whole, good, but the 
 lips are a little full, and the complexion a little muddy. Her mother says, when her head 
 aches she is always very pale. Pulse 18, 17, 19, in the quarter, very small, and a little 
 irregular. Tongue a little dry ; forehead hot ; bowels regular,. 
 
 Ordered No study. Pil. Rhei co. gr. vij. Hydr. Chlorid. gr. j. M. ft. pil. ij. hie nocte 
 sumend. Haust. Senn. co. mane. The first dose did not operate much, but the evacuation 
 was very dark and offensive. Repeated the dose the day after ; four motions first dark, 
 then more natural. She has not had any kind of fit since she took the medicine. 
 
 Nov. 12th. Ordered Zinci Sulph. gr. ij. t. d. Pulse 22, 23. 
 
 Nov. 20th. She had two or three fits, gr. iij. t. d. 
 
 Dec. 4. Has had six fits since the last date, but she says that her head is much better : 
 gr. v. t. d. 
 
 1 1th. No fits since the last date ; her head feels much better. Ordered gr. x. 
 
 22d. Gr. v. 
 
 30th. No fits ; gr. v. 
 
 1847, Jan. 5th. She reports that her daughter had one fit on the 31st of December, five 
 on the 1st of January, two on the 2d of January eight fits in all. They were not unusually 
 severe ; headache, but not more than usual : the last fit was the worst. Inf. Digitalis gij., 
 Dublin Pharmacopoeia. 
 
 July 6th. Has not been taking any medicine since February; she has had the attacks 
 more frequently during the last two or three months, but they are not quite so severe; she 
 has more warning, which she describes as a sensation in the chest. She thinks she has 
 sometimes averted an attack by walking about. She has them now generally four or five in 
 the day, at intervals of a week. Ordered Argent. Oxyd. gr. j. t. d. Pulse 24. 
 
 The following case presented many points of interest. I am afraid 
 from the severity of the attacks that there is some disease of brain. 
 Whether this is the case or not, the disease was very much controlled 
 by the digitalis. 
 
 It also shows the importance of giving medicines to tranquilize the 
 stomach at the same time that we give the digitalis. For this purpose 
 I have, on the whole, found the creosote the best ; though sometimes, 
 as in this case, I give the hydrocyanic acid. 
 
 In marking the state of the pulse in epilepsy, I always note the num- 
 ber of pulsations in each quarter separately, as I have frequently found 
 much difference between the first and last quarter. (See date Nov. 21, 
 in the following case.) When this happens I continue to count it for 
 some little time, and n-ote the numbers when it has settled down. The 
 reader must therefore understand that the figures refer to the quarter, not 
 to the whole of the minute. 
 
 Case 86. Oct. 14, 1846. M. T., set. 13, tall, healthy-looking, first fit two years ago; but 
 it is always preceded by a violent pain in the stomach about two minutes before the fit 
 occurs. She always cries out from the pain, saying, "Oh, my stomach!" and as soon as she 
 has said that, she goes into the fit; there is no second scream. She always turns very red 
 in the face before the convulsion occurs. The mother says that at night she has a different 
 kind of fit, distinguished from the day fit by its not being preceded by the pain in the sto- 
 mach; but if asleep she will awake and jump up, and say, "I am going to have my night 
 fits." She says she feels very queer for two or three days previously ; never complains of 
 singing in the ears or swimming in the head. She says she feels as if she could cry a great 
 deal ; but that she never does ; she wishes she could do so. Never complains of pain in 
 her head except after the fits. 
 
 Very excitable girl, very violent temper, especially before the fit. She is sometimes so 
 bad that they do not know what to do with her. The mother calls her a very cute, clever 
 girl ; quick at anything. Her memory is now affected. 
 
 The father died from fungoid tumor in the skull ; the mother alive and well. 
 
 The mother attributes the disease to the following circumstance : About seven years ago 
 she had an eruption (from the description I suppose eczema) on the back, which spread up 
 to the head and formed a large wound. This was cured in about six weeks, and the girl 
 
EPILEPSY. 445 
 
 has never been well since. First, she could never keep anything on her stomach, always 
 very sick ; and from that came the pain in her stomach ; for five years she used to cry out 
 four or five times a-day with the pain in the stomach ; but it was not followed by any fit. 
 
 She has been under Dr. Waller, and the care of a great many ditferent persons. She was 
 
 twice treated for worms, but with no good result. They then applied to Dr. L , the 
 
 water-doctor, under whose care she remained for three months. She was, after this, treated 
 
 by Dr. D ; after him by Dr. A , and was mesmerized by his orders twice a-day for 
 
 about two months; and lastly, they applied to Dr. Waller, who sent her to me. 
 
 She now has the fits sometimes four or five in the day, and sometimes only once ; they 
 are generally more numerous every fortnight. 
 
 Last Tuesday night she had seventeen. 
 
 There is no difference iu the night fits and the day except in the warning ; she has more 
 warning in the night. 
 
 Once she had a fit in my waiting room. T heard the cry, which was not very loud. I 
 went into the room ; she was then struggling slightly ; the convulsions were truly epileptic, 
 and principally on the left side. 
 
 Nov. 14th Pulse 18, 20. Inf. Digitalis (Dublin) gij. n. et m. 
 
 IGth. Pulse 18, 18, 17. Two bad fits, 1 p. M. and 7 p. M. 31 v. 
 
 17th. Pulse 23, 22, 23, j. h. s. 
 
 18th. Two fits yesterday. Pulse 18, 20. x. 
 
 19th. Three yesterday; one in the night; four in all; but not so strong. Pulse 24, 25, 
 23. ijfs. n. et m. Passed a large quantity of urine. 
 
 2Uth. Only one yesterday; none in the night. Pulse 23, 24. ^j. n. et m. 
 
 2 1st. None ; but she has had more headache. Pulse very variable, 30, 20, 15. ?j. n. et m. 
 
 22d. One in the night, very slight. Pulse 25, 23. Not so much headache. j. n. et m. 
 
 23d. None in the night; two in the morning; sleepy. Pulse, ten minutes alter the at- 
 tack, full, 16, 16. ^x. n. et m.; has been sick. 
 
 24th. Has been sick again. Pulse 23, 24. x. n. et m. 
 
 25th. A little sickness; two fits since yesterday. Pulse 25, 30, 27. ^x. n. et m. 
 
 26th. Little sickness ; very sleepy; speaks thick; looks silly. Pulse 24. Pulv. Jalap gr. v. 
 Cal. gr. iv. Olii carui. TT\J. M. ft. Pil. ij. h. n. sum. Inf. Senn. ^j. Magnes. Sulph. j. Acid. 
 Sulph. TT^iv. Syrup. Zingiber. ^j. mane. 
 
 27th. Was very ill all yesterday; but no fits. 
 
 28th. Acid. Hydrocyani. dil. TT^iij. ex aqua jfj. t. d. 
 
 29th. No fit. 
 
 30th. Acid. Hydr. dil. tt\,iv. aq. gj. t. d. Pulse 15, 16. 
 
 Dec. 1st. Very queer all yesterday ; a very bad fit this morning. Pulse 25, 26. Inf. Digi- 
 talis ^j. Quin. Sulph. gr. j. t. d. 
 
 2d. Better. Pulse 20, 21, sharp. Inf. Digitalis ^ifs. Quin. gr. fs. t. d. Pil. Cal. co. gr. v. om. n. 
 
 3d. Pulse 22, 20, small. Inf. Senna Jij. Magn. Sulph. gfs. Tinct. Card. co. ij. statim. 
 Inf. Digitalis ^j. Quin. Sulph. gr. fs. n. et m. 
 
 4th. Creosote TT\J. t. d. Putse 20, 17, intermittent. 
 
 5th. Ditto. Pulse 23, 24, regular. 
 
 6th. Ditto, b. d. Pulse very peculiar, stopping merely for a beat or two, and then going 
 on. Pulse 14, 13. 
 
 7th. Creosote TT\j. t. d. Pulse regular. 20, 21. Ext. Colocynth. co. gr. iv. om. 
 
 8th. Pulse irregular, 16, 18. 
 
 9th. Felt, yesterday, for some time, as if she would have a fit ; but had none. Went 
 off with crying; cried for an hour. Creosote tt\J. t. d. 
 
 10th. Ditto. Pulse 20, 20. 
 
 llth. Creosote tnj. t. d. Pulse 21. 
 
 12th. Ditto. Pulse 20, 18, 18. 
 
 13th. Very poorly all yesterday; headache; bowels purged; no sickness; bad fits at half- 
 past nine; interval nine days. Pulse 25. 
 
 15th. Conf. Aromat. gfs. (purged). Mist. Cretae ^j. Spirit. Menth. Pip. gj. bis in die. 
 Pulse 22. 
 
 16th. Bowels quieter. 
 
 17th. Rep. Mist. 
 
 18th. Inf. Digitalis ^j. n. et m. ; fit about 5 p. M., after having a dose in the morning. 
 
 19th. Pulse 18. Digitalis ^ifs. n. et m. 
 
 20th. Pulse 15. Digitalis '^ifs. n. et m. 
 
 21st. Pulse, first half minute 37, second 27, slightly irregular. Digitalis ,^ifs. 
 . 22d. Fit yesterday ; not ill to-day; no sickness or headache 5 pulse full, 18, 18; Creo- 
 sote ny. b. d. 
 
 23d. Quite comfortable ; ditto. 
 
446 HUMAN BRAIN. 
 
 24th. Had eight in the night, very severe, two in the morning. 1 p. M-. much convulsed, 
 especially on the left side; headache. Argent. Oxyd. gr. j. t. d. The fits continued in rapid 
 succession, but becoming weaker, until one o'clock in the day, since which they have ceased. 
 She did not recover the use of her left hand until the evening. 
 
 29th. Two fits in five days. 
 
 Jan. 7th. Seven fits during the day. 
 
 10th. Slight fits. 
 
 12th. Pulse 20. Continue. 
 
 14th. Two fits. 
 
 1 5th. Continue Argent. Oxyd. 
 
 22d. Has not had any fits since the last report. Rep. 
 
 23d. One fit. 
 
 25th. Three fits, not so severe. 
 
 26th. Three in the day, slighter, very numerous in the night. Continue. Did not lose 
 the use of leg, only of the hand. 
 
 Feb. 3d. Three, violent. 
 
 4th. One rather slight. 
 
 15th. Ditto. 
 
 16th. Continue the Oxyd. 
 
 20th. One slight fit. Continue the Oxyd. 
 
 25th. Three slight fits. 
 
 26th. Three fits. 
 
 27th. Four fits. 
 
 28th. First fit at four in the morning; continued for twelve hours, with scarcely inter- 
 mission ; at least two in the hour. 
 
 March I st. Seems pretty well again ; no headache ; speech slightly affected ; got the use 
 of the hand and leg sooner than usual. Rep. hirudines. 
 
 10th. Has continued the pills. 
 
 20th. Rep. 
 
 April 18th. Had several fits this day; but much slighter than they had ever been be- 
 fore; very different. 
 
 May 5th. None since ; has been in the country Blackheath; has continued the pills. 
 
 21st. One bad fit. 
 
 23d. Two fits, much lighter ones. 
 
 June 7th. One fit. 
 
 21st. One fit. 
 
 28th. One fit. 
 
 July 6th. Fits much less numerous; has applied the one leech every month to each 
 breast, and continues the pills regularly. 
 
 Dr. Bright considers that in almost all the cases he examined,* " a 
 state of cerebral congestion has existed as a more or less essential part 
 of the disease, and has even been demonstrable after death." It is 
 also interesting to me, that when he found decided morbid growths or 
 disease within the skull, in none of all these "has the organic change 
 extended into the medullary substance ; and in most it has penetrated 
 little deeper than the membranes themselves. " So that, in fact, the 
 disease has not extended beyond the hemispherical ganglion. 
 
 Treatment. If there is evidence of organic disease of the brain, the 
 prognosis must necessarily be very unfavorable, and little can be expected 
 from treatment; but not so if the disease, as is generally the case, results 
 from functional disturbance of the brain. Mild mercurials and counter- 
 irritation, not carried so far as to depress the general power, should be 
 employed when the disease appears solely dependent on cerebral disease. 
 The next point is to ascertain whether there is any derangement in the 
 function of any other viscus besides the brain; and if so, to employ the 
 most efficient remedies to set it right again. 
 
 The digestive organs are generally in fault, and they ought to be first 
 
 * Reports of Medical Cases, by R. Bright, 1831, vol. ii. p. 553. 
 
EPILEPSY. 447 
 
 attended to. Indeed, no course of tonic medicines ought to be com- 
 menced without first giving a full dose of calomel combined with colo- 
 cynth, rhubarb, or some other purgative, and the character of the faecal 
 evacuations examined. I never saw any good derived from blood-letting, 
 and I have seen a great deal of harm from it, I bled freely in one or 
 two cases some years ago, under the impression that the disease was 
 inflammatory, when there was a decidedly plethoric state of the system 
 and great congestion of the brain; but I am convinced it caused a re- 
 petition of the attacks. Even the application of leeches either hefore 
 the attack, at the time, or afterwards, only does harm. Foville* is in 
 favor of setons to the neck, and the periodical application of leeches to 
 the arms, in plethoric individuals, with large heads, habitually injected. 
 He also recommends the internal use of turpentine, and relates a case in 
 point. 
 
 Epilepsy is not unfrequently caused by disease of the heart, generally 
 hypertrophy of the left ventricle, and according to the extent of the 
 disease may therapeutic agents be pushed ; but in almost all cases hydro- 
 cyanic acid will be found of great value in subduing irritability of this 
 organ. Local depletion in the cardiac region will also be found useful, 
 but it must rrot be carried to any extent. Three or four leeches every 
 now and then will do good, whereas twelve or twenty would excite the 
 heart. I have also found a belladonna plaster of service, but it is in 
 these cases that digitalis will be found so serviceable. Aconite in small 
 doses will also be indicated. 
 
 For a knowledge of all the medicines that have been employed in the 
 treatment of epilepsy, I must refer the reader to Dr. Copland's erudite 
 article on this subject, from which he will learn that nearly every drug 
 in the Pharmacopeia has been used at one time or another. I have found 
 the sulphate of zinc, the nitrate of bismuth, the oxyde of silver, and 
 digitalis, more or less useful. I will first speak of zinc. In the two 
 succeeding cases its exhibition was followed by the cure of the disease. 
 I have, however, frequently given it since, but with only temporary bene- 
 fit, and some of the cases have recovered with other means; and I have 
 treated successfully with other medicines some cases where it had been 
 given to a great extent by other practitioners without any effect. 
 
 Case 87. J. B., set. 49, married man, has two children, piano-forte maker ; has lived freely ; 
 but for twelve months before the attack, had abstained altogether from liquors, till within two 
 months of the first fit during this latter period had been in the habit of taking sips of brandy 
 during the day, amounting sometimes to five or six glasses. Nothing particular in regard to 
 the venereal passion; has always lived with his wife. He was first attacked in March, 1841, 
 and consulted me early in May, in the same year : his own account of the case is as fol- 
 lows: 
 
 "Before the first attack, I had a violent pain in the head the whole of the day, and worse 
 towards evening; and while I was conversing with a friend, rny memory failed me for 
 some minutes before the fit, so that I could not explain what I meant. The fit lasted for 
 about twenty minutes, was accompanied with foaming at the mouth, and violent struggling; 
 it was a long time after the fit before I recovered my senses, and I was quite unconscious of 
 what had occurred. 
 
 " The second attack was about six weeks after ; I then had bad pain in the head for two 
 or three hours before : but took very little notice of it. I lost my sight, and went a few 
 paces, and fell down. I cannot say whether it was violent or not, as I was in the street at 
 the time. I had another attack the next night, while in bed : it was not so violent as the 
 
 * Diet de Med. et cie Oiir. Prat., vol. vii., 1831. 
 
448 HUMAN BRAIN. 
 
 first, but it was some time before I recovered my senses." I ordered him an aperient, and 
 having got his secretions generally in a healthy state, I gave him the sulphate of zinc 
 ordering a total abstinence from stimulating liquors. The next attack, the first after I saw 
 him, was brought on by stooping ; it did not last more than ten minutes. He had another 
 the same evening slight. The next week he had another, but recovered sooner than be- 
 fore ; and he had notice of their coming. Each attack was between eight and ten in the 
 morning. 
 
 August 5th, 1842. Has been free from attacks for at least twelve months: had an attack 
 about 1 A. M., which, from his wife's account, was one of the ordinary character of epilepsy. 
 He has strictly adhered to the plan of a total abstinence from liquors since I saw him ; he 
 can only account for it by the circumstance of his having been a little flurried lately, about 
 money matters. For the last day or two he has found himself sighing very deeply, and 
 quite unconsciously. Has felt a little dimness of vision when about his work. Ordered 
 Calomel gr. v. Jalap gr. vii. stat. 
 
 Sept. 8th. Had an attack last night. 
 
 Jan. 6th, 1843. Had another attack, which he feared was coming on, from a feeling of 
 lowness of spirits and slight headache, but it was so slight that he paid no attention to it ; he 
 has left off the sulphate of zinc for the last six weeks only aperients since. Ordered to 
 renew the zinc. 
 
 March 2d. Left off the zinc, feeling quite well ; takes Pil. Rhei co. gr. v. p. r. n. 
 ^ Feb. 7th, 1845. Has returned for advice, having had a fit the night before; has been 
 free from attacks for one year and six months, that is, from the 6th January, 1843, till 
 August, 1844, when he was in the country. He attributed it to stooping to wash his feet: 
 it came on in the night. He merely took some aperient medicine, and had no return till 
 the last just mentioned ; "but he had severe starting of his limbs on falling gff to sleep, and 
 feels a tingling, and attributes it to wind on the stomach, as when it is expelled he is easy. 
 
 On the day previous to the occurrence of the last, he had severe headache, and cold 
 shiverings, which he could not attribute to indigestion, as he has strictly observed my rules 
 of diet. He had recourse to the Cal. and Jalap, with the aperient draught, which operated 
 well, but did not avert the attack. He is free from headache, and feels w r ell, only sore from 
 the -cramp. Pulse 76; tongue dry, but clean. Ordered Zinci Sulph. gr. ij. t. d. Pil. Rhei 
 co. p. r. n. He took the Zinc for about six months. ,; , ; {_ 
 
 June 30th, 1847. Has abstained in toto from all intoxicating liquors, and continued well 
 since the last date, not having had any fit for nearly two years and a half. 
 
 The following case illustrates an important point in regard to the ad- 
 vent of epilepsy, namely, that it is often preceded by frequent and very 
 prolonged attacks of syncope. I always regard frequent fainting fits in 
 the young of either sex as a very serious premonitory symptom of ap- 
 proaching epilepsy. 
 
 Case 88. I was consulted on the llth of November, ^837, by Mrs. W., on behalf of her 
 son, who had been suffering for some years from epilepsy: he was a well-grown lad, 11 
 years old, with a vacant look, and rather a dull complexion. From the mother I had the 
 following particulars : 
 
 "Memorandum of my son's illness. He was born in India. He was not a healthy child 
 after he had attained his second year, but never had fits, not even while teething. When 
 two years old he lost the use of his limbs, and could not stir a joint without the most acute 
 pain ; continued in this state from March to November, when he quite recovered ; the suc- 
 ceeding year a similar attack at the same period. During these attacks there was no eruption 
 about him, but from the knees to the ankles there was an appearance of red and black spots, 
 as if he had been tattooed, but this was only skin deep, there being nothing above the skin. 
 The medical opinion was, that the blood was poor, the effect of an unhealthy clime, Assam. 
 Since he has been in England, no similar attack has taken place. His stomach was always 
 large, till two years ago, when his sides were much blistered and leeched, and he was 
 treated for a diseased liver. About eight months ago he complained of frequent attacks of 
 pain in his head, as if he had a weight there. The pain in his head was succeeded by 
 giddiness, for which his temples were leeched, and, bleeding profusely, he fainted at the 
 time, and again the next morning; he continued daily to faint, sometimes from six to eight 
 times in an hour; never struggled or changed color in these fainting fits; always came to 
 with cold water or salts. Previous to fainting, he complained of pain extending from the 
 lower part of his stomach to the chest. He now began to have a horror of water, or of 
 smelling anything during the faints. From April to July he had on an average never less 
 than eight fits in the day, and sometimes as many as twenty. In July the fits began to 
 change in character, still occurring daily: sometimes he was much convulsed, and at other 
 
EPILEPSY. 449 
 
 times groaned ; he would sing, dance, and talk of things he would not do when in a right 
 state of mind. During these fits, though with his eyes shut, he knew the footstep of every 
 one that entered the room; knowing any one by the feel of their hands, walking, dressing 
 himself, picking out his clothes from those of his brothers by the feel, with his eyes quite 
 shut; he was exceedingly violent if opposed." 
 
 The intellect was a good deal weakened when he first came to me for advice, and his 
 mother feared he was becoming idiotic. 
 
 The medical treatment was very simple. At first I attended to the digestive organs, and 
 after awhile I gave him the sulphate of zinc in doses of two grains. This he continued for 
 about three months, and ultimately quite recovered, and is now serving with the army in 
 India. 
 
 The medicines that I have found most beneficial are the oxyde of 
 silver and the infusion of digitalis. In two cases, already related, the 
 infusion of digitalis succeeded after the oxyde of silver and bismuth had 
 been tried, and failed. But as far as I have yet seen, the infusion of 
 digitalis is adapted to young and excitable subjects, the silver to older 
 patients, where the disease is more confirmed and the fits do not occur 
 so frequently. For a knowledge of the value of the oxyde of silver in 
 these cases, and the best mode of using it, I am indebted to my late and 
 lamented friend Dr James Johnson. For the digitalis I am indebted to 
 Dr. Corrigan, whose observations were copied in the Medical Gazette* 
 from the Dublin Hospital Gazette. Dr. C. states that the digitalis has 
 long been a quack remedy for epilepsy in Ireland, but that it was used 
 in such tremendous doses that frequently its effects were terrific. 
 
 It occurred to Dr. Corrigan that if he could succeed in saturating, as 
 it were, the nervous system with its sedative influence without the risk 
 of inducing those frightful effects which follow on the exhibition of a 
 large dose, he would gain an important point in practical medicine. 
 After many trials of its preparations he gives the preference to the infus. 
 digitalis of the Dublin Pharmacopoeia, but he cannot too strongly insist 
 on the greatest attention being paid to see that the leaves are well pre- 
 pared and of the latest gathering. The mode of the administration is to 
 begin with 3J. of the infusion every night at bedtime, increasing it after 
 a week to 3iss., and after another week to 3ij., beyond which it is rarely 
 necessary to go, and continuing it till sickness of the stomach and dilated 
 pupils are observed, when the dose is to be diminished by ^ss. or 3j., 
 till the maximum dose that can be borne without inconvenience be as- 
 certained, which quantity is to be taken for two or three months. Given, 
 in this way its administration is attended with no inconvenience beyond 
 an occasional attack of slight sickness of stomach in the morning, or 
 headache, &c., when the medicine is to be discontinued, and a day or 
 two are to be allowed to pass over before resuming its use. With the 
 exception of these symptoms there is no perceptible effect, except slow 
 action of the heart, and the patient is able to continue his ordinary avo- 
 cations. 
 
 In the use of digitalis as a sedative to the heart's action, I have never 
 found it act as a diuretic; and this I account for by not having combined 
 it with other diuretics, as the neutral salts, or the bichloride of mercury, 
 &c. I have not spoken of the state or quantity of urine, as I soon found 
 it was uninfluenced by it. Dr. Munkf has made some excellent obser- 
 
 * Vol. 36, p. 1473. 
 
 t Dr. Munk on the Action of Digitalis, p. 295, Guy's Hospital Reports, for October 1844. 
 
 29 
 
450 HUMAN BRAIN. 
 
 rations on this subject, which I have not room to quote here so fully as 
 I should wish, but I must extract those which conclude his paper. " A 
 remedy, it has been well observed, can scarcely serve and hurt the con- 
 stitution at the same time ; and digitalis, where it gradually and in a 
 kindly manner abates the heart's action, or stimulates the kidneys, never, 
 according to my experience, accumulates, or produces, in a prominent 
 degree, those alarming symptoms, upon which writers have so amply 
 dilated." 
 
 The best account of the use of digitalis as a medicine, historically and 
 therapeutically, will be found in a treatise by Dr. William Hamilton, of 
 Bury St. Edmund's, 1807. It is well worthy of perusal. Many cases 
 of epilepsy are complicated with menorrhagia, and in these cases I found 
 the digitalis additionally useful. Dr. Ferriar, who has published an 
 essay on this subject, states that he prescribed it with great benefit in 
 hemorrhage generally, but especially in menorrhagia. 
 
 In relating a few more of the cases in which I have found the digitalis 
 beneficial, I shall again advert to its use when there is any disturbance 
 of the uterine functions, and the propriety of combining it with other 
 medicines. When I give the digitalis I always keep, or have kept for 
 me, at the commencement, a daily account of the pulse, numbering the 
 pulsations in the quarter, as related in the next case; after I have em- 
 ployed it for some months, I am then satisfied with a report every other 
 day. 
 
 Case 89. November 7th, 1846. A. B. C., set. 16, a tall, delicate-looking girl, with a pleas- 
 ing countenance, has had fits since she was seven years old. The first followed scarlatina, 
 with an interval of two or three months. She had none of the usual sequelae of the dis- 
 ease. Father and mother died of phthisis. She was in strong convulsions for a short time, 
 and then insensible for above four hours. She first menstruated at 13, but not regularly 
 three and five weeks. She generally has the attacks every month in bed, three at a time. 
 In the day she has often a warning of an attack, so as to cry out, "My nose." Her grand- 
 mother has found that by pinching the nose she has averted the attack. The fits are not 
 ushered in with a decided cry. She recovers her senses in about ten minutes, and then 
 falls off to sleep. She says that the sensation it comes on with is a trembling in her bowels. 
 She cannot describe it in any other way. No headache before the fits, but always after, 
 which is removed by sleep. Bowels regular ; intellect has been very good, but is now be- 
 ginning to fail. She had ascarides five or six years ago, but none lately. 
 
 Last attack, three or four days ago, three fits; two days after, one more; two days after, 
 one; five in all. Pulse 23, 21, 22, in the quarters. Ordered, Inf. Digitalis (Dublin Phar- 
 macopoeia) \\. h** c nocte. 
 
 7th. This night she took the medicine, and had three fits, and vomited violently. 
 
 8th. She had the commencement of an attack, but it appeared to be averted by pinching 
 the nose and pouring some sal volatile into her mouth. Inf. Dig. ij. h. n. 
 
 9th. Pulse 29, quarter of minute; ^ss. 
 
 10th. Pulse 20 ; Svj. 
 
 llth. Pulse 20; j. 
 
 12th. Pulse 20, 18, 18; gx. 
 
 13th. Pulse 19. 
 
 14th. Has had several threatenings, but no complete attack ; pulse 22, 19, 19, 19; x. 
 
 15th. Pulse 19; j. 
 
 16th. Pulse 18; ^x. 
 
 17th. Pulse 21, 21, 21; ^iss. Has not had any complete fit since the 7th, but severe 
 threatening; she also complains of such horrid thoughts of cutting throats, and jumping out 
 of windows. She is now menstruating, and has been so this week; it is now always very 
 profuse. 
 
 18th. Pulse 19; iss. 
 
 19th. Pulse 20; Ziv. 
 
 20th. Pulse 16; gij. 
 
 21st. Pulse 16, 16; no complete attack, but several tremblings; hiccup and sickness. 
 
EPILEPSY. 451 
 
 Continue Pil. Rhei co. gr. viij. bac nocte. Cal. gr. ij. Inf. Senna ^j. Syrup. Zingib. j. 
 Magn. Sulph. gij. Acid Sulph. dil. tt\,iv. mane. 
 
 22d. Pulse 16, 17, 18, 17. 
 
 23d. The aperient has acted very freely; the pulse is sharp and full 20, 18; x. 
 
 24th. Pulse 20 ; 5Jxij. 
 
 25th. Pulse 18; xiv. 
 
 26th. Pulse 18, 17, 18 ; vomited this morning; gvj. Pil. Rhei. co. gr. vj. Cal. gr. j. 
 Inf. Senn. ^j. Magn. Sulph. gj.' Acid Sulph. dil. TT\,v. Syrup. Zingib. j. mane ; to be taken 
 to-night, if the sickness continues. 
 
 27th. Pulse 17 ; Pit. et H. ut supra hac nocte, 
 
 28th. Pulse 20; two fits. 
 
 29th. Pulse 20; one fit; Rep. Haust. Digit. vj. 
 
 30th. Pulse 19, 16, 18 ; Inf. Digit. |j. Pil. Rhei co. gr. v. p. r. n. 
 
 December 1st. Pulse 20 ; no attack ; gj. gij. 
 2d. Pulse 18, 17, 18, 18; one nervous attack; x. 
 
 3d. Pulse 16, 18, 18, 18; none; x. 
 
 4th. Pulse 20; three slight; ^xij. 
 
 5th. Pulse 18,20; several; 3pdj. 
 
 6th. Pulse 18, 20; four slight; ^xij. 
 
 7th. Pulse 20, 18, 20, 20; three slight attacks; xij. 
 
 8th. Pulse 18, 20, 18; ^ij. 
 
 9th. Pulse 18 ; Pil. Rhei gr. v. h. n. 
 
 10th Pulse 18; one or two slight attacks; Rep. H. Digit, gij. 
 
 llth. Pulse 19, 19, 19; ^ij. 
 
 12th. Pulse 20 ; ^xiv. "" ^ 
 
 13th. Pulse 20; xiv. 
 
 14th to 17th. Repeated nervous attacks, but slight; gxiv. 
 
 18th. The same; Hyd. Chlor. gr. iij. h. n. Haust. Aper. mane. 
 
 20th. Pulse 19, 20; omit the Digitalis. 
 
 21st. Pulse 20, 19; Rep. Hs. Digit, gxiv. The nervous affections frequent, and exces- 
 sively low in the animal spirits. 
 
 22d. Pulse 18, 19; two more complete fits; Creosote TT\J. Panis. q. s. ut fiat Pil. j. ter 
 in die. 
 
 23d. Pulse the same as day previous. 
 
 24th The same. On this occasion she was not ill as usual, previous to the menstrual 
 period, but the fits came after ; they were not so severe as usual, for she did not even know 
 of their occurrence. The menstrual discharge was not so profuse as usual. The nights 
 have been better since taking the Creosote. 
 
 26th. Pulse 18, 18, 19, 19; Creosote lt\J. t. d. 
 
 28th Pulse 18; Rep. Pil. 
 
 30th. Pulse 18, 17; two nervous; Rep. Pil. Creosote 
 
 31st. Pulse 18, 19; Rep. Pil. 
 
 January 2d, 1847. Pulse 18, 17; Rep. PiL 
 
 4th. Pulse 18, 18; Rep. Pil. Creosote. 
 
 5th. Pulse 20 ; Rep. 
 
 6th. Pulse 20, 20. 
 
 9th. -Pulse 20,20; Pil. Creosote; b. d.; Inf. Digitalis; gss. nocte. 
 
 llth. Pulse 20, 20; Rep. H.; gj. 
 
 13th. Pulse 20; Rep. H.; ^iss. nocte. 
 
 14th. Pulse 18, 16 ; half attacks less frequent and less severe than they were; 5iss. 
 
 16th. Pulse 18; Rep. Digit. 
 
 18th. One slight. 
 
 19th. Pulse 20, 20; slight attacks, not as it used to be: Rep. Digit. ?ij. 
 
 20th. Pulse 18, 18, 18; gij. 
 
 22d. Pulse 18; gij. 
 
 24th. Pulse 18, 18; gij. 
 
 26th Pulse 18, 16, 17; gij. Pil. Rhei co. gr. v. h. n. Nervous attacks less frequent, 
 some days none; less severe. 
 
 28th. Pulse 19, 18. ' 
 
 30th. Pulse 17, 16; Rep. Digit 
 February 1st. Pulse 17, 16. 
 2d. Pulse 17, 16; Rep. gij. 
 4th. Pulse 17, 16; Rep. gij. 
 6th. Pulse 16, 16, 17; Rep. 5ij. 
 8th. Pulse 18, 20. 
 
452 HUMAN BRAIN. 
 
 10th. Pulse 18,20; |ij. 
 
 12th. Pulse 19, 20; nervous attacks frequent in the last day or two; this is the case 
 after aperient medicine. 
 
 13th. Pulse 18, 19, 18; ^ij.; Creosote TT\j. b. d. 
 
 14th. Whole attack in the morning, after rising, but not so long or so severe. 
 15th. Another about 7, after rising; pulse, 11 A.M., 20, 21, 20; Inf. Digitalis, g iss. nocte, 
 ditto, ^ss. mane; omit Creosote; Hirud. ij.; singulae mammae. 
 16th. Menses returned; slept well. 
 17th. Pulse 18, 18, 18; one fit. 
 18th. Another fit, stronger. 
 
 19th. Pulse 36, 18; Inf. Digitalis gij. Spirit Menth. Pip. j. o. n. Creosote n\j. Ext 
 Rhei gr. iij. Misce fiat pil. j. bis in die sumenda. 
 22d. Pulse 18, 18. 
 
 23d. Pulse 18, 18; j. o. n. Rep. Creosote b. d. 
 25th. Pulse 18, 18. 
 26th. Pulse 16, 17, 18; gss. o. n. 
 28th. Pulse, 17, 18. 
 March 1st. Pulse 17, 17, 16. 
 2d. Pulse 18, 18; gij. 
 4th. Pulse 16, 16. 
 6th. Pulse 17, 16, 18: gij. 
 7th. ^iss. alt. nocte. 
 8th. Pulse 16, 17, 17; 5ij. 
 9th. Pulse 16, 17, 16; iss. o. n. 
 10th. Pulse 17, 17, 17. 
 12th. Pulse 17, 17 ; Rep. H. Digit, ^iss. 
 13th. Pulse 16, 16, 17; gij. o. n. 
 
 14th. Fit, 5 A. M., slight; about the monthly period, but the menses have not appeared. 
 15th. Pulse 17, 17, 17. 
 
 16th. Pulse 18, 17; Ziss. o. n. 
 
 18th. Pulse 20, 20; iss. 
 
 19th. Pulse 17, 17, 17; liss. 
 20th. Pulse 17, 17, 17; |iss. 
 22d. Pulse 17, 16, 17; giss. 
 23d. Pulse 16, 16; ^iss. 
 
 25th. Pulse 15, 16, 16. 
 
 26th. Pulse 17,17, 17, 17; one fit; giss. 
 
 27th. Pulse 22, 23, 23, 23; two fits this night; giss. 
 
 28th. Pulse 16, 17, 16; one fit in the night, with sickness; four fits in all; no Digitalis 
 
 to-night : the vomiting is so severe, that Mrs. was afraid to give her the Digitalis. She 
 
 took the Creosote twice in the day. The bowels having been confined, she has generally 
 had the Pit. Rhei co. gr. v. every other night; the last fit very slight. 
 
 29th. Pulse 17, 17, 17, 18; no Digitalis last night; Inf. Digitalis, ^iss. o. n. Creosote 
 n\j. b. d. Pil. Rhei co. gr. v. p. r. n. 
 
 31st. Pulse 15, 16, 16, 15; Rep. H. Digit. 
 
 April 1st. Pulse 16, 16; Rep. Digit. 
 
 3d. Pulse 16, 17, 16, 16. 
 
 4th. Some threatening of an attack. 
 
 5th. Pulse 16, 17, 17 ; Rep. Creosote. Rep. Digital, gij. 
 
 6th. Pulse 16, 16; Rep. Digit, gij. 
 
 8th. Pulse 17, 16, 18, 18; Rep. Creosote. Rep. Digit. ij. 
 
 10th. Pulse 18, 20, 20, 18. 
 
 llth. Pulse 15, 16, 16; Rep. Digit ij. 
 
 12th. Pulse 16, 17. 
 
 14th. Pulse 17, 16, 17. 
 
 15th. Pulse 16, 17; Rep. Dig. t ^ij. 
 
 16th. Pulse 20, 19; Rep. Dig. 5jij. 
 
 18th. Pulse 16; Rep. Dig. |ij. 
 
 19th. Pulse 20, 20 ; after dinner and exercise. 
 
 20th. Pulse 16, 15; gij. 
 
 22d. Pulse 20, 20; after trundling her hoop; 5ij. 
 
 23d. Pulse 18, 18; gij. 
 
 24th. Pulse 1 9, 20. 
 
 25th. Pulse 18, 19. 
 
 27th. Pulse 16, 16, 18 ; Ferri Sulph. gr. j. Creos. %]. Aloes co. gr. v. o. n. She men- 
 
EPILEPSY. 453 
 
 strnaled this morning. On Saturday evening, that is, the 24th, she had a very slight fit, 
 slighter than they have known them before. Ord. Ferri Sulph. gr. j. Creosote TT\J. b. d. 
 Inf. Dig. ^ij. o. n. Pil. Aloes co. gr. v. o. n. 
 
 28th. Pulse 16, 16, 18; gij. o. n. Creosote Tuj. Ferri Sulph. gr. j. Quinin. Sulph. gr. 
 j. bis in die. Pil. Aloes co. gr. v. o. n. 
 
 29th. Pulse 17, 17; ^ij. o. n. 
 
 30th. Pulse 17, 18. 
 
 May 2d. Pulse 17, 16, 16; Rep. H. Digit. 
 
 3d. Pulse 17, 16; Rep. Dig. 
 
 4th. Pulse 16, 16. 
 
 5th. Pulse 15, 16, 15; Rep. Dig. ; has passed the monthly period without any attack, the 
 first time this has occurred. 
 
 7th. Pulse 14, 15, 15. 
 
 9th. Pulse 15, 16. 
 
 10th. Pulse 16, 14 ; Rep. Omnia. 
 
 12th. Pulse 18, 18, 17. 
 
 14th. Pulse 16, 17; Rep. Inf. Dig. Ferri Sulphatis gr. j. Pil. Aloes c. Myrrh gr. ij. b. d. 
 Pil. Cal. co. gr. v. o. n. 
 
 15th. Pulse 17, 18; Rep. Digit. 
 
 16th. Pulse 16, 17. 
 
 17th. Pulse 16, 17. 
 
 18th. Slight fit this morning; sickness and vomiting afterwards; bowels freely opened. 
 Ord. Pil. Col. h. n. Inf. Dig. gj. h. n. Omit Pil. Ferri. 
 
 19th. Pulse 20, 20. Rep. Inf. Dig. gj. 
 
 20th. Pulse 18, 18. Rep. Ferri. Inf. Dig. giss. 
 
 22d. Pulse 17, 18. 
 
 24th. Pulse 16, 16. Rep. Omnia. 
 
 25th. Pulse 19,20, 19. gij. 
 
 26th. Pulse 17, 18, 17, at noon. 
 
 27th. Pulse 17, 17, 11 A.M. gij. Omit Ferri. 
 
 28th. Pulse 17, 16, 17, at noon; in the evening, 17, 18, 17. 
 
 29th. Pulse 17, 17, 18, 18, vespere. Inf.Jij. 
 
 30th. Pulse 17, 17, 17, ditto. Rep. Dig. Jij. 
 
 31st. Pulse 16, 18. Rep. Dig. gij. 
 
 June 1st. Pulse 17, 18, 17, late in the evening, after a long walk, 
 
 3d. Pulse 15, 15, 1 1 A. M. Rep. Ferri. Inf. gij. 
 
 6th. Pulse 16, 16, in the evening. 
 
 7th. p u i s e 16, 16, 16, 16, vespere. 
 
 8th. Pulse 14, 15, 15. Rep. Ferri. Inf. Digitalis gij. 
 
 9th. Pulse 17, 16, o. n. 
 
 10th. Pulse 17, 16, 17. Rep. Digit, ^ij. 
 
 llth. Very slight fit, six weeks interval. Pulse 18, 17, 18. ij. Continue Ferri quotidie. 
 
 12th. Pulse 17, 17, 17, 17. 
 
 14th. Pulse 16, 16, 16. Rep. Inf. Digit, gij. 
 
 15th. Pulse 17, 16, 17. Rep. 
 
 17th. Pulse 21, 21, vespere. 
 
 18th. Pulse 18, 18, 18, mane, Rep. Omnia. 
 
 19th. Pulse 17, 17, 17. 
 
 21st. Pulse 17, 17, 17, in the morning, after a walk of three miles. 
 
 22d. Pulse 15, 16, 16. Rep. Omnia. 
 
 24th. Pulse 16, 17, 17. 
 
 25th. Pulse 14, 15, 14. Ferri Sulph. gr. ij. b. d. 
 
 27th. Pulse 19, 20, 19. giss. h. n. 
 
 28th. Pulse 15, 15, 15. Ferri in die Inf. giss. o. n. 
 
 30th. Pulse 16, 15, 16. Rep. Digit. 
 
 July 2d. Pulse 16, 17. Ferri Sulph. gr. ij. in die. Inf. Digit, ^iss. o. n. Feels quite 
 well ; very few nervous feelings now. 
 
 I have already stated that I have not found the Digitalis so successful 
 in old standing cases of epilepsy in the adult as in the younger subject; 
 but I have always found it exert a very decided controlling power over 
 the disease. This was very strikingly exhibited in the following case, 
 which is also interesting, as showing that its long-continued use is some- 
 times attended with injurious effects. The case receives an additional 
 
454 HUMAN BRAIN. 
 
 interest from the clear way in which it is detailed by Mr. Greenhow, 
 of Tyneraouth, by whose advice I was consulted. Its connection with 
 a cutaneous eruption is important. 
 
 Case 90. Mr. S. T. P., set. 21, was, during infancy and boyhood, the subject of a chronic 
 cutaneous affection, extending over the hands, arms, and lower part of the face, and which 
 only finally disappeared within eighteen months or two years of his first epileptic seizure. 
 After the cessation of the eruption he became enormously fat for his period of life, and ac- 
 quired a pale, pasty kind of complexion. He has at no time manifested any symptom of 
 aberration of rnind or deficiency of intellect, and is at the present period (Oct. 1845), in 
 much better general health than at the period when I was first consulted. He is also much 
 less corpulent, and has lost, in a great measure, the peculiar character of the countenance 
 before described. 
 
 Mr. S. T. P. has always been prone to derangements of the stomach, accompanied by great 
 tendency to sickness, which he has been accustomed to encourage by copious draughts of 
 warm water; and by occasional headache and feverishness. His tongue, always more or less 
 furred, has a swollen, sodden kind of appearance, and is also deeply indented by the teeth. 
 The pulse is regular, rather small, and averages 70. 
 
 His father took a prominent part in the election of 1841, and he, being one of his father's 
 clerks, was exposed to great mental as well as physical excitement. At 5 A. M., July 23, 
 1841, (at that time being 17 years of age,) he was awakened out of his sleep by a sensation 
 of cramp in the left leg, which was immediately followed by an epileptic fit. I did not see 
 him during the attack, which lasted a very short time, but found his stomach much deranged 
 on the following day. At first the attacks succeeded one another at regular intervals ; gene- 
 rally between the hours of 4 and 5 A. M., and were always preceded by the aura epileptica, 
 which awoke him and gave time to alarm his father and mother, who slept in the adjoining 
 room. If at any time he had a slighter paroxysm, it was most frequently succeeded by a 
 second on the following morning. The fits have generally been followed by sleep ; but there 
 has hitherto been no tendency to coma, and whenever headache or feverishness have oc- 
 curred on the following day, they have clearly been referable to disorder of the digestive 
 organs. There has from the first been no biliary derangement, and the action of the bowels 
 is regular and efficient without the aid of medicine. 
 
 During the last two years T have been only very occasionally called to see him ; but the 
 epileptic attacks still occur, though less regularly and with longer intervals. Various modes 
 of treatment having been diligently tried without any very decided benefit, medicine has of 
 late only been had recourse to when the attack has been succeeded by feverishness or un- 
 usual derangement of the stomach. He has, however, within about a year had three or at 
 most four attacks in the day-time, and in the waking state. On the occurrence of the first 
 of these day seizures I was sent for, and found him just recovering, although unable to speak. 
 It was only after free vomiting, and the lapse of half an hour, that he recovered his speech, 
 or could walk steadily. On that occasion he attributed the paroxysm to a fright; but the 
 other day-attacks have been preceded by no apparent cause. 
 
 Taking the history of the case into consideration, I, in the first instance, directed my atten- 
 tion to removing the evident derangement of stomach, which complicated if it was not the 
 indirect cause of the epilepsy. All excitement was strictly forbidden, and a very restricted 
 diet, with abstinence from stimulants, was prescribed. Small doses of Pil. Hydrarg. with 
 stomachic tonics were administered, and his bowels were kept free by the use of mild laxa- 
 tives. Exercise in the open air was enjoined; and he, for many months, entirely gave up 
 attendance to business. An issue was also made in his arm, from which a free discharge 
 was kept up for many consecutive months. After he had had three or four attacks he was 
 seen with me in consultation by Drs. Greenhow, of North Shields, and White, of Newcastle ; 
 and, at their suggestion, the Pil. Hydrarg. was continued until the gums became tender. 
 Afterwards, at Dr. White's suggestion, he took the following: R. Pulv. Rad. Dictamni. 
 Exotic iss. Pulv. Rad. Zedoar. Flav. gr. xv. m. in ch. v divid. cap. j. primo mane quotidie 
 ex aqua. He was, at the same time, restricted to vegetable and farinaceous food ; all kinds 
 of meat, animal broths, stimulants, tea and coffee, being prohibited. The bowels were kept 
 free by daily doses of castor oil, and a free eruption was kept up on the arms for several 
 weeks by the use of the following liniment R. Ol. Croton gj. Sp. Terebirithinae gvj. T. 
 Lavend. co. 2JJ. m. ft. Liniment. 
 
 The powders were increased in strength from time to time ; but after persevering in their 
 use, without any decided benefit for seven months, they were finally abandoned. He has 
 also tried the Nit.Argenti twice for about four months, with a few weeks' interval between 
 the twocourses ; likewise the Liq. Potassio. Arsenic. All these plans of treatment having failed, 
 he has long ceased to employ internal remedies systematically, although attention to diet and 
 regimen has been frequently and stringently enforced. 
 
EPILEPSY. 455 
 
 On the receipt of this report I wrote to Mv. Greenhow to the following effect : 
 
 "Oct. 15th, 1845. I believe that epilepsy is generally dependent on disturbance of the 
 organs of digestion and generation when it is not occasioned by positive disease of the nerv- 
 ous system. I have no doubt that Mr. S. T. P.'s attacks are referable to such disturbance, 
 and not to any organic disease of the brain and spinal cord ; and if this view is correct we may 
 possibly effect a cure, though it would not be right to hold out any certain prospect of such 
 a desirable result after so much has been tried in the way of medicines ; but I never despair 
 now. after the recovery of a friend who had the disease for fifteen years, beginning at about 
 the age of twenty. 
 
 " I could, indeed, mention five or six cases of adults who have recovered under similar 
 treatment. The general plan I will now explain, with the understanding that it is only to 
 be carried out under your own supervision. Medicine is certainly of great service in this 
 disease, but diet, &c , are even more important, or rather, I should say, that the one is value- 
 less without the other. 
 
 " First, with regard to diet : 
 
 " Breakfast. Plain dry toast or home-made bread, without butter ; milk and water if milk 
 agrees, if not, weak tea or cocoa. 
 
 " Luncheon, about one. A small sandwich and a biscuit, with a tablespoonful of brandy 
 in half a tumbler of cold water, without sugar. 
 
 " Dinner, not later than five. Plain roast, boiled, or broiled mutton : no other meat. Mealy 
 potato. Farinaceous puddings, but no pastry, no fruit, no preserves, no dessert of any kind j 
 the same quantity of brandy and water; no wine or beer. 
 
 " Tea should not be a real meal, only a little very weak tea, and toast without butter. 
 
 " Cold shower-bath the first thing after getting out of bed, warm water for the feet. If 
 unaccustomed to the shower-bath, to be used tepid for the first few days. A short run or 
 walk before breakfast. As much walking exercise in the day as can be taken without fa- 
 tigue; no horse exercise; no mental excitement ; no sexual excitement ; to sleep on a matress, 
 the feet well covered. If the feet are cold on going to bed, to put them in warm water. 
 The medicines I have prescribed on another sheet. In all the cases in which this plan has 
 succeeded, it has not succeeded immediately, but the attacks have gradually lessened in force 
 and frequency. 
 
 "Sincerely hoping that we shall meet with success, I will now subscribe myself, yours 
 very sincerely, " S. S." 
 
 "Argent. Oxyd. gr. j. Ext. Cal. co. gr. ij. t. d. Liq. Potass. Brandith. ^iss. Tinct. Todin. co. 
 3J. Spirit JEth. Nit. ^iss. sumat cochl. min. ex cyatho vinoso aqua bis in die surnat." 
 
 "Tynemouth, 2ist November, 1845. 
 
 "My Dear Sir I have intended writing to you for some time past, having in the first in- 
 stance deferred doing so until I was satisfied the plan you suggested was agreeing with my 
 patient . . . 
 
 "Mr. S. T. P., I am glad to say, appears to be going on well. A few days previously to 
 commencing the medicine he had a threatening without the succeeding fit, which he entirely 
 escaped, and he has had two slight fits since. I have made him discontinue the -sandwich 
 for luncheon, and substitute plain bread or biscuit, as he has become fatter since he followed 
 your plan ; in other respects he pursues it strictly." 
 
 "Tynemouth, 25th February, 1846. 
 
 " My Dear Sir I almost fear you must have thought me inattentive in allowing so long a 
 period to elapse without again giving you a report of our patient's progress. I have not, 
 however, thought it necessary to trouble you sooner, as no material change has taken place 
 since my last, and you had led me to expect the improvement would be very slow. He has 
 now pursued the plan for four months, and although the number of attacks, during that time 
 as compared with the same period in the four preceding years, has been greater, this year 
 there have been seven seizures between the 17th of November and the present date, and 
 previously they have never exceeded five. I think his general health improved by the 
 treatment you suggested; and his father is decidedly of opinion that the attacks are shorter 
 in duration and less violent than they used to be. Under these circumstances, I am disposed, 
 provided you agree with me. in the opinion, to pursue the plan for some time longer. That 
 you may be better able to judge of his state as to the frequency of attacks under the different 
 plans of treatment he has pursued, I inclose a comparative statement of his case on these 
 points during the same period in each year since he was first seized. I ought also to men- 
 tion that his tongue is improved in character, and that his skin has assumed a more healthy 
 appearance. He dined with some friends on the 26th of November, and evidently disordered 
 his stomach. To this I attribute the attacks on Nov. 27th, Nov. 30th, and Dec. 2d ; at this 
 time he had a good deal of sickness; headache, and lassitude, with depression of spirits and 
 feverishness. Have you seen a plan, recommended I believe originally by Dr. Corrigan, for 
 
456 HUMAN BRAIN. 
 
 treating epilepsy with Digitalis ? I remember to have seen a short account of it in one of 
 the Journals, but too brief to enable me to judge of its merits. 
 
 " Believe me, my dear Sir, yours very sincerely, 
 
 "E. HEADLAM GREESHOW." 
 
 In answer to this I wrote to advise the omission of the oxyde, as I was afraid of discolor- 
 ation of the skin, as he had taken it four months, and I recommended the use of the Digi- 
 talis as prescribed by Dr. Corrigan, having now had a good deal of experience of its efficacy. 
 
 "Tynernouth Place, 10th Sept. 1846. 
 
 " My Dear Sir I have not thought it necessary to trouble you earlier with any statement 
 of the progress of Mr. S. T. P.'s case. I have kept tolerably minute notes of his state since 
 I last wrote to you, and proceed to give you a brief abstract of them. The last attack of 
 epilepsy before commencing Dr. Corrigan's plan, was on the 14th of February. On the 26th 
 he commenced taking the Digitalis, on which day his pulse was 64 ; ten days afterwards 
 (March 7th) the pulse had risen to 80. He had attacks on the 7th, 17th, and 28th of March. 
 That on the 28th was so slight that he did not become entirely insensible, although he had 
 the aura, convulsions, and loss of speech. The dose was gradually increased, until on the 31st 
 of March he took 2 ounces of the infusion, prepared according to the Dublin formula (equal 
 to 5 oz. Pharm. Lond.). On April 1st, he was very sick 5 pulse 60, weak and irregular; 
 headache, pains in the limbs, and along the course of the spine. The Digitalis was now 
 omitted for three nights, when his pulse having resumed its natural character, he recom- 
 menced with the original J oz. doses. In four days his pulse fell to 50. On the 8th day 
 (April 12th), having taken l^oz. the evening before, he complained of pain in the shoulders, 
 chest, arms, back and limbs. April 13th. Sickness; pains much increased ; slight headache; 
 pulse 90, small and feeble, but regular. From this time the Digitalis ceased to affect the 
 regularity of the pulse, which, contrary to its former and more usual effect was henceforward 
 uniformly increased in frequency as the patient came under its influence. The draught was 
 omitted on the 13th of April, but resumed on the 14th. On the 16th the pain had increased ; 
 there was also tenderness, generally, over the abdomen, more intense at the epigastrium ; 
 tongue coated, with redness of the tip; rapid emaciation. On the 17th he was covered with 
 an eruption, closely resembling measles, which extended over the back, shoulders, chest, 
 abdomen, arms, limbs, and face. No urtication. On the 18th the redness had disappeared 
 from the tongue, but the tenderness at the epigastrium continuing, eighteen leeches were 
 applied. On the 20th, the tongue had the tremulous character observed in delirium tremes; 
 and on the 22d his hands were also tremulous. On the 25th of April he had a threatening, 
 which, after walking two or three times across the floor, passed off, without a regular attack. 
 This, is the first time he ever had the aura, and other feelings of an impending fit, without 
 their being succeeded by one. He continued the Digitalis for the most part regularly, during 
 this period, only omitting it once or twice for a single night, when the symptoms were most 
 urgent. The dose, at this time, averaged l oz. (equal to 3 oz. P. Lond.), but varied ac- 
 cording to circumstances. The eruption continued with but slight alteration for many weeks, 
 only acquiring a bluish leaden kind of tinge, and being accompanied by slight desquamation 
 of the cuticle. On the 16th of May it was again necessary to apply leeches to the epigastrium. 
 The Digitalis was continued until the 20th of June, when his general health having become 
 much impaired, I began to reduce the dose. He ha.d not, however, entirely discontinued it, 
 when, on the 28th, he had an epileptic seizure, but much slighter than usual. I again caused 
 him to resume the full doses of Digitalis, and he continued them until the month of August, 
 when he had another attack. For some weeks he had complained much of pains in the 
 joints, which always diminished when the dose of Digitalis was lessened for a day or two, 
 and vice versa ; but about the middle of August these gave place to an attack of ophthalmia, 
 accompanied by pain in the facial nerve, and above the eye, as well as very acute pain in 
 the eyeball. Simple treatment failing, I was obliged to get him gently under the influence 
 of mercury, since which it has entirely disappeared. He has lost flesh greatly since com- 
 mencing this plan, and his general health is so much impaired, that, taken into consideration 
 together -with some slight 'pectoral symptoms, which have shown themselves during the 
 last few weeks. I have advised his father to abandon all treatment, at present, for the cure of 
 the epilepsy. I think you will fully agree with me, when you consider the great variety of 
 treatment that has been unavailingly tried during so long a period; and that the only remedy 
 (the Digitalis) which has really appeared to control the attacks, has produced so much dis- 
 order of the general health. In another case in which I have tried the same remedy (a 
 female), the attacks have been less frequent, but have nevertheless returned at regular in- 
 tervals. I am satisfied that Digitalis occasionally exercises a *ery decided influence over 
 the complaint, and I think that it may prove successful in a few instances ; but my experience 
 leads me to think its administration requires great caution, and I should scarcely again persist 
 
EPILEPSY. 457 
 
 so. long in its use as I have done in Mr. S. T. P.'s case. Begging you to execuse all defects, 
 as I write in haste, 
 
 " Believe me, my dear Sir, very sincerely yours, 
 
 " E. HEADLAM GREEWHOW." 
 
 List of Mr. S. T. P.'s attacks of epilepsy, between the 16th of November and 12th of Feb- 
 ruary in each year, since 1841: 
 
 1841, November 16th. Two slight attacks; first at 2 A. M. and second at 7 A. M. ; was 
 each time awoke out of his sleep by the aura. 
 
 . 23d. One attack at 7 A. M. ; was awoke by the aura. 
 
 29th. Was awoke at 7 A. M. by the aura, followed by slight convulsion, without be- 
 coming insensible. 
 
 Dec. 13th. An attack at 6J A. M.; was again awoke. 
 
 1842, Jan. 1st. An attack at 5 A. M.; ditto. 
 
 Feb. 26th. Two attacks whilst asleep, each time being awoke, as usual, by the dura; 
 the first at half-past 4, and the second at half-past 7 A. M. ; likewise a third, in the waking 
 condition at 6 p. M. These were all slight attacks, and the last was the first he ever had 
 whilst awake. 
 
 Until the 21st of November 1841, the treatment consisted of bitter tonics, and alterative 
 doses of blue pill,- with strict regimen, and the cold shower-bath, and during the remainder 
 of the period comprised in the table, of half-grain closes of Arg. Nit. three times a day. 
 
 Had no attack between September the 28th and November the 29th. The Arg. Nit. was 
 continued until the 20th of April, and from that period, he took Pulv. Dictamni Exotic, and 
 Pulv. Zedoar, as mentioned in my former report. 
 
 Nov. 29th. Two attacks, first at 5 A. M. the second at 6 A. M. -slight. I 
 
 Dec. 19th. Was awoke at 5 A. M. by the aura, followed by slight convulsion, but without 
 insensibility. 
 
 1843, Jan. 5th. A similar threatening to the last, at 5 A. M. 
 17th. Ditto, ditto. 
 
 Feb. llth. An attack at 6 A. M. 
 
 23d. Ditto, ditto, at 7 A. M. 
 
 The Pulv. Dictamni, &c., were continued until the 20th of December 1842, and then 
 abandoned. An issue was kept open in the arm for some months from August 1842, and 
 his diet was restricted to vegetables and farinacese, from April until the commencement of 
 1843. All stimulants had been prohibited from the first. 
 
 Nov. 1 1th. An attack at 3 A. M. 
 
 Dec. 2d. Ditto, ditto, 7 A. M. 
 
 22d. Ditto, ditto, 4 A. M. Likewise a threatening, such as before described at 7 A. M. 
 
 1844, Jan. 15th. An attack at 2 A. M. 
 Feb. 26th. Ditto, 7 A. M. 
 
 The issue was allowed to heal up in April or May, and I discontinued regular attendance 
 upon him, although I always heard of his attacks. Three or four times during the year 
 1844 I was called in when the seizures were unusually severe, or when his digestive organs 
 were deranged, but tried nothing on these occasions, beyond a little alterative aperient 
 Pil. Hyd. Pil. Rhei. co. Ext. Hyoscyami and occasionally Infus. Gentian or Calumbse, with 
 Garb. Sodse, for two or three days at a time. 
 
 1844, Nov. 9th. An attack at 7 A. M. 
 20th. Ditto, ditto, at 7 A. M. 
 
 Dec. 17th. Ditto, ditto, at 5 A. M. 
 
 1845, Jan. 20th. Ditto, ditto, at 5 A. M. 
 Feb. 8th. Ditto, ditto, at 3 A. M. 
 
 I was only once consulted by him between August 1844 and November 1845. During 
 the whole of this period, nothing was done, and I do not think he was particular in diet, or 
 in any other respect. 
 
 1845, Nov. 10th. An attack out of doors, at 9 A. M. 
 27th. An attack at 10 A. M. 
 
 30th. Ditto at 12 p. M. 
 Dec. 2d. Ditto, at 4 A'. M. 
 9th. Ditto, at 4 A. M. 
 
 1846, Jan. 3d. Ditto, at 3 A. M. 
 Feb. 2d. Ditto, at 6 A. M. 
 14th. Ditto, at 7 A. M. 
 
 During this period he has been pursuing the treatment recommended by Mr. Solly. 
 
 ''Tynemouth, 1st July 1847. 
 " My Dear Sir I think I mentioned that Mr. S. T. P. had an attack of ophthalmia. He 
 
458 HUMAN BRAIN. 
 
 has had several subsequent ones, accompanied by so much and such violent pain in the 
 head, that I at one time feared the membranes were implicated. The last of these attacks 
 was complicated with intractable iritis, which has resulted in the destruction of the right 
 eye ; since which his general health has been very much improved, and although still sub- 
 ject to epilepsy, the attacks come on less regularly, seldomer, and with less severity than 
 formerly. It is not now uncommon for him to have all the sensations of an attack without 
 losing his recollection. From circumstances which have since come to my knowledge, I 
 am disposed to believe, that had the patient, in this instance, followed implicitly my instruc- 
 tions as to regimen, the case would have terminated more satisfactorily. I have advised a 
 trial of the Digitalis in several cases since Mr. S. T. P.'s, but have not personally superin- 
 tended the treatment, nor found it exercise the same decided influence which it did in that 
 instance. I believe a young lady at Cambridge, for whom I have been several times consult- 
 ed, is now trying it, but I have not as yet heard the result. 
 
 " Believe me, my dear Sir, yours very sincerely, 
 
 " E. HEADLAM GHEENHOW." 
 
 I will next relate briefly some of the cases in which I have seen the 
 oxyde of silver useful. The first was in the person of a remarkably fine 
 young man, about twenty years of age, full habit of body. The disease 
 appears to have been induced in him by a change from an abstemious 
 mode of living, pursued when abroad, to the full diet and rich wines 
 found at the tables of the wealthy in this country. The first attack oc- 
 curred in the day-time after a ball the night before, no bed, and strong 
 ale for breakfast; it was ushered in with strong symptoms of inflamma- 
 tion of the brain, and treated accordingly. He suffered from the disease 
 for fifteen years, with varying severity ; the longest interval during the 
 whole of that time was three months, but this only occurred once ; the 
 usual interval was two months, and then fourteen days; the number of 
 fits at each period varied from four or five up to twenty ; on one occasion 
 he had a fit every two hours as the clock struck, for forty-eight hours. 
 He told me that he had sometimes averted a fit by taking a deep inspi- 
 ration. I asked him how he knew he was going to have a fit; he said 
 by uneasy sensations about his chest and singing in his ears. And 
 these warnings of approaching attacks have frequently enabled him to 
 leave the room where he was sitting, before the attack came on. He 
 mentioned to me that on one occasion after a series of attacks, on being 
 addressed by any one, the observation addressed, instead of conveying 
 the idea that was meant, gave rise to some other idea. Some time after 
 the attacks he suffered dreadfully from spasmodic action of the respira- 
 tory muscles, the spasms recurring at about three or five minutes, giving 
 rise to a sense of choking, which, after continuing for about three hours 
 was followed by violent pain in the region of the heart ; this was relieved 
 by the following draught; 
 
 Tinct. Hyoscyami. gj. Ant. Pot. Tart. gr. ss. Magn. Sulph gij. Mist. Camph. %j. 
 
 When the series of attacks were passing off, he usually had one or 
 two half attacks ; that is, he would be in a state of insensibility for a 
 minute or two, but there would be no cry or convulsions. The mind 
 was more affected by these than the complete attacks. There was no 
 headache before the attacks, but more or less headache afterwards; when 
 several occurred, then the pain would be violent. The memory was 
 much affected, the intelligence blunted, the temper irritable. Every 
 plan of treatment was tried and every medicine given ; he travelled 
 abroad with a medical man ; he tried homeopathy for two years ; he 
 
EPILEPSY. 459 
 
 tried mesmerism ; but one of the most celebrated professors of this art 
 declared his case unfit for it incurable. 
 
 During the greater part of his illness he was on a farinaceous diet, 
 meat diet invariably making him too plethoric ; on the farinaceous diet 
 his strength was immense, and he could walk from fifteen to twenty 
 miles a-day with ease. He commenced taking the oxyde of silver in 
 the month of October, shortly after having had five attacks at the usual 
 interval of eight weeks ; at the end of the next fortnight he had one 
 slight attack, and he has never had another. The dose was one grain 
 three times a-day, continued for two months, and then omitted for a 
 fortnight, the conjunctiva being carefully watched, to observe any change 
 of color. In addition to the oxyde of silver, he occasionally had the 
 tenth of a grain of calomel with each pill, and also the following 
 draught : 
 
 Liq. Potass, ^iss. Tinct. lodin. co. ^j. Spirit JEth. Nit Sjiss. M. capiat cochl. min. j. bis 
 in die ex cyatho parvo aquae. 
 
 The compound colocynth pill occasionally at night, if the bowels were 
 at all confined. The silver was continued, with the intervals of four- 
 teen days, for twelve months. He has now been well nearly four years, 
 and has quite recovered his mental activity. He has been closely occu- 
 pied in a public office, and has gone through a good deal of anxiety ; 
 he has returned to a meat diet, but not to the use of stimulants; he is 
 strong and well, but cannot take so much exercise as he could when 
 suffering from the disease, and he does not feel the want of it so as to 
 produce strong perspirations, which he then found much relief from. 
 
 The next case I give briefly in my patient's own words : 
 
 Case 91. "My first attack of epilepsy was when I was about eleven years old: I was 
 bled at the time, and when I recovered my strength I was not put on any particular diet, or 
 under any course of medicine. 
 
 " I had no return until I was nearly fifteen, although I had frequently felt symptoms of 
 epilepsy. 
 
 "In the beginning of June, 1838, I had an attack. I was put on very strict diet, by the 
 advice of Sir Benjamin Brodie 4 oz of meat, 6 oz. of bread. My attacks continued, on an 
 average, about every five weeks, for two years; during which time I abstained from beer, 
 wine, and spirits, but did not rigidly adhere to the diet recommended by Brodie. 
 
 " At the age of seventeen, I took for a year powdered tin, given me by a lady, and had a 
 cessation of attacks for nine months, but during that time I certainly often felt symptoms of 
 an attack. I discontinued the tin, on a return of my old complaint, 21st Jan. 1841. On the 
 27th April of the same year I had an attack ; again, July 24th; and on the 5th October. I 
 observed no particular diet, but took beer and wine in small quantities. 
 
 "On 23d October 1841, I left England, and had no attack until May 1842 ; again in Oc- 
 tober 1 842 ; and during my stay in the colony, I had them about once every three months. 
 Had an attack 5th of July (the day I landed), and on the 13th of August. 
 
 " 1844. I consulted Mr. Solly for the first time on the 8th of July, and since the 13th of 
 August 1844 have had none of the feelings which I considered attacks or warnings of an 
 attack." 
 
 Treatment. Began Argent. Oxyd. gr. j. t. d., July 8th, 1844; July 5th, an attack; one on 
 13th August. Argent. Oxyd. gr. xxij. Hyd. Chlorid. gr. iij. in Pil. xij. Sumat. j. t. d. 
 
 September 16th. Pil. Rhei co. gr. vij. Cal. gr. ij. h. n. Hs. mane. 
 
 October 6th. Added Ext. Col. co. gr. v. ad. gr. j Lingul. 
 
 November 8th. To discontinue silver, having taken it four months; has had no attack 
 since August 13th. 
 
 January 12th, 1 845. Has had no symptoms whatever of an attack ; returned to the use 
 of the silver in this form. R. Argent. Oxyd. gr. xxiv. Ext. Col. co. ^j. Cal. gr. ij. Conf. Q. 
 8. fiat Pil. xx. 
 
 April 9th. To leave off Argent. Oxyd., and take a purgative; feels quite free from all 
 symptoms. 
 
460 HUMAN BRAIN. 
 
 18th. Weak; loss of appetite; to take Quinine and Ferri Sulphas, gr. j. t. d. 
 June 24th. Feeling perfectly well, he discontinues these pills in about a week. 
 June 1847. Continues perfectly well, and is now living in South America. 
 
 In the next case the fits disappeared under the use of the oxyde of 
 silver. 
 
 Case 92. Miss S , aet. 30, of fresh complexion, had suffered from epilepsy for six 
 
 years. It came on after the subsidence of an attack of rheumatic gout; her general health 
 is good, and she menstruates regularly, but suffers a good deal of pain during that period; 
 she has no leucorrhoea or headache either before or after ; her memory is not at all affected, 
 and she has no warning when an attack is coming on ; she used to grind her teeth in sleep, 
 but does not do so now ; she has had three attacks in the last eight weeks, but previous to 
 that had an interval of six months; a fit does not last more than eight or ten minutes, and 
 they are shorter in duration than they used to be, and less violent ; they recur more frequently 
 in the night than day ; the last happened last Sunday, when she was at chapel. 
 
 On the 27th of September 1844, Miss S applied to me for medical treatment, she 
 
 suffering at the time from attacks of epilepsy. I ordered her to take R. Argent. Oxyd. gr. j. 
 Conf. 28, ut fiat Pilula, b. d. 
 
 Oct. 28th. Her medicine was altered to Pil. cap. ter in die. 
 
 Dec. 19th. Has continued the medicine regularly up to this time, but had an attack be- 
 tween twelve and one o'clock on the 5th inst., and also on the 13th in the morning about 
 seven ; she was ordered to leave off the Pil. for a fortnight, and take &. Liq. Potassse ^iss. 
 Tinct. Iodine co. gj. Sp. ^Ether Nit. ^j. mist, cujus sumat. coch. min. et cyatho vinoso aquae 
 bis in die. 
 
 Jan. 2d, 1845. She was not better, and the Oxyd. of silver was recommended. 
 
 Feb. 20. The patient has continued to take her Pil. ever since the last date, but not quite 
 regularly during the last fortnight. Ordered to continue them b. d. ; she has suffered lately 
 from slight palpitations of the heart. 
 
 April 19th. She has had one slight attack in the night. Ordered to continue the medicine 
 as before. 
 
 May 5th. Much the same ; to take her Oxyd. three times a-day. 
 
 6th. She had another slight attack in the night, but it only lasted a very short time. 
 
 13th. Has had a half attack. 
 
 27th. To continue the medicine as before, three times a-day; has had no further attack. 
 
 28th. The patient had an attack in the night. 
 
 June 6th. There has been no fit since the last date ; she was ordered to leave off the 
 Oxyd., having taken it for five months fourteen days, and ordered to resume the mixture of 
 Liq. Potassse, &c., instead. 
 
 July 5th. Has had a very slight attack in the night; the medicine to be continued. 
 
 Aug. 13th. She has had no further attack; the Oxyd. to be resumed. 
 
 Sep. 24th. Has continued the pills six weeks, and has remained quite well; she is much 
 distended in the stomach. 
 
 Oct. 15th. Ordered to leave off the Argent. Oxyd., there being some slight appearance of 
 blue upon the conjunctiva. 
 
 22d. She has had a very slight attack this morning, which lasted a few minutes, and she 
 has since slept for two hours; a very short time after she was enabled to resume her em- 
 ployment of drawing. She says she feels much better than she usually does after an attack. 
 
 25th. Ordered to resume the Oxyd., though the conjunctiva has quite a blue tint. 
 
 June 23d, 1847. She has had continued health up to this time, having had no attack 
 since April 1846. 
 
 In the next case the Oxyd. of silver exhibited great power over the 
 fits ; but I was obliged to abandon it in consequence of its tinging the 
 skin. 
 
 Co.se 93. April 13th, 1846. Jane Brown, set. 24, single, healthy looking, her counte- 
 nance not at all indicating any cerebral disease, states she has been subject to fits of an epi- 
 leptic character ever since she was nine months old ; they then attacked her ; sometimes 
 there was an interval of nine or even twelve months between : they continued to attack her, 
 with these long intervals, till about seventeen or eighteen; they then came on much more 
 frequently, sometimes only a fortnight, and at other times there has been too and three 
 months' interval. The longer she goes without the fits, the worse she is when they do 
 attack her. She has them now less frequently; her last attack was about three weeks ago; 
 ami when, after the weakness and general debility occasioned by the fits have passed off, 
 
EPILEPSY. 461 
 
 and her health and strength are returning, she is again attacked. The fits are of a strong con- 
 vulsive character, and last, with the intervals, three or four days, then, as before-mentioned, 
 leave her weak and debilitated. She is regular ; bowels in good order ; and says if she 
 could get rid of the fits she should soon get strong and well ; has not been able to go to ser- 
 vice on account of them. Ordered Argent. Oxyd. Pulv. Acaciae gr. j. ft. Pil. xviij. t. d. Nit. t. 
 Cal. co. gr. v. h. s. Si alocis constipe t. d. 
 
 May 6th. Has continued well; to continue the medicine. 
 
 26th. She states that she is better this week, but that last week she had a pain in her 
 chest, pointing to her stomach, and that this pain has usually preceded a fit, but that on this 
 occasion it did not do so ; continue the medicine. 
 
 28th. She has not had any fit since she first consulted me ; but her mother says she is 
 now in fear of one coming on ; because she has noticed that they are preceded by pain and 
 soreness in her stomach and all across her body. No pain in her head. Her health in other 
 respects is tolerably good. She has continued the pills regularly from the 13th of April. 
 Argent. Oxyd. Pulv. Acid. a. gr. j. Ext. Cal. co. gr. j. Theriag. Q. S. ut fiat Pil j. ter in die 
 sum.; bowels regular. 
 
 July 9th. Has not had any fits since she consulted me ; has taken Oxyd. three months. 
 Ordered to discontinue it for a week. 
 
 23d. Has not taken the medicine for fourteen days. On Sunday, the 19th, she experienced 
 very uncomfortable feelings in the stomach, as if she was going to have a fit, but she did not 
 lose her senses. She cannot describe the feelings, but she says they did not rise to the head 
 as they do when they terminate in a fit. She had had some fresh currant pudding with her 
 dinner. 
 
 She took some castor oil on the Monday about four or five o'clock, and after that began to 
 act, she began to feel better, and is now feeling nearly well again, but not quite. Pulse 22, 
 irritable. Ordered to resume the Argent. Oxyd. and to take Nit. Cal. co. if these feelings 
 should recur. 
 
 August 19th. Has been, on the whole, feeling well; but last Saturday and Sunday she 
 felt pain in her stomach, and an uncomfortable faint feeling; but this passed off, and she has 
 now a slight pain in her stomach. Ordered Bismuth Tris. Nit. gr. iv. t. d. 
 
 Sept. 22. Has been taking the Bismuth since the 19th ultimo. She was not so well about 
 the 17th or 18th of this month; but they did not communicate with me. 
 
 She had a fit on the 20th. Ordered to renew the Argent. Oxyd. 
 
 Oct. 15th. Has continued well and more free from pain; a little dark under the eyes. 
 To leave off for a week. 
 
 22d. Says that for the first three days after leaving off the medicine, her stomach was 
 uncomfortable ; but that after taking an aperient pill it became all right. Ordered to renew the 
 medicine. 
 
 Nov. 19th. Feels well; no pain in the head; stomach comfortable; sometimes a little 
 pain, but not much. Continue the medicine. 
 
 Dec. 2d. No fit, but was very uncomfortable two days ago, as if she was going to have 
 one, but it passed off, and she now feels pretty well. Ordered to continue the Argent. Oxyd. 
 
 1847, Jan. 4th. Has had no more fits since the last report; looks very blue under the 
 eyes, but not elsewhere. Leave off Oxyd., take Creosote. 
 
 12th. The appearance of blueness has not increased; thinks that she has had more pain 
 in her stomach lately, and some feeling of the fits. Ordered Bismuth gr. ij. t. d. 
 
 March 15th. Decidedly blue under the eyes; a blue line on the gurns of the lower jaw; 
 had a slight fit on March 9th, during the menstruation period ; interval nearly six months ; 
 the last on the 22d of Sept. Ordered Zinci Sulph. gr. ij. t. d. 
 
 31st. Bismuth Nit. gr. iv. t. d. A severe fit yesterday ; has been quite regular; it is now 
 about the monthly period. 
 
 April 13th. Much the same; slight uncomfortable feeling about the stomach. Creosote 
 TT\j. b. d. 
 
 May 1st. Had two fits just previous to the monthly period ; the flow followed a day or 
 two after; she had several half attacks, but not coming quite to a struggle. 
 
 10th. Had taken no medicine since. 
 
 17th. She is decidedly, though slightly, tinged with the Argent. ; it is manifest below the 
 eyes, and it forms a dark line on the edge of the gums ; she has not had any return of the 
 fits. As the last attack occurred just before the monthly period, I have ordered Ferri Sulph. 
 gr. j. Zinci Sulph. gr. j. b. d. Nit. Aloes c. Myrrh gr. v. o. n. 
 
 I have found the shower-bath decidedly beneficial in epilepsy, and I 
 am glad to find Dr. Watson giving his testimony strongly in its favor. 
 He states that he has found more good from the vinum ferri than other 
 
 -tH V 
 
462 HUMAN BRAIN. 
 
 tonics. He enjoins total abstinence from stimulating liquors, and then 
 goes on to recommend the olii terebinth. He says,* " You will find 
 that most persons, in respect to that disease we are now considering, 
 have some favorite or usual mode of treatment ; and if I were called 
 upon to name any single drug from which, in ordinary cases of epilepsy, 
 I should most hope for relief, I should say it was the oil of turpentine. 
 And I find that other persons have come to the same conclusion. Dr. 
 Latham, the elder, was, I believe, the first person that made known its 
 efficacy in this disorder. Foville states that he has seen excellent effects 
 from it. It is highly spoken of by Dr. Percival in the Dublin Hospital 
 reports. It is not given in large doses, but in small ones, frequently 
 repeated; from half a drachm to a drachm every six hours. You are 
 aware that it sometimes produces strangury, and, therefore, the patient 
 must be forewarned of this or carefully watched. Occasionally turpen- 
 tine has done good in virtue of its anthelmintic properties. I know that 
 a physician of my acquaintance cured a case of epilepsy in this way 
 somewhat to his own surprise. Without having in his mind any notion 
 of worms, he thought it might be as well to purge his patient, who had 
 labored for some time under epilepsy, with the oleum terebinthinaB. The 
 patient, who was the brother of a person holding at present high office 
 in this country, was residing some miles out of town. In the middle of 
 the night the doctor was summoned to him in a great hurry; the mes- 
 senger said he was supposed to be dying. He was only intoxicated, 
 however, by the free dose of turpentine he had taken. The next morn- 
 ing he passed into the close-stool a large tape worm ; he has never had 
 epilepsy since. The late Lord Hardwicke, father of the present Earl, 
 had epilepsy, and he, too, got rid of his epilepsy, and of a worm at the 
 same time. I believe that the cure was effected by turpentine, but I 
 am not certain of that. Such cases are remarkably interesting; they 
 show that irritation of the stomach or intestines may be sufficient to 
 cause the fit; they illustrate exellently well the eccentric form of the 
 disease, and they deserve always to be borne in mind when we are asked 
 to prescribe for an epileptic patient. A cure from so dreaded a com- 
 plaint by such simple means, the cause of his malady, and the certainty 
 of his having got rid of that cause, being botn so obvious to the patient, 
 may be enough sometimes to make a practitioner's fortune. But I think 
 you will sometimes find the oil of turpentine very useful, even though 
 it expels no worm, and there is no worm to expel: if the bowels should 
 be costive, the oil of turpentine and castor oil go exceedingly well 
 together." 
 
 I have not employed the turpentine, but I am not unfrequently con- 
 sulted by patients to whom it has been unsuccessfully administered. 
 In the following instance it had been given very freely by a very intel- 
 ligent physician, but without any apparent benefit. The account of the 
 case is in the husband's own words: 
 
 Case 94. " Mrs. P. S. for the last six years has been subject to violent sensations, which 
 deprives her of all power of speech, though sensible of all that passes; they last for about 
 two minutes ; the muscles of the face are contracted, and a slight grinding of the teeth. 
 But within the last two years, when the sensations have come on, and she has been asleep, 
 she has gone from one of them into a true epileptic fit, which has shaken her very much ; 
 
 * Medical Gazette, vol. xxviii. p. 376. 
 
ORGANIC DISEASES OF THE BRAIN. 463 
 
 and for an hour after could hardly keep her from fainting; complaining of cramp in the 
 calves of her legs, and violent pain in the head, and sickness; have generally given her a 
 little sal volatile in water; she had one on Nov. the 9th, and again on Dec. 21st. The sen- 
 sation came on again on Feb. 2, (but no fit,) they were stronger then than when she has 
 had a fit. Mr. T., her usual medical attendant, cupped her about a year-and a-half ago ; but 
 not more than a wineglass of blood carne away; and felt very faint. The bowels in 
 general very costive, and troubled with much wind at the chest; likewise troubled with a 
 violent irritation at the rectum." 
 
 Remarks Aged 45 years; had 13 children; violent flooding after the birth of each child; 
 had several miscarriages ; complains of great heat on the top of the head and over the eyes ; 
 youngest child twelve last July ; two miscarriages since ; the last is about ten years ; it is 
 five months since she had any show. 
 
 March 6th, 1847. Pulse 16; dose ij. h. 
 
 7th. Pulse 14, 18. giij. 
 
 8th. Pulse 14, at eight in the morning, 16, at half-past eleven. She says that after taking 
 the medicine last night she felt very faint. Her husband,,who felt her pulse, says that it was 
 15 and 16 in the quarter ; but irregular in force and frequency, and slightly intermittent. 
 She says she felt very much as she has felt after a violent flooding. If she attempted to 
 raise herself in bed she felt a numbness all over. She did not feel unusually cold, though she 
 suffers generally a good deal in that respect. 
 
 9th. To leave otf the Digitalis and take Zinci Sulph. gr. ij. b. d. Nit. Purgans o. n. 
 
 16th. Leave off the Zinci, and take Argent. Oxyd. gr. j. ter in die. Liq. Magn. Inf. Rhei 
 ijss. Tinct. Aloes co. gij. Tinct. Card. co. gj. o. n. 
 
 20th. One fit. Loss of limbs for above an hour. 
 
 23d. Continue the medicine. 
 
 April 14th. Argent. Oxyd. gr. j. Hydr. c. Creta gr. ss. ter in die. 
 
 May 10th. Has been taking warm-baths twice a-week; has been more comfortable 
 since. 
 
 Last Thursday week, April 30th, complete attacks, and several slight ones. 
 
 Pulse 18. Looks decidedly better more cheerful. 
 
 31st. Has continued the warm baths three times a-week; is wonderfully improved in 
 appearance ; looks cheerful, and countenance not so pale ; has continued the Argent. Oxyd. 
 gr. j. bis in die. No fit of any kind. Says she is much better. 
 
 "June 11, 1847. 
 
 " My dear Sir, I am in hopes there is an improvement in Mrs. P. S. ; she has not had a 
 fit at present, and not more than three of the sensations; but still there seems something 
 lurking about her; at night she is very restless, and complains of feeling very faint; whether 
 there is anything in the mixture or not, that causes it, I cannot tell, but will call upon you on 
 Monday." 
 
 June 16th. Says she has less of the sensations, arid that they now pass off with a slight 
 perspiration about the eyelids. Still troubled with a feeling of wind in the stomach. Or- 
 dered Bismuth gr. v. Ext. humuli gr. iv. Not more than five semi-attacks in a week ; very 
 slight struggle; not insensible for more than a minute and a half; they used to occur seven 
 or eight in the day. 
 
 July 3d. Feels altogether much better ; does not suffer so much from the faintness ; has 
 left off the warm baths, but has continued the Bismuth. Bowels act more comfortably, as 
 she has taken more exercise. Pulse 21, 20. Tongue clean; does not sleep altogether well 
 at night ; wakes about one, and kicks about, stretches, moans, but has no headache. Argent. 
 Oxyd. gr. j. Opii. gr. f . Ext. Col. co. gr. iij. M. pil. ter in die sum. 
 
 Organic Diseases of the Brain. By organic diseases of the brain, I 
 mean all those morbid growths from the neurine of the encephalon or its 
 membranes, which are not the result of simple hypersemia of these struc- 
 tures. These may be divided into malignant or non-malignant, accord- 
 ing to the sense in which these terms are generally employed in speaking 
 of morbid growths in other organs ; though we all know too well that 
 all morbid growths within the skull are almost always sooner or later 
 fatal, and thus equally malignant. 
 
 The consideration of these tumors is extremely unsatisfactory both in 
 a therapeutical and physical point of view. In other regions all tumors 
 are highly interesting to the surgeon, both medically and chirurgically; 
 
464 HUMAN BRAIN. 
 
 but here he feels that medicine and local applications have but little 
 power, and that the knife is of no use. 
 
 Regarding the treatment of these tumors, there is not much to be said, 
 though I agree with Dr. Abercrombie that we should not consider them 
 all as hopeless. The system must be kept rather low, but not so as to 
 impair the general health. Mercury must be employed, but in such doses 
 that the use of it may be continued for many months. The iodide of 
 mercury is of great value in these cases if it does not disturb the general 
 health. 
 
 In a physiological point the innumerable histories of these cases are 
 valueless, from the want of accuracy in their detail and the impossibility 
 of ascertaining the limits to which the influence of any tumor within 
 the skull may be excited. I shall therefore confine myself to a very brief 
 outline of this division of our subject. Under the head of organic dis- 
 eases of the brain are included those of the membranes also. The first 
 of these that we have to consider are sometimes peculiarly interesting 
 to the surgeon; I allude to those tumors of the dura mater which, per- 
 forating the skull, make their way outwards. Such is not often the pro- 
 gress of cerebral tumors, but there are several on record. Dr. Aber- 
 crombie refers to them in the following words:* u Tumors of this kind 
 sometimes arise from the external surface of the dura mater ; in this 
 case they have been frequently known to produce absorption of the bone, 
 and to rise externally under the integuments of the head, so as to be 
 mistaken for wens. Many cases of this kind are mentioned by the 
 French writers. In some of them the disease seems to have been origi- 
 nally excited by injuries: and in others an injury appears to have 
 accelerated the process by which the tumor was making its way through 
 the bone. When these tumors have been rashly meddled with by inci- 
 sion, death has generally been the consequence." The surgeon is often 
 required to decide on the nature of tumors on the head both as regards 
 diagnosis, prognosis, the propriety of operative interference, and other 
 plans of treatment. 
 
 M. Louis, who was Royal Professor of Physiology, senior Surgeon to 
 the Hospital de la Charite, and perpetual Secretary of the Royal Aca- 
 demy of Surgeons, Paris, was one of the first who pointed out' the 
 nature of the penetrating tumors of the dura mater. His paper is pub- 
 lished in the thirteenth volume of the Memoirs de PAcademie Roy. de 
 Chirurg., 1784. He states that the profession mistook the nature of these 
 tumors, because they could not believe that a soft substance, such as 
 these tumors, could penetrate a hard substance like the bones of the 
 skull. " But," says he, " does not nature show us similar phenomena 
 in the human body ? have we not seen aneurism of the arch of the aorta 
 find its way through the substance of the sternum ?" He relates twenty 
 very interesting cases in a very graphic manner ; most of them are not 
 the result of his own observation, but collected from various sources ; 
 some are accompanied with drawings. The whole paper is worthy of 
 perusal. In the first case the patient fell heavily on his buttocks, with- 
 out striking his head, but still he felt it was disturbed by 'the accident, 
 
 * Abercrombie, p. 313, op. cit. 
 
ORGANIC DISEASES OP THE BRAIN. 465 
 
 and he had great difficulty in rising. The accident was not accom- 
 panied with any pain ; but the disturbance of the dura mater appeared 
 to last for four months, and then insensibly disappeared. After a per- 
 fectly quiet interval of four months, or thereabout, one morning when 
 his barber was shaving his head he perceived a singular sound elicited 
 by the razor, like the crackling of dry parchment. The barber remarked 
 it to his customer, who tapping his head at the same spot also perceived 
 it. At this time there was neither depression nor elevation. On the fol- 
 lowing day a small tumor appeared about the size of half-a-crown, a little 
 raised, and with a pulsatory movement. The tumor increased slowly, 
 and the first opinion which he obtained regarding its nature was, that it 
 was an aneurism ; a bandage was ordered, but he could not bear the 
 pressure, which easily made it disappear, but gave rise to such giddi- 
 ness that it frightened him. He was seen by a great number of sur- 
 geons ; some of them adhered to the idea of its being an aneurism ; 
 others thought it was a hernia of the brain ; but " the greater number," 
 says Louis, u suspended their judgment, not wishing to expose it on a 
 disease that they regarded as an extraordinary affair." It increased to 
 the size of a turkey's egg, having the singular peculiarity, that pressure 
 on it removed the pain, which Louis accounts for by supposing that the 
 pain was occasioned by the pricking of the sharp points of bone from 
 the edge of the opening in the skull. But as loss of consciousness was 
 the effect of the pressure, he preferred the pain to the remedy. He died 
 on the 17th of April, 1763, about two years and four months from the 
 time of the accident. 
 
 The tumor was not even adherent to the skin ; he simply says that 
 the tumor was covered by a distinct membrane, and of the same con- 
 sistence as the ordinary sarcomatous tumors, without elasticity or fluctua- 
 tion at any part. 
 
 We must not be tempted to follow Mons. Louis into his account of 
 the other cases. The termination of his paper is characteristic of the 
 man, and teaches a lesson which may apply as well to the present times. 
 
 " I have endeavored, in writing this memoir, to follow the precepts laid 
 down by Chancellor Bacon, in the second part of his great work on the 
 remodelling of the sciences, entitled, l Novum Organum Scientiarum;' 
 in which he says that an exact observation of facts, and a correct and 
 careful induction, is the true method of understanding and interpreting 
 nature. To use this induction, says this great man, there must be a 
 sufficient number of examples and facts collected with exactness, and 
 shown with fidelity; then, considering these facts in every possible 
 light, to be assured that they do not contradict one another, we may be 
 secure of deducing some useful truth, which will lead to new dis- 
 coveries. By this mode of proceeding, experience and reason together 
 assist and enlighten one another. The Academy of Surgery has always 
 adopted these principles; it only recognizes as theory that which is 
 based upon facts ; examples must follow all rules, and must apply or 
 rather must form them." 
 
 The brothers Wenzel were the next who published facts in confirma- 
 tion of those of Louis; and it is now universally admitted that fungoid 
 30 
 
466 HUMAN BRAIN. 
 
 disease of the dura mater will sometimes cause absorption of the bones 
 of the skull, and appear externally. 
 
 Cruveilhier* divides cancerous tumors of the dura mater into two 
 classes: the one formed at the expense of the external layer, the other 
 of the internal. The latter are the most frequent. There are also 
 tumors which originate in the sub-arachnoid cellular tissue, and then, 
 causing adhesion of the two layers, it becomes difficult to say from 
 whence the disease first sprung. 
 
 But more numerous still are those encephaloid tumors which spring 
 from the tissue of the bone, and generally from the diploe. Cruveilhier 
 has given some excellent drawings of all these various kinds. In the 
 Museum of St. Bartholomew's there are several very good specimens 
 of the disease, but only one that can be unequivocally pronounced as 
 springing from the dura mater alone. 
 
 Dr. Walshe has shown that these perforating tumors of the cranium 
 are not confined in their origin to the above-named tissues, but they 
 may spring from the pia mater and cerebral substance; and that the 
 subpericranial cellular tissue also occasionally forms the nidus of this 
 disease. 
 
 Cancer in this region, says the above writer, is rarely attended with 
 development of the disease in other parts. Among sixty cases, Velpeau 
 only found three in which other organs were similarly affected. 
 
 The history of the progress of these tumors seldom throws much 
 light on their real nature and origin ; for even those which proceed 
 inwards often attain a considerable size before they produce cerebral 
 disturbance ; and those which perforate the skull generally proceed in 
 that direction at once. Their size is no guide to their nature ; they 
 have been found to vary from that of a nut to that of a second head: 
 neither is the bony ridge which generally surrounds them, any indication 
 of their nature, for the most innocent tumors are occasionally thus im- 
 bedded. Within the last year I have had two cases under my care in 
 St. Thomas's Hospital, of simple sebaceous tumors beneath the peri- 
 cranium, which had formed for themselves a complete cup. One was 
 about the circumference of a large orange ; it rose but little above the 
 surface of the cranium, and this was surrounded by a rough ridge, at 
 least a third of an inch in depth. The tumor was soft but elastic. I 
 removed it carefully, and then found the skull completely depressed, 
 forming a hollow cup at least half an inch in the centre. The bone was 
 bare, but quite firm and sound at the bottom. 
 
 What guide, then, have we to the cerebral origin of these cranial 
 tumors? The following are tolerably certain, but they are not so uner- 
 ring that, when absent, the question can be considered decided indeed, 
 the surgeon cannot be too careful in operating it is of no use touching 
 those which are cancerous, whether inter or extra cranial; two different 
 pulsatory movements, and the effect produced on the sensorium by 
 pressure. The two pulsations are occasioned by the heart's action, and 
 the respiratory movements which more or less affect the brain : they are 
 not usually very tender to the touch, though they are the seat of those 
 
 * Anat. Pathol., liv. viii. p. 2. 
 
ORGANIC DISEASES OF THE BRAIN. 467 
 
 sharp pains which generally attend the growth of cancerous disease. 
 When ulceration takes place, the real character of the disease is un- 
 masked, and no one can mistake it; but death generally ensues before 
 this stage is arrived at. 
 
 There is no portion of the dura mater in which these tumors are not 
 occasionally found, varying, of course, in their effects according to their 
 situation. They have been found attached to the falx and the tento- 
 rium. Andral relates a very interesting case of osteo-fibrous tumor 
 attached to the tentorium, which by its pressure on the left lobe of the 
 cerebellum caused much diminution in its volume, and changed its 
 natural texture into one of extraordinary hardness. The immediate 
 cause of death was an apoplectic effusion into the cerebrum.* The 
 tumor was apparently owing to a blow received four years previous to 
 death. u Immediately after the fall he experienced no uneasiness; sub- 
 sequently, however, he began to feel a dull pain towards the left part of 
 the occipital bone, which continued for a considerable time without 
 becoming severe. Giddiness occurred also from time to time, often fol- 
 lowed by total loss of consciousness, which never continued, however, 
 beyond a few minutes. At a later period new symptoms presented 
 themselves; on a sudden the upper extremity of the right side was 
 attacked with a painful, and, as it were, tetanic shock. Five or six of 
 these shocks rapidly followed this, and during the three or four days 
 following the right arm continued torpid, and somewhat weaker than 
 that of the opposite side. At first there were intervals of months be- 
 tween these attacks ; they then became more frequent, re-appearing 
 every ten or twelve days, uniformly limited to the right arm ; and at the 
 same time paralysis of this limb, at first transient, but becoming perma- 
 nent and more and more complete. Insensibly also the right lower 
 extremity lost the power of motion; it never, however, exhibited any 
 convulsive movement." 
 
 Dr. Walshe, in his admirable work on Cancer, saysf "Cancerous 
 productions occur in the brain in both the tuberiform and infiltrated 
 forms. The size of tumors and extent of infiltrations is subject to much- 
 variety; nodules not larger than a pea are met with, as well as masses 
 almost filling the place of an entire hemisphere. Tumors of medium 
 size are, however, most common. In the majority of cases the brain is 
 the seat of but one cancerous growth; several are, on the other hand, 
 discovered in certain instances. Cancerous tumors appear in some cases 
 actually continuous with the surrounding brain ; in others they are said 
 to be separated from this by cellular membrane, assuming the character 
 of a cyst in a third class of cases, without being cut off from adjoining 
 parts by a pseudo-cyst, they yet seem deficient in intimate connection 
 with the natural tissue around. The last mentioned is the most common 
 condition. The left and right hemispheres seem to suffer from the dis- 
 ease with very nearly equal frequency; both hemispheres are seldom 
 implicated, and scarcely, as far as I have ascertained, except when the 
 cerebral affection is secondary. In nineteen cases, I find the disease to 
 have been seated in the left hemisphere in nine, in the right hemisphere 
 
 * Andral, p. 2, op. cit 
 
 f The Nature and Treatment of Cancer, by Walter Hoyle Walshe, M. D., 1846, p. 888. 
 
468 HUMAN BRAIN. 
 
 in eight, in both hemispheres in two. In nineteen cases, the lobes 
 affected were the posterior in four, the middle in nine, the anterior in 
 four, the anterior and middle in one, all three lobes in one. In one of 
 these nineteen cases the optic thalamus, in two the corpus striatum, and 
 in one both these parts were the seats of the cancer. I have met with 
 one example only of implication of the convolutions as an apparently 
 primary state, and none of limitation of the disease when primary to 
 those parts; they appear to suffer but rarely by extension of cancerous 
 infiltration from adjacent textures." 
 
 Cancer is found both as a primary disease of the brain and a second- 
 ary one. Not a few cases are on record where every other organ in the 
 body was healthy except the brain. Its progress is variable, sometimes 
 rapid, though not generally so. Its presence is generally indicated by 
 the inflammation which it induces in the surrounding substance or in the 
 membranes. 
 
 The following case, which I related in the Medical Gazette in 1832, 
 illustrates the progress of this disease, and shows its insidious charac- 
 ter. It also is an instance of the cause of death, being the inflamma- 
 tion and serous effusion occasioned by the tumor, and not the tumor 
 itself. It is interesting also from the rarity of this form of cancer in the 
 brain, but especially in a child: 
 
 Case 95. * George N , aged four years and three months. This child, after having 
 
 been inactive and sleepy for several months, was seized, on the 9th of August, 1831, with 
 an epileptic fit, which lasted some hours, but was ultimately relieved by venesection, 
 leeches, and purgatives, with cold applications to the head. His stools were at this time 
 without bile ; urine high colored, and notwithstanding the daily use of the mercurial oint- 
 ment and calomel, with scammony. until the 24th (amounting to 60 grains of calomel, and 
 1 ounce of ung. hydr.), no change was effected in the secretions; and after that, aloes were 
 resorted to, when the stools immediately assumed a natural appearance, and the urine lost 
 its high color, and the child was apparently well. Medicine soon after discontinued; but, 
 however, before long, he again gradually became sleepy and forgetful: and he would fre- 
 quently lay his head down, as if it were too heavy to support. For the last two months 
 previous to his death, his intellect seemed impaired, though not to any great extent. He 
 occasionally forgot words when he was speaking, and paid very little attention to passing 
 events, though he always understood what was said to him. 
 
 On the 19th of February, 1832, medical aid was again sought. Bleeding, purgatives and 
 blistering were directed; but the parents, feeling convinced of the inutility of these mea- 
 sures, declined adopting them. He died on the 24th, having laid two ' days in a state of 
 coma. 
 
 Postmortem appearances. On cutting through the dura mater, the brain bulged out through 
 the incision, being evidently distended. The convolutions were slightly unfolded, and the 
 sulci between them partially obliterated. Neither the arachnoid, pia mater, or substance of 
 the brain, were more vascular than usual. The right lateral ventricle was found distended 
 by fluid; the septum lucidum bulged in from the pressure of the fluid in the opposite ven- 
 tricle; the arachnoid lining the ventricles was much thickened; the quantity of fluid con- 
 tained in both ventricles was about six ounces. 
 
 On proceeding with the section of the left hemisphere, a tumor was discovered in the 
 posterior lobe ; it was about the size of a hen's egg, but not perfectly homogeneous in its 
 texture ; the most external portion looked as if it consisted merely of a deposition of fibrin, 
 situated in which there were many vascular points, and also small irregular patches of a 
 thick yellow fluid, varying in size from a pin's head to a pea. This deposition formed a 
 sort of coating round the central tumor, which was as large as a pigeon's egg; though its 
 edges were not distinctly defined, it was nearly as firm as cartilage, of a pearly gray white 
 color, slightly granular on section, with claws, as it were, shooting out from the centre; it 
 was separated from the posterior cornua by a very thin layer of medullary matter, and the 
 thickened arachnoid which lined the ventricle. The rest of the brain perfectly healthy. 
 
 * Med. Gaz., x. p. 191. 
 
 ,3*8.1 , y. : ' 
 
ORGANIC DISEASES OF THE BRAIN. 469 
 
 The non-malignant tumors and membranes of the brain are the fibrous, 
 osseous, tubercular, hydatid, steatomatous, fleshy or kidney-like tumors: all 
 these various morbid products have been found by different pathologists. 
 Dr. Copland has given a very full and learned account of them, which 
 I shall not attempt to approach ; of all these deposits in the brain, the 
 tubercular are the most common, especially in children, though it is not so 
 frequently found in this situation as in the lungs or the lymphatic glands. 
 It presents the same physical and microscopic characters in the brain as 
 elsewhere. The situation of it in the brain varies much, but it is not 
 so frequently found in those parts which are most frequently attacked 
 with inflammation, namely, the hemispherical and other cerebral ganglia. 
 It is found in the tubular neurine of the hemispheres, cerebellum, crura, 
 pons Varolii, &c. 
 
 Dr. Bright frequently met with them in the cineritious neurine, but I 
 think that this is not the general rule. 
 
 Dr. Hennis Green, in an admirable paper on this subject,* points out 
 its frequency in children as compared with adults. Cruveilhier never 
 saw an example in advanced life. Louis met with only a single case in 
 117 cases of phthisis among adults. And Lugol assures us that in his 
 extensive practice at the Hospital of St. Louis, he has seen only eight 
 cases of the disease ; in four, the tuberculous matter occupied the cere- 
 brum; in three the cerebellum ; and in one the pons Varolii. In six of 
 these eight cases no symptoms existed during life ; and M. Lugol affirms, 
 " that the diagnosis of cerebral tubercle is involved in the greatest ob-. 
 scurity." Dr. Abercrombie only relates one case from his own practice, 
 which occurred in a man thirty-four years of age. " In children, on the 
 contrary," says Dr. Hennis Green, "tubercle of the brain is, compara-t 
 tively speaking, a frequent affection. I have observed one case to every 
 fifty-one in 1324 cases of acute diseases." In seventy-five cases this 
 author found that they had occurred most frequently from three to seven 
 years of age. Tubercles vary in size, from that of a pea to that of a large 
 egg; in number, from that of a single mass to that of fifty. 
 
 "In no instance," says the same author, "was the affection confined 
 to the brain. Tubercles or tubercular deposit were invariably found at 
 the same time, either in the thoracic or abdominal cavities; but in 
 several cases the greater development of the tubercles in the brain leads 
 to the idea, that the disease commenced in the nervous system." 
 
 Tubercle in the brain generally destroys life, b.y exciting- inflammation 
 of a low sub-acute character. In children this is generally followed by 
 effusion into the ventricles. It will often remain dormant for a time, and 
 then suddenly alarming symptoms will appear, and prove fatal in a few 
 days. 
 
 The following case is interesting In this point of view, and also in 
 another, to which the attention of surgeons is very frequently directed, 
 namely, whether by healing external st rumpus sores internal disease is 
 excited. In this case the internal appeared to be dormant, while the 
 external was going on, and a^ soon as the external was cured the inter- 
 nal disease appeared. 
 
 * Med.-Chir. Traps., vol. *xi. p. 192, ^ad January and June 1842. 
 

 HUMAN BRAIN. 
 
 Case 96. T. B. P., a child four years old, was under my care in St. Thomas's Hospital, 
 with strumous disease of the elbow joint, but without any indication of cerebral disease, nor 
 was anything told us by the mother to call our attention to the head. I ordered the Cod- 
 liver Oil 3J. t. d., and the Tinct. of Iodine to the chest, as I was a little fearful regarding 
 the lungs. The elbow was firmly fixed by means of a pasteboard splint. The child's health 
 improved in the hospital, as regards his appetite and appearance, but some superficial scars 
 of old wounds ulcerated and became small sores ; he was in the hospital about five weeks; 
 the sores healed, and the elbow joint became free from pain. Soon after he left the hospital 
 his health again declined, and he then complained of his head, but they had no advice for 
 him until he was seized with a fit, about one month after leaving the hospital, on the 19th 
 of March; it was slight, and only lasted a few minutes, but it was followed by others on 
 the two following days: on the third day the child became quite insensible; in this state 
 they brought him again to me. He had now all the signs of effusion on the brain; from 
 these symptoms he never rallied at all, and died in four days from the time of his first be- 
 coming comatose. When the child was brought to me with signs of cerebral mischief, I 
 learnt the following of his early history : When about two years old he complained much 
 of pain in his head, with disturbance of his bowels and enlargement of the abdomen, loss 
 of appetite and general lassitude ; by judicious treatment lie got well, and remained so until 
 about a few weeks previous to his coming into the hospital; at this time he was seized with 
 a convulsive fit, which lasted six hours ; he had four leeches behind the ears, warm bath, 
 and purgatives. About a week after, the elbow contracted and became painful, the head 
 being quite well and comfortable, so that when he came to the hospital nothing was said 
 regarding his head. 
 
 Post-mortem examination, 24 hours after death. Weather cool. Membranes healthy ; con- 
 volutions flattened ; ventricles distended with serum to nearly three times their natural size. 
 In the centre of the inferior vermiform process of the cerebellum there was a firm yellow 
 scrofulous tubercle, about the size of a large marble ; it was much harder than healthy 
 neurine. The neurine immediately surrounding it was slightly softened, but beyond a hair's 
 breadth it was all quite healthy. Lungs and heart healthy ; as also the abdominal viscera. 
 
 The plexus choroides is sometimes the seat of organic disease. One 
 of the most common changes in its condition is a consolidation and hy- 
 pertrophy of its tissue. It is doubtful whether this fleshy appearance 
 is the effect of repeated dilatation of its vessels, or a true morbid growth. 
 I am npt aware that it has been connected with any peculiar symptoms 
 during life. 
 
 Still more frequently do we find this portion of the pia mater the 
 nidus of small vesicular bodies like hydatids, but they are not so they 
 are merely cysts containing serum. Dr. Bright considers them as occa- 
 sionally the predisposing causes of apoplexy. 
 
 Among the morbid adventitious structures which are met with in the 
 brain, we must not omit to mention hamatoma, as it has been designa- 
 ted by Dr. Hooper in his illustrations of diseases of the brain. It is 
 doubtful whether this disease is anything but a form of fungus hsema- 
 todes. 
 
 Dr. Hooper has given a very beautiful drawing of this disease, which 
 he thus describes: " This tumor is fungous, and takes its origin from 
 the medullary substance of the cerebrum near the ventricle, but has no 
 connection or communication whatever with that cavity. It has a broad 
 base, and in making its way outward has separated the convolutions of 
 the brain to some distance from each other. Externally it is covered 
 by the pia mater, over which there is a very vascular membrane, which 
 is either the arachnoid altered by disease, or an adventitious membrane 
 produced by inflammation. This fungus is irregularly lobulated. To 
 the touch it feels soft and is somewhat elastic. It cut as firm as brain, 
 and presented a vascular mottled surface, of a reddish yellow color, 
 with portions here and there of a coagulated blood-like substance." 
 
ORGANIC DISEASES OF THE BRAIN. 
 
 471 
 
 " The circumstances," says Dr. Walshe,* " most distinctly permit- 
 ting the physician to affirm that a tumor exists within the cranium, are, 
 the existence for a considerable period of intense cephalalgia, especially 
 limited to a fixed point, or even to one side of the head, and if attended 
 with repeated vomiting; of convulsive movements without paralysis, 
 but followed by mere weakness, or actual paralysis of the affected parts ; 
 of different affections of the organs of sense, especially alteration of sight, 
 and of disturbance of intellect, while the general health does not very 
 materially suffer. But the previous details show that such a combina- 
 tion of circumstances will not very commonly exhibit itself." 
 
 Dr. Abercrombie does not attempt to connect any particular symptoms 
 with the various forms of organic diseases, but he gives a very inter- 
 esting outline of the principal modifications of these symptoms in the 
 aggregate, of which the following may be considered as an abstract: 
 
 First Long-continued and severe headache, the pain varying both 
 in seat and severity, sometimes occurring in regular paroxysms, leaving 
 intervals of comparative or complete relief. 
 
 In some cases the pain is acute and lancinating; in others, obtuse; 
 sometimes referred to a particular spot, as the occiput, or one temple. 
 In the more violent paroxysms the pain is intense, obliging the patient 
 to remain for a considerable time in one position, the slightest motion 
 aggravating it to perfect torture; but the remissions from this severe 
 suffering are often so remarkable as to lead a superficial observer into 
 the belief that it is merely periodical headache, or headache connected 
 with dyspepsia. Formerly the disorder of the stomach, which frequently 
 accompanies these organic diseases, was supposed to be confirmatory of 
 this view; but now medical men regard justly the vomiting which often 
 attends these headaches as a most serious symptom, directing their at- 
 tention especially to the brain. In vomiting from dyspepsia, the head- 
 ache is generally relieved after the stomach has been emptied; but not 
 so in these cases. 
 
 Secondly In another form, after some continuance of fixed pain, the 
 organs of sense become affected, as the sight, the hearing, the taste, and 
 flic smell ; ptosis or paralysis of the upper eyelids ensues ; and lastly, 
 the intellect gradually becomes dull and the memory imperfect. All 
 such symptoms must of course depend on the exact seat of the tumor ; 
 the loss of power in the different nerves depending on pressure either of 
 the nerve or of its ganglion. When the tumor is seated so as to oppress 
 the nerve alone, the loss of the use of the organ which it supplies will 
 be the only result ; but if the ganglion be affected, especially those of 
 the optic and auditory nerves, a much more serious set of symptoms will 
 rapidly ensue, such as convulsions and more or less general paralysis. 
 
 Thirdly If the tumors happen to be developed in the tubular neurine, 
 and not in or on any of the ganglia, the first indication of their existence 
 will be an excitation of the muscular system, and the result of this ex- 
 citation convulsions. Sometimes these convulsions appear under the 
 regular form of epilepsy, but generally more irregular; sometimes violent 
 paroxysms of headache precede the convulsions, which are not usual in 
 
 * Op. oil., p. 495. 
 
472 HUMAN BRAIN. 
 
 functional epilepsy. Tubercles in the cerebellum, in the tubular neurine 
 of the hemispheres, pons Varolii, and crura, will give rise to these con- 
 vulsions ; also spiculaB of bone when they reach the medullary structure. 
 Patients often die in the convulsions. If they are not rapidly cut off 
 there is generally some paralysis of one or more of the limbs. There 
 are some few cases where paralysis occurs, without being preceded by 
 more or less convulsive action of the muscles, but this is not often the 
 case in organic diseases. 
 
 Fourthly There are a class of cases which I believe occur very rarely, 
 but which Dr. Abercrombie describes in these words:* " This class 
 calls our attention to a train of symptoms which are referred to the sto- 
 mach, but which really depend upon disease of the brain. In many of 
 the cases of organic disease of the brain the stomach is affected; but 
 those to which I now allude are remarkable from the affection in the 
 stomach being the prominent symptom. In these there is often, through 
 a considerable part of their progress, very little complaint of the head, 
 or no complaint so fixed and urgent as to direct our attention to the brain 
 as the seat of disease. There is generally, however, some pain or weight 
 in the head, sometimes occurring in paroxysms like periodical headache, 
 or in paroxysms accompanied by vomiting, like what is commonly called 
 sick headache. The pain is increased by exertion, external heat, pas- 
 sions of the mind, and stimulating liquors; there is generally variable 
 appetite, bad sleep, oppression of the stomach, and frequent vomiting. 
 The vomiting sometimes occurs in the morning on first awaking, and 
 sometimes at uncertain intervals, and very suddenly, without any pre- 
 vious sickness. There are in general uneasy sensations referred to vari- 
 ous organs, by which the nature of the disease may be disguised in its 
 earlier periods; but after a certain time symptoms referable to the head 
 generally begin to appear, such as fits, loss of recollection, convulsive 
 paroxysms, and affections of sight. After this stage of the disease death 
 may occur suddenly in an attack of convulsion, or it may be preceded 
 by a train of severe suffering. In cases of this class we must beware of 
 being misled in regard to the nature of the complaint, by observing that 
 the symptoms in the stomach are alleviated by a strict regimen, or by 
 treatment directed to the stomach itself. If digestion be impeded, from 
 whatever cause, the uneasy symptoms may in this manner be alleviated; 
 but no inference can be drawn from this fact in regard to the cause of 
 the derangement. In the earlier periods of this affection the diagnosis 
 is indeed often very difficult. There is generally more permanent and 
 fixed uneasiness in the head than we should expect to find in a dyspeptic 
 case, and the uneasiness is increased by causes which would probably 
 be beneficial to a dyspeptic headache, such as activity and cheerful 
 company. The prominent morbid appearances in cases of this class 
 seem to be in the cerebellum." 
 
 Fifthly There are some cases which might at first be mistaken for 
 apoplexv of a slight transient character, until the repetition of the symp- 
 toms rather frequently and without any great increase in severity shows 
 that they cannot be dependent on effusion of blood ; for when the effu- 
 
 * Abercrombie, p. 321, op. cit 
 
ORGANIC DISEASES OF THE BRAIN. 473 
 
 sion is repeated in the brain the second attack is almost always worse 
 than the first, and so on. In some cases it consists chiefly of an habitual 
 giddiness, which makes the patient afraid to walk alone; in others there 
 are sudden attacks of all muscular power without loss of recollection, 
 which are soon recovered from. Sometimes there are attacks of perfect 
 coma, which may occur at regular or at irregular intervals, the patient 
 having in some cases such warning of their approach that he goes to bed 
 before the attack. There is usually more or less unsteadiness of the 
 limbs, and generally, but not always, headache. In some cases there 
 are affections of the sight, and these may either be permanent or occur 
 in paroxysms; and in some cases giddiness and loss of recollection are 
 excited by bodily exertion, and go off on desisting from it. 
 
 The following case illustrates very forcibly the fact that tumors of the 
 brain may be formed and grow to a considerable size without giving rise 
 to any striking cerebral symptoms until they excite inflammation in the 
 surrounding cerebral substance. The subject of the present history I 
 had known for many years, and was in the habit of seeing him fre- 
 quently. He never complained of his head to me, though he used 
 occasionally to consult me for slight ailments. Since his death I have 
 learnt that he had not been quite so active as formerly, and that he used 
 frequently to put his hand up to his head, but he never complained 
 much, and attended to his business regularly up to the date of the attack 
 now to be recorded. He used always to take a walk before breakfast, 
 and appeared to enjoy life as much as other persons. I was guided in 
 my treatment more by my previous knowledge of the general character 
 of his constitution when in his usual state of health, than merely by the 
 symptoms attending the onset of the attack. 
 
 Case 97. May 20th, 1847. I was requested to visit a gentleman, by his brother, who 
 feared that he was threatened with an attack of paralysis. My visit was paid immediately, 
 at 10 A. M. I found him lying on the sofa, in a sleepy state; he had only just risen, but he 
 complained that he was so drowsy that he did not know what to do. He is stout and fat, 
 and of lax, flabby fibre, a3t. 46, residing at his place of business in the city, and taking very 
 little exercise. Living well, and though not positively intemperate, still occasionally taking 
 porter, and brandy and water, and cigars, before going to bed. This he has not done for the 
 last few days. Last night he had some cheese for supper, and brandy and soda-water with 
 it, about half-past 10; he went to bed about half-past 11. He says that he slept badly, 
 dreaming a good deal, and that he awoke with headache. He has been slightly sick this 
 morning ; has not yet had any breakfast. His eyes are slightly, but very slightly, congested, 
 the pupils perfectly natural ; says his headache is over the forehead thinks it is a little 
 more on the right side than the opposite. The face is decidedly, though slightly, drawn to 
 the right side; the tongue is protruded straight. He has no numbness anywhere. He says 
 that he has no loss of power in either arm or leg. Feels sick, and inclined to vomit. His 
 bowels have not been open this morning he is not a subject to bear blood-letting; pulse 13 
 in the quarter, 23 in the half, 62 soft and full; hands and feet cold, as is usual to him. 
 
 Ord. Leeches, xij. capitis dextri lateri. Seidlitz powder in infusion of ginger ; feet in 
 hot water. 
 
 5 p. M. Much the same, the Seidlitz has not acted ; complains of his head. Ord. Enema 
 Tereb. ^j. ad Ib. Hirud. xij. lotio frigida. Pulse slow and feeble. 
 
 10 p. M. Much the same ; no inclination for food ; says his head is easier since the 
 leeches ; finds it more comfortable when it is rather low than high. Bowels not open ; 
 pulse 60, full and soft, quite regular; hands and feet warm. Ord. Cal. gr. iv. 6 tk * horis. 
 Emp Lyttae nuch. 
 
 21st. Has passed a restless night, complaining of his head; cannot bear to have it raised; 
 the blister has been rubbed off repeatedly during the night. Bowels not opened ; they are 
 not generally obstinate; pulse 56, soft and regular; perfectly rational, answers immediately 
 and distinctly; pupils quite natural ; tongue furred in the centre, flabby and indented on the 
 side ; no inclination for food or drink. 
 
474 HUMAN BRAIN. 
 
 Ord. Cal. to be continued, and hair to be cut very short. Rep. Enema Terebinth. 
 
 5 p. M. Enema has returned immediately; bowels have not acted; head very uncom- 
 fortable, but the intellect intact; pulse 56; head hot. 
 
 Ord. Olei Tiglii Tl\j. Before this was given, the bowels acted. C. Cruentee temporibus 
 ad^viij. 
 
 10 p. M. Better; head more comfortable. Ord. Cal. gr. iv. bis 4ta hora postea 6ta hora. 
 
 22d. Has had a better night; pulse 56, soft. Bowels open, urine abundant. Tongue 
 cleaning; decidedly better; continue the calomel. 
 
 23d, 9 A. M. Says he has had a better night; quite rational; head cooler; to continue 
 the calomel. 
 
 3 p. M. Bowels not open ; rather more drowsy. Ord. Infus. Senna ^ij. Magnes. Sulph. 
 ^ss. Syrup Zinzib. gij. 
 
 8 p. M. Very drowsy, but no stertor; answers rationally but slowly, and says his head is 
 decidedly better; pulse 56, soft; bowels confined. Ord. Enema Terebinth. 
 
 10 p. M. Bowels opened; a good deal exhausted getting out of bed; very drowsy. Ord. 
 to continue the calomel. 
 
 May 24th, 9 A. M. Addressed me cheerfully when I entered his room ; said he had a 
 good night. The nurse says he slept well. Pulse soft and slow; tongue furred; mouth 
 slightly tender; bowels open; has not taken any calomel since my last visit. Ord. Garga- 
 risma sodae chloratis ^j. ad ^vij. Nurse says she has observed some convulsive trembling 
 in his arms, but not more on one side than the other. He says his head is easy when it 
 rests on the pillow, but that he cannot raise it without pain. 
 
 12 A. M. Pulse 48, soft; cheerful; no change. Repeat Cal. gr. iv. 
 
 5 p. M. Not so well; more drowsy; eyes congested; pulse 48; quite conscious, but says 
 he only wants to be left alone. Feeling it was a question whether he would not be better 
 for the loss of more blood, I sought a consultation with Dr. Cobb. He went into the case 
 most carefully, and agreed in the propriety of cupping from the head. Suggested giving 
 him a little ammonia, thus Liq. Ammon. Acet. giij. Ammon. Carbon, gr. v. Aq. distill, gj 
 (jtis. horis. As his mouth is tender, we may suspend the calomel. 
 
 10 p. M. Rather relieved by the cupping; pulse 52. Says his head is more comfortable. 
 
 25th. Much better ; cheerful ; countenance improved, not so red ; eye less injected. 
 Continue the ammonia. 
 
 9 P. M. Ord. Pil. Aloes gr. viij. Hyd. Chlorid. gr. ij. n. m. 
 
 26th, 9 A. M. Bowels open ; much the same. Continue the ammonia. 
 
 12 A. M. Much the same. 
 
 9 P. M. The nurse says he has been slightly wandering in his mind, asking repeatedly 
 for brandy and water, and then talking about a party he had, and that his brother would be 
 annoyed by the row they kicked up. She also said that he had been very restless, not 
 sleeping at all. When I saw him, he answered quite rationally ; but on the nurse telling 
 him to ask me if he might have what he had been asking for, he said, " Brandy and water," 
 in a sharp, snappish tone, unlike his usual manner. From this account, I judged that there 
 was threatening of delirium tremens, and I determined to give him an opiate. 
 
 Ord. Liq. Opii sed. TT\,xx. Liq. Hyd. Bichlorid. gj. Aq. Menth. |[j. h. n. 
 
 27th, 9 A. M. Has passed a quiet night; dozing this morning. Nurse says he awoke 
 rational this morning. When she asked him if he would have tea, he said, " No, not at 
 present, some toast water." Much the same during the day. Continue the ammonia. 
 
 In the evening rather restless. Ord. Liq. Opii ut antea. 
 
 28th. Much the same. Continue the ammonia. 
 
 29th. Mouth still tender from the mercury; tongue foul; very feeble, when moving 
 from one room to another; passes all his urine in bed, involuntarily; dozes and rambles. 
 
 9 p. M. Has had a goood deal of twitching in the arms and legs ; countenance not more 
 drawn than before. Dr. Cobb saw him with me, and thought him rather better. We 
 ordered Potass. Oxymur. J}j. ex aq. 
 
 30th. Went to sleep about 10, and therefore the nurse did not give him the Liq. Opii. 
 He awoke about 2 o'clock, and was then restless, but he went to sleep again without any 
 opium. When I saw him at 9 A. M., he answered cheerfully, but he was inclined to ramble. 
 Pulse 56. 
 
 Ord. Continue the Ammonia and Potass. Oxymur. 
 
 10 p. M. Has taken more nourishment to-day, but has been very restless, talking a great 
 deal about whisky and water, sherry, &c. Has not slept at all during the day ; has taken 
 his draught, and is now asleep. 
 
 31st. Much the same all day. Continue the same. 
 
 June 1st. Better; more cheerful and more collected; set up during the day; eat a little 
 meat for dinner. In the evening was quite silly, wanting to put his boots on, and go out ; 
 would not go to bed. They sent for me, and in my absence Dr. Cobb kindly attended. The 
 
ORGANIC DISEASES OF THE BRAIN. 475 
 
 excitement of seeing him brought him to himself, and he went to bed quite quietly at half- 
 past 10. At 11, I found him sleeping soundly, without any opiate draught. I ordered it 
 to be given if he awoke, and was restless. 
 
 June 2d. Cheerful and collected ; has eat an egg for his breakfast ; says he is much 
 better. He awoke about 2 in the morning, took the opiate draught, and then went to sleep 
 again. Ord. to continue the Potash, Oxymur. and Ammonia. 
 
 12. Saw him with Dr. Cobb, in order to decide as to the propriety of giving him some 
 beer with his dinner. He agreed, and we allowed it to him*. 
 
 6 p. M. All the better for the ale (Hodgson's). 
 
 3d. Has had a good night. Awoke about 2, and took the opiate draught ; has been 
 able to retain his water since the 31st; pulse 60. 
 
 4th. Continues to improve. 
 
 5th, 9 A. M. Cheerful and collected; has passed a pretty good night. 
 
 3 P. M. Mrs. B. complains that he has been rambling a good deal, asserting quite confi- 
 dently that he had been at Dalston the night before, and showing delusions on other 
 points. Pulse soft, 50. This incoherency passed off after he had his dinner ; and when I 
 saw him at 3, he was quite rational. I ordered him a meat supper, with another glass of 
 bitter beer, and Liq. Opii sedative TT^xxx. hora somni. 
 
 11 P.M. Has been quite sensible all the evening; enjoyed his supper at 7 ; took his 
 draught at 9; went oft' to sleep quietly. Slept well till 4 ; got out of bed to evacuate; re- 
 turned again quietly and went to sleep, and slept till between 8 and 9. 
 
 6th, 9 A. M. Found him cheerful and perfectly collected ; pulse soft, 50 ; slept well. 
 
 R. Infus. Calurnbae ^v. Ammon. Sesquicarb. %ss. Spirit Myrist. gij. Tinct. Card. co. 
 vi. M. ft. Mist. 6 ta< bis die 11 A. M. and 4 P.M. This mixture was continued till June 17th. 
 
 R. Liq. Opii sedat. gss. Mist. Camph. ^j. M. ft. Haust. h. n. s. et repet 3 si opus sit. 
 
 R. Infus. Senna ^iss. Magn. Sulph. giij. M. ft. Syr. Zinzib. ^j. M. ft. Haust. mane sum si 
 opus sit. Two or three aperient draughts have been taken. 
 
 6th. About 11 P. M. I took him nine miles out of town in an open carriage. He was 
 quite himself; enjoyed the ride, and a mutton chop and pint of ate at the end of it. I 
 left him then in other hands, with directions for the same plan of treatment to be followed. 
 
 10th. Going on well in every respect. 
 
 12th. R. Pulv. Rhei. Pil. Hydrarg. a. a. gr. iv. M. ft. Pil. ij. nocte sumendus. 
 
 R. Haust. Aper. ut antea, mane post pil. 
 
 R. Sp. ./Ether Sulph. co. ^ij. Liq. Arnmon. Acet. ijij. Aq. Rosae ^iv. Aq. ad xvj. M. ft. 
 Lotio capite continue admovend. 
 
 15th. Much better, having passed a tranquil night; he rose without much effort, and got 
 down into the dining-room, about ten o'clock. Rested on the sofa for an hour ; and the tone 
 of his mind was evidently more healthy and natural, as tie talked of his future prospects 
 quietly, and seemed quite collected, except as to where he was, and the hour, &c. 
 
 Had the best part of a larnb chop, and a glass of bitter ale, at twelve, having taken a 
 dose of tonic mixture at eleven. Walked round the garden with the assistance of an arm, 
 for ten or twelve minutes, then came in and read the newspaper for a short time, and fell 
 into a natural sleep for half an hour; awoke without the usual excitement, his pulse count- 
 ing 53. He was quiet, but cheerful, and ate a bit of boiled fish, at five o'clock, and his 
 second glass of ale, and after resting for an hour on the sofa, he walked on the common for 
 more than a quarter of an hour without feeling tired. Had his cup of cocoa, and a little 
 bread and butter, at eight o'clock, and went to bed at half-past nine. Bowels irritable. 
 
 16th. Awoke with a very bad headache, having had a restless night; he was scarcely 
 able to sit up for the hair-dresser to shave him, after which operation he lay down on the 
 bed, and was some time before he could finish dressing. His head continued very ted with 
 what he described to the doctor as a " bumping" headache, ate a little meat, and had his ale, 
 at twelve, after which he fell into a heavy sleep for an hour ; awoke with much less head- 
 ache, but the eyes bright, and pupils dilated, and his countenance vacant. He became rest- 
 less ; wanted his boots, &c., to go to town ; inquiring of the servants where the omnibus 
 went from, &c. For an hour and a half, his friends had great difficulty to keep him amused 
 and quiet, but as it. poured with rain, he could not then get out. He had some fish at five, 
 and the weather clearing, he went for an hour's drive, when he got quite cheerful, and en- 
 joyed it : after he came home again, became restless, and soon retired to bed. 
 
 17th. I found him very drowsy, complaining of great pain in his head, which was hot, 
 and the face flushed: pulse 40, full and laboring, occasionally slightly intermittent. It ap- 
 peared to me very clear that we had now to contend again with the old mischief, and that 
 from an anaemic state of brain, we had now an hyperaamic condition. I recommended the 
 application of forty leeches, and the head to be shaved.' 
 
 R. Spirit Terebinth, ^j. Mist. Cath. Com. iv. M. ft. Mist, pro Enema. 
 
476 HUMAN BRAIN. 
 
 R. Hydrarg. Prot. Chlor. gr. ij. sit. pulv. 3 Uis - horis sumend. Mitte viij. Enema Tere- 
 binth. 
 
 He was so rftstless, that not more than fifteen leeches were applied. 
 
 18th. Impossible to rouse him, either for his breakfast or the hair-dresser: he had been 
 restless and wandering all night, with occasionally heavy sleep. His bowels had been very 
 inactive, although pills, &c. had been given at night. He remained in that drowsy state till 
 two o'clock, when he slightly improved ; at three o'clock a dose of Croton oil, Tr^ij. was 
 given, and another at six o'clock, after which the bowels were relieved, and he rallied won- 
 derfully, his hands and feet becoming warm, and his pulse rising to 60. Was pot able to 
 get up at all. 
 
 R. Hydrarg. Prot. Chlor. gr. iij. Sacchar. gr. v. 01. Croton. TT^ij. M. pro pulv. statim sumend. 
 1 P/M. et repet. post horas tres. Mitte ij. 
 
 19th. Awoke without much pain, having slept tolerably, but his ideas confused, and great 
 exhaustion all day. Slept heavily, and had no appetite, and about six o'clock in the evening 
 had most violent pain, more particularly in the right side of the head, which lasted till twelve 
 at night, when he became exhausted, and fell into a good sleep for an hour or two ; was 
 quite conscious and collected while in the violent pain, but became wandering and confused 
 when it subsided. Bowels inactive. 
 
 20th. Awoke from his sleep so exhausted he could hardly speak, but perfectly sensible. 
 In the afternoon, took some pills, after which his bowels were much relieved ; but he was 
 so weak he could not stand, even with the assistance of two persons, nor take any nourish- 
 ment. Not much pain in his head, and he was evidently suffering from exhaustion. 
 
 R. Ol. Croton TT^ij. Ext. Coloc. co. gr. viij. M. ft. Pil. ij. statim sumend. (11 A. M.) 
 
 R. Potass. Bicarb, gij. Aq. Distillat. ^viij. M. ft. Mistur. Alkalin. 
 
 R. Acid Citric )iv. Aq. viij. M. ft. Mistur. Acid. Cap. Coch. amp. duo sing, dosis. Mistur. 
 Alkalin. 2 dis< vel 3 tiis - horis in actu effervescentiae. 
 
 R. Liq. Opii sedat. TT^xx. Conf. Arom. j. Aq. Cinnam. vij. M. ft. Haust. Signa. the 
 soothing draught. Mitte ij. One taken early in the morning of the 21st. 
 
 2 1st. Had been restless from the irritability of his bowels, but slept heavily towards 
 morning, and continued in a heavy, drowsy state, but conscious (though unable to speak) 
 when he was roused to take nourishment, or medicine, which he swallowed at all times with 
 difficulty, and sometimes could not swallow at all. 
 
 8 P. M. I found him sleeping, and spoke to him, and with difficulty got him to put out his 
 tongue: he did not open his eyes, but on my asking him if he knew me, he nodded his head, 
 evidently recognizing my voice. About an hour afterwards, he was unconscious, and I could 
 not rouse him at all : head rather hot ; pulse 40, soft and feeble. 
 
 We agreed that he would not bear any kind of depletion, but that we would try and stimu- 
 late the kidneys. 
 
 R. Ammon. Sesquicarb. gss. Tinct. Cardamom, co. ^ss. Syrup Aurant. giij. Sp. Myrist. 
 gj. Aq. Anethi. ^iv. M. Capt. Coch. j. amp. omni hora. Commenced about mid-day, and 
 continued till 6 p. M. 
 
 R. Acet. Lyttoe ^j. pro capitis applicatione. 
 
 R. Potassse Bicarb. g\ss. Sp. Junip. co. |;ss. Tinct. Lyttae !jj. Syrup Aurant. ij. Aqua; 
 viij. M. Capt. Coch. amp. duo statim et 3 tu - vel 4 tl - q. q. hora sumend.; 
 
 22d. Passed a tranquil, heavy night, without much natural sleep, but was somewhat better 
 in the morning: bowels quite inactive: towards the middle of the day, roused a little, took 
 his medicine, but very little nourishment during the day, and the face became hectic on the 
 cheeks. The application of tinct. lyttje took a slight effect on the forehead, but none on the 
 head. Very drowsy, but sensible when asked a question, although hardly able to articulate 
 an answer. 
 
 7 o'clock. Pulse 50, yawned and shuddered a good deal, moving his arms upwards, and 
 grasping anything within his immediate reach. Bowels still inactive. Became still more 
 restless, with the hands moving constantly towards the head, breathed with difficulty, and 
 between 11 and 12 at night had a troublesome cough, with difficulty of breathing. Pulse 
 low and fluttering, and was certainly unconscious: passed a tolerable night, alternately rest- 
 less and heavy ; took half a cup of beef-tea, in spoonfuls ; but the pulse rather better on 
 Wednesday morning. 
 
 23d. Pulse 55; face still red, but did not complain (when asked) of pain, anywhere, ex- 
 cept the right hand; continued tranquil, and conscious when spoken to. 
 
 2 o'clock. Pulse 60; remained in a complete stupor, and without action of the bowels. 
 
 10 o'clock. Had a simple enema, which had a moderate effect, and relapsed into the 
 game state in which he has remained all night. He has taken a few spoonfuls of beef tea, 
 and his stimulant medicine, as ordered. His right hand is rather swollen, but does not seem 
 in so much pain as yesterday. His eyes have but once been open since Sunday. 
 
 24th. Pulse 48; comatose all day. 
 
HYPERTROPHY OF THE BRAIN. 477 
 
 25th. At 2 A. at. this poor sufferer was released, after a most severe struggle. 
 
 Post-mortem, 28 hours after death, temperature 60 : 
 
 External appearance. Ecchymosis from gravitation on the posterior part of the head, neck, 
 and body, generally : the blood-vessels of the scalp not particularly full. 
 
 Internal appearance. Vessels of dura mater very full ; bled freely after tearing off the skull 
 and the skull itself rather thin and vascular ; convolutions flattened by pressure of the skull j 
 veins of pia mater full ; brain generally full of blood ; cortical substance rather darker than 
 usual, but not inflamed ; all the ventricles very much dilated, especially the descending cor- 
 nua; fifth ventricle also very large, containing nearly a drachm of fluid; section on a level 
 with the corpus callosum natural. On making an incision into the right hemisphere, on a 
 level with the upper part of corpus striatum, a difference in the color presented itself, in the 
 medullary substance; this was a diffused yellowish stain the texture softened; on slicing 
 the brain a little further, and dissecting the whole carefully, it proved to be ramollissement^ 
 of the medullary substance surrounding a distinct fungoid tumor. The softened brain was 
 about the sixth of an inch in depth, and was of a reddish color as it approached the tumor. 
 The tumor was the size of a pullet's egg, nearly circular in form, medullary fungus in tex- 
 ture, contained in a distinct cyst. It was situated in the medullary substance of the right 
 hemisphere to the outer side of the corpus striatum, and to the inner side, and in contact 
 with the convolutions of the Insula of Reil in the fissura Sylvii. Thoracic and abdominal 
 viscera healthy. 
 
 Hypertrophy of the Brain. It is now a well-established fact that the 
 brain, like the heart and other organs of the body, occasionally becomes 
 hypertrophied. The neurine which composes it is actually increased in 
 quantity ; but this increase is not so clearly the effect of the undue ex- 
 ercise of the organ as the hypertrophy of the heart. When the heart is 
 hypertrophied it can generally be accounted for by its having had double 
 duty to perform in consequence of some obstruction either at the com- 
 mencement or in the course of the arteries, or some other circumstance 
 which has called its powers unusually into play, such as a defective con- 
 dition of the valves. But this is not so clearly proved with regard to 
 the brain. Still it must be allowed that as the disease generally occurs 
 in childhood while the brain is still growing, and there has been a cer- 
 tain degree of intellectual precocity in some of the cases on record, there 
 is sufficient evidence to use as an argument against the early stimulation 
 of the brain. 
 
 There can be no doubt that many a child has been sacrificed in early 
 youth to the pride of parents, who, delighted with the intellectual activity 
 of their children, have striven to make them prodigies of learning. But 
 in these cases of early and undue employment of the brain, inflamma- 
 tion of the hemispherical ganglion, or of the lining membrane of the 
 ventricles with serous effusion, has usually been the cause of either a 
 fatal issue or of subsequent mental imbecility. The late Mr. Deville 
 related to me an interesting case of this kind. An extremely intelligent 
 boy, of about twelve years of age, was brought to him for phrenological 
 examination by a parent who was very proud of the intellectual endow- 
 ments of his child. Mr. Deville gave his opinion of the boy's character, 
 at the same time cautioning the father of the dangerous course he was 
 pursuing. But the father's reply was, " all that other boys considered 
 labor and hard study are mere child's play to him ; that his studies could 
 not be hurting him, he enjoyed them so much." Again Mr. Deville 
 endeavored to save the child, but the father would not attend to the 
 warning. Two years from that time the father again called on Mr. De- 
 ville, and in reply to his inquiries after his child the father burst into 
 tears his child was an idiot. 
 
478 HUMAN BRAIN. 
 
 Hypertrophy of the brain is easily recognized after death, in conse- 
 quence of its immediately bulging out the dura mater as soon as the 
 skull-cap is removed. The texture of the brain is so extremely elastic 
 and compressible that as soon as the box is opened it rises up, showing 
 most unequivocally that it is too large for its containing cavity. The 
 hypertrophied brain is always unnaturally hard, and the tubular structure 
 almost bloodless. The blood-vessels have evidently been so compressed 
 that their cavities are at last obliterated. It is not certain that we can 
 account for the hardness by the same physical cause, but it seems most 
 probable, notwithstanding the apparently rapid course which the disease 
 pursues in some cases, that the hardness is not the result of inflamma- 
 tory action, but of the pressure. Dr. Sims, from whose paper I have 
 quoted a case, considers that there are two kinds of hypertrophy, the 
 one consisting simply of a mere addition of similar particles, the other 
 resulting from a change in texture. I think it very doubtful if they are 
 not one and the same disease. Induration of the brain does take place 
 quite independent of hypertrophy, where there is no pressure to account 
 for it, as will be mentioned further on. It appears that this disease was 
 first distinctly recognized by the celebrated Laennec. It has been as- 
 serted that it was known to Morgagni, but I see no reason for this opi- 
 nion. The only observations of this famous observer which could 
 countenance this idea are in his fourth epistle, in which he treats of 
 serous apoplexy. The existence of this disease was scarcely allowed 
 at all at that time, so that he was obliged to use every argument he could 
 to prove it. In this letter, when endeavoring to account for apoplectic 
 symptoms being produced by a very small effusion, he says, u This must 
 be accounted for from the bulk of the cerebrum or cerebellum being 
 disproportioned to the bulk of the cranium ; and as this want of sym- 
 metry frequently happens betwixt other parts, why may it not sometimes 
 happen betwixt these also ?" He says he was led to this opinion by 
 u observing in some, how very deep a hollow was formed by the vessels 
 that are prominent in the dura mater." He makes no remark which 
 could lead one to believe that he had ever met with a case of true hyper- 
 trophy. His observations are so accurate and his perception so acute 
 that he would not have passed it over if he had seen it. The first ob- 
 servations of Laennec occur in some reflections on hydrocephalus, added 
 to a memoir of M. Matthay, of Geneva. He says,* that " there is a 
 third alteration which produces the same effects, the brain being in some 
 instances too large for the skull, as was remarked by Morgagni. M. 
 Jadelot has told me that he has observed the same thing in infants, and 
 has remarked that a great number of those who die of internal hydroce- 
 phalus do not show anything else on opening the body besides this dis- 
 proportion of volume between the brain and cranium. It has also 
 happened that I have seen some patients that I have regarded as attacked 
 with internal hydrocephalus, and who on opening the bodies have pre- 
 sented but a small quantity of w r ater in the ventricles, whilst the convo- 
 lutions of the brain strongly flattened showed that this viscus had under- 
 gone compression, which could only be attributed to too great volume, 
 and consequently to a too active nutrition of the cerebral mass." 
 
 * Journal de Medecine de MM. Corvisart, Leroux et Boyer, torn. ii. p. 669. Neur. 1806. 
 
HYPERTROPHY OF THE BRAIN. 479 
 
 In 1823, he again treats of this disease, having evidently seen several 
 cases in the meantime. The following description, which is in his own 
 \vords, gives so complete an account of the disease, that it is impossible 
 to add much to it : " This alteration, comparatively common in infants, 
 is rare in the adult. It is characterized by very great firmness of the 
 cerebral substance, by a considerable widening of the cerebral convolu- 
 tions of the brain, although the ventricles contain little or no serum. It 
 may be developed slowly, but more frequently it is an acute affection, 
 the symptoms of which are very analogous to those of hydrocephalus. 
 It appears to be the result neither of inflammation nor of the excess of 
 action of this organ, for it is not more common in men of study than in 
 others ; and it is rare that inflammation is even occasionally the cause 
 of hypertrophy, unless it be in that of the tonsil glands. In almost all 
 other organs, prolonged frequency or repeated inflammation ends by 
 producing atrophy." 
 
 M. Scoutteten was the next who detected any cases of this disease. 
 His observations are published in the 7th volume of the Archives 
 General de Med., Jan. 1825. He gives the case of a child five years 
 and a half old. His head was very large, but his intellect below par ; 
 he died after sixteen days' illness ; he only entirely lost his conscious- 
 ness on the day of'his death. The post-mortem appearances were those 
 of hypertrophy. 
 
 M. Dance* in 1828 related four interesting cases of this disease, all 
 occurring in adults from the age of twenty-four to thirty years. 
 
 The first case was a young man of twenty-six years of age, who re- 
 ceived a blow at the age of fourteen with a hatchet on the vertex of 
 the head, just twelve years before his death; he was not stunned by the 
 blow, but he was attacked with delirium, and remained seven months 
 ill ; from this time till about six weeks before his death he suffered but 
 little in his head, except from cold, any exposure to which gave him 
 pain. Previous to his death his principal symptoms were violent parox- 
 ysms of pain and a very slow pulse. There was but little disturbance 
 of intellect, or sensation. The appearance of the brain was most striking. 
 " All the convolutions, particularly at the upper part, had increased 
 to double their normal size, they were flattened, and so jammed one 
 against the other, that it was difficult to perceive the separations between 
 them, so that the surface of the brain presented a plain surface, without 
 elevation or depression. The arachnoid and pia mater were firmly ad- 
 herent, as was the pia mater to the convolutions, and these membranes 
 seemed thinner than natural ; they were not at all injected, and were so 
 glued together that they could not be separated without tearing them. 
 The whole cerebral substance looked much like the white of a hard- 
 boiled egg; its weight and density were considerable, it did not fall to 
 pieces, and resisted under pressure. When drawn out, it elongated 
 considerably, and then resumed its shape, like an elastic body; no trace 
 of vessels, no mottled appearance, nor no red hue, was to be seen ; on 
 the contrary, the cortical portion appeared paler, the medullary whiter, 
 than usual. The ventricles contained no fluid ; their cavities appeared 
 
 * Observations pour servir a 1'Histoire de 1'Hypertrophie du Cerveau, par la Donee, Rep. 
 General d'Anat. de Physiol. et du Pathol., p. 197. 
 
480 HUMAN BRAIN. 
 
 but of half their usual size, from the encroachment of their walls. When 
 the cerebral mass was removed, there did not appear to be a drop of 
 fluid in the cranial cavity, the surface of the arachnoid being as dry as 
 parchment ; the pons Varolii was slightly in the same state as the brain ; 
 but the cerebellum and medulla oblongata presented no abnormal ap- 
 pearances. The other organs were quite healthy."* 
 
 In the second case, the subject of it, twenty-four years of age, was 
 slightly imbecile in intellect ; he suffered from pain in his head, but not 
 from any convulsions, previous to his admission into the hospital. On 
 the sixth day after his entrance there, he was seized with convulsions, 
 stiffness of the limbs, and grinding of the teeth ; after suffering from 
 several such fits, he sunk into a comatose state, and with dilated pupils 
 and stertorous breathing, died. 
 
 The post-mortem appearances were strikingly similar to the last. The 
 cerebellum was healthy in every respect. 
 
 In the third case, the intellect of the patient, who was thirty years of 
 age, had been for some months gradually giving way. A few days 
 previous to death he was found lying on the ground, insensible and 
 paralyzed ; he slightly recovered his consciousness, but not to any extent. 
 The post-mortem appearances were the same as in the two last cases. 
 
 The fourth case is too interesting to abridge. f 
 
 Case 98. "A house-painter, thirty years of age, of an athletic constitution, was taken to 
 the Hotel Dieu, having epileptiform paroxysms, which recurred three or four times in the 
 day. 
 
 " We did not see him till the day after his admission ; he spoke with extreme slowness 
 and with remarkable difficulty, which seemed to arise from want of memory, for he sought 
 his answers for some time, and repeated them again and again, as if to assure himself of 
 their exactitude. He did not understand all the questions that were asked him, yet he 
 gave us a history of himself, conformable in many points to that which we had got from 
 his wife. His pulse was full and rather quick ; his face red ; the skin hot ; his respiration 
 was interrupted by involuntary sighs; there was no change in the form of the mouth, nor 
 paralysis of any of the limbs. 
 
 "For six years previously he had been subject to determination of blood to the head; at 
 times he was attacked by a giddiness, which lasted from three to four minutes ; he then lost 
 the use of his senses and became quite stupefied. But three years since he fell from a third 
 floor, and these fits became changed to true epileptic attacks, recurring at first at long inter- 
 vals, but afterward following one another more closely, so that at this time he had four or 
 five fits a day. He was habitually of a gloomy, taciturn character ; he was of a full habit, 
 and frequently complained of pain in his head and stomach. Blood-letting had always 
 calmed and lessened these attacks ; spirituous liquors, in which he sometimes indulged, 
 always augmented his malady. On the 12th of March, three days before his admittance 
 into the hospital, having drank two glasses of punch, he was attacked in the night by very 
 violent convulsions; a physician was called, who prescribed twenty leeches to the epigas- 
 trium ; but the patient was not benefited by the application. 
 
 " At the hospital he was bled, which seemed only to make him worse. During the 
 night of the 16th he had three fits in close succession, of a true epileptic character. On the 
 morning of the 17th he had a distracted air, not answering questions ; soon became comatose, 
 with loss of sensation and motion. Eyes closed, pupils contracted, mouth half open, tongue 
 raised, respiration stertorous, profuse perspiration, pulse 140. Sometimes tension and stiff- 
 ness of the limbs, followed by general collapse, and death at 10 A. M. The post-mortem 
 appearances were those of true hypertrophy. 
 
 M. Meriadec Laennec was the next who wrote on this subject ; but 
 his memoir was written without being aware of the existence of that of 
 M. Dance: he relates five cases, all adults. i In all the cases there 
 
 * Op. cit., p. 200. f P. 206. 
 
 J Observ. pour servir THistorie de 1'Hypertrophie duCerveau: Revue Med., torn. iv. 1818. 
 
HYPERTROPHY OF THE BRAIN. 481 
 
 were epileptic fits or epileptiform convulsions. In all, the post-mortem 
 appearances were the same ; all characteristic of hypertrophy of the 
 brain. In three of the cases, the patients had suffered from lead colic, 
 and were exposed to the influence of lead at the time of their attacks. 
 
 In the first case, the patient 32 years of age, the course of the disease 
 was most rapid, the cerebral symptoms only lasting ten days ; but the 
 usual post-mortem appearances were found. 
 
 In the second, the patient, 44 years of age, was ill apparently about 
 one month ; the symptoms were those of cerebritis, and the appearances 
 those belonging to hypertrophy; there were hardening and flattening of 
 the convolutions, and absence of blood in the substance. 
 
 In the third case, the patient, aatat. 43, had an epileptic fit on the 1st 
 of January ; they were repeated at intervals ; on the 21st he had several, 
 succeeding each other very closely, and he sank on this day. The 
 post-mortem appearances the same as in the others. 
 
 In the fourth case, the patient, aatat. 22, had an epileptic attack on 
 the 30th of March, and died on the 2d of April, having had several fits 
 previous to her death. 
 
 In the fifth case, the patient, atat. 13, was a delicate child from 
 birth ; weak intellect, but not idiotic ; suffered in his head for above a 
 year previous to death. 
 
 M. Meriadec Laennec considers that the rapidity of the course of this 
 hypertrophy of the brain allies it more nearly than any other hypertrophy 
 to the inflammatory turgescences. 
 
 Dr. Sims published some cases of hypertrophy and atrophy of the brain 
 in the nineteenth volume of the Transactions of the Medico-Chirurgi- 
 cal Society. One of these is interesting, from its affording an instance 
 of very partial hypertrophy. The disease is generally confined to the 
 hemispheres of the cerebrum ; but in this case the corpora striata, one 
 thalamus, and the tuber annulare, were alone affected. 
 
 Case 99. C. D., set. 60, a lunatic for twenty years, with lucid intervals; he was ap- 
 proaching to a state of fatuity; he complained much of great weakness of the lower extre- 
 mities ; he had a carcinomatous disease of the lower lip, which Mr. Perry removed. The 
 wound looked well at the time of his death. 
 
 Inspection. Head. The skull was remarkably hard ; there was serous effusion between, 
 the membranes, and a large quantity in the intergyral spaces. On opening the ventricles, 
 the corpora striata appeared pressed much closer to each other than usual. The right 
 corpus striatum was twice its ordinary size; the left slightly enlarged. The left thalamus 
 was very much enlarged. The tuber annulare appeared half as large again as usual; the 
 crura cerebri were also enlarged. 
 
 The latest information regarding hypertrophy is from the pen of Dr. 
 Mauthner, of Vienna.* The following account is taken from an admi- 
 rable review of the work in the British and Foreign Medical Review, 
 vol. xxi. p. 387. 
 
 Dr. Mauthner weighed the brain of 216 children, at all ages from 
 birth up to the eighth year, during the whole of which period an increase 
 in its weight is pretty constantly going on. 
 
 " During this time," says he, u we find a minimum of 10 oz. 6 dr. 
 rise to a maximum of 44| oz. The average weight begins with 13J, 
 
 * Die Krankheiten des Gehirns und Riickenmarks bei Kindern. Durch Krankheitsfalle 
 aus dem ersten Kinderspitale erlautert, von Dr. L. W. Mauthner. Wien, 1844. 
 
 31 
 
482 . HUMAN BRAIN. 
 
 and rises to 35.V oz. During the first year it grows from 13JL to 20^, or 
 7 oz. ; in the second, from 20^ to 25J, or 5 oz. ; in the third, from 5} 
 to 32, or 6| oz. ; and between the fourth and eighth year, from 32 to 
 35J, or 3| oz. Hence it appears that the brain grows more rapidly in 
 the first year of life ; that in the second and third years its increase is 
 still considerable, but that its growth is slower after the fourth year. In 
 conclusion it may be observed, as a remarkable fact, that the minimum 
 weight usually occurs in cases of atrophy or phthisis ; the maximum in 
 pneumonia, scarlet fever, apoplexy, and cerebral tubercle." P. 162. 
 
 He points out the frequent coincidence with enlargements of the thy- 
 mus gland, of the left ventricle of the heart, and of the liver ; facts which 
 lend some support to Miinchmeyer's theory of the connection of asthma 
 thyinicum with hypertrophy of the brain. He describes an induration 
 of the brain in anatomical characters similar to hypertrophy ; but in which 
 the brain is not larger than natural. The skull is smaller, probably the 
 result of excessive activity of the process of ossification ; and hence the 
 pressure to which the brain is subjected. In these cases the child is 
 always deficient in intellectual power, and is frequently idiotic, and 
 unable to walk. The head retains its natural size, but the" sutures close 
 unusually early, and the parietal and occipital protuberances are unusu- 
 ally prominent. 
 
 Such children present none of those indications of rachitis which so 
 often coincide with hypertrophy of the brain ; but the lower animal life 
 thrives at the expense of the higher; the skin is firm, and the body fat 
 and ruddy; the muscles and bones strong, the constitution robust, and 
 the appetite craving. 
 
 It further appears, from a minute examination of the condition of the 
 brain in these cases, that its weight is, to a great degree, dependent on 
 the quantity of blood which it contains. 
 
 " In detailing the symptoms that ordinarily attend hypertrophy of the 
 brain, M. Mauthner distinguishes the passive from the active form of the 
 affection. 
 
 "In passive hypertrophy, the cranium early presents a striking devia- 
 tion from its natural appearance, in the enlargement and globular promi- 
 nence of the occiput. The parietal protuberances subsequently project, 
 the coronal and sagittal sutures continue open in the ninth or even in 
 the twelfth month, and the fontanelles remain unclosed for a much longer 
 time than natural ; the growth of hair is scanty, and the veins of the 
 scalp are much injected. Children in this state sleep much, though 
 they are easily startled ; they sweat much about the head ; and when in 
 a sitting posture, the head drops forward by its own weight. Attacks of 
 crowing inspiration occur when the child cries, and not unfrequently 
 end in, or are accompanied by, regular convulsions, and the severity and 
 frequency of these seizures are greatest during the period of dentition. 
 
 " Digestion is at the same time impaired, and vomiting and diarrhoea 
 are frequent. By degrees the symptoms of pressure on the brain become 
 more evident, or they are suddenly developed, as the result of the super- 
 vention of some other disease. 
 
 " When hypertrophy of the brain has reached this stage, the skull 
 deviates still more from its natural shape: the forehead sometimes be- 
 
HYPERTROPHY OF THE BRAIN. 483 
 
 comes prominent and globose like the occiput; and while the skull goes 
 on acquiring an increased curvature, the region of the temples continues 
 flat, and thus contributes to give to the head the appearance of being 
 formed by the union of the segments of four spheres. During this stage 
 of the affection, the preternatural softening and thinning of the cranial 
 bones, corresponding to the prominences of the convolutions, are dis- 
 tinctly perceptible, especially at the occiput. The functions of the 
 brain become now much disturbed ; headache, giddiness, impairments 
 of muscular power, and loss of memory, occur; the child grows sullen, 
 peevish, sleepless, whimpers continually, and rolls the head constantly 
 from side to side. At the same time it becomes choked with phlegm, 
 while the skin becomes every day more flabby, the muscles shrink, the 
 bones grow soft, and the muscular power rapidly diminishes. 
 
 " Hence these children lie usually on their back, breathing with habi- 
 tual wheezing, and suffering from constant dyspnoea, with occasional 
 asthmatic seizures, such as have been already described. When in this 
 condition, slight causes suffice to produce a general excitement of the 
 vascular system, and to excite diseased action in other parts, which ren- 
 der still more obvious the influence of the hypertrophy on the nervous 
 system generally. If the child happen to catch a slight cold, attacks of 
 convulsive cough, or of asthma, occur in consequence, or convulsions 
 come on, which terminate life in a few days." P. 174. 
 
 " Such," says the reviewer of M. Mauthner, " is the course usually 
 run by this affection ; but its symptoms differ when, as is sometimes the 
 case, the hypertrophy is partial, or when the disease assumes the active 
 form, or that in which the walls of the skull, owing to the energy of 
 the process of ossification, do not expand in proportion to the rapid 
 growth of the brain. Its symptoms then are usually those of active 
 cerebral disease; the result of compression of the brain, and its con- 
 sequent congestion." 
 
 In the chapter on chronic hydrocephalus, the diagnosis between that 
 disease and hypertrophy of the brain is stated at great length. The 
 chief differences insisted on by M. Mauthner are thus thrown into a 
 table by the reviewer : 
 
 Hypertrophy of the Brain. Chronic Hydrocephaluis. 
 
 1. The posterior part of the skull first pre- 1. The forehead is the first part to present 
 sents an unnatural prominence. unnatural prominence ; the altered direction 
 
 of the eyes and the very great width of the 
 sutures and fontanelles are likewise charac- 
 teristic. 
 
 2. Children lie horizontally, or throw the 2. Children He on the belly, with the head 
 head back. lower than the rest of the body, burying the 
 
 face in the pillow. 
 
 3. Face puffy, eyes inexpressive and star- 3. Countenance withered, having expres- 
 ing ; mouth half open. sion of premature old age. 
 
 4. Functional disturbance comes on very 4. Functional disturbance occurs early, and 
 gradually ; not before the period of dentition involves the cerebrum from the very begin- 
 or weaning; and consists, at first, in affec- ning. 
 
 tion of the respiratory apparatus, difficulty of 
 breathing, and attacks of apnoaa. 
 
 5. Patients fat and leucophlegmatic. 5. Patient ill-nourished, subject to rickets 
 
 and tabes mesenterica. 
 
484 HUMAN BRAIN. 
 
 Dr. Mauthner* has pointed out a peculiar form of induration of the 
 brain occurring in children who have died of marasmus. It consists of 
 a partial induration of the organ, and though often associated with dimi- 
 nution in the size and weight of the organ, is sometimes met with inde- 
 pendent of any alteration of its volume. He regards it as a result of a 
 state of congestion or inflammation ; but the symptoms by which it is 
 attended are very obscure, consisting in convulsions, torpor, and very 
 rapid emaciation. The centrum ovale and the walls of the lateral ven- 
 tricles, especially at the anterior or posterior horn, are its most frequent 
 seats, and it is sometimes remarkably evident when it affects the tania 
 semicircularis. The indurated portion usually has an elongated form, 
 is distinguishable by the gray color of the cerebral substance, but espe- 
 cially by its cartilaginous hardness. The form of induration of the 
 brain, of which Dr. Mauthner relates three instances, has, to the best of 
 my knowledge, never been noticed by any other writer. It is, there- 
 fore, worthy of mention, though, at present, little more than a patholo- 
 gical curiosity. 
 
 The treatment of hypertrophy of the brain necessarily differs according 
 to the circumstances under which it occurs. In that form which is con- 
 nected with rickets, absorbents with rhubarb and preparations of iron, 
 and a properly-regulated diet continued for months, are often very use- 
 ful. Cold sponging of the surface is frequently of service, but in con- 
 sequence of the tendency to perspiration about the head, care should be 
 taken not to leave it quite bare ; but it should be constantly covered 
 with a light cap. In the other form of the disease, whatever might 
 tend to excite the brain must be avoided, while the long-continued use 
 of the iodide of potassium has been found beneficial. Warm baths and 
 the occasional application of the moxa, and blisters to the back of the 
 neck, have likewise been of service. 
 
 * British and Foreign Medical Review, loc. cit., vol. xxi. p. 390. 
 

 . 
 
 INDEX. 
 
 COMPARATIVE ANATOMY AND PHYSIOLOGY OF BRAIN. 
 
 A. 
 
 Ai, or three-toothed sloth, 122 
 
 Accessory, spinal, 239 
 
 Acrita, of MacLeay, 51 
 
 Agouti, 118, 119 
 
 Alcock, Dr. B., root of fifth pair, 184, 236 
 
 Alimentary canal, its relation to the nervous 
 system, 59 
 
 Amphibia, 82, 93 
 
 Analysis, chemical, of brain, 38 
 
 Anastomosis of nerves, 41, 42 
 
 Animals classified according to nervous sys- 
 tem, 51 
 
 Animal kingdom, divisions, 51, 52 
 
 lowest form, 51, 59, 63 
 
 simply nutrient, 59 
 
 Animalcule, the wheel, 63 
 
 Ant-eater, 122 
 
 Antennae, nerves of, 68 
 
 Ape's brain, 108, 111, 116, 117, 119, 122, 125 
 
 cerebral vessels, 129 
 
 Aqueduct, Sylvii, foetus and fish, 87, 88 
 
 Arabians, their physiology of the nerves, 58 
 
 Arachnoid tunic, 133, 136, 137, 143, 165 
 
 Arbor vitae, 203, 210 
 
 Area germinativa, 247 
 
 Aristotle's physiology, 56 
 
 Arms and stomach, earliest animal form, 51, 
 59, 64, 71, 77 
 
 Arnold, F., nerves of dura mater, 136, 143 
 
 Arteries of brain, 241242 
 
 Arteries, spinal, 142, 242 
 
 vertebral, 126128, 135, 138, 159, 242 
 
 Articulata, 51, 59, 61, 67, 70, 71, 82 
 
 spinal ganglia of, 181 
 
 Arsakay, encephalon, 36 
 
 Ascaris, simple nervous system, 52 
 
 Ascidia mammillata, 64 
 
 Atrophy, senile, of brain, 39 
 
 Axis cylinders, 4043, 48, 49 
 
 B. 
 
 Baboon, carotids, 126 
 Badger, cerebral vessels, 129 
 Baillarger, cortical substance, 205 
 Basilar artery, 127 
 Beaver, cerebral vessels, 129 
 Beclard, ganglionic nerves, 58 
 Bell, Sir C., decussation of the spinal columns, 
 
 187, 195, 198, 202 
 fifth pair, 188 
 
 Bell, nerves of sensation, 260 
 
 physiology of the brain, 41, 51, 61, 74 
 
 roots of spinal nerves, 172, 178, 189, 202 
 
 Bellingeri, roots of spinal nerves, 174 
 Bennet, foetal brain, 36 
 Berenger, gray matter, 34 
 Bichat, arachnoid, 136137 
 
 physiology of brain, 57 
 
 foramen of, 168 
 
 - - ganglionic nerves, 59 
 
 Bidder, cerebro-spinal system, 46, 47 
 
 Bird, Dr. G., excretion of phosphorus, 45, 46 
 
 Birds' brain, 82, 95, 96, 97, 119, 206, 220, 223, 
 
 225,250,251,262 
 Bischoff, foetal brain, 247 
 
 spinal nerves, 176 
 
 Blainville, nerves, 230 
 Blane, reflex functions, 74 
 Blumenbach, ganglionic nerves, 58 
 Bouillaud, cerebellum, 193 
 Bowman, axis cylinder, 40 
 
 and Todd, 43, 262 
 
 Brain alters its form during life, 266 
 
 base of, 114, 156, 158 
 
 convolutions, 118; 119125, 159163 
 
 cortical substance, 55, 164 168 ; 
 
 earliest development of, 77, 78, 79, 82 
 
 how to remove it from skull, 141 
 
 instrument of mind, 258, 265, 266 
 
 in mammalia, 97 
 
 movements of, 138 
 
 progressive development of, 82, 246 256 
 
 its relation to generative process, 98, 260, 
 
 262 
 
 series of ganglia, 55, 56 
 
 size in insects, 69, 76 
 
 system, 57 
 
 four ganglia, 67 
 
 vertical section, 157, 197 
 
 wastes, 39, 45, 141, 145, 267 
 
 Brain and nervous system of, 
 
 Agouti, 118120 
 
 Ai, 122 
 
 Amphibia, 82, 93 
 
 Ant-eater, 122 
 
 Ape, 108, 111, 116, 117, 119, 122125 
 
 Asterias, 53 
 
 Baboon, 116, 124 
 
 Badger, 111, 122 
 
 Bat, 116, 119, 122 
 
 Bear, 111, 115, 120, 121, 122, 125 
 
486 
 
 INDEX. 
 
 Brain and nervous system of, 
 
 Beaver, 99, 100, 117, 120 
 
 Boar, 125 
 
 Blackbird, 95 
 
 Butterfly, 77, 78, 83 
 
 Buzzard, 95 
 
 Calf, 108, 129, 184,239,249 
 
 Canary, 96 
 
 Carnivora, 111, 113, 115, 116, 117 
 
 Carp, 89, 103, 223, 255 
 
 optic nerve of, 232 
 
 Caterpillar, 77 
 
 Cat, 40, 47, 108, 115, 121, 122, 125, 129, 
 183 
 
 embryo of, 248 
 
 Cephalopoda, 7981 
 Centipede, 68 
 Cheetah, 119 
 Cheiroptera, 116, 119 
 Chimpanzee, 116, 124 
 Chilognatha, 68 
 Civet, 121 
 Coati, 121 
 Cod, 35 
 
 optic nerve of, 232, 233 
 
 Conchifera, 62, 65 
 Coney, 122 
 Corals, 62 
 Crab, 75 
 Crocodile, 95 
 
 Crow, 95 
 
 Cuckoo, 95 
 Cuttle-fish, 7980 
 
 Cymothea, 67 
 
 Dog, 116, 121, 125,230,263 
 
 Dolphin, 108, 117 
 
 Duck, 95, 96 
 
 Edentata, 104 
 
 Eel, 83, 85, 91,93 
 
 Egg, 53 
 
 Elephant, 108112, 119, 122,123, 124, 
 129 
 
 its weight, 145 
 
 Embryo, 83, 87, 159, 161, 246256 
 
 Ferret, 116, 120, 122, 125, 159 
 
 FcEtus, 128, 247 
 
 Fowl, 95, 96, 264 
 
 Fox, 120122, 125, 161 
 
 Frog, 47, 93, 206 
 
 Gasteropoda, 65, 66 
 
 Genet, 121 
 
 Giraffe, 129 
 
 Goat, 108, 129 
 
 Goose, 96 
 
 Guinea-pig, 47 
 
 Haddock, 86 
 
 optic nerve, 232 
 
 Hare, 120, 218, 224 
 
 Hedge-hog, 74, 116, 118 
 
 Horse, 108, 109, 117, 166, 183 
 
 its weight, 145 
 
 olfactory nerve, 230 
 
 cerebellum, &c., 224, 230, 239, 249 
 
 Hyrax, 119, 122 
 
 Idiot, 39, 160 
 
 Imago, 7778 
 Infant, 205, 226 
 Insect, 69 
 
 Insectivora, 116, 119 
 Invertebrata, 130 
 lulus, 68, 71 
 
 Jrain and nervous system of, 
 
 Kangaroo, 98100, 113, 122, 125 
 
 Leopard, 129 
 
 Lemur, 116, 125 
 
 Lymax ater, 66 
 
 Limpet, 65 
 
 Lion, 115118, 121, 125 
 
 Lizard, 93, 95, 251 
 
 Lynx, 111, 119 
 
 Magpie, 95 
 
 Mammalia, 82, 97, 116, 117, 206, 248, 
 
 252, 262 
 
 Marsupiata, 9899, 116, 119 
 Marten, 115, 121, 125 
 Megatherium, 104 
 Molluscs, 51, 57, '60, 62, 65, 67, 92 
 Monkey, 108, 116, 117, 118, 122 
 Monotremata, 98, 119 
 Moth, 7779 
 Mole, 116, 166 
 
 optic nerve of, 232, 233 
 
 Mouse, 98 
 
 Myriapoda, 68, 69, 70, 74 
 Mammalia, brain of, classified according 
 to convolutions, 118 125; with com- 
 parative anatomy of the human brain, 
 118126 
 Narwhal, weight of brain, 145 
 
 Necroph. leophag., 68 
 
 Negro, 169 
 
 Newt, 93 
 
 Nautilus, 78, 79, 80, 81 
 
 Old age, 206 
 
 Opossum, 116, 117 
 
 Otter, 125 
 
 Ourang-outang, 117 
 
 Oyster, 64 
 
 power of vision, 64 65 
 
 Ox, 100, 108, 109, 117,125 
 
 spinal cord, 189 
 
 cerebellum, 224 
 
 Panther, 121 
 
 Parrot, 96 
 
 Partridge, 96 
 
 Peccary, 125 
 
 Pig, 108, 122, 125 
 
 Pigeon, 95, 96, 263 
 
 Pike, 91 
 
 Polecat, 120, 122 
 
 Polypus, 59, 62 
 
 Porcupine, 103, 120 
 
 Porpoise, 108114, 116, 117, 125, 183 
 
 Pteropus, 122 
 
 Rabbit, 98, 101, 102, 117 
 
 embryo, 248 
 
 Rat, 98, 118 
 
 Reptiles, 82, 93, 95, 1 12, 250, 251, 255, 
 256 
 
 Roebuck, 125 
 
 Rodentia, 98103, 113, 116, 118, 119, 
 129 
 
 Ruminantia,104, 109, 113, 117,121,252 
 
 Salamander, 93, 95 
 
 Sandhopper, 67, 82 
 
 Scolopendra, 71 
 
 Seal, 111, 115, 117, 122, 125 
 
 Sepia, 81, 83 
 
 Shark (no air bag), 92 
 
 Sheep, 104110, 113, 121, 122, 125, 
 166, 183, 189, 202, 224, 230 
 
 Skate, 83, 86, 9193, 223, 255 
 
INDEX. 
 
 487 
 
 Brain and nervous system of, 
 
 Skate, optic nerve of, 232 
 
 Sloth, 104, 122 
 
 Slug, 65 
 
 Snake, 93, 95, 251 
 
 Sparrow, 96 
 
 Spirostrepti, Spiroboli, 72 
 
 Sponges, 62 
 
 Squirrel, 98, 100, 103, 104, 120 
 
 Stag, 128 
 
 Storks, 96 
 
 Sturgeon, 86 
 
 optic nerve of, 233 
 
 Swine, 129 
 
 Starfish, 53, 59, 206, 208 
 
 Talitrus locusta, 67, 69 
 
 Teeth, 48 
 
 Tiger, 126 
 
 Toad, 93 
 
 Tortoise, 47, 223, 251 
 
 Tunicata, 62 
 
 Turtle, 93, 94, 95, 203 
 
 Vertebrata, 51, 61, 130, 181, 226 
 
 olfactory nerve of, 68 
 
 Weazel, 122, 125, 129 
 
 Whale, 115, 122, 125 
 
 weight of brain, 145 
 
 Whiting, 86, 103, 223 
 
 Wolf, 121 
 
 Wombat, 98, 99, 122, 125 
 
 Woodpecker, 95 
 
 Wren, 96 
 Branchial sac, 62 
 
 apertures, 246 
 
 Branchiogastric nerves, in the electric ray, 
 
 90 
 Breschet, ganglionic nerve of, 58, 59 
 
 veins of cord, 142 
 
 par vagum, 185 
 
 Broussais. ganglionic nerve, 59 
 
 cerebellum, 193, 261, 262 
 
 Burrows, cerebro-spinal fluid, 140 
 Budge, Dr. J., spinal cord, 177 
 Burdach, membranes of cranium, 131, 137 
 decussation of nerve, 126, 212 
 
 C. 
 
 Calamus scriptorius, 201 
 Calf, vertebral arteries of, 127, 128 
 Camel, carotids of, 128 
 Camper, optic ganglia, 88 
 Capillaries, uses of, 42 
 Cardiac plexus (Cuttlefish), 80 
 Carotids, 126127, 241 
 Carpenter, cerebral ganglia, 332 
 
 development of ovum, 247 
 
 excito-motory nerve, 332 
 
 nervous system, 44, 45, 51, 62, 65 
 
 wasting of brain, 45 
 
 Carus, optic ganglia, 87 
 Cat, vertebral arteries of, 125 
 Cauda equina, 156 
 Caudate vesicles, 43 
 Cavernous sinus, 135 
 Cella cordae Willisii, 134 
 Cells of glands, 33, 44 
 
 nucleated (Goodsirs), 44 
 
 theory of, 44 
 
 Centrum ovale, 164 165 
 Cephalic ganglia, 66 67, 85 
 Cerebellum, 185, 203, 217, 225, 261 
 
 Cerebellum of animals, 104, 112 (elephant), 
 116,221,223225 
 
 arteries of, 243 
 
 birds, 9596 
 
 fishes, 36 
 
 flying fish, 36 
 
 ganglia, 85 
 
 laminated ganglia, 220 
 
 commissures, 211, 215, 221, 230 
 
 man, 189194,204 
 
 Cerebral or brain system, 57 
 
 ganglia, 166 
 
 vessels, 126129, 142, 241, 244 
 
 Cerebro-spinal axis, 130, 181, 206, 257268 
 
 spinal fluid, 139141 
 
 chemical analysis of, 141 
 
 nerves, 46 57 
 
 Cetacea, brain contains oil, 38, 112115, 122 
 
 dura mater, 133 
 
 Chamois, carotids, 128, 129 
 
 Chaussier, ganglionic nerve, 58 
 
 Cilia, class Tunicata, 63 
 
 Cinereum tuber, 89, 92, 103, 158, 159 
 
 Cineritious matter, 34, 37, 55, 56, 83, 9698, 
 
 164, 182, 204, 210211, 215, 226, 231, 233, 
 239 
 
 of cord, 174, 175176, 181 
 
 Clendinning, weight of brain, 151 
 
 Cloquet, nervous system of Ascaris, 52 
 
 Cod, optic nerve, 232, 233 
 
 Columns, spinal, 70, 71, 131, 189192, 197, 
 
 200, 260 
 
 Combe, phrenology, 257, 258, 265 
 Commissures, cerebellum, 157 
 
 inter-cerebral, 203 217 
 
 great transverse, 206 217 
 
 longitudinal, 208210, 260 
 
 Chaussier, 211 
 
 mollis, 2ia 
 
 optic nerve, 158 
 
 organs of comparison, 56 
 
 spinal cord, 231, 171, 174 
 
 the, 37, 52, 56, 7173, 8692, 94, 97, 
 
 100, 101, 105, 110, 165, 166, 167, 169, 174, 
 
 204, 206217, 230, 259, 268 
 Conductors, insulated, nerves, 42 
 Conolly, lunacy, 267 
 Consciousness, the nervous system no proof of, 
 
 50, 59, 264 
 
 Continuity of nervous filaments, 42 
 Convulsive diseases, 60 
 Convoluted surface of brain, 156, 159163, 
 
 165, 205 
 
 Convolutions, an index of intelligence, 118 
 
 126 
 birds, beasts, &c., 95, 96, 104, 105, 116, 
 
 118, 160 
 
 classified, 119125, 159 
 
 of brain, 208215 
 
 longitudinal, 122, 159, 161, 163 
 
 Cooper's, Sir A., experiments on rabbits, 44 
 
 Mr., spinal nerve, 176 
 
 Cord, spinal, 51 
 
 Corpora geniculata, 117, 166, 169, 234 
 
 mammillaria, 158 
 
 olivaria, 181183, 188, 199 
 
 ganglia of lingual nerve, 111, 261 
 
 striata, 8792, 102, 105, 117, 166, 176, 
 
 196,204,211, 262 
 
 Corpus callosum, 56102, 117, 206250 
 Corpus denticulatum, 215, 220 
 
INDEX. 
 
 Corpus fimbriatum, 214 
 
 Corpuscles, Pacinian, 40 
 
 Cortical substance, a distinct ganglion, 55, 204 
 
 Cranium, a series of vertebrae, 131 
 
 Crocodile's heart, 246 
 
 Cruracerebelli,221 223 
 
 cerebri, 6871, 102106, 158, 176, 182, 
 
 195, 200, 201, 213, 215 
 Crustacea, aganglionic, 71, 75 
 Cruveilhier, arachnoid, 137 
 
 decussation of spinal cord, 137 
 
 medulla spinalis, 175 
 
 mode of dissecting brain, 171 
 
 nerves of dura mater, 136 
 Cryptoneura, 51 
 
 Cuvier, ganglionic nerve, 51, 52, 59 
 Cyclo-gangliata of Grant, 51, 58 
 Cycloneurose of Grant, 51 
 
 D. 
 
 Decussation of pyramidal bodies, (Hippocrates, 
 Aretaeus, Dion, Cassius, &c.), 185187, 210 
 
 of spinal columns, 189, 202 
 
 Deglutition, 60 
 
 Dementia condition of brain, 140, 141 
 Desmoulins, optic thalami, 87 
 Development, brain and nerves, 244 256 
 
 law of, 53, 244246 
 
 Deville, phrenology, 266 
 Diemerbroeck, gray matter, 34 
 Diploneurose of Grant, 51 
 Divisions of animal kingdom, 51, 52 
 Dog, cerebral vessels, 129 
 
 nerves, 230 
 
 hemispheres, 264 
 
 Dura mater, 132133, 138143, 226 
 
 cetacea, 133 
 
 nerves of, 135, 136 
 
 E. 
 
 Edentata, 104 
 
 Egestion, 60 
 
 Ehrenberg, medullary neurine, 39 
 
 Electric ray, Cruveilhier, 90 
 
 Elephant, cerebral vessels, 129 
 
 Embryo, heart, 246 
 
 lungs, 246 
 
 EncephaJon, configuration of, 156 
 Eustachius, trigeminal nerve, 58 
 Excito-motory nerves, 37, 51, 57, 59, 60, 62, 
 
 68, 175, 188, 230, 236, 239, 260, 262 
 Eye, theory of sight, decussation of optic 
 
 nerves, 231 
 Eyelids, action of, 60 
 
 F. 
 
 Falx major and minor, 133, 136 
 Fat of brain, M. John's analysis, 38 
 Fibres of nerves continuous, 41, 73, 145 
 insulated, 42, 73 
 
 gray, 46 
 
 , size of, 46 
 
 individually endowed, 73 
 
 of re-inforcement, 70 73, 202 
 
 of spinal cord, 70 
 
 connected with cerebellum, 191, 
 
 192, 194, 195 
 connected with cerebrum, 198,200, 
 
 205 
 Fibrous matter of brain, 33, 39, 42, 46, 49, 56, 
 
 145, 207215, 221224 
 
 Fibrous neurine of cord, 174 178 
 Figurate surface of brain, 164 170, 208 
 Fishes, brain and cerebellum, 36, 8292, 96, 
 
 112, 159, 164, 169, 184, 206, 223, 226, 230, 
 
 249-251, 262 
 
 - heart, 246 
 
 - lungs, 246 
 
 - sight of, 232 
 
 - skull, 86 
 
 thyroid gland or branchiola, 243 
 Fissura Sylvii, 119122, 159, 161, 210 
 Fissure of spinal cord, 172, 175 
 Fletcher, gray matter, 36 
 Fletcher's Lectures, history of ganglionic 
 
 nerves, 58 
 Flourens, cerebellum, 193 
 
 hemispheres of brain, 84 
 
 - manifestations of intellect, 263 
 Fluid, cerebro-spinal, 139 141 
 -- chemical analysis of, 141 
 Fornix, 56, 117, 166, 208, 209, 211 
 Foville, analysis of brain, 38 
 
 - auditory nerve, 238 
 
 - cerebellum, 193 
 
 - convolutions of brain, 159 
 
 corpus callosum, 207 
 
 - decussation of nerve, 202 
 
 - pneumogastric, 239 
 
 i restiform bodies, 182 
 
 - spinal cord, 178, 179 
 Frog, heart, 47 
 
 - spinal cord and sympathetic, 47, 178 
 
 G. 
 
 rain, 57, 58, 126, 166, 180 
 
 Galen, physiology of brai 
 Gall, cerebellum, 261 
 
 - gray matter, 35, 120, 174 
 
 - olivary bodies, 183 
 
 - phrenology, 265 
 
 - spinal canal, 172 
 
 - weight of brain, 152 
 Ganglia, 51, 54, 59, 65, 166, 206, 259 
 
 - auditory and pneumogastric, 66, 89, 93, 
 94, 103, 109, 183185, 239, 261 
 
 - at base of optic nerve, 85 
 
 - branchial, 66, 67, 90, 92 
 
 - cerebral or cephalic, 6667, 165, 202, 203 
 
 - lingual, 110, 184 
 
 - medulla oblongata, 182, 261 
 
 - nerves enter and leave, 47 
 
 - of sensation, 84, 85, 94 
 
 - of 7th and 8th pairs, 85 
 
 - of spinal cord, roots of nerves, 172, 173, 
 180, 193 
 
 - of volition, 68 
 
 - pharyngeal, 67 
 
 - respiratory, 67, 69, 92, 94, 185 
 semilunar, 55, 196 
 
 - their nature, 5457, 259 
 
 - hemispherical, 44, 55, 204207, 262, 263 
 
 - tentacular, 269 
 
 - pedal, 65, 67, 69, 72, 75 
 
 Ganglionic system of the sympathetic, 57 67, 
 
 80 
 
 Garner, vision of oysters, 64 
 Gasteropoda, their reproduction, 65 
 Gelatinous neurine, 46, 49 
 Generation, relation of brain to, 98, 193, 261 
 Giraffe, rete mirabile, 129 
 Glands, cells and tubes, 34 44 
 two-fold structure, 3344 
 
INDEX. 
 
 489 
 
 Glandulae Pacchionae, 132 
 Grainger, corpus callosum, 207 
 
 excito-motory nerve, 260 
 
 nervous system, 51, 61 
 
 spinal cord, 175 
 
 third pair nerves, 235 
 
 Grant, divisions of nervous system, 51, 58, 67 
 
 Gray fibres, 46 
 
 matter of brain or neurine, 33, 42, 44, 55, 
 
 60, 61,68,96,164,173183,204,210,211, 
 
 214,215,220, 221,239,240 
 neurine, source of power, 34, 36, 46, 56, 
 
 179 
 
 tubercle in brain, 89 
 
 Goat, vertebral arteries of, 127, 129 
 Good, Mason, ganglionic nerves, 58 
 Goodsirs, Messrs., nucleated cells, 43 
 Gottsche, optic ganglia, 88 
 Gunz, corpus fimbriatum, 214 
 
 H. 
 
 Hall, Dr. M., excito-motory nerve, 37, 51, 60, 
 62, 67, 70, 74, 160, 165 
 
 Haller, cerebro-spinal system, 50 
 
 fluid, 139 
 
 gray matter, 34, 88, 96 
 
 nerves of dura mater, 136 
 
 weight of brain, 151 
 
 Hamilton, Sir W., weight of brain, 151 
 
 Hannover, corpuscles of brain, 47 
 
 Hanwell Asylum, 266 
 
 Harwood, rete mirabile, 129 
 
 Heads, long, indicate intelligence, 119 
 
 Heart, progressive development of, 246 
 
 Hedgehog, cerebral vessels, 129 
 
 carotids, 125 
 
 Helmhotz, corpuscles of brain, 47 
 
 Hemispheres, not the seat of sensation, 263 
 
 Hemispherical ganglia, 46, 55, 84, 159163, 
 166, 204205, 206, 207, 262, 263 
 
 birds, 95 
 
 fish, 8486, 9092 
 
 sheep, 104, 118 
 
 Henle, gray matter, 44, 46 
 
 Hetero-gangliata, 51, 52, 57 
 
 Hertwig and Flourens on intellectual manifes- 
 tations, 263 
 
 Hippocampi, 117, 214, 215 
 
 sense of smell, 214 
 
 Hoare, ganglionic nerve, 58 
 
 Holmes Coote, spinal cord of fishes, 83 
 
 Homo gangliata,51,52, 67 
 
 Human brain, anatomy of, 130 243 
 
 protective apparatus for, 130 
 
 Human brain, weight, 145 155. Tables of, 
 147150 
 
 Hunter, John, whale's brain, 115 
 
 Hydra viridis, 59 
 
 I. 
 
 Idiot, convolutions of brain, 160 
 Imperceptible sensation, 59 
 Implacentalia, 97 
 IncideAt nerves, 59 
 Incubation of egg, 53 
 Infant's brain, 39, 205, 226 
 Inflammation, chronic, of brain, 205 
 Infundibulum, 158, 226 
 Ingestion, 60 
 
 Insanity, change of cortical substance, 165,204, 
 205, 266, 267 
 
 Insects' brain, size of, 69 
 
 Insectivora, 116, 119 
 
 Intellect, its seat in brain, 46, 75 
 
 convolutions, 118, 119 126,258 
 
 long heads, 119 
 
 Intestinal villi, 44 
 Instinct, nerves of, 67, 68, 263 
 John's M., analysis of brain, 38 
 Irritability of muscle, 37 
 Jules Cloquet, Ascaris, 52 
 
 K. 
 
 Kangaroo, 98 113, 122125 
 
 Knox, arachnoid, 136 143 
 
 Kolliker, cerebro-spinal system, 46, 47, 48 
 
 L. 
 
 Laennec, nerves of Ascaris, 53 
 
 Laminae, cerebellum of birds, 96 
 
 Lancisi, ganglionic nerve, 58 
 
 Larynx, pneumogastric, 239 
 
 Lateral sinuses, 135 
 
 Lauth, gray matter, 34 
 
 Law of development, 53, 244, 246 
 
 Legallois, cerebro-spinal system, 60 
 
 Leopard, cerebral vessels, 129 
 
 Leuret, brain of animals, 109, 117, 118, 119 
 
 126 
 
 birds, 95, 96 
 
 fishes, 85, 93, 94 
 
 convolutions, 159 
 
 Lieutaud, nerves of dura mater, 136 
 Life, animal and vegetable, 56, 57 
 
 organic, of Bichat, 57, 59 
 
 phenomena, two kinds, 56 
 
 Ligamentum denticulatum, 143 
 
 Lingual nerves, ganglia, 111, 114, 184 
 
 Lobstein, nerves of dura mater, 136 
 
 Locomotion of Gasteropoda, 66, 67 
 
 Locus perforatus, 160 
 
 Locus niger, caudate vesicles, 43, 198, 202, 
 
 213, 215, 262 
 
 quadrilateralis, 159, 210 
 
 Long heads indicate intelligence, 119 
 Longitudinal commissure, 208 210,260,261, 
 
 265, 266 
 
 sinuses, 135 
 Lumbar nerves, 260 
 Lunacy, 267 
 
 M. 
 
 Macartney, filiform process, 143, 144 
 
 Magendie, cerebellum, 193 
 
 cerebro-spinal fluid, 139, 140 
 
 ' nerves of sensation, 260 
 ' roots of spinal nerves, 172 
 
 Mammalia, classified according to convolu- 
 tions, 118124, 125 
 
 number of cervical vertebrae, 174 
 
 Mamillary tubercle, 117, 158 
 
 Man's brain, comparative anatomy of, 118 
 126 
 
 Mayo, cerebellum, a volatic pile, 220 
 
 decussation of optic nerve, 231 232 
 
 fibres, corpus callosum, 207, 208 
 
 fifth pair, 188 
 
 gray matter, 35, 60, 165 
 
 lingual nerve, 240 
 
 nerves of sensation, 260 
 
 Meckel, auditory nerve, 239 
 
 ganglionic nerve, 58, 59 
 
INDEX. 
 
 Meckel, gray matter, 34 
 
 spinal columns, 191 
 
 Medulla oblongata, dissection of, 193 195 
 
 ganglia, 66, 69, 80, 107 
 
 man, 170, 175, 181203, 219, 261 
 
 respiration, 6065, 159 
 
 sheep, 107112, 114 
 
 spinalis, 171 
 
 Medullary matter, 3439, 43, 46, 203 
 
 neurine, conductor of power, 34, 37, 46, 
 
 56, 259 
 
 neurine of cord, 174 
 
 Membranous matter, basis of organs, 33 
 
 Mental exertion, excretion of phosphorus, 44 
 
 Mesentery of cat, Pacinian corpuscles, 40 
 
 Monro, ganglionic nerve, 58 
 
 Morgagni, spinal canal, 172 
 
 Motor and sensory columns, 166, 181 187, 
 
 196, 199, 202 
 tract, 187198, 203, 216, 223, 229, 235, 
 
 236, 237 
 
 root of fifth, 236 
 
 Movements of brain, 138 
 
 Muller, continuity of nervous fibres, 145 
 
 contraction of muscles, 259 
 
 decussation of optic nerve, 232, 234 
 
 intellect, 263 
 
 Muscle, irritability, 36 
 Muscular contractions, 259 
 Myelencephala, 51,52, 82 
 
 N. 
 
 Nematoneura, 51, 52 
 Nerves, base of brain, 159 
 
 cerebral, description of, 229240, 259 
 
 commissures of, 37, 52, 54, 259 
 
 conductors, 56 
 
 entering and leaving ganglia, 47, 48 
 
 excito-motory, 37, 52, 54, 57, 59, 172, 
 
 173185 
 
 gelatinous, 34, 46 
 
 lingual, 111,114 
 
 medium of connection with external 
 
 world, 51, 258 
 
 not similar to blood-vessels, 42 
 
 of antennae, 68 
 
 of dura mater, 135 
 
 of instinct, 67, 74, 263 
 
 of involuntary muscles, 48 
 
 of mandibles and maxillae, 68 
 
 of spinal cord, roots, 172, 174, 260 
 
 origin of, porpoise, 114 
 
 - peripheral anastomosis, 41 
 
 spinal accessory, 239 
 
 their number, 229, 230 
 
 1st, olfactory, 229230 
 
 2d, optic, 229 231 
 
 3d, oculo-muscular, 230, 235, 237 
 
 4th, pathetic, 235 
 
 5th, trigeminal, 55, 58, 232, 236 
 
 6th, abducentes, 230, 237 
 
 7th & 8th, 229, 230, 237 
 
 7th, facial, portio dura, 237 
 
 8th, auditory, portio mollis, 238, 239 
 
 9th, glosso-pharyngeal, 229, 230, 239 
 
 10th, pneumogastric, par vagum, 229, 
 
 230, 239 
 
 llth, lingual, 240 
 
 Nervous fibres, continuous, 42, 56, 74, 145, 
 
 259 
 pressed, the consequences, 48 
 
 Nervous fibres, protected, why, 48 
 
 sympathetic, 48 
 
 ring, oesophagus, 54, 60 
 
 system, absent in hydra viridis, 59 
 
 classifies animals, 51 
 
 its magnitude in relation to animal 
 
 endowments, 51 , 77, 79, 81 , 8284, 92, 95, 
 
 96,99, 100, 112, 118126,165,171,258, 
 
 263, 264, 265 
 
 no proof of consciousness, 51 
 
 relation to alimentary canal, 59 
 
 simplest form, 53-- 59 
 
 Neurilemma, 47, 143, 175 
 
 Neurine, its nature and mode of distribution, 
 
 33, 34, 42, 43, 4951, 55, 56, 76, 77, 95, 
 
 103, 143, 145, 173, 182, 187, 206, 259 
 
 subtle in insects, 31, 32 
 
 medullary, 259 
 
 not visible in foetus, 247 
 
 pulpy, 42, 56, 173, 195, 250 
 
 nuclei, 43 45 
 
 two kinds, 34, 55, 56, 173, 259 
 
 vesicular, ganglia, 259 
 
 Newport, nervous system, 51, 61, 67, 69, 257, 
 
 260 
 Niger locus, caudate vesicles, 43, 198, 202, 
 
 213,215,262 
 Noble, phrenology, 266 
 Nucleated cells, 43, 44, 46 
 Nutrition an organic function, 59, 74 
 
 - 0< 
 Occipital sinuses, 135 
 
 (Esophagus, nervous ring of, 54, 66, 68, 74, 
 
 75,77,78,82,83 
 Oil, brain of Cetacea, 38 
 Old age, brain, 205 
 Olfactory ganglia, 85, 93, 94, 95, 96, 101, 104, 
 
 115, 116, 179,214, 231,260 
 
 whiting and carp, 86, 90 
 
 Opossum, 117 
 
 Optic ganglia, 85, 86, 88, 93, 95, 97, 98, 99, 
 
 100, 101, 115, 158, 169, 199, 203, 216, 231, 
 
 260, 262, 263 
 
 nerves, whiting and carp, 86, 90 
 
 thalami, 116, l'l7, 202, 203 
 
 Organic life, 57, 58, 68, 69 
 
 Orycteropus, 122 
 
 Ostrich, 96 
 
 Otter, cerebral vessels, 129 
 
 Otto, membranes, brain, 53, 138 
 
 Ovum, development of, 247 
 
 Owen, divisions of nervous system, 51, 74, 79 
 
 placentalia, 97 
 
 convolutions, 119 
 
 Ox, cerebral vessels, 129 
 Oyster, 64 ; vision, 64 
 
 P. 
 
 Pacchionus, 132 
 Pachydermata, 109, 113 
 Pacinian corpuscles, 40, 41 
 Paget, cerebro-spinal system, 46 
 Pappenhein, nerves of dura mater, 136* 
 Paralysis, loss of exercise of will, 37, 48 
 Peacock, weight of brain, 151 
 Pedal ganglion, 65, 66, 67, 72, 75 
 Pellatan, decussation, optic nerve, 233 
 Peripheral nerves anastomose, 41 
 Permanent skeleton, 130 
 Petrosal sinus, 135 
 
INDEX. 
 
 491 
 
 Pharynx, 60, 67 
 
 Philip, Wilson, 58 
 
 Philosophy, Newtonian, 245 
 
 Phosphorus in brain, 38, 44, 45 
 
 Phrenic nerve, diaphragm, mammalia, 174, 
 
 185,260 
 Phrenology, 131, 215, 258, 259, 264266, 
 
 268 
 Physiology, 245 
 
 cerebral, of the older physicians, 259 
 
 cerebro-spinal system, 257 268 
 
 Pia-mater, 137143, 166,248 
 
 filiform process, 143, 144 
 
 spinal cord, 172, 175 
 
 Pig, carotids, 127 
 
 Pineal gland, 93, 94, 100, 102,101, 113,117, 
 
 118, 169, 210 (Amphibia) 
 Pituitary gland (skate) 92, 107, 226 
 Placenta, similarity to plexus choroid, 138 
 Placentalia,97, 101 
 Plexus choroid, 113, 137, 138, 166 
 Polydermidae, 68, 71 
 Pneumogastric, 60, 64, 93, 94, 103, 114 
 Polypus, 59, 62 
 Pons Varolii, 100108, 116, 153, 169, 183, 
 
 195, 200, 201, 203, 211, 218, 220, 222, 261 
 
 deficient in birds, reptiles, &c., 97 
 
 Porpoise, carotids, 126 
 Portal, nerves, dura mater, 135 
 
 spinal canal, 172 
 
 Portio dura, 145 
 
 Posterior roots spinal cord, 55 
 
 Prichard, cerebellum, 193 
 
 Prochaska, excito-motory, 239, 260 
 
 Propagation by germs, 63 
 
 Prout, phosphate urine, 44 46 
 
 Purkinge, axis cylinder, 40 
 
 Pulpy neurine,43, 173, 195 
 
 Pyramidal bodies, and decussation of fibres, 
 
 185187, 199, 201, 210, 261 
 
 R. 
 
 Rabbit, embryo of, 248 
 
 Radiata of Cuvier, 51, 63 
 
 Rapp of Tubingen, vertebral arteries, 127, 
 
 129 
 Reflex functions of nerve, 59, 70, 73, 175, 
 
 263, 264 
 Reid, medulla oblongata, 134, 198, 199 
 
 weight of brain, 146151 
 
 Reil, cerebellum, 218, 221 
 
 of birds, 223 
 
 gray matter, 35, 96 
 
 mode of preparing cerebellum, 217 
 
 Remak fibres, 47 
 
 Reptiles, 82, 93, 95, 112, 250, 255, 262 
 
 Respiration, 60 67, 94, 184, 185 
 
 Restiform ganglia (Ruysch and Rolando), 181 
 
 184, 191, 200, 221, 261 
 Rete mirabile (Galen), 126, 127, 241 
 Retzius, foetal brain, 254 
 Richerand, ganglionic nerve, 59 
 Rodentia, 98129 
 Rolando, corpus callosum, 208 
 
 foetal brain, 248 
 
 optic thalami, 235 
 
 nerves, 231 
 
 septum lucidum, 213 
 
 spinal cord, 175, 182, 192 
 
 Roots, posterior spinal cord, 55 
 Rosenthal, axis cylinder, 40 
 
 Ryan's Journal, gray matter source of power, 
 
 36 
 
 Rudolphi, divisions of nervous system, 51 
 Ruminantia, 104129 
 Ruysch, gray matter, 34, 35 
 
 S. 
 
 Salivary glands, 68 
 Scarpa, ganglionic nerve, 58, 88 
 Schleidan, villi, 44 
 
 Schoeps, experiments on cerebrum, 264 
 Schwann, white substance of brain, 40, 44, 49 
 Scolopendra, 71 
 Section, vertical, of brain, 157 
 Secretion, an organic function, 59 
 Senile atrophy of brain, 39 
 Sensation, imperceptible, 59 
 , nerves of, 37, 172188, 230, 236, 239, 
 
 260, 
 
 Sensory tract, 187189, 200203 
 Septum lucidum, 166, 214 
 Serosity of brain, 38 
 Serres, brain of birds, 96 
 
 fishes, 85, 89, 92 
 
 spinal cord of foetus, 249 
 
 Sheep, rete mirabile, 127 129 
 Sight and smell of Gasteropoda, 66 
 Simon, theory of thyroid, 243 
 Sims, weight of brain, 145, 151 
 Sinuses, cerebral, 134 142 
 Skate, optic nerves of, 232 
 Skeleton, earliest development, 79 
 
 shelly, dermal, 130 
 
 to protect nerves, 79, 82 
 
 Skull alters with age, 131 
 
 mode of opening, 131, 132 
 
 of fishes, 85 
 
 to protect brain, 82, 130, 131 
 
 Soemmerring, number of nerves, 229 
 
 weight of brain, 151 
 
 Speech, organs of, 261 
 Sphincters, 6064 
 Spina bifida, 140 
 
 cerebrata of Grant, 51, 67 
 
 Spinal arteries, 142, 242 
 
 Spinal cord, 37, 41, 46, 51, 53, 55, 60, 61, 67 
 
 69, 82, 103, 156, 169, 171, 182, 248, 261 
 
 commissures, 260 
 
 connection with cerebrum, 181 
 
 dissection of, 171 181, 185, 187' 
 
 distinct nervous centre, 177, 180 
 
 dura mater, 143 
 
 fishes, 83 
 
 fissures of, 177 
 
 fetus, 83, 249 
 
 ganglia, 172, 173 
 
 gray matter, 173 180, 185 
 
 how to remove it, 142, 143 
 
 incubated egg, 53 
 
 roots of nerve, 55, 172 177 
 
 structure in insects, 69 
 
 transverse section of, 172 174 
 
 various nerves of, 175179, 187, 199, 
 
 260, 262 
 
 Spinal system, 5758, 67, 260 
 Spirostrepti, Spiroboli, 71 
 Spurzheim, decussation of pyramidal bodies, 
 
 186 
 
 gray matter, 35, 120 
 
 number of nerves, 230 
 
 optic thalami, 235 
 
492 
 
 INDEX. 
 
 Spurzheim, phrenology, 266 
 spinal canal, 172 
 
 weight of brain, 152 
 
 Stadelman, axis cylinder, 40 
 Stag, carotids, 127128 
 Stein, optic thalami, 235 
 Stilling, lingual nerve, 240 
 
 nervous fibres, 41, 42 
 
 pneumogastric, 239 
 
 spinal canal, 174 
 
 Stomach, simplest animal construction, 51 
 
 Substantia perforata, 159 
 
 Swammerdam, arachnoid, 132 
 
 Swine, cerebral vessels, 129 
 
 Sylvius, gray matter, 34 
 
 Sympathetic, the, 34, 4648, 5758, 68, 70 
 
 237 
 pituitary gland, its ganglion, 226 
 
 T. 
 
 Tactual ganglia, 262 
 
 Taenia semicircularis, 166, 214 
 
 Temporary skeleton, 130 
 
 Tentacula, 6466 
 
 Tentorium, 133 
 
 Thalami nervum opticorum, 166, 202, 210, 
 
 215, 226, 235, 253, 262 
 Theca vertebralis, 165 
 Thyroid, theory of, 243 
 Tiedemann, corpus callosum, 206, 207, 211 
 
 foetal brain, 87, 248252 
 
 gray matter, 35, 36 
 
 nerves, 231 
 
 starfish, 53 
 
 weight of brain, 151 
 
 Tiger, carotids, 126 
 
 Todd and Bowman, 43, 262 
 
 axis cylinder, 40, 41, 262 
 
 cerebro-spinal fluid, 140 
 
 filiform process, 143, 144 
 
 glandulae Pacchioni, 132 
 
 olivary bodies, 183 
 
 pituitary gland, 226 
 
 spinal canal, 173 
 
 Torcular Herophili, 135 
 
 Tract, sensory and motory, 187198, 221, 
 
 223,229,236, 237, 261,262 
 Tractus opticus, 158, 195, 233, 234 
 Transverse commissure, 206, 260, 261 
 Treviranus, gray matter, 34, 88 
 Trifacial ganglia, 85 
 Tuber cinereum, 89, 92, 103, 158, 159 
 Tubercula quadrigemina, 85, 87,88, 102, 106, 
 
 262, 263 
 
 Tubes of glands, 34 
 
 Tubular neurine, 34, 37, 39, 41,43,46, 48, 55 
 Tunica arachnoidea, 133, 136 143 
 Turtle, respiration, 94 
 Twain band or fornix, 212 
 
 V. 
 
 Valentin, gray matter, 41, 42, 47 
 Valsalva, nerves of dura mater, 136 
 Valve of Vieussens, 169, 215 
 Vauquelin, analysis of brain, 38 
 Veins, cerebral, 133, 134, 166 
 
 Veins of spinal cord, 142 
 Velum interpositum, 169 
 Vena Galeni, 166 
 Ventricle, fifth, 166 
 
 fourth (whiting), 86, 161, 201 
 
 of brain, 86, 105, 117, 136, 137, 140, 160, 
 
 164, 165, 166168, 201, 203, 209, 210, 253 
 Vertebrata, 51, 61, 68, 141, 180, 226 
 Vertebral arteries 126 
 
 column, 130 
 
 Vertical section of brain, 157 
 
 Vesicular neurine, source of power, 33 37, 
 
 4244, 50, 205, 259, 261 
 Vessels of brain, 126128, 166, 241243 
 Vermiform process, 218, 219, 224, 225 
 Vicq d'Azyr, cerebellum, 220 
 
 corpus callosum, 206 
 
 optic ganglia, 88 
 
 Vieussens, ganglionic nerve, 58 
 
 gray matter, 34, 212 
 
 nerves of dura rriater, 136 
 
 Villi, intestinal, 44 
 
 Vimont, cerebellum, 264 
 
 Visceral nerves (lulus), 68 
 
 Vomiting, 60 
 
 Volckmann, cerebro-spinal system, 46, 47 
 
 Volition, lost by paralysis, 37, 172 
 
 nerves of, 37, 6769, 172, 178, 179, 188, 
 
 239, 259, 264 
 
 W. 
 
 Wagner, Rudolph, weight of brain, 145 
 Walker, posterior columns, 193 
 Wallach, spinal canal, 173 
 Wasting of brain, 39, 45, 141, 145, 267 
 Weazel, cerebral vessels of, 129 
 Weight of brain, 145155 
 
 tables, 147150 
 
 Wengel, glandulae Pacchioni, 132 
 Wenzel, corpus callosum, 206 
 
 foetal brain, 251 
 
 gray matter, 35 
 
 hippocampus, 214 
 
 optic nerve, 239 
 
 weight of brain, 152 
 Whale, brain, its weight, 145 
 Wheatstone, decussation of nerves, 232 
 White substance of brain, 46, 48 
 Whytt, excito-motory, 260 
 
 reflex function, 74 
 
 Will, on corpuscles of brain, 47 
 Will or volition, excito-motory, 51, 61 
 Willis, ganglionic nerve, 58 
 
 gray matter, 35 
 
 - nerves, 230 
 
 weight of brain, 145 
 
 - the circle of, 127, 128, 129, 242 
 Winslow, ganglionic nerves, 58 
 
 nerves of dura mater, 136 
 Wollaston, semi-decussation of optic nerves, 
 
 231,233 
 World, external, medium of connection with, 
 
 the nerves, 50 
 
 Wrisberg, nerves of dura mater, 136 
 Wutzer, ganglionic nerves, 59 
 
INDEX. 
 
 493 
 
 PATHOLOGY OF THE BRAIN. 
 
 A. 
 
 Abercrombie, anarnic coma, 282 
 
 apoplexy, 364 366 
 
 simple, 390 
 
 of cerebellum, 385 
 
 bleeding in apoplexy, 395 
 
 cerebral fullness, 270 
 
 coma, 344 
 
 inflammation membranes, 313 
 
 organic disease of the brain, 433 
 
 ramollissement, 293, 294 
 
 i treatment of inflammation, 352 354 
 
 tumors of brain, 464, 469, 471 
 
 Abernethy, trephining, 417 
 Abscess of cerebellum, 385 
 Aconite in epilepsy, 447 
 Actual cautery, 353 
 Adams, simple apoplexy, 390 
 Alison, determinations of blood, 431 
 
 inflammation of brain, 362 
 
 simple apoplexy, 390 
 
 Andral, apoplexy, 334 
 
 of cerebellum, 384 
 
 convulsions, 338 
 
 corpus striatum, lesion of, 375 
 
 effusion, 349 
 
 induration, 351 
 
 meningitis, 313, 315, 316, 340, 341 
 
 ramollissement, 291, 293 
 
 Anaemic affections, 273275, 362, 366 
 
 coma, 281, 288 
 
 Apoplexy, 363 374 
 
 simple, 390394 
 
 base of brain, 366370 
 
 cerebellum, 382384 
 
 meningeal, 365, 378-9, 470 
 
 premonitory symptoms, how treated, 393 
 
 serous, 366, 387, 390, 418 
 
 treatment, 393405 
 
 Arachnoid, inflammation of, 305, 313 315, 322 
 Armstrong, delirium tremens, 276 
 Arnott, determinations of blood, 431 
 Asthma and hypertrophy of brain, 481 483 
 Atrophy of brain, 302, 481 
 
 B. 
 
 Bayle, mental alienations, 314 
 Bell, B., trephining, 417 
 Bennett, hydrocephalus, 285 
 
 Hughes, ramollissement, 295 
 
 Blake, delirium tremens, 275, 276, 280 
 Bleeding, in epilepsy, 446, 447 
 
 apoplexy, extent of,I392 396, 398 
 
 Blood corpuscles in inflammation, 294 296 
 
 determinations of, 431 435, 443 
 
 Brain, debility of, 432 
 
 elasticity of, 478 
 
 organic disease of, 433, 463 478 
 
 weight of in disease, 482484 
 
 Bright, bleeding in apoplexy, 396 
 
 cerebral irritation, 304, 306, 307, 343, 
 
 432, 433 
 
 congestive epilepsy, 446 
 
 danger of calomel in apoplexy, 402 
 
 nux vomica in paralysis, 402 
 
 pituitary gland, 438 
 
 sanguineous apoplexy, 385 
 
 tumors of brain, 496 
 
 Burrows, bleeding in apoplexy, 398 
 
 cerebral fullness, 270272, 432 
 
 meningeal apoplexy, 378 
 
 simple apoplexy, 389 
 
 strychnia in paralysis, 408 
 
 C. 
 
 Calomel, danger of, in apoplexy, 402 
 Carotids, effects of tying, 274 
 
 in epilepsy, 274, 437 
 
 throbbings of, 431 
 Carswell, meningeal apoplexy, 378 
 Case of abscess cerebellum, 384 
 
 amaurosis, 359 
 
 anaemic apoplexy, 366 
 
 apoplexy, 365, 370, 371, 375, 376, 377, 
 
 379, 380, 382, 383, 384, 387, 389, 391, 395, 
 
 396 
 
 fright, 334 
 
 atrophy of brain, 303 
 
 cerebral anaemia, 288, 289 
 
 concussion, 318, 319, 320 
 
 convulsions, 343, 371, 405, 422 
 
 delirium tremens, 277, 281 
 
 epilepsy, 428, 430, 440, 443, 444, 447, 
 
 448, 457, 459, 460 
 
 from cold, 438 
 
 from syphilis, 439 
 
 hysterical, 441 
 
 tying carotid for, 437 
 
 use of digitalis, 436, 437, 450, 454 
 
 use of turpentine, 460, 462 
 
 erysipelas, 285, 288 
 
 fracture of skull, and convulsions, 411 
 
 hydrocephalus, 296 
 
 " of hypertrophy and induration of brain, 
 
 477, 479481 
 
 inflammation of brain, bleeding, 352 
 
 cortical substance, 308, 312 
 
 dura mater, 322, 325 
 
 from fright, 328, 329 
 
 use of purgatives, 355 
 
 inflammation of the brain with effusion, 
 
 348 
 injury of the head, 411 
 
 mania, 306, 326, 327, 333 
 
 meningitis, 347 
 
 chronic, 359, 361 
 
 mental irritability, 335, 337, 339, 340 
 
 ossification of dura mater, 323, 325 
 
494 
 
 INDEX. 
 
 Case ofotitis, 322 
 
 paralysis, 374, 403 
 
 softening of brain, 290, 298 
 
 syphilitic inflammation of brain, 326, 
 
 327, 439 
 thahim. nerv. optic., lesion of, 377 
 
 trephining, 411 
 
 tubercular deposit of brain, 469 
 
 tumor of brain, 468, 473 
 
 Cautery, actual, 352 
 
 Circulation through the encephalon, variable, 
 
 270273 
 
 Centric and centripetal convulsions, 427 
 Cerebellum, abscess of, 385 
 
 apoplexy of, 382 384 
 
 inflammation of, 303 
 
 Cerebral anaemia, 289 
 
 Cerebro-spinal softening, two kinds, 297 
 
 Chevers, Norman, effects of tying the carotid, 
 
 273, 274 
 
 Chlorosis, anaemia of brain, 276, 278 
 Choroid plexus, hyperremia of, in epilepsy, 366 
 
 seat of organic disease, 470 
 
 Cineritious matter, source of power, 307 
 
 substance of, diseased, 306 
 
 Cold, cause of epilepsy, 438 
 
 ablutions, effect of, in apoplexy, 355, 392 
 
 Colles, use of mercury, 360 
 Coma, 343, 390 
 
 anaemic, from exhaustion, 281 
 
 Concussion, 317320 
 
 Congestive apoplexy, 390 
 
 Convulsions, 338, 343, 344, 405, 423, 427, 437, 
 
 479482 
 
 Convulsions after injury of the head, 411 
 Cooper, Sir A., epilepsy, 426 
 experiments on cerebral and vertebral 
 
 arteries of dogs, 273, 274 
 Copeman, bleeding in apoplexy, 401 
 Copland, apoplexy, 432 
 
 bleeding in, 3,96 
 
 . cause of epilepsy, 434 
 
 delirium tremens, 275 
 
 induration of brain, 350 
 
 tumors of brain, 468 
 
 Corpus striatum, lesion of, 374, 376 
 Corrigan, digitalis in epilepsy, 449, 450 
 Creosote in epilepsy, 444 
 Croton oil in apoplexy, 402 
 Crowing inspiration, 452 
 Cruveilhier, atrophy of brain, 302 
 
 ramollissement, 393 
 
 tumors of dura mater, 466, 468 
 
 D. 
 
 Dance, hypertropy of brain, 479 
 Delirium, 315, 316 
 
 tremens, 275 281 
 
 Dementia, 350 
 
 Dentition, 351, 427 
 
 Depletion, delirium tremenf, 279 
 
 Development of brain in fetus, arrest of, 302 
 
 Deville, hypertrophy of brain, 477 
 
 Diet, delirium tremens, 280 
 
 Digitalis in epilepsy, 435, 436, 437, 447, 449, 
 
 450, 453 
 
 Diseases of brain, divisions of, 269, 270 
 Douglas, paralysis, 385 
 Dupuytren, delirium tremens, 280 
 
 wounds of the head, 415 
 
 Dura mater, inflammation of, 321 
 
 Dura mater, lacerations of, 413, 415 
 
 ossification of, 323 
 
 pulsation of, 420 
 
 pus beneath, 421 
 
 tumors of, 464, 465, 466 
 
 E. 
 
 Ear-ache, 322, 323 
 Effusion, 349 
 Epilepsy, 422463 
 
 cause of, 435, 438, 443 
 
 congestive, 433, 446 
 
 essential, sympathetic and symptomatic, 
 
 442 
 
 forewarnings, 415, 437, 438, 448 
 
 hysterical, 442 
 
 intellect, state of, 425, 458 
 
 prognosis, 440 446 
 
 pulse, 444 
 
 theory of, 430 
 
 treatment, 446 
 
 tying carotids for, 274, 437 
 
 Epileptic attacks, 335, 480 
 
 coma, 424 
 
 similitudes, 364, 387 
 
 Epidemic meningitis, 351 
 Eruptions of scalp, dentition, 351 
 Esquirol, epileptic plethora, 433 
 
 kinds of epilepsy, 442 
 
 prognosis in epilepsy, 443 
 
 F. 
 
 Fatuity, 279, 302 
 
 Fardell, ramollissement, 349 
 
 Fear, cause of meningitis, 328 
 
 Ferriar on digitalis, 449 
 
 Foville, epileptic plethora, 433, 445 
 
 G. 
 
 Georget, epilepsy, 426 
 
 Gluge, ramollissement, 295 
 
 Gooch, anaemic coma, 283 
 
 Green, tumors of brain, 468, 469 * -*-r~ 
 
 Guthrie, injuries of head, 415 
 
 pulsation of dura mater, 421 
 
 trephining, 419 
 
 H. 
 
 Hamilton, digitalis in epilepsy, 449 
 
 Hall, Dr. M., coma from exhaustion, 281 283 
 
 convulsions, 427, 428 
 
 Haematoma of brain, 470, 471 
 
 Hssmorrhoidal evacuations, 353 
 
 Hardening of brain, 305 
 
 Head, determination of blood to, 431, 435, 
 
 437, 438, 443 
 Headache, meningitis, 340343 
 
 1 organic disease of brain, 433 
 
 Heart disease, a cause of apoplexy, 367, 368, 398 
 
 epilepsy, 447 
 
 Hemispheres inflamed, 303 316, 322, 228 
 
 349 
 
 symptoms, 307, 406 
 
 Henle, ramollissement, 294 
 
 Hennen, trephining, 418 
 
 Hewett, meningeal apoplexy, 378 
 
 History of the pathology of convulsions, 447 
 
 Holland, epileptic plethora, 434 
 
 indiscriminate blood-letting, 399 401 
 
 inflammation of brain, 353 
 
 use of mercury, 363 
 
INDEX. 
 
 495 
 
 Hooper, hsematoma, 470 
 Hunter, John, trephining, 417 
 Hydatids of choroid plexus, 433, 470 
 Hydrocephalus, 281, 285, 302, 478, 483, 484 
 Hydrocyanic acid in epilepsy, 447 
 Hyperaemia of brain, symptoms, 279, 285, 304 
 
 328, 351, 362 
 
 Hypertrophy of brain, 477 484 
 Hysterical epilepsy, 442 
 
 T. 
 
 Ice, application of, 355 
 
 Idiotcy, from hypertrophy of brain, 477, 482 
 Indigestion, cerebral disturbance, 369 
 Induration of brain, 350351, 477, 481, 482 
 Inebriation, 308 
 Infants, coma of, 282 
 Inflammation, blood corpuscles, 295, 297 
 
 of brain, e'xternal, 303 
 
 internal, 304, 328 
 
 Intellect, deranged, 308, 315, 318, 339, 344, 
 
 425, 479, 481, 482 
 Intellectual precocity, 477 
 Insanity, 302, 305, 315327, 333, 350, 351, 
 
 354359, 369, 431, 443 
 Joy, cause of meningitis, 328 
 
 K. 
 Kellie, cerebral fullness, 270 
 
 L. 
 Laennec, induration and hypertrophy of brain, 
 
 478, 480 
 Lallemande, convulsionsj 407 
 
 ramollissement, 291 
 
 Lawrence, trephining, 408 
 Light, effect of, delirium tremens. 276 
 Liver, enlargement of thymus gland, 482 
 Louis, tumors of dura mater, 464, 469 
 Lugol, tumors of the brain, 469 
 Lunatics, 351, 354 
 
 M. 
 
 Mania, compared with delirium tremens, 276 
 Martinet, meningitis, 315 
 Mayo, apoplexy, 406 
 Mauthner, hypertrophy of brain, 482 
 
 weight of brain, 481 
 
 Medulla, conductor of power, 308 
 
 inflamed, 304, 306343 
 
 oblongata, apoplexy of, 371 
 
 Meningeal apoplexy, 378382 
 Meningitis, 304, 313318, 337339, 361 
 Mental imbecility, 305, 306, 357 
 
 irritability, 335, 339, 369, 405 
 
 Mercury, use of, 358 362 
 Monro, cerebral fullness, 270 
 Morgagni, induration of brain, 478 
 
 lesion of corpus striata, 375 
 
 paralysis, 408 
 
 scirrhus of cerebellum, 385 
 
 serous apoplexy, 478 
 
 softening of brain, 291 
 
 Munk, digitalis in epilepsy, 449 
 
 N. 
 Nux vomica, paralysis, 402 
 
 0. 
 
 (Enanthe crocata, produces epileptic convul- 
 sions, 437 
 
 Ollivier, apoplexy, 405 
 
 Opium, use of, delirium tremens, 279 280 
 
 inflammation of brain, 320, 362 
 
 Ossification of dura mater, 323, 325 
 Otitis, 322 
 
 P. 
 
 Paralysis, 338, 385, 402, 407, 408, 409, 421 
 
 Parent Duchatelet, meningitis, 315 
 
 Payen, induration of brain, 351 
 
 Peacock, ramollissement, 298 
 
 Phthisis, atrophy of brain, 482 
 
 Pia mater, inflamed, 313, 322 
 
 Pinel, induration of brain, 351 
 
 Pituitary and pineal glands, (Copland,) 432 
 
 Pituitary gland, epilepsy (Wenzels), 432, 438 
 
 Pneumonia, increased weight of brain, 482 
 
 Pons Varolii, apoplexy of, 371 
 
 Portal, lesions of cerebellum, 385 
 
 Prichard, inflammation of brain, 353 
 
 determinations of blood, 443 
 
 Pruss, meningeal apoplexy, 380 
 Pulsations of brain, 420 
 Pulse, delirium tremens, 280 
 
 epilepsy, 444 
 
 Pupil, contracted or dilated, 344, 414 
 
 R. 
 
 Rachitis and hypertrophy of brain, 482 483 
 Radial nerve, removal for epilepsy, 426 
 Ramollissement, 281, 290302, 305, 349, 384 
 
 its nature, 292, 293, 294 
 
 Respiration arrested by apoplexy, 390 
 Rheumato-syphilitic inflammation of brain, 325 
 Rogers, account of apoplexy at Madras, 392 
 Rollett, actual cautery, meningitis, 352 
 Rostan, ramollissement, 291, 294 
 
 Saunders, delirium tremens, 275 
 
 Sauvages, epilepsy, 426 
 
 Scarlatina, increased weight of brain, 482 
 
 inflammation of brain, 327 
 
 Senile atrophy of brain, 302 
 Sensation, deranged, 307 
 Serous apoplexy, 387390 
 
 effusion, 389, 396 
 
 delirium tremens, 276, 305 
 
 Sewell, Brodie, serous apoplexy, 389 
 
 Shower-bath in epilepsy, 461 
 
 Sieve-like softening of brain, 349 
 
 Signs of injury of brain, 414 417 
 
 Silver, oxide of, in epilepsy, 447, 449, 458, 
 
 460 
 Sims, hypertrophy of brain, 478, 481 
 
 ramollissement, 298 
 
 Skull, thick, insanity, 324 
 
 Smith, Mr. E., cause of epilepsy, 324 
 
 Spinal cord, softening, 298 
 
 Stimulants, use in delirium tremens, 280, 281 
 
 Strychnia in paralysis, 403 
 
 Sutton, delirium tremens, 275 
 
 Syphilitic inflammation of dura mater, 323, 
 
 439 
 
 T. 
 
 Thalamus nervi optici, lesion of, 377 
 Thymus gland, enlarged, 482 
 Treatment, apoplexy, 393405 
 
 epilepsy, 446 
 
 inflammation of brain, 352 353, 363 
 
496 
 
 INDEX. 
 
 Treatment, premonitory symptoms of apo- 
 plexy, 394 
 
 Trephining, 414415 
 Tubercular deposits of brain, 469, 482 
 Tubular matter, inflamed, 303 
 Tumors of brain, 463 
 
 diagnosis, 466 
 
 symptoms, 470 473 
 
 Turpentine in epilepsy, 447, 461 
 Tyrrell, therapeutics, 356 360 
 
 V. 
 
 Valentin, ramollissement, 295 
 Velpeau, tumors of dura mater, 466 
 Ventricle, left, of heart, and enlarged thymus, 
 
 482 
 
 Vogel, ramollissement, 295 
 Volition, deranged, 307 
 Vomiting, inflamed medulla, 343 
 
 W. 
 
 Wagner, ramollissement, 295 
 
 Walshe, tumors of dura mater, 466, 467, 471 
 
 Watson, bleeding in apoplexy, 395 
 
 cerebral fullness, 272 
 
 delirium tremens, 277 
 
 epilepsy, 427, 433, 461 
 
 inflammation of dura mater, 321, 322 
 
 treatment of apoplexy, 394 
 
 Wenzels, pituitary gland in epilepsy, 432, 438 
 tumors of dura mater, 465 
 
 THE END 
 
*-.*- ' CATALOGUE - 
 
 OF 
 
 BLANCHARD & LEA'S 
 MEDICAL AND SURGICAL PUBLICATIONS. 
 
 TO THE MEDICAL PROFESSION. 
 
 In submitting the following catalogue of our publications in medicine and the 
 eollateral sciences, we beg to remark that no exertions are spared to render the issues 
 of our press worthy a continuance of the confidence which they have thus far enjoyed, 
 both as regards the high character of the works themselves, and in respect to every 
 point of typographical accuracy, and mechanical and artistical execution. Gentlemen 
 desirous of adding to their libraries from our list, can in almost all cases procure the 
 works they wish from the nearest bookseller, who can readily order any which may 
 not be on hand; and who, as well as ourselves, will be happy to answer any 
 
 inquiries as to price, &c. 
 
 BLANCHARD & LEA. 
 
 PHILADELPHIA, July 1, 1854. 
 
 TWO MEDICAL PERIODICALS, FREE OF POSTAGE, 
 
 FOR FIVE DOLLARS PER ANNUM. 
 
 
 
 THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, subject to 
 
 postage, when not paid for in advance, - - -- - - -$500 
 
 THE MEDICAL NEWS AND LIBRARY, invariably in advance, - - 1 00 
 or, BOTH PERIODICALS furnished, FREE OF POSTAGE, for Five Dollars remitted 
 in advance. 
 
 THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
 EDITED BY ISAAC HAYS, M. D., 
 
 is published Quarterly, on the first of January, April, July, and October. Each number contains 
 at least two hundred and eighty large octavo pages, appropriately illustrated, wherever necessary, 
 by engravings. It has now been issued regularly for a period of THIRTY-FIVE years, during a quarter 
 of a century of which it has been under the control of the present editor. Throughout this long" 
 space of time, it has maintained its position in the highest rank of medical periodicals both at home 
 and abroad, and has received the cordial support of the entire profession in this country. Its list of 
 Collaborators will be found to contain a large number of the most distinguished names of the pro- 
 fession in every section of the United States, rendering the department devoted to 
 
 ORIGINAL COMMUNICATIONS 
 
 practitioners. 
 
 vantages presented by all the different 
 
 full of varied and important matter, of great interest to ail practitioners. 
 As the aim of the Journal, however, is to combine the adv 
 
 varieties of periodicals, in its 
 
 REVIEW DEPARTMENT 
 
 will be found extended and impartial reviews of all important new works, presenting subjects of 
 novelty and interest, together with very numerous 
 
 BIBLIOGRAPHICAL NOTICES, 
 
 including nearly all the medical publications of the day, both in this country and Great Britain, with 
 a choice selection of the more important continental works. This is followed by the 
 
BLANCHARD & LEA'S MEDICAL 
 
 QUARTERLY SUMMARY, 
 
 being a very full and complete abstract, methodically arranged, of the 
 
 IMPROVEMENTS AND DISCOVERIES IN THE MEDICAL SCIENCES, 
 
 This department of the Journal, so important to the practising physician, is the object of especial 
 care on the part of the editor. It is classified and arranged under different heads, thus facilitating 
 the researches of the reader in pursuit of particular subjects, and will be found to present a very 
 full and accurate digest of all observations, discoveries, and inventions recorded in every branch of 
 medical science. The very extensive arrangements of the publishers are such as to afford to the 
 editor complete materials for this purpose, as he not only regularly receives 
 
 ALL THE AMERICAN MEDICAL AND SCIENTIFIC PERIODICALS, 
 
 but also twenty or thirty of the more important Journals issued in Great Britain and on the Conti- 
 nent, thus enabling him to present in a convenient compass a thorough and complete abstract of 
 everything interesting or important to the physician occurring in any part of the civilized world 
 
 An evidence of the success which has attended these efforts may be found in the constant and 
 steady increase in the subscription list, which renders it advisable for gentlemen desiring the, 
 Journal, to make known their wishes at an early day, in order to secure a year's set with certainty, 
 .the publishers having frequently been unable to supply copies when ordered late in the year. To 
 their old subscribers, many of whom have been on their list for twenty or thirty years, the publish- 
 ecs leel that no promises are necessary; but those who may desire for the first time to subscribe, 
 can rest assured that no exertion will'be spared to maintain the Journal in the high position which 
 it has occupied for so long a period. 
 
 By reference to the terms it will be seen that, in addition to this large amount of valuable and 
 practical information on every branch of medical science, the subscriber, by paying in advance, 
 becomes entitled, without further charge, to 
 
 THE MEDICAL NEWS AND LIBRARY, 
 
 a monthly periodical of thirty-two large octavo pages. Its " NEWS DEPARTMENT" presents the 
 current information of the day, while the " LIBRARY DEPARTMENT" is devoted to presenting stand- 
 ard works on various branches of medicine. Within a few years, subscribers have thus received, 
 without expense, the following works which have passed through its columns : 
 
 WATSON'S LECTURES ON THE PRACTICE OF PHYSIC. 
 BRODIE'S CLINICAL LECTURES ON SURGERY. 
 
 TODD AND BOWMAN'S PHYSIOLOGICAL ANATOMY AND PHYSIOLOGY OF MAN. 
 724 pages, with numerous wood-cuts, being all that has yet appeared in England. 
 
 WEST'S LECTURES ON THE DISEASES OF INFANCY AND CHILDHOOD. 
 
 
 MALGAIGNE'S OPERATIVE SURGERY, with wood-cuts, and 
 
 SIMON'S LECTURES ON GENERAL PATHOLOGY. 
 
 While the year 1854, presents 
 
 BENNETT ON PULMONARY TUBERCULOSIS, 
 
 BEAUTIFULLY ILLUSTRATED ON WOOD. 
 
 J5P" Subscribers for 1853, who do not possess the commencement of Todd and Bowman's 
 Physiology, can obtain it, in a handsome octavo volume, of 552 pages, with over 150 illustration?. 
 by mail, free of postage, on a remittance of $2 50 to the publishers. 
 
 It will thus be seen that for the small sum of FIVE DOLLARS, paid in advance, the subscriber 
 wiil obtain a Quarterly and a Monthly periodical, 
 
 EMBRACING ABOUT FIFTEEN HUNDRED LARGE OCTAVO PAGES 
 
 mailed to any part of the United States, free of postage. 
 
 These very favorable terms are now presented by the publishers with the view of removing all 
 difficulties and objections to a full and extended circulation of the Medical Journal to the office of 
 every member of the profession throughout the United Slates. The rapid extension of mail facili- 
 ties, will now place the numbers before subscribers with a certainty and dispatch not heretofore 
 attainable; while by the system now proposed, every subscriber throughout the Union is placed 
 upon an equal footing, at the very reasonable price of Five Dollars for two periodicals, without 
 further expense. 
 
 Those subscribers who do not pay in advance will bear in mind that their subscription of b ive 
 Dollars will entitle them to the Journal only, without the News, and that they will be at the expense 
 of their own postage on the receipt of each number. The advantage of a remittance when order- 
 ing the Journal will thus be apparent. 
 
 As the Medical News and Library is in no case sent without advance payment, its subscriber? 
 will always receive it free of postage. 
 
 It should also be borne in mind that the publishers will now take the r.isk of remittances by mail, 
 only requiring, in cases of loss, a certificate from the subscriber's Postmaster, that the money wa* 
 duly mailed and forwarded. 
 
 feT Funds at par at the subscriber's place of residence received in payment of subscriptions. 
 
 Address, BLANCHARD & LEA, PHILADELPHIA. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 ANALYTICAL COMPENDIUM 
 
 OF MEDICAL SCIENCE, containing Anatomy, Physiology, Surgery, Midwifery, 
 Chemistry, Materia Medica, Therapeutics, and Practice of Medicine. By JOHN NEILL, M. D., 
 and F. G. SMITH, M. D. Second and enlarged edition, one thick volume royal 12mo. of over 
 1000 pages, with 350 illustrations. J3F 3 See NEILL. 
 
 ABEL (F. A.), F. C. S. 
 Professor of Chemistry in the Royal Military Academy, Woolwich. 
 
 AND 
 
 C. L. BLOXAM, 
 
 Formerly First Assistant at the Royal College of Chemistry. 
 
 HANDBOOK OF CHEMISTRY, Theoretical, Practical, and Technical, with a 
 
 Recommendatory Preface by Dr. HOFMANN. In one large octavo volume of .602 pages, with 
 
 illustrations. (Now Ready.) 
 
 There was still wanting some book which should j who resolves to pursue for himself a steady search 
 aid the young analytical chemist through all the \ into the chemical mysteries of creation. For such 
 phases of the science. The " Handbook" of Messrs, a student tfce 'Handbook' will prove an excellent 
 Abel and Bloxam appears to supply that want. As guide, since he will find in it, not merely the most 
 Dr. Hofmann says in his brief Preface, " The pre- ! approved modes of analytical investigation, |but 
 sent volume is a synopsis of their (the authors') ex- ] descriptions of the apparatus necessary, with such 
 perience in laboratory teaching ; it gives the neces- | manipulatory details as rendered Faraday's ' Che- 
 sary instruction in chemical manipulation, a concise mica! Manipulations' so valuable at the time of its 
 account of general chemistry as far as it is involved publication. Beyond this, the importance of the 
 in the operations of the laboratory, and lastly, quali- i work is increased by the introduction of much of the 
 tative and quantitative analysis. It must be under- ; technical chemistry of the manufactory." Athe- 
 stood that this is a work fitted for the earnest student, naum. 
 
 ASHWELL (SAMUEL), M. D. 
 A PRACTICAL TREATISE ON THE DISEASES PECULIAR TO WOMEN. 
 
 Illustrated by Cases derived from Hospital and Private Practice. With Additions by PAUL BECK 
 GOOOARD, M. D. Second American edition. In one octavo volume, of 520 pages. 
 
 ARNOTT (NEILL), M. D. 
 ELEMENTS OF PHYSICS; or Natural Philosophy, General and Medical. 
 
 Written for universal use, in plain or non-technical language. A new edition, by ISAAC HAYS, 
 M. D. Complete in one octavo volume, of 484 pages, with about two hundred illustrations. 
 
 BENNETT (J. HUGHES), M. D., F. R. S. E., 
 
 Professor of Clinical Medicine in the University of Edinburgh, &c. 
 
 THE PATHOLOGY AND TREATMENT OF PULMONARY TUBERCU- 
 
 LOSES, and on the Local Medication of Pharyngeal and Laryngeal Diseases frequently mistaken 
 for or associated with, Phthisis. In one handsome octavo volume, with beautiful wood-cuts. 
 Now publishing in the " Medical News and Library" for 1854, and furnished gratis to advance- 
 paying subscribers to the American Journal of the Medical Sciences. 
 
 How it may be most effectually carried into prac- 
 tice, our readers will learn from Dr. Bennett's pages, 
 especially from the histories of the valuable and in- 
 teresting cases which he records. Indeed, if the au- 
 thor had only reported these cases he would have 
 benefited his profession, and deserved our thanks. As 
 it is, however, his whole volume is so replete with 
 valuable matter, that we feel bound to recommend 
 our readers, one and all, to peruse it. Loud. Lancet. 
 
 The elegant little treatise before us shows how 
 faithfully and intelligently these investigations have 
 been pursued, and how successfully the author's 
 studies have resulted in clearing up some of the most 
 doubtful points and conflicting doctrines hitherto 
 entertained in reference to the history and treatment 
 of pulmonary tuberculosis. IV. Y. Journal of Medi- 
 cal and Collateral Science, March, 1854. 
 
 
 
 BENNETT (HENRY), M. D. 
 A PRACTICAL TREATISE ON INFLAMMATION OF THE UTERUS 
 
 ITS CERVIX AND APPENDAGES, and on its connection with Uterine Disease. Fourth 
 
 American, from the third and revised London edition. In one neat Octavo volume, of 430 pages 
 
 with wood-cuts. (Now Ready.) 
 
 This edition will be found materially improved over its predecessors, the author having carefully 
 revised it, and made considerable additions, amounting to about seventy-five pages. 
 
 This edition has been carefully revised and altered, , that the bulk of the profession are not fully alive to 
 and various additions have been made, which render j the importance and frequency of the disease of which 
 it more complete, and, if possible, more worthy of it takes cognizance. The present edition is so much 
 the high appreciation in which it is held by the enlarged, altered, and improved, that it can scarcely 
 
 medical profession throughout the world. A copy A.JJ i ._ ^ ^ 
 
 should be in the possession of every physician. 
 Charleston Med. Journal and Review, March, 1854. 
 
 We are firmly of opinion that in proportion as a 
 
 knowledge of uterine diseases becomes more appre- 
 eiated, this work will be proportionably established 
 as a text-book in the profession. The Lancet. 
 
 When, a few years back, the first edition of the 
 present work was published, the subject was one 
 almost entirely unknown to the obstetrical celebrities 
 of the day ; and even now we have reason to know 
 
 be considered the same work. Dr. Ranking's Ab- 
 stract. 
 
 Few works issue from the medical press which 
 are at once original and sound in doctrine; but such, 
 we feel assured, is the admirable treatise now before 
 us. The important practical precepts which the 
 author inculcates are all rigidly deduced from facts. 
 . . . Every page of the book is good, and eminently 
 practical. ... So far as we know and believe, it is 
 the best work on the subject of which it treats 
 Montkly Journal of Medital Science. 
 
BLANCHARD & LEA'S MEDICAL 
 
 BEALE (LIONEL JOHN), M. R. C. S., &c. 
 THE LAWS OF HEALTH IN RELATION TO MIND AND BODY. 
 
 A Series of Letters from an old Practitioner to a Patient. In one handsome volume, royal 12mo., 
 extra cloth. 
 
 BILLING (ARCHIBALD), M. D. 
 
 THE PRINCIPLES OF MEDICINE. Second American, from the Fifth and 
 Improved London edition. In one handsome octavo volume, extra cloth, 250 pages. 
 
 BLAKISTON (PEYTON), M. D., F. R. S., &c. 
 PRACTICAL OBSERVATIONS ON CERTAIN DISEASES OF THE 
 
 CHEST, and on the Principles of Auscultation. In one volume. 8vo., pp. 384. 
 
 BURROWS (GEORGE), M. D. 
 ON DISORDERS OF THE CEREBRAL CIRCULATION, and on the Con- 
 
 nection between the Affections of the Brain and Diseases of the Heart. In one 8vo. vol., with 
 colored plates, pp. 21t>. 
 
 BUDD (GEORGE), M. D., F. R. S., 
 
 Professor of Medicine, in King's College, London. 
 
 ON DISEASES OF THE LIVER. Second American, from the second and 
 enlarged London edition. In one very handsome octavo volume, with four beautifully colored 
 plates, and numerous wood-cuts, pp. 468. New edition. (Just Issued.) 
 
 The reputation which this work has obtained as a full and practical treatise on an important class 
 of diseases will not be diminished by this improved and enlarged edition. It has been carefully and 
 thoroughly revised by the author; the number of plates has been increased, and the style of its me- 
 chanical execution will be found materially improved. 
 
 The full digest we have given of the new matter 
 introduced into the present volume, is evidence of 
 the value we place on it. The fact that the profes- 
 sion has required a second edition of a monograph 
 such as that, before us, bears honorable testimony 
 to its usefulness. For many years, Dr. Jiudd's 
 
 work must be the authority of the jrreat mass o) 
 British practitioners on the hepatic diseases ; and it 
 is satisfactory that the subject has been taken up by 
 so able and experienced a physician. British ami 
 Foreign Medieo-Chirurgical Review. 
 
 BUCKLER (T. H.), M. D., 
 
 Formerly Physician to the Baltimore Almshouse Infirmary, &c. 
 
 ON THE ETIOLOGY, PATHOLOGY, AND TREATMENT OF FIBRO- 
 
 BKONCH1TIS AND KHEUMATIC PNEUMONIA. In one handsome octavo volume, extra 
 
 doth. (Now Ready.) 
 
 The concluding chapter on Treatment is full of 
 sound practical suggestions, which make this emi- 
 nently a book to be prized by the " working doctor" 
 
 rather than the mere closet student. IV. J. Medical 
 
 Reporter, March, 1854. 
 
 
 BLOOD AND URINE (MANUALS ON). 
 BY JOHN WILLIAM GRIFFITH, G. OWEN REESE, AND ALFRED 
 
 MARKWICK. One thick volume, royal 12mo., extra cloth, with plates, pp. 460. 
 
 BRODIE (SIR BENJAMIN C.), M. D., &c. 
 CLINICAL LECTURES ON SURGERY. 1 vol. 8vo. ; cloth. ^50 pp. 
 
 BY THE SAME AUTHOR. 
 
 SELECT SURGICAL WORKS, 1 vol. 8vo. leather, containing Clinical Lectures 
 
 on Surgery, Diseases of the Joints, and Diseases of the Urinary Organs. 
 
 BIRD (GOLDING), A. M., M. D., &c. 
 URINARY DEPOSITS: THEIR DIAGNOSIS, PATHOLOGY, AND 
 
 THERAPEUTICAL INDICATIONS. A new and enlarged American, from the last improved 
 London edition. With over sixty illustrations. In one royal 12mo. volume, extra cloth. 
 
 The new edition of Dr. Bird's work, though not I suits of those microscopical and chemical researches 
 increased in size, has been greatly modified, and I regarding the physiology and pathology of the uri- 
 inuch of it rewritten. It now presents, in a corn- I nary secretion, which nave contributed so much to 
 
 pendious form, the gist of all that is known and re 
 liable in this department. From its terse style and 
 ronvenient size, it is particularly applicable to the 
 student, to whom we cordially commend it. The 
 Medical Examiner. 
 
 It can scarcely be necessary for us to say anything 
 of the merits of this well-known Treatise, which so 
 admirably brings into practical application the re- 
 
 the increase of our diagnostic powers, and 10 the 
 extension and satisfactory employment of our thera- 
 peutic resources. In the preparation of this new 
 edition of his work, it is obvious that Dr. Golding 
 Bird has spared no pains to render it a faithful repre- 
 sentation of the present state of scientific knowledge 
 on the subject it embraces. The British and Foreign 
 Medic o-Chirurgical Review. 
 
 BY THE SAME AL T THOR. 
 
 ELEMENTS OF NATURAL PHILOSOPHY; being an Experimental Intro- 
 duction to the Physical Sciences. Illustrated with nearly four hundred wood-cuts. From the 
 third London edition. In one neat volume, royal 12mo. pp. 402. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 BARTLETT (ELISHA), M. D., 
 
 Professor of Materia Medica and Medical Jurisprudence in the College of Physicians and 
 Surgeons, New York. 
 
 THE HISTORY, DIAGNOSIS, AND TREATMENT OF THE FEVERS 
 
 OF THE UNITED STATES. Third edition, revised and improved. In one octavo volume, 
 
 of six hundred pages, beautifully printed, and strongly bound. 
 
 In preparing a new edition of this standard work, the author has availed himself of such obser- 
 vations and investigations as have appeared since the publication of his last revision, and he has 
 endeavored in every way to render it worthy of a continuance of the very marked favor with which 
 it has been hitherto received. 
 
 The masterly and elegant treatise, by Dr. Bartlett 
 is invaluable to the American student and practi- 
 tioner. Dr. Holmes's Report to the Nat, Med. Asso- 
 ciation. 
 
 We regard it, from the examination we have made 
 of it, the best work on fevers extant in our language, 
 and as such cordially recommend it to the medical 
 
 Take it altogether, it is the most com 
 of our fevers which has yet been pu 
 every practitioner should avail himself of its con- 
 tent8.-Tke Western Lancet. 
 
 mplte history 
 ublished, and 
 
 Of the value and importance of such a work, it is 
 needless here to speak; the profession of the United 
 State* owe much to the author for the very able 
 volume which he has presented to them, and for the 
 careful and judicious manner in which he has exe- 
 cuted his task. No one volume with which we are 
 acquainted contains so complete a history of our 
 fevers as this. To Dr. Bartlett we owe our best 
 
 public. St. Louis Medical and Surgical Journal. 
 
 thanks for the very able volume he has given us, as 
 
 embodying certainly the most complete, methodical, 
 and satisfactory account of our fevers anywhere to 
 be met with. The Charleston Med. Journal and 
 Review. 
 
 BOWMAN (JOHN E.), M.D. 
 PRACTICAL HANDBOOK OF MEDICAL CHEMISTRY. In one neat 
 
 volume, royal 12mo., with numerous illustrations, pp. 288. 
 
 BY THE SAME AUTHOR. 
 
 INTRODUCTION TO PRACTICAL CHEMISTRY, INCLUDING ANA- 
 
 LYSIS. With numerous illustrations. In one neat volume, royal 12mo. ppf350. 
 
 BARLOW (GEORGE HJ, M.D. 
 A MANUAL OF THE PRINCIPLES AND PRACTICE OF MEDICINE. 
 
 In one octavo volume. (Preparing.) 
 
 CYCLOPAEDIA OF PRACTICAL MEDICINE. 
 
 Edited by DUNGLISON, FORBES, TWEEDIE, and CONOLLY, in four large octavo 
 volumes, strongly bound. j^" See DUNGLISON. 
 
 ; 
 
 COLOMBAT DE L'ISERE. 
 A TREATISE ON THE DISEASES OF FEMALES, and on the Special 
 
 Hygiene of their Sex. Translated, with many Notes and Additions, by C. D. MEIGS, M. D. 
 
 Second edition, revised and improved. la one large volume, octavo, with numerous wood-cuts. 
 
 pp. 720. 
 
 The treatise of M. Colombat is a learned and la- | M. Colombat De LTsere has not consecrated ten 
 borious commentary on these diseases, indicating i years of studious toil and research to the frailer sex 
 very considerable research, great accuracy of judg- > in vain ; and although we regret to hear it is at the 
 ment, and no inconsiderable personal experience. , expense of health, he has imposed a debt of gratitude 
 With the copious notes and additions of its experi- as well upon the profession, as upon the mothers and 
 enced and very erudite translator and editor, Dr. j daughters of beautiful France, which that gallant 
 Meigs, it presents, probably, one of the most corn- nation knows best how to acknowledge. New Or- 
 plete and comprehensive works on the subject we leans Medical Journal. 
 possess. American Med. Journal. 
 
 COPLAND (JAMES), M. D., F. R. S., &c. 
 OF THE CAUSES, NATURE, AND TREATMENT OF PALSY AND 
 
 APOPLEXY, and of the Forms, Seats, Complications, and Morbid Relations oi Paralytic and 
 Apoplectic Diseases. In one volume, royal 12mo., extra cloth, pp. 326. 
 
 CHAPMAN (PROFESSOR N.), M. D., &c. 
 LECTURES ON FEVERS, DROPSY, GOUT, RHEUMATISM, &c. &c. 
 
 In one neat 8vo. volume, pp. 450. 
 
 CLYMER (MEREDITH), M. D., &c. 
 FEVERS; THEIR DIAGNOSIS, PATHOLOGY, AND TREATMENT. 
 
 Prepared and Edited, with large Additions, from the Essays on Fever in Tweedie's Library oi 
 Practical Medicine. In one octavo volume, of 600 pages. 
 
 CARSON (JOSEPH), M. D., 
 
 Professor of Materia Medica and Pharmacy in the University of Pennsylvania. 
 
 SYNOPSIS OF THE COURSE OF LECTURES Otf MATERIA MEDICA 
 
 AND PHARMACY, delivered in the University of Pennsylvania. In one very neat octavo 
 volume, of 208 pages. 
 
BLANCHARD & LEA'S MEDICAL 
 
 CARPENTER (WILLIAM B.), M. D., F. R. S., &c., 
 
 Examiner in Physiology and Comparative Anatomy in the University of London. 
 
 PRINCIPLES OF HUMAN PHYSIOLOGY; with their chief applications to 
 
 Psychology, Pathology, Therapeutics, Hygiene, and Forensic Medicine. Fifth American, from 
 ' the" fourth and enlarged London edition. With three hundred and fourteen illustrations. Edited, 
 with additions, by FRANCIS GURNEY SMITH, M. D., Professor of the Institutes of Medicine in the 
 Pennsylvania Medical College, &c. In one very large and beautiful octavo volume, of about 1100 
 large pages, handsomely printed and strongly bound in leather, with raised bands. New edition. 
 (Lately Issued.) 
 
 This edition has been printed from sheets prepared for the purpose by the author, who has 
 introduced nearly one hundred illustrations not in the London edition ; while it has also enjoyed 
 the advantage of a careful superintendence^on the part of the editor, who has added notices of .^uch 
 more recent investigations as had escaped the author's attention. Neither care nor expense has 
 been spared in the mechanical execution of the work to render it superior to former editions, and it 
 is confidently presented as in every way one of the handsomest volumes as yet placed before the 
 medical profession in this country. 
 
 The most complete work on the science in our j The best text-book in the language on this ex- 
 language. Am. Med. Journal. j tensive subject. London Med. Times. 
 
 The most complete exposition of physiology which i A complete cyclopaedia of this branch of science, 
 any language can at present give. Brit, and For. " " * Med - Times. 
 Mzd.-Chirurg. Review. 
 
 We have thus adverted to some of the leading 
 additions and alterations," which have been in- 
 
 The standard of authority on physiological sub- 
 jects. * # * In the present edition, to particularize 
 the alterations and additions which have been made, 
 would require a review of the whole work, since 
 
 troduced by the author into this edition of his phy- I scarcely a subject has not been revised and altered, 
 siology. These will be found, however, very far to i added to, or entirely remodelled to adapt it to the 
 exceed the ordinary limits of a new edition, " the I present state of the science. Charleston Med. Journ. 
 
 old materials having been incorporated with the 
 new, rather than the new with the old." It now 
 certainly presents th most complete treatise on the 
 subject within the Teach of the American reader; 
 and while, for availability as a text-book, we may 
 perhaps regret its growth in bulk, we are sure that 
 the student of physiology will feel the impossibility 
 of presenting a thorough digest of the facts of the 
 
 language. Stethoscope. 
 
 The most complete work now extant in our lan- 
 guage. N. O. Med. Register. 
 
 Any reader who desires a treatise on 
 may feel himself entirely safe in ordering this. 
 Western Med. and Surg. Journal. 
 
 From this hasty and imperfect allusion it will be 
 seen by our readers that the alterations and addi- 
 tions to this edition render it almost a new work 
 and we can assure our readers that it is one of the 
 best summaries of the existing facts of i 
 
 science witnin a more limited compass. Medical best summaries of the existing facts of physiological 
 Examiner. science within the reach of the English student and 
 
 physician. N. Y. Journal of Medicine. 
 The greatest, the most reliable, and the best book 
 on the subject which we know of in the English 
 
 The profession of this country, and perhaps also 
 of Europe, have anxiously and for some time awaited 
 the announcement of this new edition of Carpenter's 
 Human Physiology. His former editions have for 
 many years been almost the only text-book on Phy- 
 siology in all our medical schools, and its circula- 
 tion among the profession has been unsurpassed by 
 any work in any department of medical science. 
 
 It is quite unnecessary for us to speak of this 
 work as its merits would justify. The mere an- 
 
 The changes are too numerous to admit of an ex- 
 tended notice in this place. At every point where 
 the recent diligent labors of organic chemists and 
 micrographers have furnished interesting and valu- 
 able facts, they have been appropriated, and no pains [ nouncement of its appearance will' afford the highest 
 have been spared, in so incorporating and arranging pleasure to every student of Physiology, while its 
 them that the work may constitute one harmonious perusal will be of infinite service in advancing 
 system. Southern Med. and Surg. Journal. ' physiological science. Ohio Med. and Surg. Journ. 
 
 BY THE SAME AUTHOR. (In PretS.) 
 
 PRINCIPLES OF GENERAL AND COMPARATIVE PHYSIOLOGY. 
 
 Intended as an Introduction to the Study of Human Physiology; and as a Guide to the Philo- 
 sophical pursuit of Natural History. New and improved edition. In one large and handsome 
 octavo volume, with several hundred beautiful illustrations. 
 
 The very thorough revision, and extensive alterations made by the author, have caused a delay 
 in the promised appearance of this work. It is now, however, at press, and may be expected for 
 publication during the ensuing summer. A very large number of new and important illustrations 
 nave been prepared for it, and the publishers trust to render the volume worthy of its extended 
 reputation in every point of typographical finish, as one of the handsomest productions of the 
 American press. A few notices of the former edition are appended. 
 
 critical, and unprejudiced view of those labors and 
 of combining the varied, heterogeneous materials at 
 his disposal, so as to form an harmonious whole. 
 We feel that this abstract can give the reader a very 
 imperfect idea of the fulness of this work, and no 
 idea of its unity, of the admirable manner in which 
 material has been brought, from the most various 
 sources, to conduce to its completeness, of the lucid- 
 ity of the reasoning it contains, or of the clearness 
 of language in which the whole is clothed. Not the 
 profession only, but the scientific world at large, 
 must feel deeply indebted to Dr. Carpenter for this 
 great work. It must, indeed, add largely even to 
 his high reputation. Medical Times. 
 
 Without pretending to it, it is an Encyclopedia of 
 the subject, accurate and complete in all respects 
 a truthful reflection of the advanced state at which 
 the science has .now arrived. Dublin Quarterly 
 Journal of Medical Science. 
 
 A truly magnificent work in itself a perfect phy- 
 siological study. Ranking's Abstract. 
 
 This work stands without its fellow. It is one 
 few men in Europe could have undertaken ; it is one 
 no man, we believe, could have brought to so suc- 
 cessful an issue as Dr. Carpenter, ft required for 
 its production a physiologist at once deeply read in 
 the labors of others, capable of taking a general, 
 
 BY THE SAME AUTHOR. (Preparing.) 
 
 THE MICROSCOPE AND ITS REVELATIONS. In one handsome volume, 
 
 beautifully illustrated with plates and wood-cuts. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 CARPENTER (WILLIAM B.), M. D., F. R. S., 
 
 Examiner in Physiology and Comparative Anatomy in the University of London. 
 
 ELEMENTS (OK MANUAL) OF PHYSIOLOGY, INCLUDING PHYSIO- 
 LOGICAL ANATOMY. Second American, from a new and revised London edition. With 
 one hundred and ninety illustrations. In one very handsome octavo volume. 
 
 In publishing the first edition of this work, its title was altered from that of the London volume, 
 by the substitution of the word "Elements 7 ' for that of " Manual," and with the author's sanction 
 the title of " Elements" is still retained as being more expressive of the scope of the treatise. A 
 comparison of the present edition with the former one will show a material improvement, the 
 author having revised it thoroughly, with a view of rendering it complete4y on a level with the 
 most advanced state of the science. By condensing the less important portions, these numerous 
 additions have been introduced without materially increasing the bulk of the volume, and while 
 numerous illustrations have been added, and the general execution of the work improved, it has 
 been kept at its former very moderate price. 
 
 The best and most complete eapose" of modern 
 Physiology, in one volume, extant in the English 
 language. St. Louis Medical Journal. 
 
 To say that it is the hest manual of Physiology 
 now before the public, would not do sufficient justice 
 to the author. B uffalo Medical Journal. 
 
 la his former works it would seem that he had 
 exhausted the subject of Physiology. In the present, 
 hegives the essence, as it were, of the whole. N. Y. 
 Journal of Medicine. 
 
 Those who have occasion for an elementary trea- 
 tise on Physiology, cannot do better than to possess 
 themselves of the manual of Dr. Carpenter. Medical 
 Examiner. 
 
 With such an aid in his hand, there is no excuse 
 for the ignorance often displayed respecting the sub- 
 jects of which it treats. From its unpretending di- 
 mensions, it may not be so esteemed by those anxious 
 to make a parade of their erudition; but whoever 
 masters its contents will have reason to be proud of 
 
 his physiological acquirements. The illustrations 
 are well selected and finely executed. i 
 
 Press. 
 
 -Dublin Med. 
 
 BY THE SAME AUTHOR. 
 
 
 A PRIZE ESSAY ON THE USE OF ALCOHOLIC LIQUORS IN HEALTH 
 
 AND DISEASE. New edition, with a Preface by D. F. CONDIE, M. D., and explanations of 
 scientific words. In one neat 12mo. volume. (Now Ready.) 
 
 This new edition has been prepared with a view to an extended circulation of this important little 
 work, which is universally recognized as the best exponent of the laws of physiology and pathology 
 applied to the subject of intoxicating liquors, in a form suited both for the profession and the public. 
 To secure a wider dissemination of its doctrines the publishers have done up copies in flexible 
 cloth, suitable for mailing, which will be forwarded through the post-office, free, on receipt of fifty 
 cents. Societies and others supplied in quantities for distribution at a liberal deduction. 
 
 CHELIUS (J. M.), M. D., 
 Professor of Surgery in the University of Heidelberg, &a. 
 
 A SYSTEM OF SURGERY. Translated from the German, and accompanied 
 
 with additional Notes and References, by JOHN F. SOUTH. Complete in three very large octavo 
 volumes, of nearly 2200 pages, strongly bound, with raised bands and double titles. 
 
 We do not hesitate to pronounce it the best and 
 most comprehensive system of modern surgery with 
 which we are acquainted. Medico-C fiirurgical Re- 
 
 The fullest and ablest digest extant of all that re- 
 lates to the present advanced state of surgical pa- 
 thology. American Medical Journal. 
 
 As complete as any system of Surgery can well 
 be. Southern Medical and SurgicalJournal. 
 
 The most learned and complete systematic treatise 
 now extant. Edinburgh Medical Journal. 
 
 A complete encyclopaedia of surgical science a 
 very complete surgical library by far the most 
 complete and scientific system of surgery in the 
 English language. N. Y. Journal of Medicine. 
 
 The most extensive and comprehensive account of 
 the art and science of Surgery in our language. 
 Lancet. 
 
 CHRISTISON (ROBERT), M. D., V. P. R. S. E., fcc. 
 
 A DISPENSATORY; or. Commentary on the Pharmacopeias of Great Britain 
 and the United States; comprising the Natural History, Description, Chemistry, Pharmacy, Ac- 
 tions, Uses, and Doses of the Articles of the Materia Medica. Second edition, revised and ira- 
 
 important New Remedies. Witfi copious Addi- 
 avings. By R. EGLESFELD GRIFFITH, M. D. 
 over 1000 pages. 
 
 There is not in any language a more complete aad 
 perfect Treatise. N. Y. Annalist. 
 
 In conclusion, we need scarcely say that we 
 strongly recommend this work to all classes of our 
 readers. As a Dispensatory and commentary on the 
 Pharmacopoeias, it is unrivalled in the English or 
 any other language. The Dublin Quarterly Journal . 
 
 We earnestlyyjeoommend Dr. Christison's Dis- 
 pensatory to air our readers, as an indispensable 
 
 It is not needful that we should compare it with 
 the other pharmacopeias extant, which enjoy and 
 merit the confidence of the profession : it is enough 
 to say that it appears to us as perfect as a Dispensa- 
 tory, in the present state of pharmaceutical science, 
 could be made. If it omits any details pertaining to 
 this branch of knowledge which the student has a 
 right to expect in such a work, we confess the omis- 
 sion has escaped our scrutiny. We cordially recom- 
 mend this work to such of our readers as are in need 
 of a Dispensatory. They cannot make choice of a 
 better-Western Journ. of Medicine a.nd Surgery. 
 
 companion, not in the Study only, but in the Surgery 
 also. British and Foreign Medical Review. 
 
8 
 
 BLANCHARD & LEA'S MEDICAL 
 
 CONDIE (D. F.), M. D., &c. 
 A PRACTICAL TREATISE ON THE DISEASES OF CHILDREN. Fourth 
 
 edition, revised and augmented. In one large volume, 8vo., of nearly 750 pages. (Just Issued.) 
 FROM THE AUTHOR'S PREFACE. 
 
 The demand for another edition has afforded the author an opportunity of again subjecting the 
 entire treatise to a careful revision, and of incorporating in it every important observation recorded 
 since the appearance of the last edition, in reference to the pathology and therapeutics of the several 
 diseases of which it treats. 
 
 In the preparation of the present edition, as in those which have preceded, while the author has 
 appropriated to his use every important fact that he has found recorded in the works of others, 
 having a direct bearing upon either of the subjects of which he treats, and the numerous valuable 
 observations pathological as well as practical dispersed throughout the pages of the medical 
 journals of Europe and America, he has, nevertheless, relied chiefly upon his own observations and 
 experience, acquired during a long and somewhat extensive practice, and under circumstances pe- 
 culiarly well adapted for the clinical study of the diseases of early life. 
 
 Every species of hypothetical reasoning has, as much as possible, been avoided. The author has 
 endeavored throughout the work to confine himself to a simple statement of well-ascertained patho- 
 logical facts, and plain therapeutical directions his chief desire being to render it what its title 
 imports it to be, A PRACTICAL TREATISE ON THE DISEASES OF CHILDREN. 
 
 We feel assured from actual experience that no 
 physician's library can be complete without a copy 
 of this work. N. Y. Journal of Medicine. 
 
 A veritable psediatric encyclopaedia, and an honor 
 to American medical literature. Ohio Medical and 
 Surgical Journal. 
 
 We feel persuaded that the American medical pro- 
 fession will soon regard it not only ns a very good, 
 but as the VERY BEST " Practical Treatise on the 
 Diseases of Children." American Medical Journal. 
 
 We pronounced the first edition to be the best 
 work on the diseases of children in the English 
 language, and, notwithstanding all that has been 
 published, we still regard it in that light. Medical 
 Examiner. 
 
 Dr. Condie's scholarship, acumen ? industry, and 
 practical sense are manifested in this, as in all his 
 numerous contributions to science. Dr. Holmes' s 
 Report to the American Medical Association. 
 
 Taken as a whole, in our judgment, Dr. Condie's 
 Treatise is the one from the perusal of which the 
 practitioner in this country will rise with the great- 
 est satisfaction Western Journal of Medicine and 
 Surgery. 
 
 One of the best works upon the Diseases of Chil- 
 dren in the English language. Western Lancet. 
 
 Perhaps the most full and complete work now be- 
 fore the profession of the United States; indeed, we 
 may say in the English language. It is vastly supe- 
 rior to most of its predecessors. Transylvania Med. 
 Journal. 
 
 COOPER (BRANSBY B.), F. R. S., 
 
 Senior Surgeon to Guy's Hospital, &c. 
 
 LECTURES ON THE PRINCIPLES AND PRACTICE OF SURGERY. 
 
 In one very large octavo volume, of 750 pages. (Lately Issued). 
 
 For twenty-five years Mr. Bransby Cooper has I Cooper's Lectures as a most valuable addition to 
 been surgeon to Guy's Hospital; and the volume | our surgical literature, and one which cannot fail 
 before us may be said to consist of an account of to be of service both to students and to those Avho 
 the results of his surgical experience during that are actively engaged in the practice of their profes- 
 long period We cordially recommend Mr. Bransby I sion. The Lancet. 
 
 COOPER (SIR ASTLEY P.), F. R. S., &c. 
 A TREATISE ON DISLOCATIONS AND FRACTURES OF THE JOINTS. 
 
 Edited by BRANSBY B. COOPER, F. R. S., &c. With additional Observations by Prof. J. C. 
 WARREN. A new American edition. In one handsome octavo volume, with numerous illustra- 
 tions on wood. 
 
 BY THE SAME AUTHOR. 
 
 ON THE ANATOMY AND TREATMENT OF ABDOMINAL HERNIA. 
 
 One large volume, imperial 8vo., with over 130 lithographic figures. 
 
 BY THE SAME AUTHOR. 
 
 ON THE STRUCTURE AND DISEASES OF THE TESTIS, AND ON 
 
 THE THYMUS GLAND. One vol. imperial 8vo., with 177 figures, on 29 plates. 
 
 BY THE SAME AUTHOR. 
 
 ON THE ANATOMY AND DISEASES OF THE BREAST, with twenty- 
 
 five Miscellaneous and Surgical Papers. One large volume, imperial 8vo., with 252 figures, on 
 
 36 plates. 
 
 These last three volumes complete the surgical writings of Sir Astley Cooper. They are very 
 handsomely printed, with a large number of lithographic plates, executed in the best style, and are 
 presented at exceedingly low prices. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 CHURCHILL (FLEETWOOD), M. D., M. R. I. A. 
 ON THE THEORY AND PRACTICE OF MIDWIFERY. A new American, 
 
 from the last and improved English edition. Edited, with Notes and Additions, by D. FRANCIS 
 CONDIE, M. D., author of a "Practical Treatise on the Diseases of Children," &c. With 139 
 illustrations. In one very handsome octavo volume, pp. 510. (Lately Issued.) 
 
 To bestow praise on a book that has received such 
 marked approbation would be superfluous. We need 
 only say, therefore, that if the first edition was 
 thought worthy of a favorable reception by the 
 medical public, we can confidently affirm that this 
 will be found much more eo. The lecturer, the 
 practitioner, and the student, may all have recourse 
 to its pages, and derive from their perusal much in- 
 terest and instruction in everything relating to theo- 
 retical and practical midwifery. Dublin Quarterly 
 Journal of Medical Science. 
 
 A work of very great merit, and such as we can 
 confidently recommend to the study of every obste- 
 tric practitioner. London Medical Gazette. 
 
 This is certainly the most perfect system extant. 
 It is the best adapted for the purposes of a text- 
 book, and that which he whose necessities confine 
 him to one book, should select in preference to all 
 others. Southern Medical and Surgical Journal. 
 
 The most popular work on midwifery ever issued 
 from the American press. Charleston Med. Journal. 
 
 Were we reduced to the necessity of having but 
 one work on midwifery, and permitted to choose, 
 we would unhesitatingly take Churchill. Western 
 Med. and Surg. .Journal. 
 
 It is impossible to conceive a more useful and 
 elegant manual than Dr. Churchill's Practice of 
 Midwifery. Provincial Medical Journal. 
 
 Certainly, in our opinion, the very best work on 
 the subject which exists. N. Y. Annalist. 
 
 No work holds a higher position, or is more de- 
 serving of being placed in the hands of the tyro, 
 the advanced student, or the practitioner. Medical 
 Examiner. 
 
 Previous editions, under the editorial supervision 
 of Prof R. M. Huston, have been received with 
 marked favor, and they deserved it; but this, re- 
 printed from a very late Dublin edition, carefully 
 revised and brought up by the author to the present 
 time, does present an unusually accurate and able 
 exposition of every important particular embraced 
 in the department of midwifery. * * The clearness, 
 directness, and precision of its teachings, together 
 with the great amount of statistical research which 
 its text exhibits, have served to place it already in 
 the foremost rank of works in this department of re- 
 medial science. N. O. Med. and Surg. Journal. 
 
 In our opinion, it forms one of the best if not the 
 very best text-book and epitome of obstetric science 
 which we at present possess in the English lan- 
 guage. Monthly Journal of Medical Science. 
 
 The clearness and precision of style in which it is 
 written, and the great amount of statistical research 
 which it contains, have served to place it in the first 
 rank of works in this departmentof medical science. 
 N. Y. Journal of Medicine. 
 
 Few treatises will be found better adapted as a 
 text-book for the student, or as a manual for the 
 frequent consultation of the young practitioner. 
 American Medical Journal. 
 
 BY THE SAME AUTHOR. 
 
 ON THE DISEASES OF INFANTS AND CHILDREN. In one large and 
 
 handsome volume of over 600 pages. 
 
 We regard this volume as possessing more claims 
 to completeness than any other of the kind with 
 which we are acquainted. Most cordially and earn- 
 estly, therefore, do we commend it to our profession- 
 al brethren, and we feel assured that the stamp of 
 their approbation will indue time be impressed upon 
 it. After an attentive perusal of its contents, we 
 hesitate not to say, that it is one of the most com- 
 prehensive ever written upon the diseases of chil- 
 dren, and that, for copiousness of reference, extent of 
 research, and perspicuity of detail, it is scarcely to 
 be equalled, and not to be excelled, in any lan- 
 guage. Dublin Quarterly Journal. 
 
 After this meagre, and we know, very imperfect 
 notice of Dr. Churchill's work, we shall conclude 
 by saying, that it is one that cannot fail from its co- 
 piousness, extensive research, and general accuracy, 
 to exalt still higher the reputation of the author in 
 this country. The American reader will be particu- 
 larly pleased to find that Dr. Churchill has done full 
 justice throughout his work to the various A merican 
 authors on this subject. The names of Dewees, 
 Eberle, Condie, and Stewart, occur on nearly every 
 page, and these authors are constantly referred to by 
 the author in terms of the highest praise, and with 
 the most liberal courtesy. The Medical Examiner. 
 
 The present volume will sustain the reputation 
 acquired by the author from his previous works. 
 The reader will find in it full and judicious direc- 
 tions for the management of infants at birth, and a 
 compendious, but clear account of the diseases to 
 which children are liable, and the most successful 
 mode of treating them. We must not close this no- 
 tice without calling attention to the author's style, 
 which is perspicuous and polished to a degree, we 
 regret to say, not generally characteristic of medical 
 works. We recommend the work of Dr. Churchill 
 most cordially, both to students and practitioners, 
 as a valuable and reliable guide in the treatment of 
 the diseases of children. Am. Journ. of the Med. 
 Sciences. 
 
 We know of no work on this department of Prac- 
 tical Medicine which presents so candid and unpre- 
 judiced a statement or posting up of our actual 
 knowledge as this. N. Y. Journal of Medicine. 
 
 Its claims to merit both as a scientific and practi- 
 cal work, are of the highest order. Whilst we 
 would not elevate it above every other treatise on 
 the same subject, we certainly believe that very few 
 are equal to it, and none superior. Southern Med. 
 and Surgical Journal. 
 
 BY THE SAME AUTHOR. 
 
 ESSAYS ON THE PUERPERAL FEVER, AND OTHER DISEASES PE- 
 CULIAR TO WOMEN. Selected from the writings of British Authors previous to the close of 
 the Eighteenth Century. In one neat octavo volume, of about four hundred and fifty pages. 
 
 To these papers Dr. Churchill has appended notes, 
 embodying whatever information has been laid be- 
 fore the profession since their authors' time. He has 
 also prefixed to the Essays on Puerperal Fever, 
 which occupy the larger portion of the volume, an 
 interesting historical sketch of the principal epi- 
 
 demics of that disease. The whole forms a very 
 valuable collection of papers, by professional writers 
 of eminence, on some of the most important accidents 
 to which the puerperal female is liable. American 
 Journal of Medical Sciences. 
 
10 
 
 BLANCHARD & LEA'S MEDICAL 
 
 CHURCHILL (FLEETWOOD), M. D., M. R. I. A., &c. 
 
 ON THE DISEASES OF WOMEN; including those of Pregnancy and Child- 
 bed. A new American edition, revised by the Author. With Notes and Additions, by D FRAN- 
 CIS CONDIE, M. D., author of " A Practical Treatise on the Diseases of Children." In one large 
 and handsome octavo volume, with wood-cuts, pp. 684. (Just Issued.) 
 
 From the Aiithor^s Preface. 
 
 In reviewing this edition, at the request of my American publishers, I have inserted several new 
 sections and chapters, and I have added, I believe, all the information we have derived from recent 
 researches ; in addition to which the publishers have been fortunate enough to secure the services 
 of an able and highly esteemed editor in Dr. Condie. 
 
 "\Venow regretfully take leave of Dr. Churchill's 
 book. Had our typographical limits permitted, we 
 should gladly have borrowed more from its richly 
 stored pages. In conclusion, we heartily recom- 
 mend it to the profession, and would at the same 
 time express our firm conviction that it will not only 
 add to the reputation of its author, but will prove a 
 work of great and extensive utility to obstetric 
 practitioners. Dublin Medical Press. 
 
 Former editions of this work have been noticed in 
 previous numbers of the Journal. The sentiments of 
 high commendation expressed in those notices, have 
 only to be repeated in this; not from the fact that 
 the profession at large are not aware of the high 
 merits which this work really possesses, but from a 
 desire to see the principles and doctrines therein 
 contained more generally recognized, and more uni- 
 versally carried out in practice. N. Y. Journal of 
 Medicine. 
 
 We know of no author who deserves that appro- 
 bation, on "the diseases of females," to the same 
 extent that Dr. Churchill does. His, indeed, is the 
 only thorough treatise we know of on the subject; 
 and it may be commended to practitioners and stu- 
 dents as a masterpiece in its particular department. 
 The former editions of this work have been com- 
 mended strongly in this journal, and they have won 
 their way to an extended, and a well-deserved popu- 
 
 larity. This fifth edition, before us. is well calcu- 
 lated to maintain Dr. Churchill's high reputation. 
 It was revised and enlarged by the author, for his 
 American publishers, and it seems to us that there is 
 scarcely any species of desirable information on its 
 subjects that may not be found in this work. The 
 Western Journal of Medicine and Surgery. 
 
 We are gratified to announce a new and revised 
 edition of Dr. Churchill's valuable work on the dis- 
 eases of females We have ever regarded it as one 
 of the very best works on the subjects embraced 
 within its scope, in the English language; and the 
 present edition, enlarged and revised by the author, 
 renders it still more entitled to the confidence of the 
 profession. The valuable notes of Prof. Huston 
 have been retained, and contribute, in no small de- 
 gree, to enhance the value of the work. It ia a 
 source of congratulation that the publishers have 
 permitted the author to be, in this instance, his 
 own editor, thus securing all the revision which 
 an author alone is capable of making. The Western 
 Lancet. 
 
 Asa comprehensive manual for students, or a 
 work of reference for practitioners, we only speak 
 with common justice when we say that it surpasses 
 any other that has ever issued on the same sub- 
 ject from the British press. The Dublin Quarterly 
 Journal. 
 
 DEVVEES (W. P.), M.D., &c. 
 
 A COMPKEHENSIVE SYSTEM OF MIDWIFERY. Illustrated by occa- 
 sional Cases and many Engravings. Twelfth edition, with the Author's last Improvements and 
 Corrections. In one octavo volume, of 600 pages. (Just Issued.) 
 
 BY THE SAME AUTHOR. 
 
 A TREATISE ON THE PHYSICAL AND MEDICAL TREATMENT OF 
 
 CHILDREN. Tenth edition. In one volume, octavo, 548 pages. (Just Issited.) 
 
 BY THE SAME AUTHOR. 
 
 A TREATISE ON THE DISEASES OF FEMALES. Tenth edition. In 
 
 one volume, octavo, 532 pages, with plates. (Just Issued.) 
 
 DICKSON (PROFESSOR S. H.), M. D. 
 ESSAYS ON LIFE, SLEEP, PAIN, INTELLECTION, HYGIENE, AND 
 
 DEATH. In one very handsome volume, royal 12mo. 
 
 
 
 DANA (JAMES D). 
 
 ZOOPHYTES AND CORALS. In one volume, imperial quarto, extra cloth, 
 
 with wood-cuts. 
 
 ALSO, 
 
 AN ATLAS TO THE ABOVE, one volume, imperial folio, with sixty-one mag- 
 niiicent plates, colored after nature. Bound in half morocco. 
 
 ALSO, 
 
 ON THE STRUCTURE AND CLASSIFICATION OF ZOOPHYTES. 
 
 Sold separate, one vol., cloth. 
 
 DE LA BECHE (SIR HENRY T.), F. R. S., Ac. 
 
 THE GEOLOGICAL OBSERVER. In one very large, and handsome octavo 
 volume, of 700 pages. With over three hundred wood-cuts. (Lately Issued.) 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 11 
 
 DRUITT (ROBERT), M.R. C.S., &c. 
 THE PRINCIPLES AND PRACTICE OF MODERN SURGERY. A new 
 
 American, from the improved London edition. Edited by F. W. SARGENT, M. D., author of 
 " Minor Surgery," &c. Illustrated with one hundred and ninety-three wood-engravings. In 
 one very handsomely printed octavo volume, of 576 large pages. 
 
 Dr. Druitt's researches into the literature of his 
 subject have been not only extensive, but well di- 
 rected ; the most discordant authors are fairly and 
 impartially quoted, and, while due credit is given 
 to each, their respective merits are weighed with 
 an unprejudiced hand. The grain of wheat is pre- 
 served, and the chaff is unmercifully stripped off. 
 The arrangement is simple and philosophical, and 
 the style, though clear and interesting, is so precise, 
 that the book contains more information condensed 
 into a few words than any other surgical work with 
 which we are acquainted. London Medical Times 
 and Gazette, February 18, 1654. 
 
 No work, in our opinion, equals it in presenting 
 so much valuable surgical matter in so small a 
 compass. St. Louis Med. and Surgical Journal. 
 
 Druitt's Surgery is too well known to the Ameri- 
 can medical profession to require its announcement 
 anywhere. Probably no work of the kind has ever 
 been more cordially received and extensively circu- 
 lated than this The fact that it comprehends in a 
 comparatively small compass, all the essential ele- 
 ments of theoretical and practical Surgery that it 
 is found to contain reliable and authentic informa- 
 tion on the nature and treatment of nearly all surgi- 
 cal affections is a sufficient reason for the liberal 
 patronage it has obtained. The editor, Dr. F. W. 
 Sargent, has contributed much to enhance the value 
 of the work, by such American improvements as are 
 calculated more perfectly to adapt it to our own 
 views and practice in this country. It abounds 
 everywhere with spirited and life-like illustrations, 
 which to the young surgeon, especially, are of no 
 minor consideration. Every medical man frequently 
 needs just such a work as this, for immediate refe- 
 rence in moments of sudden emergency, when he has 
 Dot time to consult more elaborate treatises. The 
 Ohio Medical and Surgical Journal. 
 
 The author has evidently ransacked every stand- 
 ard treatise of ancient and modern times, and all that 
 
 is really practically useful at the bedside will be 
 found in a form at once clear, distinct, imd interest- 
 ing. Edinburgh Monthly Medical Journal. 
 
 Druitt's work, condensed, systematic, lucid, and 
 practical as it is, beyond most works on Surgery 
 accessible to the American student, has had much 
 currency in this country, and under its present au- 
 spices promises to rise to yet higher favor. The 
 Western Journal of Medicine and Surgery. 
 
 The most accurate and ample resume of the pre- 
 sent state of Surgery that we are acquainted with. 
 Dublin Medical Journal. 
 
 A better book on the principles and practice of 
 Surgery as now understood in England and America, 
 has not been given to the profession. Boston Medi- 
 cal and Surgical Journal. 
 
 An unsurpassable compendium, not only of Sur- 
 gical, but of Medical Practice. London Medical 
 Gazette. 
 
 This work merits our warmest commendations, 
 and we strongly recommend it to young surgeons as 
 an admirable digest of the principles and practice of 
 modern Surgery. Medical Gazette. 
 
 It may be said with truth that the work of Mr. 
 Druitt affords a complete, though brief and con- 
 densed view, of the entire field of modern surgery. 
 We know of no work on the same subject having the 
 appearance of a manual, which includes so many 
 topics of interest to the surgeon ; and the terse man- 
 ner in which each has been treated evinces a most 
 enviable quality of mind on the part of the author, 
 who seems to have an innate power of searching 
 out and grasping the leading facts and features of 
 the most elaborate productions of the pen. It is a 
 useful handbook for the practitioner, and we should 
 deem a teacher of surgery unpardonable who did not 
 recommend it to his pupils. In our own opinion, it 
 is admirably adapted to the wants of the student. 
 Provincial Medical and Surgical Journal . 
 
 DUNGLISON, FORBES, TWEEDIE, AND CONOLLY. 
 THE CYCLOPAEDIA OF PRACTICAL MEDICINE: comprising Treatises on 
 
 the Nature and Treatment of Diseases, Materia Medica, and Therapeutics, Diseases of Women, 
 and Children, Medical Jurisprudence, &c. &c. In four large super royal octavo volumes, of 
 3254 double-columned pages, strongly and handsomely bound. 
 
 *^* This work contains no less than four hundred and eighteen distinct treatises, contributed by 
 sixty-eight distinguished physicians. 
 
 The most complete work on Practical Medicine 
 extant; or, at least, in our language. Buffalo 
 Medical and Surgical Journal. 
 
 For reference, it is above all price to every prac- 
 titioner. We stern Lancet. 
 
 One of the most valuable medical publications of 
 the day as a work of reference it is invaluable. 
 Western Journal of Medicine and Surgery. 
 
 It has been to us, both as learner and teacher, a 
 work for ready and frequent reference, one in which 
 modern English medicine is exhibited in the most 
 advantageous light. Medical Examiner. 
 
 We rejoice that this work is to be placed within 
 the reach of the profession in this country, it being 
 
 unquestionably one of very great value to the prac- 
 titioner. This estimate of it has not been formed 
 from a hasty examination, but after an intimate ac- 
 quaintance derived from frequent consultation of it 
 during the past nine or ten years. The editors are 
 practitioners of established reputation, and the list 
 of contributors embraces many of the most eminent 
 professors and teachers of London, Edinburgh, Dub- 
 lin, and Glasgow. It is, indeed, the great merit of 
 this work that the principal articles have been fur- 
 nished by practitioners who have not only devoted 
 especial attention to the diseases about which they 
 have written, but have also enjoyed opportunities 
 for an extensive practical acquaintance with them, 
 and whose reputation carries the assurance of their 
 competency justly to appreciate the opinions of 
 others, while it stamps their own doctrines with 
 high and just authority. American Medical Journ. 
 
 
 DUNGLISON (ROBLEY), M. D., 
 
 Professor of the Institutes of Medicine, in the Jefferson Medical College, Philadelphia. 
 
 HUMAN HEALTH; or, the Influence of Atmosphere and Locality, Change of 
 
 Air and Climate, Seasons, Food, Clothing, Bathing, Exercise, Sleep, &c. &c., on Healthy Man ; 
 constituting Elements of Hygiene. Second edition, with many modifications and additions. In 
 one octavo volume, of 464 pages. 
 
12 
 
 BLANCHARD & LEA'S MEDICAL 
 
 DUNGLISON (ROBLEY), M. D., 
 
 Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia. 
 
 MEDICAL LEXICON; a Dictionary of Medical Science, containing a concise 
 
 Explanation of the various Subjects and Terms of Physiology, Pathology, Hygiene, Therapeutics, 
 Pharmacology, Obstetrics, Medical Jurisprudence, &c. With the French and other Synonymes ; 
 Notices of Climate and of celebrated Mineral Waters; Formulae for various Officinal, "Empirical, 
 and Dietetic Preparations, etc. Eleventh edition, revised. In one very thick octavo volume, of 
 over nine hundred large double-columned pages, strongly bound in leather, with raised band*. 
 (Just Issued.) 
 
 Every successive edition of this work bears the marks of the industry of the author, and of his 
 determination to keep it fully on a level with the most advanced state of medical science. Thus 
 nearly FIFTEEN THOUSAND WORDS have been added to it within the last few years. As a complete 
 Medical Dictionary, therefore, embracing over FIFTY THOUSAND DEFINITIONS, in all the 
 branches of the science, it is presented as meriting a continuance of the great favor and popularity 
 which have carried it, within no very long space of time, to an eleventh edition. 
 
 Every precaution has been taken in the preparation of the present volume, to render its mecha- 
 nical execution and typographical accuracy worthy of its extended reputation and universal use. 
 The very extensive additions have been accommodated, without materially increasing the bulk of 
 the volume by the employment of a small but exceedingly clear type, cast for this purpose. The 
 press has been watched with great care, and every effort used to insure the verbal accuracy so ne- 
 cessary to a work of this nature. The whole is printed on fine white paper ; and, while thus exhi- 
 biting "in every respect so great an improvement over former issues, it is presented at the original 
 exceedingly low price. 
 
 We welcome it cordially; it is an admirable work, J valuable work, we directed the attention of our 
 and indispensable to all literary medical men. The ' H ,,.., t~ ;.. ^.,; Q , m ~,\* . ,,., n ~ A A<* 
 labor which has been bestowed apon it is something 
 prodigious. The work, however, has now been 
 done, and we are happy in the thought that no hu- 
 man being will have again to undertake the same 
 gigantic task. Revised and corrected from time to 
 time, Dr. Dunglison's (i Medical Lexicon" will last 
 for centuries. British and Foreign Med. Chirurg. 
 Review, July, 1853. 
 
 The fact that this excellent and learned work has 
 
 passed through eight editions, and that a ninth is 
 rendered necessary by the demands of the public, 
 affords a sufficient evidence of the general apprecia- 
 tion of Dr. Dunglison's labors by the medical pro- 
 fession in England and America. It is a book which 
 will be of great service to the student, in teaching 
 him the meaning of all the technical terms used in 
 medicine, and will be of no less use to the practi- 
 tioner who desires to keep himself on a levd with 
 the advance of medical science. London Medical 
 Times and Gazette. 
 
 In taking leave of our author, we feel compelled 
 to confess that his work bears evidence of almost 
 incredible labor having been bestowed upon its com- 
 position. Edinburgh Journal of Med. Sciences. 
 Sept. 1853. 
 
 A miracle of labor and industry in one who has 
 written able and voluminous works on nearly every 
 branch of medical science. There could be no more 
 useful book to the student or practitioner, in the 
 present advancing age, than one in which would be 
 found, in addition to the ordinary meaning and deri- 
 vation of medical terms so many of which are of 
 modern introduction concise descriptions of their 
 explanation and employment; and all this and much 
 more is contained in the volume before us. It is 
 therefore almost as indispensable to the other learned 
 professions as to our own. In fact, to all who may 
 have occasion to ascertain the meaning of any word 
 belonging to the many branches of medicine. From 
 
 readers to its peculiar merits; and we need do 
 little more than state, in reference to the present 
 reissue, that, notwithstanding the large additions 
 previously made to it, no fewer than four thou- 
 sand terms, not to be found in the preceding edi- 
 tion, are contained in the volume before us. 
 Whilst it is a wonderful monument of its author's 
 erudition and industry, it is also a work of great 
 practical utility, as we can testify from our own 
 experience; for we keep it constantly within OUT 
 reach, and make very frequent reference to it, 
 nearly always finding in it the information we seek. 
 British and Foreign Med.-Chirurg. Review. 
 
 It has the rare merit that it certainly has no rival 
 in the English language for accuracy and extent 
 of references. The terms generally include short 
 physiological and pathological descriptions, so that, 
 as the author justly observes, the reader does not 
 possess in this work a mere dictionary, but a book, 
 which, while it instructs him in medical etymo- 
 logy, furnishes him with a large amount of useful 
 information. The author's labors have been pro- 
 perly appreciated by his own countrymen ; and we 
 can only confirm their judgment, by recommending 
 this most useful volume to the notice of our cisat- 
 lantic readers. No medical library will be complete 
 without it. London Med. Gazette. 
 
 It is certainly more complete and comprehensive 
 than any with which we are acquainted in the 
 English language. Few, in fact, could be fonnd 
 belter qualified than Dr. Dunglison for the produc- 
 tion of such a work. Learned, industrious, per- 
 severing, and accurate, he brings to the task all 
 the peculiar talents necessary for its successful 
 performance; while, at the same time, his fami- 
 liarity with the writings of the ancient and modern 
 " masters of our art," renders him skilful to note 
 the exact usage of the several terms of science, 
 and the various modifications which medical term- 
 inology has undergone with the change of theo- 
 ries or the progress of improvement. American 
 Medical Sciences. 
 
 a careful examination of the present edition, we can T ntir ~ n j n ftkf 
 vouch for its accuracy, and for its being brought 
 quite up to the date of publication ; the author states , "e of the most complete and copions known to 
 in his preface that he hasadded to it about four thou- the cultivators of medical science. Boston Med. 
 sand terms, which are not to be found in the prece- Journal. 
 
 ding one.- Dublin Quarterly Journal of Medical The most compreh ensive and best English Dic- 
 tionary of medical terms extant. Buffalo Medical 
 On the appearance of the last edition of this | Journal. 
 
 BY THE SAME AUTHOR. 
 
 THE PRACTICE OF MEDICINE. A Treatise on Special Pathology and The- 
 rapeutics. Third Edition. In two large octavo volumes, of fifteen hundred pages. 
 
 Upon every topic embraced in the work the latest 
 information will be found carefully posted up. 
 Medical Examiner. 
 
 The student of medicine will find, in these two 
 elegant volumes, a mine of facts, a gathering of 
 precepts and advice from the world of experience, 
 that will nerve him with courage, and faithfully 
 direct him in his efforts to relieve the physical suf- 
 
 ferings of the race. .Boston Medical and Surgical 
 Journal. 
 
 It is certainly the most complete treatise of which 
 we have any knowledge. Western Journal of Medi- 
 cine and Surgery. 
 
 One of the most elaborate treatises of the kind 
 we have. Southern Med. and Surg. Journal. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 13 
 
 
 DUNGLISON (ROBLEY), M.D., 
 
 Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia. 
 
 
 HUMAN PHYSIOLOGY. Seventh edition. Thoroughly revised and exten- 
 sively modified and enlarged, with nearly five hundred illustrations. In two large and hand- 
 somely printed octavo volumes, containing nearly 1450 pages. 
 
 It has long since taken rank a one of the medi- I Physiology in the English language, and is highly 
 cat classics of our language. To say that it is by | creditable to the author and publishers. Canadian 
 Oir the best text-book of physiology ever published Medical Journal. 
 in this country, is but echoing the general testi- 
 mony of the profession .N. Y. Journal of Medicine. \ The most complete and satisfactory system of 
 
 I Physiology in the English language. Amer. Med. 
 There is no single book we would recommend to | Journal. 
 the student or physician, with greater confidence 
 
 Chan the present, because in it will be found a mir- The best work of the kind in the English laa- 
 rorof almost every standard physiological work of guage. Silliman's Journal. 
 the day. We most cordially recommend the work 
 
 to every member of the profession, and no student i The most full and complete system of Physiology 
 should be without it. It is the completes! work on in our language. Western Lancet. 
 
 BY THE SAME AUTHOR. (Just Issued.) 
 
 GENERAL THERAPEUTICS AND MATERIA MEDIC A; adapted for a 
 
 Medical Text-book. Fifth edition, much improved. With one hundred and eighty-seven illus- 
 trations. In two large and handsomely printed octavo vols., of about 1100 pages. 
 The new editions of the United States Pharmacopeia and those of London and Dublin, have ren- 
 dered necessary a thorough revision of this work. In accomplishing this the author has spared no 
 pains in rendering it a complete exponent of all that is new and reliable, both in the departments 
 of Therapeutics and Mtiteria Medica. The book has thus been somewhat enlarged, and a like im 
 provemeat will be found in every department of its mechanical execution. As a convenient text- 
 book for the student, therefore, containing within a moderate compass a satisfactory resume of its 
 important subject, it is again presented as even more worthy than heretofore of the very great favor 
 which it has received. 
 
 In this work of Dr. Dunglison, we recognize the ! 
 game untiring industry in the collection and em- 
 bodying of facts on the several subjects of which he : 
 treats, that has heretofore distinguished him, and J 
 we cheerfully point to these volumes, as two of the 1 
 most interesting that we know of. In noticing the 
 additions to this, the fourth edition, there is very 
 Little ia the periodical or annual literature of the I 
 profession, published in the interval which has j 
 elapsed since the issue of the first, that has escaped i 
 the careful search of the author. As a book for 
 reference, it is invaluable. Charleston Med. Jour- 
 nal and Review. 
 
 As a text-book for students, for whom it is par- 
 ticularly designed, we know of none superior to 
 it. St. Louis Medical and Surgical Journal. 
 
 It purports to be a new edition, but it is rather 
 a new book, so greatly has it been improved, both, 
 in the amount and quality of the matter which it 
 contains. N. O. Medical and Surgical Journal. 
 
 We bespeak for this edition, from the profession, 
 an increase of patronage over any of its former 
 ones, on account of its increased merit. N. 1". 
 Journal of Medicine. 
 
 It may be said to be the work now upon the sub- We consider this work unequalled. Boston Med. 
 jects upon which it treats. Western Lancet. ' and Surg. Journal. 
 
 BY THE SAME AUTHOR. 
 
 NEW REMEDIES, WITH FORMULAE FOR THEIR ADMINISTRATION. 
 
 Sixth edition, with extensive Additions. In one very large octavo volume, of over 750 pages. 
 One of the most useful of the author's works. diseases and for remedies, will be found greatly to 
 Southern Medical and Surgical Journal. enhance its value. New York Med. Gazette. 
 
 This well-known and standard book has now 
 reached its sixth edition, and has been*enlarged and 
 improved by tlie introduction of all the recent gifts 
 to therapeutics which the last few years have so 
 richly produced, including the anaesthetic agents, 
 &c. This elaborate and useful volume should be 
 found in every medical library, for as a book of re- 
 ference, for physicians, it is unsurpassed by any 
 other work ia existence, and the double index for 
 
 The great learning of the author, and his remark- 
 able industry in pushing his researches into every 
 source whence information is derivable, has enabled 
 him to throw together an extensive mass of facts 
 and statements, accompanied by full reference to 
 authorities; which last feature renders the work 
 practically valuable to investigators who desire to 
 examine the original papers. The American Journal 
 of Pharmacy. 
 
 DURLACHER (LEWIS). 
 A TREATISE ON CORNS, BUNIONS, THE DISEASES OF NAILS, 
 
 AND THE GENERAL MANAGEMENT OF THE FEET. IH one 12mo. volume, cloth. 
 pp. 134. 
 
 DE JONGH (L. J.), M. D., &c. 
 THE THREE KINDS OF COD-LIVER OIL, comparatively considered, with 
 
 their Chemical and Therapeutic Properties. Translated, with an Appendix and Cases, by 
 EDWARD CARRY, M D. To which is added an article on the subject from " Dunglison on New 
 Remedies." In oue small 12mo. volume, extra cloth. 
 
 DAY (GEORGE E.), M. D. 
 A PRACTICAL TREATISE ON THE DOMESTIC MANAGEMENT AND 
 
 MORE IMPORTANT DISEASES OF ADVANCED LIFE. With an Appendix on a new 
 and successful mode ot treating Lumbago and other forms of Chronic Rheumatism. One volume 
 octavo, 226 pages. 
 
14 
 
 BLANCHARD & LEA'S MEDICAL 
 
 ELLIS (BENJAMIN), M.D. 
 THE MEDICAL FORMULARY : being a Collection of Prescriptions, derived 
 
 from the writings and practice of many of the most eminent physicians of America and Europe. 
 Together with the usual Dietetic Preparations and Antidotes for Poisons. To which is added 
 an Appendix, on the Endermic use of Medicines, and on the use of Elher and Chloroform. The 
 whole accompanied with a few brief Pharmaceutic and Medical Observations. Tenth edition, 
 revised and much extended by ROBERT P. THOMAS, M. D., Professor of Materia Medica in the 
 Philadelphia College of Pharmacy. In one neat octavo volume, of two hundred and ninety-six 
 pages. (Now Ready, Revised and enlarged to 1854.) 
 
 This work has received a very complete revision at the. hands of the editor, who has made what- 
 ever alterations and additions the progress of medical and pharmaceutical science has rendered ad- 
 visable, introducing fully the new remedial agents, and revising the whole by the latest improvements 
 of the Pharmacopoeia. To accommodate these additions, the size of the page has been increased, 
 and the volume itself considerably enlarged, while every effort has been made to secure the typo- 
 graphical accuracy which has so long merited the confidence of the profession. 
 
 After an examination of the new matter and the 
 alterations, we believe the reputation of the work 
 built up by the author, and the late distinguished 
 editor, will continue to fl onrisli under the anspiees 
 of the present editor, who has the industry and accu- 
 racy, and, we would say, conscientiousness requi- 
 site for the responsible task. American Journal of 
 Pharmacy, March, 1S4. 
 
 It will prove particularly useful to students nnd 
 young practitioners, as the most important prescrip- 
 tions employed in modern practice, which lie scat- 
 tered through our medical literature, are here col- 
 lected and conveniently arranged for reference. 
 Charleston Med. Journal and Review. 
 
 ERICHSEN (JOHN)., 
 
 Professor of Surgery in University College, London, &c. 
 
 THE SCIENCE AND ART OF SURGERY; BEING A TREATISE ON SURGICAL 
 
 INJURIES, DISEASES, AND OPERATIONS. With Notes and Additions by the American Editor. Il- 
 lustrated with over three hundred engravings on wood. In one large and handsome octaro 
 volume, of nearly nine hundred closely printed pages. (Now Ready.) 
 This is a new work, brought up to May, 1854. 
 
 This work, which is designed as a lext-book for the student and practitioner, will be found a very 
 complete treatise on the principles and practice of surgery. Embracing both these branches of the 
 subject simultaneously, and elucidating the one by the other, it enables the reader to take a compre- 
 hensive view of the objects of his study, and presents the subjects discussed in a clear and con- 
 nected manner. The author's style will be found easy and flowing, and the illustrations having 
 been drawn under his especial supervision, are with few exceptions new, and admirably adapted 
 to elucidate the text to which they refer. In every point of mechanical execution, it will be one of 
 the handsomest works issued from the American press. 
 
 which he is Professor, and we can eordinHy recom- 
 mend it as a work of reference, both to students and 
 practitioners. Medical Times and Gazette. 
 
 The aim of Mr. Erichsen appears to be to improve 
 pon the plan of Samuel Cooper; and by connecting 
 in one volume the science and art of Surgery, to 
 supply the student with a text-book and the practi- 
 tioner with a work of reference, in which scientific 
 principles and practic.il details are alike included. 
 \Ve may say, after a careful pernsal of some of 
 the chapters, and a more hasty examination of the 
 remainder, that it must raise the character of the 
 author, and reflect great credit upon the College to 
 
 " We do not hesitate to say that the volume before 
 us gives a very admirable practical view of the sci- 
 ence and art of surgery of the present day, and we 
 have no doubt that it will be highly valued as a sur- 
 gical guide as well by the surgeon as by the student 
 of surgery. Edinburgh Med. and Svrg. Journal. 
 
 FERGUSSON (WILLIAM), F. R. S., 
 
 Professor of Surgery in King's College, London, Sec. 
 
 A SYSTEM OF PRACTICAL SURGERY. Fourth American, from the third 
 
 and enlarged London edition. In one large and beautifully printed octavo volume, of about seven 
 hundred pages, with three hundred and ninety-three handsome illustrations. (Just Issued.) 
 
 sively on operative surgery j but this defect is now 
 removed, and the book is more than ever adapted for 
 
 The most important subjects in connection with 
 practical surg&ry which have been more recently 
 
 brought under the notice of, and discussed by, the 
 surgeons of Great Britain, are fully and dispassion- 
 ately considered by Mr. Fergusson, and that which 
 was before wanting has now been supplied, so that 
 we can now look upon it as a work on practical sur- 
 gery instead of one on operative surgery alone. And 
 we think the author has shown a wise discretion in 
 making the additions on surgical disease which are 
 to be found in the present volume, and has very 
 much enhanced its value ; for, besides two elaborate 
 chapters on the diseases of bones and jointSj which 
 were wanting before, he has headed each chief sec- 
 tion of the work by a general description of the sur- 
 gical disease and injury of that region of the body 
 which is treated of in each, prior to entering into the 
 consideration of the more special morbid conditions 
 and their treatment. There is also, as in former 
 editions, a sketch of the anatomy of particular re- 
 gions. There was some ground formerly for the 
 complaint before alluded to, that it dwelt too exclu- 
 
 the purposes of the practitioner, whether he confine* 
 himself more strictly to the operative department, 
 or follows surgery on a more comprehensive scale. 
 Medical Times and Gazette. 
 
 No work was ever written which more nearly 
 comprehended the necessities of the student and 
 practitioner, and was more carefully arranged to 
 1 ' ,._flr. Y. Med. and Svrg. 
 
 that single purpose than this 
 Jovrnal. 
 
 The addition of many new pages makes this work 
 more than ever indispensable to the student and prac- 
 titioner. Ranking's Abstract. 
 
 Among the numerous works upon surgery pub- 
 lished of late years, we know of none we value 
 more highly than the one before us. It is perhaps 
 the very best we have for a text-book and for ordi- 
 nary reference, being concise and eminently practi- 
 cal. Southtrn Med. and Kvrg. Jovrnal. 
 
 FRICK (CHARLES), M. D. 
 
 RENAL AFFECTIONS; their Diagnosis and Pathology. 
 One volume, royal 12mo. 5 extra cloth. 
 
 With illustrations. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 FOWNES (GEORGE), PH. D., &c. 
 ELEMENTARY CHEMISTRY; Theoretical and Practical. With numerous 
 
 illustrations. A new American, from the last and revised London edition. Edited, with Addi- 
 tions, by ROBERT BRIDGES, M. D. In one large royal 12mo. volume, of over 550 pages, with 181 
 wood-cuts, sheep, or extra cloth. (Now Ready.) 
 
 The lamented death of the author has caused the revision of this edition to pass into the hands of 
 loose distinguished chemists, H. Bence Jones and A. W. Hofmann, who have fully sustained its 
 reputation by the additions which they have made, more especially in the portion devoted to Organic 
 Chemistry, considerably increasing the size of the volume. This labor has been so thoroughly 
 performed, that the American Editor has found but little to add, his notes consisting chiefly of such 
 matters as the rapid advance of the science has rendered necessary, or of investigations which had 
 apparently been overlooked by the author's friends. 
 
 The volume is therefore again presented as an exponent of the most advanced state of chemical 
 science, and as not unworthy a continuation of the marked favor which it has received as an ele- 
 mentary text-book. 
 
 We know of no better text-book, especially in the 
 difficult department of organic chemistry, upon 
 which it is particularly full and satisfactory. We 
 would recommend it to preceptors as a capital 
 u office book" for their students who are beginners 
 in Chemistry. It is copiously illustrated with ex- 
 cellent wood-cuts, and altogether admirably " got 
 ap." N. J. Medical Reporter, March, 1654. 
 
 A standard manual, which has long enjoyed the 
 reputation of embodying much knowledere in a small 
 space. The author lias achieved the difficult task of 
 condensation with masterly tact. His book is con- 
 eise without being dry, and brief without being too 
 dogmatical or general. Virginia Med.and Surgical 
 Journal. 
 
 The work of Dr. Fownes has long been before 
 the public, and its merits have been fully appreci- 
 ated as the best text-book on chemistry now in 
 existence. We do not, of course, place it in a rank 
 superior to the works of Brande, Graham, Turner, 
 Gregory, or Gmelin, but we say that, as a work 
 for students, it is preferable to any of them. Lon- 
 don Journal of Medicine. 
 
 A work well adapted to the wants of the student. 
 It is an excellent exposition of the chief doctrines 
 and facts of modern chemistry. The size of the work. 
 and still more the condensed yet perspicuous style 
 in which it is written, absolve it from the charges 
 very properly urged against most manuals termed 
 popular. Edinburgh Monthly Journal of Meiical 
 Science. 
 
 GRAHAM (THOMAS), F. R. S., 
 Professor of Chemistry in University College, London, Ice. 
 
 THE ELEMENTS OF CHEMISTRY. Including the application of the Science 
 
 to the Arts. With numerous illustrations. With Notes and Additions, by ROBERT BRIDGES, 
 M. D., &c. fee. Second American, from the second and enlarged London edition 
 PART I. (Lately Issued) large 8vo., 430 pages, 185 illustrations. 
 PART II. (Preparing) to match. 
 
 The great changes which the science of chemistry has undergone within the l$st few years, ren- 
 der a new edition of a treatise like the present, almost a new work. The author has devoted 
 several years to the revision of his treatise, and has endeavored to embody in it every fact and 
 inference of importance which has been observed and recorded by the great body of chemical 
 investigators who are so rapidly changing the face of the science. In this manner the work has 
 been greatly increased in size, and the number of illustrations doubled ; while the labors of the editor 
 have been directed towards the introduction of such matters as have escaped the attention of the 
 author, or as have arisen since the publication of the first portion of this edition in London, in 1850. 
 Printed in handsome style, and at a very low price, it is therefore confidently presented to the pro- 
 fession and the student as a very complete and thorough text-book of this important subject. 
 
 GROSS (SAMUEL D.), M. D., 
 Professor of Surgery in the Louisville Medical Institute, Sec. 
 
 A PRACTICAL TREATISE ON THE DISEASES AND INJURIES OF 
 
 THE URINARY ORGANS. In one large and beautifully printed octavo volume, of over seven 
 hundred pages. With numerous illustrations. 
 
 A volume replete with truths and principles of the 
 utmost value in the investigation of these diseases. 
 American Medical Journal. 
 
 Dr. Gross has brought all his learning, experi- 
 ence, tact, and judgment to the task, and has pro- 
 duced a work worthy of his high reputation. We 
 feel perfectly safe in recommending it to our read- 
 ers as a monograph unequalled in interest and 
 practical value by any other on the subject in our 
 language. Western Journal of Med. and Snrg. 
 
 It has remained for an American writer to wipe 
 
 this department of art. We have, indeed, unfeigned 
 pleasure in congratulating all concerned in this pub- 
 lication, on the result of their labours; and expe- 
 rience a feeling something like what animates a long- 
 expectant husbandman, who, oftentimes disappointed 
 by the produce of a favorite field, is at last agree- 
 ably surprised by a stately crop which may bear 
 comparison with any of its former rivals. The 
 grounds of our high appreciation of the work will 
 be obvious as we proceed; and we doubt not that. 
 the present facilities for obtaining American books 
 will induce many of our readers to verify our re- 
 
 Britisk 
 
 away this reproach ; and so completely has the task commendation by their own perusal of it. 
 been fulfilled, that we venture to .predict for Dr. \ and Forei gn Medico-Chirurgical Review. 
 Gross's treatise a permanent place in the literature 
 of surgery, worthy to rank with the best works of Whoever will peruse the vast amount of valuable 
 the present age. Not merely is the matter good, practical information it contains, and which we 
 but the getting up of the volume is most creditable have been un.-ible even to notice, will, we think, 
 to transatlantic enterprise; the paper and print agree with us, that there is no work in the English 
 would do credit toa first-rate London establishment ; language which can make any just pretensions to 
 and the numerous wood-cuts which illustrate it, de- be its equal. N. Y. Journal of Medicine. 
 monstrate that America is making rapid advances in i 
 
 BY THE SAME AUTHOR. (In Press.) 
 
 A PRACTICAL TREATISE ON FOREIGN BODIES IN THE AIR-PAS- 
 
 SAGES. In one handsome octavo volume, with illustrations. 
 
 BY THE SAME AUTHOR. (Preparing.) 
 
 A SYSTEM OF SURGERY; Diagnostic, Pathological, Therapeutic, and Opera- 
 
16 
 
 BLANCHARD & LEA'S MEDICAL 
 
 GLUGE (GOTTLIEB), M. D., 
 
 Professor of Physiology and Pathological Anatomy in the University of Brussels, &e. 
 
 AN ATLAS OF PATHOLOGICAL HISTOLOGY. Translated, with Notes 
 
 and Additions, by JOSEPH LEIDY, M. D., Professor of Anatomy in the University of Pennsylva- 
 nia. In one volume, very large imperial quarto, with three hundred and twenty figures, plain 
 and colored, on twelve copperplates. 
 
 This being, as far as we know, the only work in I the unconnected observations of a great namber of 
 which pathological histology is separately treated J authors. The development of the morbid tissues, 
 of in a comprehensive manner, it will, we think, for | and the formation of abnormal products, may now 
 this reason, be of infinite service to those who desire be followed and studied with the same ease and 
 to investigate the subject systematically, and who I satisfaction as the best arranged system of phy- 
 bave felt the difficulty of arranging in their mind | siology. American Med. Journal. 
 
 GRIFFITH (ROBERT E.), M. D., &c. 
 
 A UNIVERSAL FORMULARY, containing the methods of Preparing and Ad- 
 ministering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceu- 
 tists. SECOND EDITION, thoroughly revised, with numerous additions', by ROBERT P. THOMAS, 
 M. D., Professor of Materia Mediea in the Philadelphia College of Pharmacy. In one large and 
 handsome octavo volume, of over six hundred pages, double columns. (Just Ready.) 
 
 The speedy exhaustion of a large edition, and the demand for a second, sufficiently show the posi- 
 tion which this work has so rapidly attained as an authoritative and convenient work of reference for 
 the physician and pharmaceutist. The opportunity thus afforded for its improvement has not been 
 neglected. In its revision, Professor Thomas (to whom this task has been confided in consequence 
 of the death of the author), has spared no labor, in the hope of rendering it the most complete and 
 correct work on the subject as yet presented to the profession AH the newly introduced articles 
 of the Materia Mediea have been inserted, such formulse as had escaped the attention of the author 
 have been added, and the whole has been most carefully read and examined, to insure the absolute 
 oorrectness, so indispensable in a work of this nature. The amount of these additions may be esti- 
 mated from the fact that not only has the page been considerably enlarged, but the volume has also 
 been increased by about fifty pages, while the arrangement of the formulse and the general typo- 
 graphical execution will be found to have undergone great improvement. To the practitioner, its 
 copious collection of all the forms and combinations of the articles of the Pharmacopoeia render it 
 an invaluable book of reference, while its very complete embodiment of officinal preparations of aM 
 kinds, derived from all sources, American, English, and Continental, make it an indispensable assist- 
 lant to the apothecary. 
 
 Dr. Griffith's Formulary is worthy of recommen- 
 dation, not only on account of the care which has 
 been bestowed on it by its estimable author, but for 
 its general accuracy, and the richness of its details. 
 Medical Examiner. 
 
 Most cordially we recommend this Universal 
 Formulary, not forgetting its adaptation to drug- 
 gists and apothecaries, who would find themselves 
 A'astly improved by a familiar acquaintance with 
 this every-day book of medicine. The Boston Med. 
 and Surg. Journal. 
 
 Pre-eminent among the best and most useful com- 
 pilations of the present day will be found the work 
 before us, which can have been produced only at a 
 very great cost of thought and labor. A short de- 
 scription will suffice to show that we do not put 
 too high an estimate on this work. We are not cog- 
 nizant of the existence of a parallel work. Its value 
 will be apparent to our readers from the sketch of 
 its contents above given. We strongly recommend 
 it to all \vho are engaged either in practical medi- 
 cine, or more exclusively with its literature. Lond. 
 Med. Gazette. 
 
 A valuable acquisition to the medical practitioner, 
 and a usefal book of reference to the apothecary OB 
 numerous occasions. Amer. Journal of Pharmacy. 
 
 A very useful work, and a most complete compen- 
 dium on the subject of materia medica. We know 
 of no work in our langruige, or any other, so com- 
 prehensive in all its details. London Lancet. 
 
 
 BY THE SAME AUTHOR. 
 
 MEDICAL BOTANY; or, a Description of all the more important Plants used 
 in Medicine, and of their Properties, Uses, and Modes of Administration. In one large octavo 
 volume, of 704 pages, handsomely printed, with nearly 350 illustrations on wood. 
 
 One of the few hooks which supply a positive de- 
 ive. Western Lancet. 
 
 One of the greatest acquisitions to American medi- 
 cal literature. It should by all means be introduced, 
 at the very earliest period, into our medical schools, 
 and occupy a place in the library of every physician 
 in the land. South-western Medical Advocate. 
 
 Admirably calculated for the physician and stu- 
 dent we have seen no work which promises 
 greater advantages to the profession. N. O. Med. 
 and Surg. Journal. 
 
 ficiency in our medical literature. 
 
 We hope the day is not distant when this work 
 will not only be a text-book in every medical school 
 and college in the Union, but find a place in the li- 
 brary of every private practitioner. N. Y. Journal 
 of Medicine. 
 
 GREGORY (WILLIAM), F. R. S. E., 
 
 Professor of Chemistry in the University of Edinburgh, Ac. 
 
 LETTERS TO A CANDID INQUIRER ON ANIMAL 
 
 Description and Analysis of the Phenomena. Details of Facts and Cases, 
 royal 12mo., extra cloth. 
 
 MAGNETISM. 
 
 In one neat volume, 
 
 GARDNER (D. PEREIRA), M. D. 
 
 MEDICAL CHEMISTRY, for the use of Students and the Profession : being a 
 Manual of the Science, with its Applications to Toxicology, Physiology, Therapeutics, Hygiene, 
 &c. In one handsome royal 12mo. volume, with ill ustra' ions. 
 
 ban 
 
AND SCIENTIFIC PUBLICATIONS. 17 
 
 HASSE (C. E.), M. D. 
 
 AN ANATOMICAL DESCRIPTION OF THE DISEASES OF RESPIRA- 
 TION AND CIRCULATION. Translated and Edited by SWAINE. In one volume, octavo. 
 
 HARRISON (JOHN), M.D. 
 AN ESSAY TOWARDS A CORRECT THEORY OF THE NERVOUS 
 
 SYSTEM. In one octavo volume, 292 pages. 
 
 HUNTER (JOHN). 
 TREATISE ON THE VENEREAL DISEASE. With copious Additions, by 
 
 DR. PH. RICOED, Surgeon to the Venereal Hospital of Paris. Edited, with additional Notes, by 
 F. J. BUMSTEAD, M. D. In one octavo volume, with plates (Now Ready.) ^^ See RICORD. 
 ALSO, HUNTER'S COMPLETE WORKS, with Memoir, Notes, &c. &c. In four neat octavo 
 volumes, with plates. 
 
 HUGHES (H. M.), M. D., 
 
 Assistant Physician to Guy's Hospital, &c. 
 
 A CLINICAL INTRODUCTION TO THE PRACTICE OF AUSCULTA- 
 
 TION, and other Modes of Physical Diagnosis, in Diseases of the Lungs and Heart. Second 
 American from the Second and Improved London Edition. In one royal 12mo. vol. (Just Ready.) 
 It has been carefully revised throughout. Some small portions have been erased ; much has 
 been, I trust, amended; and a great deal of new matter has been added; so that, though funda- 
 mentally it is the same book, it is in many respects a new work. Preface. 
 
 HORNER (WILLIAM E.), M. D., 
 Professor of Anatomy in the University of Pennsylvania. 
 
 SPECIAL ANATOMY AND HISTOLOGY. Eighth edition. Extensively 
 
 revised and modified. In two large octavo volumes, of more than one thousand pages, hand- 
 somely printed, with over three hundred illustrations. 
 
 This work has enjoyed a thorough and laborious revision on the part of the author, with the 
 view of bringing it fully up to the existing state of knowledge on the subject of general and special 
 anatomy. To adapt it more perfectly to the wants of the student, he has introduced a large number 
 of additional wood-engravings, illustrative of the objects described, while the publishers have en- 
 deavored to render the mechanical execution of the work worthy of the extended reputation which 
 it has acquired. The demand which has carried it to an EIGHTH EDITION is a sufficient evi- 
 dence of the value of the work, and of its adaptation to the wants of the student and professional 
 reader. 
 
 HOBLYN (RICHARD D.), A. M. 
 A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE 
 
 COLLATERAL SCIENCES. Second and Improved American Edition. Revised, with nu- 
 merous Additions, from the second London edition, by ISAAC HAYS, M. D., &c. In one large 
 royal 12mo. volume, of over four hundred pages, double columns. (Nearly Ready.) 
 In passing this work a second time through the press, the editor has subjected it to a very tho- 
 rough revision, making such additions as the progress of science has rendered desirable, and sup- 
 plying any omissions that may have previously existed. As a concise and convenient Dictionary 
 of Medical Terms, at an exceedingly low price, it will therefore be found of great value to the stu- 
 dent and practitioner. 
 
 HOPE (J.), M. D., F. R. S., &c. 
 A TREATISE ON THE DISEASES OF THE HEART AND GREAT 
 
 VESSELS. Edited by PENNOCK. In one volume, octavo, with plates, 572 pages. 
 
 HERSCHEL (SIR JOHN F. W.), F. R. S., &c. 
 OUTLINES OF ASTRONOMY. New American, from the third London edition. 
 
 In one neat volume, crown octavo, with six plates and numerous wood-cuts. (Just Issued.) 
 
 HUMBOLDT (ALEXANDER). 
 ASPECTS OF NATURE IN DIFFERENT LANDS AND DIFFERENT 
 
 CLIMATES. Second American edition, one vol. royal 12mo., extra cloth. 
 
 JONES (T. WHARTON), F. R. S., &c. 
 THE PRINCIPLES AND PRACTICE OF OPHTHALMIC MEDICINE 
 
 AND SURGERY. Edited by ISAAC HAYS, M. D., &c. In one very neat volume, large royal 
 12mo., of 529 pages, with four plates, plain or colored, and ninety-eight wood-cuts. 
 The work amply sustains, in every point the al- might become, a manual for daily reference and 
 ready high reputation of the author as an ophthalmic consultation by the student and the general practi- 
 surgeon as well as a physiologist and pathologist, tioner. The work is marked by that correctness. 
 The book is evidently the result of much labor and clearness, and precision of style which distinguish 
 research, and has been written with the greatest all the productions of the learned author. British 
 care and attention. We entertain little doubt that and Foreign Medical Review. 
 this book will become what its author hoped it 
 
18 
 
 BLANCHARD & LEA'S MEDICAL 
 
 JONES (C. HANDFIELD), F. R. S., &, EDWARD H. SIEVEKING, M. D. 
 A MANUAL OF PATHOLOGICAL ANATOMY. With numerous engravings 
 
 ou wood. la oae handsome volume. (Preparing.) 
 
 KIRKES (WILLIAM SENHOUSE), M. D., 
 
 Demonstrator of Morbid Anatomy at St. Bartholomew's Hospital, &c.; and 
 
 JAMES PAGET, F. R. S., 
 
 Lecturer on General Anatomy and Physiology in St. Bartholomew's Hospital. 
 
 A MANUAL OF PHYSIOLOGY. Second American, from the second and 
 
 improved London edition. With one hundred and sixty-five illustration!*, 
 handsome royal 12mo. volume, pp.550. (Just Issued.) 
 
 In one large and 
 
 In the present edition, the Manual of Physiology 
 has been brought up to the actual condition of the 
 science, and fully sustains the reputation which it 
 has already so deservedly attained. We consider 
 the work of MM. Kirkes and Paget to constitute one 
 of the very best handbooks of Physiology we possess 
 presenting just such an outline of the science, com- 
 prising an account of its leading facts and generally 
 admitted principles, as the student requires during 
 his attendance upon a course of lectures, or for re- 
 ference whilst preparing for examination. The text 
 is fully and ably illustrated by a series of very supe- 
 rior wood-engravings, by which a comprehension of 
 some of the more intricate of the subjects treated of 
 is greatly facilitated. Am. Medical Journal . 
 
 We need only say, that, without entering into dis- 
 cussions of unsettled questions, it contains all the 
 recent improvements in this department of medical 
 science. For the student beginning this study, and 
 the practitioner who has but leisure to refresh his 
 memory, this book is invaluable, as it contains all 
 
 that it is important to know, without special details, 
 which are read with interest only by those vrfvo 
 would make a specialty, or desire to possess a criti- 
 cal knowledge of the subject. Charleston Medical 
 Journal . 
 
 One of the best treatises that can be put into the 
 hands of the student. London Medical Gazette. 
 
 The general favor with which the first edition of 
 this work was received, and its adoption as a favor- 
 ite text-book by many of our colleges, will insure- a 
 large circulation to this improved edition. It will 
 fully meet the wants of the student. Southern 
 Med. and Surg. Journal. 
 
 Particularly adapted to those who desire to pos- 
 sess a concise digest of the facts of Human Physi- 
 ology. British and Foreign Med.-Chirurg. Review. 
 
 We conscientiously recommend it as an admira- 
 ble " Handbook of Physiology." London Journal 
 of Medicine. 
 
 KNAPP (F.), PH. D., &c. 
 
 TECHNOLOGY ; or, Chemistry applied to the Arts and to Manufactures. Edited, 
 with numerous Notes and Additions, by Dr. EDMUND RONALDS and Dr. THOMAS RICHARDSON. 
 First American edition, with Notes and Additions, by Prof. WALTER R. JOHNSON. In two hand- 
 some octavo volumes, printed and illustrated in the highest style of art, with about five hundred 
 wood-engravings. 
 
 PHYSIOLOGICAL 
 
 (Preparing.) 
 
 LEHMANN. 
 CHEMISTRY. Translated by GEORGE E. DAY, M. D. 
 
 LEE (ROBERT), M. D., F. R. S., &c. 
 CLINICAL MIDWIFERY; comprising the Histories of Five Hundred and 
 
 Forty-five Cases of Difficult, Preternatural, and Complicated Labor, with Commentaries. From 
 the second London edition. In one royal 12mo. volume, extra cloth, of 238 pages. 
 
 LA ROCHE (R.), M. D., &c. 
 
 PNEUMONIA ; its Supposed Connection, Pathological and Etiological, with Au- 
 tumnal Fever*, including an Inquiry into the Existence and Morbid Agency of Malaria. In one 
 handsome octavo volume, extra cloth, of 500 pages. 
 
 A more simple, clear, and forcible exposition of i the periodical press, and yet in the work before us 
 the groundless nature and dangerous tendency of! he has exhibited an amount of industry Hnd learning, 
 certain pathological and etiological heresies, has j research and ability, beyond what we are accustomed 
 seldom been presented to our notice. N. Y. Journal j to discover in modern medical writers; while his 
 of Medicine and Collateral Science, March, 1854. j own extensive opportunities for observation and 
 
 I experience have been improved by the most laudable 
 
 This work should be carefully studied by Southern diligence, and display a familiarity with the whole 
 physicians, embodying as it does the reflections of j su bject in every aspect, which commands both our 
 an original thinker and close observer on a subject | reg p ec t and confidence. As a corrective of prevalent 
 peculiarly their own. Virginia Med. and Surgical j and mischievous error, sought to be propagated by 
 Journal. j novices and innovators, we could wish that Dr. ta 
 
 The author had prepared us to expect a treatise i Roche's book could be widely read. N. Y. Medical 
 from him, by his brief papers on kindred topics in ! Gazette. 
 
 LONGET (F. A.) 
 
 TREATISE ON PHYSIOLOGY. With numerous Illustrations. Translated 
 from the French by F. G. Smith, M. D., Professor of Institutes of Medicine in the Pennsylvania 
 Medical College. (Preparing.) 
 
AND SCIENTIFIC PUBLICATIONS. 19 
 
 LAWRENCE (W.), F. R. S., Sec. 
 A TREATISE ON DISEASES OF THE EYE. A new edition, edited, 
 
 with numerous additions, and 243 illustrations, by ISAAC HAYS, M. D., Surgeon to Wills Hospi- 
 tal, &c. In one very large and handsome octavo volume, of 950 pages*, strongly bound in leather 
 with raised bands. (Now Ready.) 
 This work is thoroughly revised and brought up to 1854. 
 
 This work is so universally recognized as the standard authority on the subject, that the pub- 
 Kshers in presenting this new edition have only to remark that in its preparation the editor has 
 carefully revised every portion, introducing additions and illustrations wherever the advance of 
 science has rendered them necessary or desirable. In this manner it will be found to con- 
 tain over one hundred pages more than the last edition, while the list of wood-engravings 
 has been increased by sixty-seven figures, besides numerous improved illustrations substituted 
 for such as were deemed imperfect or unsatisfactory. The various important contributions to 
 ophthalmological science, recently made by Dalrymple, Jacob, Walton, Wilde, Cooper, &c., 
 both in the form of separate treatises and contributions to periodicals, have been carefully 
 examined by the editor, and, combined with the results of his own experience, have been 
 freely introduced throughout the volume, rendering it a complete and thorough exponent of 
 the most advanced state of the subject. Among the most important additions may be mentioned 
 a full account of the recent microscopical investigations into the structure and pathology of the 
 eye ; the description of several affections not treated of in the original ; an account of the 
 catoptric investigation of the eye, and of its employment as a means of diagnosis ; a description 
 of recently invented instruments for illuminating the retina, and of some new methods for examin- 
 ing the interior structures of the eye. Very great improvements will likewise be found in the 
 typographical and mechanical execution of the work. 
 
 In a future number we shall notice more at length I octavo pages has enabled both author and editor to 
 this admirable treatise -the safest guide and most do justice" to all the details of this subject, and con- 
 comprehensive work of reference, which is within | dense in this single volume the present state of our 
 the reach of all classes of the profession. Stetho- j knowledge of the whole science in this department, 
 scwe, March, 1854. whereby its practical value cannot be excelled. We 
 
 ! heartily commend it, especially as a book of refe- 
 
 This standard text-book on the department of , rence, indispensable in every medical library. The 
 which it treats, has not been superseded, by any or ' additions of the American editor very greatly en- 
 all of the numerous publications on the subject i hance the value of the work, exhibiting the learning 
 heretofore issued. Nor with the multiplied improve- j and experience of Dr. Hays, in the light in which he 
 ments of Dr. Hays, the American editor, is it at all ought to be held, as a standard authority on all sub- 
 likely that this great work will cease to merit the j jects appertaining to this specialty, to which he has 
 confidence and preference of students or practition- j rendered so many valuable contributions. N. Y. 
 era. Its ample extent nearly one thousand large | Medical Gazette. 
 
 BY THE SAME AUTHOR. 
 
 A TREATISE ON RUPTURES; from the fifth London edition. In one octavo 
 
 volume, sheep, 480 pages. 
 
 LISTON (ROBERT), F. R. S. f &c. 
 LECTURES ON THE OPERATIONS OF SURGERY, and on Diseases and 
 
 Accidents requiring Operations. Edited, with numerous Additions and Alterations, by T. D. 
 MUTTER, M. D. In one large and handsome octavo volume, of 566 pages, with 216 wood-cuts. 
 
 LALLEMAND (M.). 
 
 THE CAUSES, SYMPTOMS, AND TREATMENT OF SPERMATOR- 
 RHOEA. Translated and edited by HENRY J. McDouGAL. In one volume, octavo, 320 pages. 
 Second American edition. (Now Ready.) 
 
 LARDNER (DIONYSIUS), D. C. L., &c. 
 HANDBOOKS OF NATURAL PHILOSOPHY AND ASTRONOMY. 
 
 Revised, with numerous Additions, by the American editor. FIRST COURSE, containing Mecha- 
 nics, Hydrostatics, Hydraulics, Pneumatics, Sound, and Optics. In one large royal 12mo. 
 volume, of 750 pages, with 424 wood-cuts. SECOND COURSE, containing Heat, Electricity, Mag- 
 netism, and Galvanism, one volume, large royal 12mo., of 450 pages, with 250 illustrations. 
 THIRD COURSE ( now ready), containing Meteorology and Astronomy, in one large volume, royal 
 12mo. of nearly eight hundred pages, with thirty-seven plates and two hundred wood-outs. The 
 whole complete in three volumes, of about two thousand large pages, with over one thousand 
 figures on steel and wood. 
 
 The various sciences treated in. this work will be found brought thoroughly up to the latest 
 period. 
 
 The work furnishes a very clear and satisfactory ] factory manner the information they desire. The 
 account of our knowledge in the important depart- | Virginia Med. and Surg. Journal. 
 ment of science of which it treats. Although the 
 
 medical schools of this country do not include the i The present treatise is a most complete digest of 
 study of physics in their course of instruction, yet j all that has been developed in relation to the great 
 no student or practitioner should be ignorant of its j forces of nature, Heat, Magnetism, and Electricity, 
 laws. Besides being of constant application in prac- Their laws are elucidated in a manner both pleasing 
 tice, such knowledge is of inestimable utility in fa- and familiar, and at the same time perfectly intelli- 
 eilitating the study of other branches of science. To! gible to the student. The illustrations are suffi- 
 
 students, then, and to those who, having already en 
 
 ing already 
 ness, arede 
 
 tared upon the active pursuits of business, are desir- 
 ous to sustain and improve their knowledge of the 
 general truths of natural philosophy, we can recom- 
 mend this work as supplying in a clear and satis 
 
 ciently numerous and appropriate, and altogether 
 we can cordially recommend the work as well-de- 
 serving the notice both of the practising physician 
 and the student of medicine. The Med. Examiner. 
 
20 
 
 BLANCHARD & LEA'S MEDICAL 
 
 MEIGS(CHARLES D.), M. D., 
 
 Professor of Obstetrics, &c., in the Jefferson Medical College, Philadelphia. 
 
 WOMAN : HER DISEASES AND THEIR REMEDIES. A Series of Lec- 
 tures to his Class. Third and Improved edition. In one large and beautifully printed octavo 
 volume. (Just Ready. Revised and enlarged to 1854.) 
 
 The gratifying- appreciation of his labors, as evinced by the exhaustion of two large impressions 
 of this work within a few years, has not been lost upon the author, who has endeavored in every 
 way to render it worthy of the favor with which it has been received. The opportunity thus 
 afforded for a second revision has been improved, and the work is now presented as in every way 
 superior to its predecessors, additions and alterations having been made whenever the advance of 
 science has rendered them desirable. The typographical execution of the work will also be found 
 to have undergone a similar improvement and the work is now confidently presented as in every 
 way worthy the position it has acquired as the standard American text-book on the Diseases of 
 Females. 
 
 It contains a vast amount of practical knowledge, 
 
 lined 
 
 by one who has accurately observed and retai 
 the experience of many years, and who tells the re- 
 sult in a free, familiar, and pleasant manner. Dub- 
 lin Quarterly Journal. 
 
 There is an off-hand fervor, a glow, and a warm- 
 heartedness infecting the effort of Dr. Meigs, which 
 is entirely captivating, and which absolutely hur- 
 ries the reader through from beginning to end. Be- 
 sides, the book teems with solid instruction, and 
 it shows the very highest evidence of ability, viz., 
 the clearness with which the information is pre- 
 sented. We know of no better test of one's under- 
 standing a subject than the evidence of the power 
 of lucidly explaining it. The most elementary, as 
 well as the obscurest subjects, under the pencil of 
 Prof. Meigs, are isolated and made to stand out in 
 such bold relief, as to produce distinct impressions 
 upon the mind and memory of the reader. The 
 Charleston Med. Journal. 
 
 Professor Meigs has enlarged and amended this 
 great work, for such it unquestionably is, having 
 passed the ordeal of criticism at home and abroad, 
 but been improved thereby ; for in this new edition 
 the author has introduced real improvements, and 
 increased the value and utility of the book im- 
 measurably. It presents so many novel, bright, 
 and sparkling thoughts; such an exuberance of new 
 ideas on almost every page, that we confess OUF- 
 selves to have become enamored with the book 
 and its author; and cannot withhold our congratu- 
 lations from our Philadelphia confreres, that such a 
 teacher is in their service. AVe regret that our 
 limits will not allow of a more extended notice of 
 thit work, but must content ourselves with thus 
 f commending it as worthy of diligent perusal by 
 physicians as well as students, who are seeking to 
 be thoroughly instructed in the important practical 
 subjects of which it treats. N. Y. Med. Gazette. 
 
 BY THE SAME AUTHOR. 
 
 OBSTETRICS : THE SCIENCE AND THE ART. Second edition, revised 
 
 and improved. With one hundred and thirty-one illustrations. In one beautifully printed octavo 
 volume, of seven hundred and fifty-two large pages. (Lately Published.) 
 
 The rapid demand for a second edition of this work is a sufficient evidence that it has supplied 
 a desideratum of the profession, notwithstanding the numerous treatises on the same subject which 
 have appeared within the last few years. Adopting a system of his own, the author has combined 
 the leading principles of his interesting and difficult subject, with a thorough exposition of its rules 
 of practice, presenting the results of long and extensive experience and of familiar acquaintance 
 with all the modern writers on this department of medicine. As an American Treatise on Mid- 
 wifery, which has at once assumed the position of a classic, it possesses peculiar claims to the at- 
 tention and study of the practitioner and student, while the numerous alterations and revisions 
 which it has undergone in the present edition are shown by the great enlargement of the work, 
 which is not only increased as to the size of the page, but also in the number. Among other addi- 
 tions may be mentioned 
 
 A NEW AND IMPORTANT CHAPTER ON "CHILDBED FEVER." 
 
 BY THE SAME AUTHOR. (Now Ready.) 
 
 A TREATISE ON ACUTE AND CHRONIC DISEASES OF THE NECK 
 
 OF THE UTERUS. With numerous plates, drawn and colored from nature in the highest 
 style of art. In one handsome octavo volume, extra cloth. 
 
 The object of the author in this work has been to present in a small compass the practical results 
 of his long experience in this important and distressing class of diseases. The great changes intro- 
 duced into practice, and the accessions to our knowledge on the subject, within the last few years, 
 resulting from the use of the metroscope, brings within the ordinary practice of every physician 
 numerous cases which were formerly regarded as incurable, and renders of great value "a work like 
 the present combining practical directions for diagnosis and treatment with an ample series of illus- 
 trations, copied accurately from colored drawings made by the author, after nature. No such accu- 
 rate delineations of the pathology of the neck of the uterus have heretofore been given, requiring, 
 as they do the rare combination of physician and artist, and their paramount importance to the 
 physician in whose practice such cases are frequent, is too evident to be dwelt upon, while in 
 artistic execution they are far in advance of anything of the kind as yet produced in this country. 
 
 BY THE SAME AUTHOR. 
 
 OBSERVATIONS ON CERTAIN OF THE DISEASES OF YOUNG 
 
 CHILDREN. In one handsome octavo volume, of 214 pages. 
 
 ' 
 
 BY THE SAME AUTHOR. (Preparing.) 
 
 ON THE NATURE, SIGNS, AND TREATMENT 0$ PUERPERAL 
 
 FEVER. In one handsome octavo volume. 
 
AND SCIENTIFIC P CJBLIC ATIONS. 
 
 21 
 
 MILLER (JAMES), F. R. S. E., 
 
 Professor of Surgery in the University of Edinburgh, &c. 
 
 PRINCIPLES OF SURGERY. Third American, from the second and revised 
 
 Edinburgh edition. Revised, with Addition?, by F. W. SARGENT, M. D., author of " Minor Sur- 
 gery," &c. In one large and very beautiful volume, of seven hundred and fifty-two pages, with 
 two hundred and forty exquisite illustrations on wood. 
 
 The publishers have endeavored to render the present edition of this work, in every point of me- 
 ehanical execution, worthy of its very high reputation, and they confidently present it to the pro- 
 fession as one of the handsomest volumes as yet issued in this country. 
 
 This edition is far superior, both in the abundance | guage. This opinion, deliberately formed after a 
 and quality of its material, to any of the preceding, j careful study of the first edition, we have had no 
 We hope it will be extensively read, and the sound i cause to change on examining the second. This 
 principles which are herein taught treasured up for edition has undergone thorough revision by the au- 
 appliention. The work takes rank with thor ; many expressions have been modified, and a 
 
 _r_ r> it e ni :_. :* *_:_! A~ * mass of new matter introduced. The book is got up 
 
 in the finest style, and is an evidence of the progress 
 of typography in our country. Charleston Medical 
 Journal and Review. 
 
 future 
 
 Watson's Practice of Physic ; it certainly does not 
 fall behind that great \vork in soundness of princi- 
 ple or depth of reasoning and research. No physi- 
 cian who values his reputation, or seeks the interests 
 of his clients, can acquit himself before his God and 
 the world without making himself familiar with the 
 sound and philosophical views developed in the fore- 
 going book. New Orleans Medical and Surgical 
 J 
 
 We recommend it to both student and practitioner, 
 feeling assured that as it now comes to us, it pre- 
 sents the most satisfactory exposition of the modern 
 doctrines of the principles of surgery to be found in 
 any volume in any language. N. Y. Journal of 
 Medicine. 
 
 Tovrnal. 
 
 Without doubt the ablest exposition of the prin- 
 ciples of that branch of the healing art in any lan- 
 
 BY THE SAME AUTHOR. (Now Ready.) 
 
 THE PRACTICE OF SURGERY. Third American from the second Edin- 
 
 burgh edition. Edited, with Additions, by F. W. SARGENT, M. D , one of the Surgeons to Will's 
 
 Hospital, &c. Illustrated by three hundred and nineteen engravings on wood. In one larg>e 
 
 octavo volume, of over seven hundred pages. 
 
 This new edition will be found greatly improved and enlarged, as well by the addition of much 
 new matter as by the introduction of a large and complete series of handsome illustrations. An 
 equal improvement exists in the mechanical execution of the work, rendering it in every respect 
 a companion volume to the "Principles." 
 
 No encomium of ours could add to the popularity By the almost unanimous voice of the profession, 
 of Miller's Surgery. Its reputation in this country his works, both on the principles and practice of 
 is unsurpassed by that of any other work, and, when surgery have been assigned the highest rank. If we 
 
 taken in connection with the author's Principles of 
 Surgery, constitutes a whole, without reference to 
 which no conscientious surgeon would be willing 
 to practice his art. The additions, by Dr. Sargent, 
 have materially enhanced the value of the work. 
 Southern Medical and Surgical Journal. 
 
 It is seldom that two volumes have ever made so 
 profound an impression in so short a time as the 
 " Principles" and the " Practice" of Surgery by 
 Mr. Miller or so richly merited the reputation they 
 have acquired. The author is an eminently sensi- 
 ble, practical, and well-informed man, who knows 
 exactly what he is talking about and exactly how to 
 talk it. Kentucky Medical Recorder. 
 
 The two volumes together form a complete expose 
 of the present state of Surgery, and they ought to be 
 on the. shelves of every surgeon. N. J. Med. Re- 
 porter. 
 
 were limited to but one work on surgery, that on 
 should be Miller's, as we regard it superior to all 
 others. St. Louis Med. and Surg. Journal. 
 
 The author distinguished alike as a practitioner 
 and writer, has in this and his " Principles," pre- 
 sented to the profession one of the most compl etc and 
 reliable systems of Surgery extant. His style of 
 writing is original, impressive, and engaging, ener- 
 getic, concise, and lucid. Few have the faculty of 
 condensing so much in small space, and at the same 
 time so persistently holding the attention; indeed, 
 he appears to make the very process of condensation 
 a means of eliminating attractions. Whether as a 
 text-book for students or a book of reference for 
 practitioners, it cannot be too strongly recommend- 
 ed. Southern Journal of the Medical and Physical 
 Sciences. 
 
 MALGAIGNE (J. F.). 
 
 OPERATIVE SURGERY, based on Normal and Pathological Anatomy. Trans- 
 lated from the French, by FREDERICK BRITTAN, A. B., M. D. With numerous illustrations on 
 wood. In one handsome octavo volume, of nearly six hundred pages. 
 
 We have long been accustomed to refer to it as one 
 of the most valuable text-books in our library. 
 Buffalo Med. and Surg. Journal. 
 
 Certainly one of the best books published on ope- 
 rative surgery. Edinburgh Medical Journal. 
 
 To express in a few words our opinion of Mal- 
 
 gaigne's work, we unhesitatingly pronounce it the 
 
 very best guide in surgical operations that has come 
 
 before the profession in any language. Charleston 
 
 \ Med. and Surg. Journal. 
 
 MOHR (FRANCIS), PH. D., AND REDWOOD (TH EOPHI LUS). 
 
 PRACTICAL PHARMACY. Comprising the Arrangements, Apparatus, and 
 Manipulations of the Pharmaceutical Shop and Laboratory. Edited, with extensive Additions, 
 by Prof. WILLIAM PROCTER, of the Philadelphia College of Pharmacy. In one handsomely 
 printed octavo volume, of 570 pages, with over 500 engravings on wood. 
 It is a book, however, which will be in the hands 
 of almost everyone who is much interested in phar- 
 maceutical operations, as we know of no other pub- 
 
 lication so well calculated to fill a void long felt. 
 Medical Examiner. 
 
 The book is strictly practical, and describes only 
 manipulations or methods of performing the nume- 
 rous processes the pharmaceutist has to go through, 
 hi the preparation and manufacture of medicines, 
 together with all the apparatus and fixtures neces- 
 
 sary thereto. On these matters, this work is very 
 full and complete, and details, in a style uncom- 
 monly clear and lucid, not only the more compli- 
 cated and difficult processes, but those not less im- 
 portant oneg, the most simple and common. Buffalo 
 Medical Journal. 
 
 The country practitioner who is obliged to dis- 
 pense his own medicines, will find it a most valuable 
 assistant. Monthly Journal and Retrospect. 
 
22 BLANCHARD & LEA'S MEDICAL 
 
 MACLISE (JOSEPH), SURGEON. 
 
 SURGICAL ANATOMY. Forming one volume, very large imperial quarto. 
 With sixty-eight large and splendid Plates, drawn in the best style and beautifully colored. Con- 
 taining one hundred and ninety Figures, many of them the size of life. Together with copious 
 and explanatory letter-press. Strongly and handsomely bound in extra cloth, being one of the 
 cheapest and best executed Surgical works as yet issued in this country. 
 
 Copies can be sent by mail, in five parts, done up in stout covers. 
 
 This great work being now concluded, the publishers confidently present it to the attention of the 
 profession as worthy in every respect of their approbation and patronage. No complete work of 
 the kind has yet been published in the English language, and it therefore will supply a want long 
 felt in this country of an accurate and comprehensive Atlas of Surgical Anatomy to which the 
 student and practitioner can at all times refer, to ascertain the exact relative position of the various 
 portions of the human frame towards each other and to the surface, as well as their abnormal de- 
 viations. The importance of such a work to the student in the absence of anatomical material, and 
 to the practitioner when about attempting an operation, is evident, while the price of the book, not- 
 withstanding the large size, beauty, and finish of the very numerous illustrations, is so low as to 
 place it within the reach of every member of the profession. The publishers therefore confidently 
 anticipate a very extended circulation for this magnificent work. 
 
 One of the greatest artistic triumphs of the age 
 in Surgical Anatomy. British American Medical 
 Journal. 
 
 Too much cannot be said in its praise; indeed, 
 we have not language to do it justice. Ohio Medi- 
 cal and Surgical Journal. 
 
 The most admirable surgical atlas we have seen. 
 
 of keeping up his anatomical knowledge. Medieal 
 Times. 
 
 The mechanical execution cannot be excelled. 
 Transylvania Medical Journal. 
 
 A work which has no parallel in point of acen- 
 racy and cheapness in the English language. N. Y. 
 Journal of Medicine. 
 
 To the practitioner deprived of demonstrative dis- 
 
 eections upon the human subject, it is an invaluable To a11 engaged in the study or practice of their 
 
 companion. N. J. Medical Reporter. I profession, such a work is almost indispensable. 
 
 ,, _,...,,, I Dubltn Quarterly Medical Journal. 
 
 The most accurately engraved and beautifully 
 colored plates we have ever seen in an American I No practitioner whose means will admit should 
 
 book one of the best and cheapest surgical works 
 
 ever published. Buffalo Medical Journal. 
 
 Country practitioners will find these plates of im- 
 
 It is very rare that so elegantly printed, so well 
 illustrated, and so useful a work, is offered at so 
 moderate a price. Charleston Medical Journal. 
 
 fail to possess it. Ranking's Abstract. 
 
 mense value. N. Y. Medical Gazette. 
 We are extremely gratified to announce to the 
 
 ! profession the completion of this truly magnificent 
 Its plates can boast a superiority which places I work w hich, as a whole, certainly stands unri- 
 thern almost beyond the reach of competition. Medi- va n e d, both for accuracy of drawing, beauty of 
 cat examiner. coloring, and all the requisite explanations of the 
 
 Every practitioner, we think, should have a work | subject in hand. The New Orleans Medical and 
 
 of this kind within reach. Southern Medical and 
 
 Surgical Journal. 
 
 This is by far the ablest work on Surgical Ana- 
 
 Wosuch lithographic illustrations of surgical re- tomy that has come under our observation. We 
 gions have hitherto, we think, been given. Boston kno ( v of no other wor k that would justify a stu- 
 Medical and Surgical Journal. \ dent> in any degree5 for neglect of actual diggec . 
 
 As a surgical anatomist, Mr. Maclise has proba- ! tion - ln those sudden emergencies that so often 
 
 taneous command 
 
 bly no superior. British and Foreign Medico-Chi- 
 rurgical Review. 
 
 arise > and which re q u , ire th f instantaneous command 
 of minute anatomical knowledge, a work of this kind 
 keeps the details of the dissecting-room perpetually 
 fresh in the memoi 
 cine and Surgery. 
 
 The very low price at which this work is furnished, and the beauty of its execution, 
 require an extended sale to compensate the publishers for the heavy expenses incurred. 
 
 Of great value to the student engaged in dissect- I fres'hin the memory. The Western Journal of Medi- 
 ing, and to the surgeon at a distance from the means I cin 
 
 MULLER (PROFESSOR J.), M.D. 
 PRINCIPLES OF PHYSICS AND METEOROLOGY. Edited, with Addi- 
 
 tions, by R. EGLESFELD GRIFFITH, M. D. In one large and handsome octavo volume, extra 
 doth, with 550 wood-cuts, and two colored plates. 
 
 The Physics of Mailer is a work superb, complete. I tion to the scientific records of this country may be 
 unique: thegreatest want known to English Science ( duly estimated by the fact that the cost of the origi- 
 could not have been better supplied. The work is I nal drawings and engravings alone has exceeded the 
 of surpassing interest. The value of this contribu- | sum of 2,000. Lancet. 
 
 MAYNE (JOHN), M. D., M. R. C. S., 
 A DISPENSATORY AND THERAPEUTICAL REMEMBRANCER. Com- 
 
 prising the entire lists of Materia Medica, with every Practical Formula contained in the three 
 British Pharmacopoeias. With relative Tables subjoined, illustrating, by upwards of six hundred 
 and sixty examples, the Extemporaneous Forms and Combinations suitable for the different 
 Medicines. Edited, with the addition of the Formulae of the United States Pharmacopoeia, by 
 R. EGLESFELD GRIFFITH, M. D. In one 12mo. volume, extra cloth, of over 300 large pages. 
 
 MATTEUCCI (CARLO). 
 LECTURES ON THE PHYSICAL PHENOMENA OF LIVING BEINGS. 
 
 Edited by J. PEREIRA, M. D. In one neat royal 12mo. volume, extra cloth, with cuts, 388 pages. 
 
AND SCIENTIFIC PUBLICATIONS. 23 
 
 , f 
 
 NEILL (JOHN), M. D., 
 
 Surgeon to the Pennsylvania Hospital, &c.; and 
 FRANCIS GURNEY SMITH, M.D., 
 
 Professor of Institutes of Medicine in the Pennsylvania Medical College. 
 
 AN ANALYTICAL COMPENDIUM OF THE VARIOUS BRANCHES 
 
 OF MEDICAL SCIENCE ; for the Use and Examination of Students. Second edition, revised 
 and improved. In one very large and handsomely printed royal 12mo. volume, of over one 
 thousand pages, with three hundred and fifty illustrations on wood. Strongly bound in leather, 
 with raised bands. 
 
 The speedy sale of a large impression of this work has afforded to the authors gratifying evidence 
 of the correctness of the views which actuated them in its preparation. In meeting the demand 
 for a second edition, they have therefore been desirous to render it more worthy of the favor with 
 which it has been received. To accomplish this, they have spared neither time nor labor in embo- 
 dying in it such discoveries and improvements as have been made since its first appearance, and 
 such alterations as have been suggested by its practical use in the class and examination-room. 
 Considerable modifications have thus been introduced throughout all the departments treated of in 
 tlie volume, but more especially in the portion devoted to the "Practice of Medicine," which has 
 been entirely rearranged and rewritten. The authors therefore again submit their work to the 
 jwofession, with the hope that their efforts may tend, however humbly, to advance the great cause 
 of medical education. 
 
 Notwithstanding the enlarged size and improved execution of this work, the price has not been 
 increased, and it is confidently presented as one of the cheapest volumes now before the profession. 
 
 In the rapid course of lectures, where work for 
 Ihe students is heavy, and review necessary for an 
 examination, a compend is not only valuable, but 
 it is almost a sine qua non. The one before us is, 
 in most of the divisions, the most unexceptionable 
 of all books of the kind that we know of. The 
 newest and soundest doctrines and the latest im- 
 provements and discoveries are explicitly, though 
 concisely, laid before the student. Of course it is 
 useless for us to recommend it to all last course 
 students, but there is a class to whom we very 
 sincerely commend this cheap book as worth its 
 weight in silver that class is the graduates in 
 medicine of more than ten years' standing, who 
 have not studied medicine since. They will perhaps 
 find out from it that the science is not exactly now 
 what it was when they left it off. The Stethoscope 
 
 Having made free use of this volume in our ex- 
 aminations of pupils, we can speak from experi- 
 ence in recommending it as an admirable compend 
 for students, and as especially useful to preceptors 
 who examine their pupils. It will save the teacher 
 much labor by enabling him readily to recall all of 
 the points upon which his pupils should be ex- 
 amined. A work of this sort should be in the hand* 
 of every one who takes pupils into his office with a 
 view of examining them; and this is unquestionably 
 the best of its class. Let every practitioner who has 
 pupils provide himself with it, and he will find the 
 labor of refreshing his knowledge so much facilitated 
 that he will be able to do justice to his pupils at very 
 little cost of time or trouble to himself. Transyl- 
 vania Med. Journal. 
 
 NELIGAN (J. MOORE), M. D., M. R. I. A., &c. 
 A PRACTICAL TREATISE ON DISEASES OF THE SKIN. In one 
 
 neat royal 12mo. volume, of 334 pages. 
 
 OWEN (PROF. R). 
 ON THE DIFFERENT FORMS OF THE SKELETON. One vol. royal 
 
 12mo., with numerous illustrations. (Preparing.) 
 
 POPULAR PHYSIOLOGY. 
 THE PHYSIOLOGY OF ANIMAL AND VEGETABLE LIFE. In one 
 
 neat royal 12mo. volume, of about 200 pages, with 100 wood-cuts. (Just Ready.) 
 The latest information on physiological subjects will be found in this work, popularly and clearly 
 explained, rendering it suitable for schools and school libraries, as well as for private readers. 
 
 PHILLIPS (BENJAMIN), F. R. S., &c. 
 
 SCROFULA; its Nature, its Prevalence, its Causes, and the Principles of its 
 Treatment. In one volume, octavo, with a plate. 
 
 PANCOAST (J.), M. D. f 
 Professor of Anatomy in the Jefferson Medical College, Philadelphia, &c. 
 
 OPERATIVE SURGERY; or, A Description and Demonstration of the various 
 Processes of the Art ; including all the New Operations, and exhibiting the Slate of Surgical 
 Science in its present advanced condition. Complete in one royal 4to. volume, of 380 pages of 
 letter-press description and eighty large 4to. plates, comprising 486 illustrations. Second edition, 
 improved. 
 
 Blanchard & Lea having become the publishers of this important book, have much pleasure in 
 offering it to the profession. 
 
 This excellent work is constructed on the model 
 of the French Surgical Works by Velpeau and Mal- 
 gaigne; and, so far as the English language is con- 
 
 cerned, we are proud as an American to say that, 
 
 01 ITS KIND IT HAS NO SUPERIOR. A'. Y. Jovmal of 
 
 Medicine. 
 
 PARKER (LANGSTON)., 
 
 Surgeon to the Queen's Hospital, Birmingham. 
 
 THE MODERN TREATMENT OF SYPHILITIC DISEASES, BOTH PRI- 
 MARY AND SECONDARY; comprising the Treatment of Constitutional and Confirmed Syphi- 
 lis, by a safe and successful method. With numerous Cases, Formulee, and Clinical Observa- 
 tions. From the Third and entirely rewritten London edition. In one neat octavo volume. 
 (Nearly Ready .) 
 
 : \ 1( . 8911 
 
24 
 
 BLANCHARD & LEA'S MEDICAL 
 
 (Now Complete.) 
 
 PEREIRA (JONATHAN), M. D., F. R. S., AND L. S. 
 THE ELEMENTS OF MATERIA MEDICA AND THERAPEUTICS. 
 
 Third American edition, enlarged and improved by the author; including Notices of most of the 
 Medicinal Substances in use in the civilized world, and forming an Encyclopaedia of Materia 
 Medica. Edited, with Additions, by JOSEPH CARSON, M. D., Professor of Materia Medica and 
 Pharmacy in the University of Pennsylvania. In two very large octavo volumes of 2100 pages, 
 on small "type, with over four hundred and fifty illustrations. 
 VOLUME I. Lately issued, containing the Inorganic Materia Medica, over 800 pages, with 145 
 
 illustrations. 
 
 VOLUME II. Now ready, embraces the Organic Materia Medica, and forms a very large octavo 
 volume of 1250 pages, with two plates and three hundred handsome wood-cuts. 
 The present edition of this valuable and standard work will enhance m every respect its well- 
 deserved reputation. The care bestowed upon its revision by the author may be estimated by the 
 fact that its size has been increased by about five hundred pages. These additions have extended 
 to every portion of the work, and embrace not only the materials afforded by the recent editions of 
 the pharmacopoeias, but also all the important information accessible to the care and industry of 
 the author m treatises, essays, memoirs, monographs, and from correspondents in various parts of 
 the globe. In this manner the work comprises the most recent and reliable information respecting 
 all the articles of the Materia Medica, their natural and commercial history, chemical and thera- 
 peutical properties, preparation, uses, doses, and modes of administration, brought up to the present 
 time, with a completeness not to be met with elsewhere. A considerable portion of the work 
 which preceded the remainder in London, has also enjoyed the advantage of a further revision by 
 the author expressly for this country, and in addition to this the editor, Professor Carson, has made 
 whatever additions appeared desirable to adapt it thoroughly to the U S. Pharmacopoeia, and to 
 the wants of the American profession. An equal improvement will likewise be observable in every 
 department of its mechanical execution. It is printed from new type, on good white paper, with a 
 greatly extended and improved series of illustrations. 
 
 Gentlemen who have the first volume are recommended to complete their copies without delay. 
 The first volume will no longer be sold separate. 
 
 When we remember that Philology, Natural His- [ Medica. although completed under the supervision of 
 tory, Botany, Chemistry, Physics, and the Micro- | others, is by fur the most elaborate treatise in the 
 scope, are all brought forward to elucidate the sub- English language, and will 1 , While medical literature 
 ject, one cannot fail to see that the reader has here I is cherished, continue a monument alike honorable 
 a work worthy of the name of an encyclopedia of j to his genius, as to his learning and industry. 
 
 Materia Medica. Our own opinion of its merits is 
 that of its editors, and also that of the \yhole profes- 
 sion, both of this and foreign countries namely, 
 " that in copiousness of details, in extent, variety, 
 and accuracy of information, and in lucid explana- 
 tion of difficult and recondite subjects, it surpasses 
 all other works on Materia Medica hitherto pub- 
 lished." We cannot close this notice without allud- 
 ing to the special additions of the American editor, 
 which pertain to the prominent vegetable produc- 
 tions of this country, and to the directions of the 
 
 United States Pharmacopoeia, in connection with all 
 the articles contained in the volume which are re- 
 ferred to by it. The illustrations have been increased, 
 and this edition by Dr. Carson cannot well be re- 
 garded in any other light than that of a treasure 
 
 American Journal of Pharmacy, March, 1854. 
 
 The work, in its present shape, and so far as can 
 be judged from the portion before the public, forms 
 the most comprehensive and complete treatise on 
 materia medica extant in the English language. 
 Dr. Pereira has been at great pains to introduce 
 into his work, not only all the information on the 
 natural, chemical, and commercial history of medi- 
 cines, which might be serviceable to the physician 
 and surgeon, but whatever might enable his read- 
 
 ers to understand thoroughly the mode of prepar- 
 ing and manufacturing various articles employed 
 either for preparing medicines, or for certain pur- 
 poses in the arts connected with materia mediea 
 and the practice of medicine. The accounts of the 
 
 which should be found in the library of every physi- ! physiological and therapeutic effects of remedies are 
 cian.-New York Journal of Medical and Collateral \ given with great clearness and accuracy, and m a 
 
 Science, March, 1854. 
 The third edition of his "Elements of Materia 
 
 manner calculated to interest as well as instruct 
 the reader. The Edinburgh Medical and Surgical 
 Journal. 
 
 PEASELEE (E. R.), M. D. 
 
 Professor of Anatomy and Physiology in Dartmouth College, &c. 
 
 HUMAN HISTOLOGY, in its applications to Physiology and General Pathology, 
 designed as a Text-Book for Medical Students. With numerous illustrations. In one handsome 
 royal 12mo. volume. (Preparing:) 
 
 The subject of this work is one, the growing importance of which, as the basis of Anatomy and 
 Physiology, demands for it a separate volume. The book will therefore supply an acknowledged 
 deficiency in medical text-books, while the name of the author, and his experience as a teacher for 
 the last thirteen years, is a guarantee that it will be thoroughly adapted to the use of the student. 
 
 
 
 PIRRIE (WILLIAM), F. R. S. E., 
 Professor of Surgery in the University of Aberdeen. 
 
 THE PRINCIPLES AND PRACTICE OF SURGERY. Edited by JOHN 
 
 NEILL, M. D., Demonstrator of Anatomy in the University of Pennsylvania, Surgeon to the 
 Pennsylvania Hospital, &c. In one very handsome octavo volume, of 780 pages, with 316 illus- 
 trations. (Just Issued.) 
 
 We know of no other surgical work of a reason- 
 able size, wherein there is so much theory and prac- 
 tice, or where subjects are more soundly or clearly 
 taught. The Stethoscope. 
 
 There is scarcely a disease of the bone or goft 
 parts, fracture, or dislocation, that is not illustrated 
 by accurate wood-engravings. Then, again, every 
 instrument employed by the surgeon is thus repre- 
 sented. These engravings are not only correct, but 
 really beautiful, showing the astonishing degree of 
 perfection to which the art of wood- engraving baa 
 
 arrived. Prof. Pirrie, in the work before us, has 
 elaborately discussed the principles of surgery, and 
 a safe and effectual practice predicated upon them. 
 Perhaps no work upon this subject heretofore issued 
 is so full upon the science of the art of surgery. 
 Nashville Journal of Medicine and Surgery. 
 
 One of the best treatises on surgery in the English 
 language. Canada Med. Journal. 
 
 Our impression is, that, as a manual for students, 
 Pirrie's is the best work extant. Western Med. and 
 Surg. Journal. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 25 
 
 RAMSBOTHAM (FRANCIS H.), M.D. 
 THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND 
 
 SURGERY, in reference to the Process of Parturition. Sixth American, from the last London 
 edition. Illustrated with one hundred and forty-eight Figures, on fifty-five Lithographic Plates. 
 In one large and handsomely printed volume, imperial octavo, with 520 pages. 
 In this edition, the plates have all been redrawn, and the text carefully read and corrected. It 
 is therefore presented as in every way worthy the favor with which it has so long been received. 
 
 From Prof. Hodge, of the University of Pa. 
 
 To the American public, it is most valuable, from its intrinsic undoubted excellence ? and as being 
 the best authorized exponent of British Midwifery. Its circulation will, I trust, be extensive throughout 
 our country. 
 
 When the whole profession is thus unanimous 
 in placing such a work in the very first rank as 
 regards the extent and correctness of all the details 
 
 We recommend the student who desires to mas- 
 ter this difficult subject with the least possible 
 trouble, to possess himself at once of a copy of this 
 work. American Journal of the Med. Sciences. 
 
 It stands at the head of the long list of excellent 
 obstetric works published in the last few years in 
 Great Britain, Ireland, and the Continent of Eu- 
 rope. We consider this book indispensable to the 
 library of every physician engaged in the practice 
 of midwifery. Southern Med. and Surg. Journal. 
 
 of the theory and practice of so important a branch 
 of learning, our commendation or condemnation 
 would be of little consequence; but regarding it 
 as the most useful of all works of the kind, we 
 think it but an act of justice to urge its claims 
 upon the profession. N. O. Med. Journal. 
 
 RICORD (P.), M. D., 
 Surgeon to the Hopital du Midi, Paris, &c. 
 
 ILLUSTRATIONS OF SYPHILITIC DISEASE. Translated from the French, 
 
 by THOMAS F. BETTON, M. D. "With the addition of a History of Syphilis, and a complete Bib- 
 liography and Formulary of Remedies, collated and arranged, by PAUL B. GODDAHD, M. D. "With 
 fifty large quarto plates, comprising one hundred and seventeen beautifully colored illustrations. 
 In one large and handsome quarto volume. 
 
 Blanchard & Lea having purchased the remainder of this valuable work, which was originally 
 soid as a subscription book, are now prepared to offer it to the profession. It is universally known 
 as one of the handsomest volumes as yet presented in this country, and as containing the only ex- 
 tended and thorough series of illustrations on the subject. 
 
 BY THE SAME AUTHOR. (Now Ready.} 
 
 A TREATISE ON THE VENEREAL DISEASE. By JOHN HUNTER, F. R. S. 
 
 With copious Additions, by PH. RICORD, M. D. Edited, with Notes, by FREEMAN J. BUMSTEAD, 
 M. D. In one handsome octavo volume, with plates. 
 
 From the Translator's Preface. 
 
 " M. Ricord's annotations to Hunter's Treatise on the Venereal Disease were first published at 
 Paris, in 1840, in connection with Dr. G. Richelot's translation of the work, including the contri- 
 butions of Sir Everard Home and Mr. Babington. In a second edition, which has recently ap- 
 peared, M. Ricord has thoroughly revised his part of the work, bringing it up to the knowledge of 
 the present day, and so materially increasing it that it now constitutes full one-third of the volume. 
 
 " This publication has been received with great favor by the French, both because it has placed 
 within their reach an important work of Hunter, and also because it is the only recent practical 
 work which M. Ricord has published, no edition of his Traite des Maladies Vcntriennes having 
 appeared for the last fifteen years." 
 
 In the notes to Hunter, the master substitutes him- 
 self for his interpreters, and give? his original thoughts 
 to the world, in a summary form it is true, but in a 
 lucid and perfectly intelligible manner. In conclu- 
 sion \ve can say that this is incontestably the best 
 treatise on syphilis with which we are acquainted, 
 and, as we do not often employ the phrase, we may 
 be excused for expressing the hope that it may find 
 a place in the library of every physician Virginia 
 Med. and Surg Journal. 
 
 Every one will recognize the attractiveness and 
 value which this work derives from thus presenting 
 the opinions of these two masters side by side. But, 
 it must be admitted, what has made the fortune of 
 the book, is the fact that it contains the ''most com- 
 plete embodiment of the veritable doctrines of the 
 Hopital du Midi," which hns ever been made public. 
 The doctrinal ideas of M. Ricord, ideas which, if not 
 universally adopted, are inconlestably dominant, have 
 heretofore only been interpreted by moreor lessskilful 
 secretaries, sometimes accredited and sometimes not. 
 
 BY THE SAME AUTHOR. 
 
 LETTERS ON SYPHILIS, addressed to the Chief Editor of the Union Medicale. 
 
 With an Introduction, by Amedee Latour. Translated by \V. P. Lattimore, M. D. In one neat 
 octavo volume. 
 
 Blanchard & Lea are now the publishers of this valuable work. 
 
 From the Translator's Preface. 
 
 To those who have listened to the able and interesting lectures of our author at the Hopital du 
 Midi, this volume will need no commendation; while to those who have not had the pleasure to 
 which we allude, the book will commend itself by the truths it contains, told as they are in the 
 game inimitable style in which M. Ricord delivers his clinical lectures. 
 
 BY THE SAME AUTHOR. 
 
 A PRACTICAL TREATISE ON VENEREAL DISEASES. With a Then* 
 
 peutical Summary and Special Formulary. Translated by SIDNEY UOANE, M. D. Fourth edition. 
 One volume, octavo, 340 pages. 
 
 - 
 
26 
 
 BLANCHARD & LEA'S MEDICAL 
 
 HT 
 
 .; _ ,_..._^i RIGBY (EDWARD), M. D., 
 
 Physician to the General Lying-in Hospital, &c. 
 
 A SYSTEM OF MIDWIFERY. With Notes and Additional Illustrations. 
 
 Second American Edition. One volume octavo, 422 pages. 
 
 ROYLE (J. FORBES), M. D. 
 MATERIA MEDIC A AND THERAPEUTICS; including the Preparations of 
 
 the Pharmacopoeias of London, Edinburgh, Dublin, and of the United States. With many new 
 medicines. Edited by JOSEPH CARSON, M. D., Professor of Materia Medica and Pharmacy in 
 the University of Pennsylvania. With ninety-eight illustrations. In one large octavo volume, 
 of about seven hundred pages. 
 
 ductions on the other extreme, which are nees 
 
 This work is, indeed, a most valuable one, and 
 will fill up an important vacancy that existed be- 
 tween Dr. Pereira's most learned and complete 
 system of Materia Medica, and the class of pro- 
 
 sarily imperfect from their small extent. British 
 and Foreign Medical Review. 
 
 SKEY (FREDERICK C.), F. R. S., &c. 
 OPERATIVE SURGERY. In one very handsome octavo volume of over 650 
 
 pages, with about one hundred wood-cuts. 
 
 Its literary execution is superior to most surgical 
 treatises. It abounds in excellent moral hints, and 
 is replete with original surgical expedients and sug- 
 geetions. Buffalo Med. and Surg. Journal. 
 
 With high talents, extensive practice, and a long 
 experience, Mr. Skey is perhaps competent to the 
 task of writing a complete work on operative sur- 
 gery. Charleston Med. Journal. 
 
 We cannot withhold from this work our high com- 
 rrendition. Students and practitioners will find it an 
 invaluable teacher and guide upon every topic con- 
 nected with this department. N. Y. Medical Ga- 
 zette. 
 
 A work of the very highest importance a work 
 by itself. London Med. Gazette. 
 
 SHARPEY (WILLIAM), M. D., JONES QUAIN, M. D., AND 
 RICHARD QUAIN, F. R. S., &c. 
 
 HUMAN ANATOMY. Revised, with Notes and Additions, by JOSEPH LEIDY, 
 
 M. D. Complete in two large octavo volumes, of about thirteen hundred pages. Beautifully 
 illustrated with over five hundred engravings on wood. 
 
 It is indeed a work calculated to make an era in 
 anatomical study, by placing before the student 
 every department of his science, with a view to 
 the relative importance of each ; and so skilfully 
 have the different parts been interwoven, that no 
 one who makes this work the basis of his studies, 
 will hereafter have any excuse for neglecting or 
 undervaluing any important particulars connected 
 with the structure of the human frame; and 
 
 whether the bias of his mind lead him in a more The most comple te Treatise on Anatomy in the 
 especial manner to surgery, physic, or physiology, English language. Edinburgh Medical Journal. 
 he will find here a work at once so comprehensive I 
 
 and practical as to defend him from exclusiveness \ There is no work in the English language to be 
 on the one hand, and pedantry on the other. preferred to Dr. Quain's Elements of Anatomy. 
 Monthly Journal and Retrospect of the Medical London Journal of Medicine . 
 Sciences. 
 
 We have no hesitation in recommending this trea- 
 tise on anatomy as the most complete on that sub- 
 ject in the English language; and the only one, 
 perhaps, in any language, which brings the. state 
 of knowledge forward to the most recent disO- 
 veries. The Edinburgh Med. and Surg. Journal. 
 
 Admirably calculated to fulfil the object for which 
 it is intended. Provincial Medical Journal. 
 
 SMITH (HENRY H.), M. D., AND HORNER (WILLIAM E.), M. D. 
 AN ANATOMICAL ATLAS, illustrative of the Structure of the Human Body. 
 
 In. one volume, large imperial octavo, with about six hundred and fifty beautiful figures. 
 
 late the student upon the completion of this Atlas, 
 as it is the most convenient work of the kind that 
 has yet appeared ; and we must add, the very beau- 
 tiful manner in which it is "got up'' is so creditable 
 to the country as to be flattering to our national 
 pride. American Medical Journal. 
 
 These figures are well selected, and present a 
 complete and accurate representation of that won- 
 derful fabric, the human body. The plan of this 
 Atlas, which renders it so peculiarly convenient 
 for the student, and its superb artistical execution, 
 have been already pointed out. We must congratu- 
 
 SARGENT (F. W.), M. D. 
 ON BANDAGING AND OTHER POINTS OF MINOR SURGERY. In 
 
 one handsome royal 12mo. volume of nearly 400 pages, with 128 wood-cuts. 
 
 The very best manual of Minor Surgery we have | We have carefully examined this work, and find it 
 seen; an American volume, with nearly four hundred well executed and admirably adapted to the use of 
 
 pages of good practical lessons, illustrated by about 
 one hundred and thirty wood-cuts. In these days 
 of " trial," when a doctor's reputation hangs upon 
 a clove hitch, or the roll of a bandage, it would be 
 well, perhaps, to carry such a volume as Mr. Sar- 
 gent's always in our coat-pocket, or, at all events, 
 to listen attentively to his instructions at home. 
 Buffalo Med. Journal. 
 
 the student. Besides the subjects usually embraeed 
 in works on Minor Surgery, there is a short chapter 
 on bathing, another oh anaesthetic agents, and an 
 appendix of formulae. The author has given an ex- 
 cellent work on this subject, and his publishers hare 
 illustrated and printed it in most beautiful style- 
 The Charleston Medical Journal. 
 
 A TREATISE ON 
 
 extra cloth, 286 pages. 
 
 STANLEY (EDWARD). 
 DISEASES OF THE BONES. 
 
 In one volume, octavo, 
 
AND SCIENTIFIC PUBLICATIONS. 27 
 
 STILLE (ALFRED), M. D. 
 PRINCIPLES OF THERAPEUTICS. In one handsome volume. (Preparing.) 
 
 SIMON (JOHN), F. R. S. 
 GENERAL PATHOLOGY, as conducive to the Establishment of Rational 
 
 Principles for the Prevention and Cure of Disease. A Course of Lectures delivered at St. 
 Thomas's Hospital during the summer Session of 1850. In one neat octavo volume. (Lately 
 Issued.} 
 
 SMITH (TYLER W.), M. D., 
 
 Lecturer on Obstetrics in the Hunterian School of Medicine. 
 
 ON PARTURITION, AND THE PRINCIPLES AND PRACTICE OF 
 
 OBSTETRICS. In one large duodecimo volume, of 400 pages. 
 
 SIBSON (FRANCIS), M.D. 
 
 Physician to St. Mary's Hospital. 
 
 
 MEDICAL ANATOMY. Illustrating the Form, Structure, and Position of the 
 
 Internal Organs in Health and Disease. In large imperial quarto, with splendid colored plates. 
 To match "Maclise's Surgical Anatomy." (Preparing.) 
 
 SOLLY (SAMUEL), F. R. S. 
 THE HUMAN BRAIN; its Structure, Physiology, and Diseases. With a 
 
 Description of the Typical Forms of the Brain in the Animal Kingdom. From the Second and 
 much enlarged London edition. In one octavo volume, with 120 wood-cuts. 
 
 SCHOEDLER (FRIEDRICH), PH.D., 
 
 Professor of the Natural Sciences at Worms, &c. 
 
 THE BOOK OF NATURE; an Elementary Introduction to the Sciences of 
 Physics, Astronomy, Chemistry, Mineralogy, Geology, Botany, Zoology, and Physiology. First 
 American edition, with a Glossary and other Additions and Improvements; from the second 
 English edition. Translated from the sixth German edition, by HENRY MEDLOCK, F. C. S., &c. 
 In one thick volume, small octavo, of about seven hundred pages, with 679 illustrations on wood. 
 Suitable for the higher Schools and private students. (Now Ready.) 
 
 This volume, as its title shows, covers nearly all 
 the sciences, and embodies a vast amount of informa- 
 tion for instruction. No other work that we have 
 
 seen presents the reader with so wide a range of ele- 
 mentary knowledge, with so full illustrations, at o 
 cheap a rate. Silliman's Journal, Nov. 1853. 
 
 TAYLOR (ALFRED S.), M. D., F. R. S., 
 
 Lecturer on Medical Jurisprudence and Chemistry in Guy's Hospital. 
 
 MEDICAL JURISPRUDENCE. Third American, from the fourth and improved 
 
 English Edition. With Notes and References to American Decisions, by EDWARD HARTSHORNE, 
 M. D. In one large octavo volume, of about seven hundred pages. (Just Issued.) 
 
 reference, that would be more likely to afford the aid 
 
 We know of no work on Medical Jurisprudence 
 which contains in the same space anything like the 
 same amount of valuable matter .N. Y. Journal of 
 Medicine. 
 
 The American editor has appended several ini- 
 
 desired. We therefore recommend it as the best and 
 safest manual for daily use. American Journal of 
 Medical Sciences. 
 
 We have heretofore had reason to refer to it in 
 
 portant facts, the whole constituting by far the best, terma of comme ndation, and need now only state 
 most reliable, and interesting treatise on Medical i that) in the edition before us, the author has corn- 
 
 Jurisprudence, and one that we cannot too strongly 
 recommend to all who desire to become acquainted 
 with the true and correct exposition of this depart- 
 ment of medical literature.- Northern Lancet. 
 No work upon the subject can be put into the 
 
 pletely revised the whole work, making many addi- 
 tions and alterations, and brought it fully up to the 
 present state of knowledge. The task of the Ameri- 
 can editor has been to present all the important 
 facts and cases that have recently occurred in our 
 
 hands of students either of law or medicine which ; own country, bearing on the subjects treated of. 
 will engage them more closely or profitably; and No better work can be placed in the hands of th 
 none could be offered to the busy practitioner of j phy sician or jurist. St. Louis Medical and Surgical 
 either culling, for the purpose of casual or hasty j Journal. 
 
 BY THE SAME AUTHOR. 
 
 ON POISONS, IN RELATION TO MEDICAL JURISPRUDENCE AND 
 
 MEDICINE. Edited, with Notes and Additions, by R. E. GRIFFITH, M. D. In one large octavo 
 volume, of 688 pages. 
 
 The most elaborate work on the subject that pu r 
 literature possesses. British and Foreign Medico- 
 C-hirurgical Review. 
 
 It contains a vast body of facta, which embrace 
 all that is important in toxicology, all that is 
 necessary to the guidance of the medical jurist, and 
 all that can be desired by the lawyer. Medico- 
 Chirurgical Review. 
 
 One of the most practical and trustworthy workg 
 on Poisons in our language. Western Journal oj 
 Medicine. 
 
 It is, so far as our knowledge extends, incompa- 
 rably the best upon the subject; in the highest de- 
 gree creditable to the author, entirely trustworthy, 
 and indispensable to the student and practitioner. 
 N. Y. Annalist 
 
 THOMSON (A. T.), M. D., F. R. S., &c. 
 
 DOMESTIC MANAGEMENT OF THE SICK ROOM, necessary in aid of 
 Medical Treatment for the Cure of Diseases. Edited by R. E. GRIFFITH, M. D. la one large 
 royal 12mo. volume, with wood-cuts, 360 pages. 
 
 aril vd bsnvj vi 
 
28 
 
 BLANCHARD & LEA'S MEDICAL 
 
 TOMES (JOHN), F. R. S. 
 A MANUAL OF DENTAL PRACTICE. Illustrated by numerous engravings 
 
 on wood. In one handsome volume. (Preparing.) 
 
 TODD (R. B.), M. D., AND BOWMAN (WILLIAM), F. R. S. 
 PHYSIOLOGICAL ANATOMY AND PHYSIOLOGY OF MAN. With 
 
 numerous handsome wood-cuts. Parts I, II, and III, in one octavo volume, 552 pages. Part IV 
 
 will complete the work. 
 
 The distinguishing peculiarity of this work is, that the authors investigate for themselves every 
 fact asserted ; and it is the immense labor consequent upon the vast number of observations re- 
 quisite to carry out this plan, which has so long delayed the appearance of its completion. The 
 first portion oi Part IV, with numerous original illustrations, was published in the Medical News 
 and Library for 1853, and the completion will be issued immediately on its appearance in London. 
 Those who have subscribed since the appearance of the preceding portion of the work can have 
 tte three parts by mail, on remittance of $2 50 to the publishers. 
 
 TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
 VOLUME VI, for 1853, large 8vo., of 870 pages, with numerous colored plates 
 
 and wood-cuts. 
 Also to be had, a few sets of the Transactions from 1848 to 1853, in six large octavo volumes, 
 
 price $25. These volumes are published by and sold on account of the Association. 
 
 WATSON (THOMAS), M. D., &c. 
 LECTURES ON THE PRINCIPLES AND PRACTICE OF PHYSIC. 
 
 Third American, from the last London edition. Revised, with Additions, by D. FRANCIS CONDIE, 
 M. D , author of a " Treatise on the Diseases of Children," &c. In one octavo volume, of nearly 
 eleven hundred large pages, strongly bound with raised bands. 
 To say that it is the very best work on the sub- | Confessedly one of the very best works on the 
 
 ject now extant, is but to echo the sentiment of the 
 medical press throughout the country. N. O. 
 Medical Journal. 
 
 Of the text-books recently republished Watson is 
 very justly the principal favorite. Holmes's Rep. 
 to Nat. Med. Assoc. 
 
 By universal consent the work ranks among the 
 very best text-books in our language. Illinois and 
 Indiana Med. Journal. 
 
 Regarded on all hands as one of the very best, if 
 not the very best, systematic treatise on practical 
 medicine extant. St. Louis Med. Journal. 
 
 principles and practice of physic in the English or 
 any other language. Med. Examiner. 
 
 Asa text-book it has no equal ; as a compendium 
 of pathology and practice no superior. New York 
 Annalist. 
 
 We know of no work better calculated for being 
 placed in the hands of the student, and for a text- 
 book; on every important point the author seems 
 to have posted up his knowledge to the day. 
 Amer. Med. Journal. 
 
 One of the most practically useful books that 
 ever was presented to the student. N. Y. Med. 
 Journal. 
 
 WALSHE (W. H.), M. D., 
 
 Professor of the Principles and Practice of Medicine in University College, London. 
 
 DISEASES OF THE HEART, LUNGS, AND APPENDAGES; their 
 
 Symptoms and Treatment. In one handsome volume, large royal 12mo., 512 pages. 
 We consider this as the ablest work in the En- I the author being the first stethoscopist of the day. 
 gltsli language, on the subject of which it treats j | Charleston Medical Journal. 
 
 WHAT TO OBSERVE 
 AT THE BEDSIDE AND AFTER DEATH, IN MEDICAL CASES. 
 
 Published under the authority of the London Society for Medical Observation. In one very 
 handsome volume, royal 12mo , extra cloth (Just Issued.) 
 
 We hail the appearance of this book as the grand 
 deaideratum.CAariesion Medical Journal. 
 
 This is truly a very capital book. The whole 
 medical world will reap advantages from its publi- 
 cation. The medical journals will soon show its 
 influence on the character of the ; ' Reports of Cases" 
 which they publish. Dre. Ballard and Walshe have 
 
 given to the world, through a small but useful 
 medical organization, a cheap but invaluable book. 
 We do advise every reader of this notice to buy it 
 and use it. Unless he is so vain as to imagine him- 
 self superior to the ordinary human capacity, he will 
 in six months see its inestimable advantages. 
 Stethoscope. 
 
 
 WILDE (W. R.), 
 Surgeon to St. Mark's Ophthalmic and Aural Hospital, Dublin. 
 
 AURAL SURGERY, AND THE NATURE AND TREATMENT OF DIS- 
 EASES OF THE EAR. In one handsome octavo volume, with illustrations. (Now Ready.) 
 
 and treatment of 
 
 
 So little is generally known in this country concerning the causes, symptoms, 
 aural affections, that a practical and scientific work on that subject, from a practitioner of Mr. 
 Wilde's great experience, cannot fail to be productive of much benefit, by attracting attention 
 to this obscure class of diseases, which too frequently escape attention until past relief. The im- 
 mense number of cases which have come under Mr. Wilde's observation for many years, have 
 afforded him opportunities rarely enjoyed for investigating this branch of medical science, and his 
 work may therefore be regarded as of the highest authority. 
 
 This work certainly contains more information on 
 the subject to which it is devoted than any other 
 with which we are acquainted. We feel grateful to 
 the author fcfr his manful effort to rescue this depart- 
 ment of surgery from the hands of the empirics who 
 nearly monopolize it. We think he has successfully 
 shown that aural diseases are not beyond the re- 
 sources of art j that they are governed by the same 
 
 laws, and amenable to the same general methods of 
 treatment as other morbid processes. The work \t, 
 not written to supply the cravings of popular patro- 
 nage, but it is wholly addressed to the profession, 
 and bears on every page the impress of the reflections 
 of a sagacious and practical surgeon. Va. Surg. and 
 Med. Journal. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 29 
 
 WILSON (ERASMUS), M.D., F. R. S., 
 
 Lecturer on Anatomy, London. 
 
 A SYSTEM OF HUMAN ANATOMY, General and Special. Fourth Ameri- 
 can, from the last English edition. Edited by PAUL B. GODDARD, A. M., M D. With two hun- 
 dred and fifty illustrations. Beautifully printed, in one large octavo volume, of nearly six hun- 
 dred pages. 
 
 In many, if not all the Colleges of the Union, it 
 has become a standard text-book. This, of itself, 
 is sufficiently expressive of its value. A work very 
 desirable to the student; one, the possession of 
 which will greatly facilitate his progress in the 
 study of Practical anatomy. New York Journal of 
 Medicine. 
 
 Its author ranks with the highest on Anatomy. 
 Soutiu-rn Medical and Surgical Journal. 
 
 It offers to the student all the assistance that can 
 
 be expected from such a work. Medical Examiner. 
 
 The most complete and convenient manual for the 
 
 student we possess. American Journal of Medical 
 
 Science. 
 
 In every respect, this work as an anatomical 
 guide for the student and practitioner, merits pur 
 I warmest and most decided praise. London Medical 
 I Gazette. 
 
 BY THE SAME AUTHOR. 
 
 THE DISSECTOR; or, Practical and Surgical Anatomy. Modified and Re- 
 arranged, by PAUL BECK GODDARD, M. D. A new edition, with Revisions and Additions. In 
 one large and handsome volume, royal 12mo., with one hundred and fifteen illustrations. 
 
 In passing this work again through the press, the editor has made such additions and improve- 
 ments as the advance of anatomical knowledge has rendered necessary to maintain the work in the 
 high reputation which it has acquired in the schools of the United States, as a complete and faithful 
 guide to the student of practical anatomy. A number of new illustrations have been added, espe- 
 cially in the portion relating to the complicated anatomy of Hernia. In mechanical execution the 
 work will be found superior to former editions. 
 
 BY THE SAME AUTHOR. 
 
 ON DISEASES OF THE SKIN. Third American, from the third London 
 edition. In one neat octavo volume, of about five hundred pages, extra cloth. (Just Issued.) 
 Also, to be had done up with fifteen beautiful steel plates, of which eight are exquisitely colored ; 
 representing the Normal and Pathological Anatomy of the Skin, together with accurately colored 
 delineations of more than sixty varieties of disease, most of them the size of nature. The Plates 
 are also for sale separate, done up in boards. 
 
 The increased size of this edition is sufficient evidence that the author has not been content 
 with a mere republication, but has endeavored to maintain the high character of his work as the 
 standard text-book on this interesting and difficult class of diseases. He has thus introduced such 
 new matter as the experience of the last three or four years has suggested, and has made such 
 alterations as the progress of scientific investigation has rendered expedient. The illustrations have 
 aiso been materially augmented, the number of plates being increased from eight to sixteen. 
 
 The "Diseases of the Skin," by Mr. Erasmus 
 Wilson, may now be regarded as the standard work 
 in that department of medical literature. The 
 plates by which this edition is accompanied leave 
 nothing to be desired, so far as excellence of delinea- 
 tion and perfect accuracy of illustration are con- 
 cerned* Medico-Cfiirurgical Review. 
 
 Of these plates it is impossible to speak too highly . 
 The representations of the various forms of cuta- 
 neous disease are singularly accurate, and the color- 
 ing exceeds almost anything we have met with in 
 point of delicacy and finish. British, and Foreign 
 Medical Review. 
 
 BY THE SAME AUTHOR. 
 
 ON CONSTITUTIONAL AND HEREDITARY SYPHILIS, AND ON 
 
 SYPHILITIC ERUPTIONS. In one small octavo volume, beautifully printed, with four exqui- 
 site colored plates, presenting more than thirty varieties of syphilitic eruptions. 
 
 Dr. Wilson's views on the general subject of 
 Syphilis appear to us in the main sound and judi- 
 cious, and we commend the book as an excellent 
 monograph on the subject. Dr. Wilson has pre- 
 sented us a very faithful and lucid description of 
 Syphilis and has cleared up many obscure points in 
 
 connection with its transmissibility, pathology and 
 sequelae. His facts and references will, we are satis- 
 fied, be received as decisive, in regard to many 
 questiones vexatne. They appear to us entitled to 
 notice at some length. Medical Examiner. 
 
 BY THE SAME AUTHOR. 
 
 A TREATISE ON THE MANAGEMENT OF THE SKIN AND HAIR 
 
 IN RELATION TO HEALTH. Second American, from the fourth London edition. One neat 
 volume, royal 12mo. 
 
 WHITEHEAD (JAMES), F. R. C. S., &c. 
 THE CAUSES AND TREATMENT OF ABORTION AND STERILITY; 
 
 being the Result of an Extended Practical Inquiry into the Physiological and Morbid Conditions 
 of the Uterus. Second American Edition. In one volume, octavo, 368 pages. (Now Ready.) 
 
 this department of our profession, that the practi- 
 tioner who does not consult the recent works on the 
 complaints of females, will soon find himself in the 
 rear of his more studious brethren. This is one of 
 the works which must be studied by those who 
 would know what the present state of our knowledge 
 is respecting the causes and treatment of abortion 
 and sterility. The Western Journal of Medicine and 
 
 The simple title of this work gives a very imper- 
 fect idea of its contents. The subject of sterility 
 occupies a mere fraction of space, and upwards of 
 ode-naif of the whole volume is taken up with an 
 elaborate account of menstruation as a physiological 
 process, and of the disorders which its deviations 
 from health are apt to produce. Medical Chirurg. 
 Review. 
 
 Such are the advances made from year to year in 
 
 Surgery. 
 
30 
 
 BLANCHARD & LEA'S MEDICAL 
 
 WEST (CHARLES), M. D., 
 
 Physician to the Hospital for Sick Children, &c. 
 
 LECTURES ON THE DISEASES OF INFANCY AND CHILDHOOD. 
 
 Second American, from the second and enlarged London edition. (Now Ready.) In one volume, 
 octavo, of nearly five hundred pages. 
 
 From the Preface to the Second Edition. 
 
 In the preparation of the second edition of these Lectures, the whole work has been carefully 
 revised. A few formulae have been introduced and a minute alphabetical index has been appended 
 while additions amounting altogether to fifty pages, have been made, wherever I felt that more 
 extended observation, or more careful reflection had enabled me to supply some of those deficiencies 
 which I am well aware, are still far too numerous. The work now contains the result of 640 
 observations, and 199 post-mortem examinations, chiefly made among 16,276 children who came 
 under my notice during the ten years of my connection with the Children's Infirmary in Lambeth. 
 
 We take leave of Dr. West with great respect for 
 his attainments, n due appreciation of his acute 
 powers of observation, and a deep sense of obliga- 
 tion for this valuable contribution to our profes- 
 sional literature. His book is undoubtedly in many 
 respects the best we possess on diseases of children. 
 The extracts we have given will, we hope, satisfy 
 our readers of its value; and yet in all candor we 
 must say that they are even inferior to some other 
 parts, the length of which prohibited our entering 
 upon them. That the book will shortly be in the 
 hands of most of our readers we do not doubt, and it 
 will give us much pleasure if our strong recommend- 
 ation of it may contribute towards the result. The 
 Dublin Quarterly Journal of Medical Science. 
 
 Dr. West has placed the profession under deep ob- 
 ligation by this able, thorough, and finished work 
 
 upon a subject which almost daily taxes to the ut- 
 most the skill of the general practitioner. He has 
 with singular felicity threaded his way through all 
 the tortuous labyrinths of the difficult subject he has 
 undertaken to elucidate, and has in many of the 
 darkest corners left a light, for the benefit of suc- 
 ceeding travellers, which will never be extinguished. 
 Not the least captivating feature in this admirable 
 performance is its easy, conversational style, which 
 acquires force from its very simplicity, and leaves 
 an impression upon the memory, of the truths it 
 conveys, as clear and refreshing as its own purity. 
 The author's position secured him extraordinary fa- 
 cilities for the investigation of children's diseases, 
 and his powers of observation and discrimination 
 have enabled him to make the most of these great 
 advantages. Nashvillt Medical Journal. 
 
 WILLIAMS (C. J. B.), M. D., F. R. S. 3 
 
 Professor of Clinical Medicine in University College, London, fee. 
 
 PRINCIPLES OF MEDICINE; comprising General Pathology and Therapeu- 
 tics, and a brief general view of Etiology, Nosology, Semeiology, Diagnosis, Prognosis, and 
 Hygienics. Edited, with Additions, by MEREDITH CJLYMER, M. D. Fourth American, from the 
 last and enlarged London edition. In one octavo volume, of 476 pages. (Now Ready.) 
 
 This new edition has been materially enlarged and brought up by the editor. 
 
 It possesses the strongest claims to the attention of the medical student and practitioner, from 
 the admirable manner in which the various inquiries in the different branches of pathology are 
 investigated, combined, and generalized by an experienced practical physician, and directly applied 
 to the investigation and treatment of disease. EDITOR'S PREFACE. 
 
 Few books have proved more useful, or met with 
 
 The best exposition in our language, or, we be- 
 lieve, in any language, of rational medicine, in its 
 present improved and rapidly improving state. 
 British and Foreign Medico-Chirurg. Review. 
 
 a more ready sale than this, and no practitioner 
 should regard his library as complete without it. 
 Ohio Med. and Surg. Journal. 
 
 BY THE SAME AUTHOR. 
 
 A PRACTICAL TREATISE ON DISEASES OF THE RESPIRATORY 
 
 OR.GANS; including Diseases of the Larynx, Trachea, Lungs, and Pleurae. With numerous 
 Additions and Notes, by M. CLYMER, M. D. With wood-cuts. In one octavo volume, pp. 508. 
 
 YOUATT (WILLIAM), V. S. 
 
 THE HORSE. A new edition, with numerous illustrations; together with a 
 general history of the Horse; a Dissertation on the American Trotting Horse; how Trained and 
 Jockeyed; an Account of his Remarkable Performances; and an Essay on the Ass and the Mule. 
 By J. S. SKINNER, formerly Assistant Postmaster-General, and Editor of the Turf Register. 
 One large octavo volume. 
 
 BY THE SAME AUTHOR. 
 
 THE DOGr. Edited by E. J. LEWIS, M. D. With numerous and beautiful 
 
 illustrations. In one very handsome volume, crown 8vo., crimson cloth, gilt. 
 
 ILLUSTRATED MEDICAL CATALOGUE, 
 
 BLANCHARD & LEA are preparing a Catalogue of their Medical, Surgical, and Scien- 
 tific Publications, containing descriptions of the works, with Notices of the Press, and 
 specimens of the Illustrations, making a pamphlet of sixty-four large octavo pages. It will 
 be prepared with great care, and without regard to expense, forming one of the most beau- 
 tiful specimens of typographical execution as yet issued in this country. Copies will be 
 sent by mail, and the postage paid, on application to the Publishers, by inclosing two three 
 cent postage stamps. 
 
AND SCIENTIFIC PUBLICATIONS. 
 
 31 
 
 B. & L. subjoin a condensed list of their publications in general and educational 
 literature, of which more detailed catalogues will be furnished on application. 
 
 HISTORY AND BIOGRAPHY. 
 
 BROWNING'S HISTORY OF THE HUGUE LOUIS BLANC'S FRENCH REVOLUTION. 1 vl. 
 
 NOTS, 1 vol. 8vo. 
 
 CAMPBELL'S (LORD) LIVES OF THE LORD 
 CHANCELLORS OF ENGLAND, from the earl- 
 iest Times to the Reign of George IV. In seven 
 handsome crown octavo volumes, extra cloth or 
 half morocco. 
 
 CAMPBELL'S (LORD) LIVES OF THE CHIEF 
 JUSTICES OF ENGLAND, from the Norman 
 Conquest. In two handsome crown octavo vols., 
 to match the ' Chancellors." 
 
 WXON'S LIFE OF WILLIAM PENN. A new 
 work. 1 vol. royal 12mo., extra cloth. 
 
 GRAHAME'S COLONIAL HISTORY OF THE 
 UNITED STAPES 2 vols. Svo. A new edition. 
 
 GUIZOT'S LIFE OF CROMWELL. Two large 
 vols., royal l'2mo. (Now ready.) 
 
 HERVEY'S MEMOIRS OF GEORGE II. 2 vols. 
 royal I2mo., extra doth. 
 
 HUGHES'S OUTLINES OF SCRIPTURE GEO 
 GRAPH Y AND HISTORY, I vol., royal 12mo., 
 with colored maps. (Just issued.) 
 
 IWGERSOLL'S HISTORY OF THE LATE WAR. 
 2 vols. 8vo. 
 
 KENNEDY'S LIFE OF WILLIAM WIRT. 2d 
 edition, 2 vols. royal L2mo., extra cloth, with Por- 
 trait. 
 
 Sme work, library edition. 2 vols. 8vo. 
 
 KAVANAGH S WOMAN IN FRANCE IN THE 
 EIGHTEENTH CENTURY. 1 vol. royal 12mo., 
 extra cloth 
 
 LOUIS BLANC'S FRANCE UNDER LOUIS PHI 
 LJPPE, 1830-1840. 2 vols. crown 8vo., extra cloth. 
 
 crown Svo . extra cloth. 
 MARSH (MRS.) ROMANTIC HISTORY OF THE 
 
 HUGUENOTS. 2 vols. royal 12mo., extra cloth. 
 NIEBUHRS ANCIEN T HISTORY. By LEONHABD 
 
 SCHMITZ. In three handsome crovvn octavo vols., 
 
 (Lately Issued.) 
 PARDOE'S FRANCIS THE FIRST. 2 vols. royal 
 
 12mo.. extra cloth. 
 PALGRAVES NORMANDY AND ENGLAND. 
 
 In three vols crown 8vo.. (Preparing.) 
 RUSH'S COURT OF LONDON. 1 vol. Svo. 
 RANKE'S HISTORY OF J HE REFORMATION 
 
 IN GERMANY. To he complete in 1 vol. Svo. 
 RANKES HISTORY OF THE OTTOMAN AND 
 
 SPANISH EMPIRES. 8vo. Price 50 cents. 
 RUSSEL'S LIFE OF CHARLES JAMES FOX. 
 
 2 vols., handsome royal I2mo. (Now ready.) 
 Some Work. Second Series. (Preparing ) 
 STRICKLAND'S LIVES OF THE QUEENS OF 
 
 ENGLAND, from the Norman Conquest. Com- 
 plete in 6 handsome crown Svo. volumes, vanoue 
 
 styles of binding. 
 STRICKLAND'S LIVES O^ THE QUEENS OF 
 
 HENRY VIII. In one handsome crown Svo. vol., 
 
 extra cloth, various styles. 
 STRICKLAND'S LIFE OF QUEEN ELIZABETH. 
 
 In one handsome crown Svo. volume, extra cloth, 
 
 various styles. 
 STEINMETZ'S HISTORY OF THE JESUITS. 
 
 2 vols. crowu Svo., extra cloth. 
 
 MISCELLANEOUS. 
 
 ACTON (MRS.) MODERN COOKERY. Edited by 
 
 Mrs. S J HALE. 1 handsome volume, royal I2mo., 
 
 extra cloth, with illustrations. 
 ACDISON ON CONTRACTS, and on Parties to 
 
 Actions, ex contractu. 1 large octavo volume, law 
 
 sheep. 
 BUFFUM'S SIX MONTHS IN THE GOLD 
 
 MINES. 1 vol. royal 12rao., extra cloth or paper, 
 
 50 cents. 
 
 BAIRD'S WEST INDIES AND NORTH AMERI- 
 CA. 1 vol. royal 12mo.. extra cloth. 
 CRATER ON THE DISEASES OF HORSES. By 
 
 SKINNER. 1 vol 12mo. 
 CRATER'S CATTLE AND SHEEP DOCTOR. 1 
 
 vol.l2mo., cuts. 
 DON QUIXOTE. With numerous illustrations by 
 
 Johamiot. 2 vols. Svo. cloth, or half morocco. 
 ENCYCLOPEDIA OF GEOGRAPHY. In three 
 
 octavo vols., many cuts and map?, various bindings. 
 ENCYCLOPAEDIA AMERICANA. 14 vols. Svo., 
 
 various bindings. 
 
 Vod. 14. bringing the work up to 1846, sold separate. 
 EXPLORING EXPEDITION, NARRATIVE OF. 
 
 In six vols., imperial quarto, with several hundred 
 
 plates, maps, and wood-cuts 
 EVANS'S SUGAR-PLANTERS MANUAL. 1 vol. 
 
 Svo , extra cloth, plates. 
 ERMAN'S TRAVELS IN SIBERIA 2 vols. royal 
 
 12mo., extra cloth. 
 FIELDING'S SELECT WORKS. In one vol. Svo. 
 
 cJoth. or 4 parts, paper. 
 FLETCHER'S NOTES FROM NINEVEH. 1 vol. 
 
 royal 12mo., extra cloth. 
 HAWKER ON SHOOTING. Edited by PORTER. 
 
 With plates and cuts. 1 vol. Svo., beautiful extra 
 
 cloth, new edition. (Just Issued.) 
 HOLTHOUSE'S LAW DICTIONARY. By PEN 
 
 tHOTON. 1 vol. large I2mo.. law sheep. 
 JOHNSON'S DICTIONARY OF GARDENING. 
 
 By LANDRhTH. 1 vol. large royal 12mo., 650 pages, 
 
 many cuts. 
 
 LANGUAGE OF FLOWERS. 8th edition, i vol. 
 
 18mo., colored plates, crimson cloth, gilt 
 LEWIS'S HINTS TO SPORTSMEN. 1 vol. royal 
 12mo., extra cloth, illustrated. 
 
 LYNCH'S NARRATIVE OF THE U. S. EXPE- 
 DITION TO THE DEAD SEA AND RIVER 
 JORDAN. 1 large octavo volume, with numerous 
 plates and maps. 
 
 Same work, condensed edition, in neat royal 12mo. 
 
 MACFARLANE'S TURKEY AND ITS DBS- 
 TIN Y. 2 vols. roval 12mo., extra cloth. 
 
 MACKAY'S TRAVELS IN THE UNITED 
 S TATES. 2 vols. royal l'2rno.. extra cloth. 
 
 MARTINEAU'S EASTERN LIFE. 1 vol. crown 
 Svo. .extra cloth. 
 
 MARTINEAU'S HOUSEHOLD EDUCATION. 1 
 vol. royal 12mo., extra cloth. 
 
 FACET'S HUNGARY AND TRANSYLVANIA. 
 2 vols. royal 12mo., extra cloth. 
 
 PULSZKY'S HUNGARIAN LADY. 1 vol. royal 
 12tno., extra cloth. 
 
 PICCIOLA The Prisoner of Fenestrella. Illustrated 
 edition, with cuts, royal 12mo., beautiful crimson 
 cloth. 
 
 Same work, fancy paper, price 50 cents. 
 
 READINGS FOR THE YOUNG FROM SIR 
 WALTER SCOTT, 2 vols. royal ISmo., extra 
 crimson cloth, plates. 
 
 SELECT WORKS OF TOBIAS SMOLLETT 
 Cloth or paper. 
 
 SHAW'S OUTLINES OF ENGLISH LITERA- 
 TURE. 1 large vol. royal 12mo., extra cloth. 
 
 SMALL BOOKS ON GREAT SUBJECTS. In three 
 neat volumes, royal ISmo.. extra cloth. 
 
 SAM SLICK'S NEW WORK WISE SAWS AND 
 MODERN INSTANCES. 1 vol. 12mo., (Now 
 Ready.) 
 
 THOMSON'S DOMESTIC MANAGEMENT OF 
 THE SICK ROOM. 1 vol. 12mo. 
 
 WHEATON'S INTERNATIONAL LAW. 1 vol 
 large 8vo , law sheep, or extra cloth. 3d edition, 
 much improved. 
 
 YOUATT ON THE HORSE, &c. By SKINNEB. I 
 vol Svo., many cuts. 
 
 YOUATT ON THE DOG. With plates. 1 vol. 
 crown Svo.. beamiful frimson cloth. 
 
 YOUATT ON THE PIG. 1 vol. 12mo., extra cloth, 
 with cuts. 
 
 Same work in paper, price 50 cenls. 
 
 NATURAL SCIENCE. 
 
 AMERICAN ORNITHOLOGY. By PRINCE CHARLES 
 BONAPARTE. In four handsome folio volumes, with 
 beautiful colored plates. 
 
 ARNOTT'S ELEMENTS OF PHYSICS. New Edi- 
 ition. By ISAAC HAYS, M. D. In one octavo volume- 
 with 200 illustrations. 
 
BLANCHARD & LEA'S SCIENTIFIC PUBLICATIONS. 
 
 NATURAL SCIENCE. Continued. 
 
 BRODERIP'S ZOOLOGICAL RECREATIONS. 1 
 vol. royal 12no., extra cloth. 
 
 BOWMAN S PRACTICAL CHEMISTRY. 1vol. 
 royal 12mo.. extra cloth ; cuts. 
 
 BIRD'S NATURAL PHILOSOPHY. 1 vol. roynl 
 12rno.. with many cuts. 
 
 BKALE ON THE LAWS OF HEALTH IN RE- 
 LA TION TO MIND AND BODY. 1 vol. royal 
 12mo.. extra cloih. 
 
 BREWSTERS TREATISE ON OPTICS. 1 vol. 
 Itao..eut*. 
 
 CARPENTER'S GENERAL AND COMPARA- 
 TIVE PHYSIOLOGY. With numerous wood 
 cuts. 1 vol large Svo , new edition. (Preparing.) 
 
 CARPENTER ON THE MICROSCOPE. Hand- 
 somely illustrated. (Preparing.) 
 
 DANA ON CORALS. 1 vol. royal 4to., extra cloth, 
 with wood- cuts. 
 
 Atlas to do .large imperial folio, half morocco, with 
 over 60 magnificent colored plates. 
 
 DE LA BECHE'S GEOLOGICAL OBSERVER. 
 1 large vol. 8vo over 300 cuts. (Now Ready.) 
 
 FOWNES'S RECENT WORK ON CHEMISTRY. 
 New edition. By BRIDGES. 1 vol. 12mo., many 
 cuts, sheep or extra cloth. 
 
 GRAHAM'S ELEMENTS OF CHEMISTRY. Large 
 Svo.. many cuts. (Part I, lately issued, Part II, 
 
 GREGORY > ON ANIMAL MAGNETISM. 1vol. 
 royal 12mo. 
 
 GRIFFITH'S CHEMISTRY OF THE FOUR SEA- 
 SONS. 1 vol. I2ino.,many cuts. 
 
 GRIFFITH'S MEDICAL BOTANY. 1 vol. large 
 9vo., extra cloth, nearly 400 cuts. 
 
 HERSCHEL'S OUTLINES OF ASTRONOMY. 
 1 vol. crown 8vo., ex. cl.. with plates and wood cuts. 
 
 HUMBOLDT'S ASPECTS OF NATURE. 2d edi- 
 tion. 1 large vol. royal 12mo., extra cloth. 
 
 HANDBOOKS OF NATURAL PHILOSOPHY 
 AND ASTRONOMY. By DIONYSITJS LARDNER. 
 3 thick vols. royal I2mo.. with 1000 wood cuts. 
 
 HALE'S ETHNOLOGY AND PHILOLOGY OF 
 THE U. S. EXPLORING EXPEDITION. 1 vol. 
 royal 4io., extra cloth. 
 
 JOHNSTON'S PHYSICAL ATLAS OF NATU- 
 RAL PHENOMENA. In one large and handsome 
 imperial 4to. vol., half bound in morocco, with 26 
 maps, beautifully colored. 
 
 KNAPP'S TECHNOLOGY, OR CHEMISTRY 
 APPLIED TO THE ARTS AND TO MANU- 
 FACTURES. Translaied by Ronalds. EdUed by 
 Johnson. Vol I., with 244 large wood engravings. 
 Vol. II., large Svo.. wiih 250 wood engravings. 
 
 MULLER'S PHYSICS AND METEOROLOGY. 1 
 vol. large Svo . 2 colored plates, and 550 wood-cuts. 
 
 MILLWRIGHT'S AND MILLER'S GUIDE. By 
 OLIVER EVANS. In one vol. 8vo., sheep, many plates. 
 
 MATTEUCCI ON PHYSICAL PHENOMENA OF 
 LIVING BEINGS. 1 vol. royal 12mo.. ex. cl.. cuts. 
 
 ORR'S CIRCLE OF THE SCIENCES, royal 12mo., 
 with numerous illustrations, containing Animal and 
 Vegetable Physiology, by the Editor and Professor 
 Owen. The Different Forms of the Skeleton, by 
 Prof. Owen. Physical Geography and Geology, by 
 Prof. Ansted. Natural Philosophy, by Rev. W. 
 Mitchell. &c. &c. 
 
 SOMERVILLE'S PHYSICAL GEOGRAPHY. 
 New edition. 1 large vol. royal 12mo., extra cloth. 
 
 SCHOEDLER AND MEDLOCK'S BOOK OF NA- 
 TURE. With Additions and Improvements In 
 one thick volume, crown 8vo., with over 679 illus- 
 trations. 
 
 WEISBACH'S PRINCIPLES OF THE MECHA- 
 NICS OF MACHINERY AND ENGINEERING. 
 2 large octavo volumes, extra cloth, 900 beautiful 
 wood engravings. 
 
 EDUCATIONAL WORKS. 
 
 ARNOTT'S ELEMENTS OF PHYSICS. New edi- 
 tion. Complete in I vol. Svo , many illustrations. 
 
 BOLMAR'S FRENCH SERIES, consisting of: - 
 LEVIZAC'S FRENCH GRAMMAR, 1 volume. 
 
 12mo.. sheep. 
 PERRIN'S FABLES, with KEY. 1 vol. I2mo., half 
 
 bound. 
 
 COLLOQUIAL PHRASES, I vol. ISmo., hf. bound. 
 A VENTURES DE TELEMAQUE, I vol. 12mo., 
 
 half bound. 
 
 KEY to do. do. do. 
 
 FRENCH VERBS, 1vol. 12mo., half bound. 
 
 BAIRD'S CLASSICAL MANUAL. AnEpitomeof 
 Ancient Geography, Mythology, Antiquities, and 
 Chronology. I vol. royal 18mo., extra cloth. 
 
 Same work, half bound, embossed leather backs. 
 
 BIRD'S ELEMENTS OF NATURAL PHILOSO- 
 PHY. 1 vol. royal 12mo.. sheep, or ext. cl. 372 cuts. 
 
 BUTLER'S ATLAS OF ANCIENT GEOGRAPHY. 
 Revised edition. 1 vol. Svo. half bound, 21 colored 
 maps. 
 
 BUTLER'S GEOGRAPHIA CLASSICA. Revised 
 edition; 1 vol. 12mo., half bound. 
 
 BREWSTER'S TREATISE ON OPTICS. With 
 additions. By BACHE. t vol. 12mo., half bound, cuts. 
 
 BROWNE'S GREEK CLASSICAL LITERATURE. 
 1 vol. crown Svo .extra cloth. 
 
 BROWNE'S ROMAN CLASSICAL LITERA- 
 TURE. 1vol. crown Svo., ex. cloth. (Now Ready.) 
 
 FOSTER'S HANDBOOK OF MODERN EURO 
 PEAN LITERATURE 1 vol. royal 12mo.,ex. cl. 
 
 FOVVNE'S CHEMISTRY FOR STUDENTS. New 
 edition. By BRIDGES. 1 vol royal I2mo., many cuts, 
 extra cloth, or sheep. 
 
 GRAHAM'S ELEMENTS OF CHEMISTRY. 2d 
 edition, enlarged Edited by BRIDGES. Svo. many 
 cuts. Part I., lately issued. Part II., preparing. 
 
 HERSCHEL'S OUTLINES OF ASTRONOMY. A 
 new edition. With numerous plates and wood- 
 cuts. 1 vol. crown 8vo., extra cloth. 
 
 HUGHES'S OUTLINES OF SCRIPTURE GEO- 
 GRAPHY AND HISTORY, I vol., royal 12mo., 
 with colored maps. (Just issued.) 
 
 JOHNSTON'S ATLAS OF PHYSICAL GEOGRA- 
 PHY. 1 vol., with 26 colored plates, hf. bound. | 
 
 LARDNER'S HANDBOOKS OF NATURAL PHI- 
 LOSOPHY AND ASTRONOMY. 
 FIRST COURSE, containing Mechanics, Hydrosta- 
 tics, Hydraulics, Pneumatics, Sound, and Optics. 
 1 very large vol., royal 12mo., sheep, 424 cuts. 
 SECOND COURSK, containing Heat, Electricity, Mag- 
 netism, and Galvanism. 1 vol. royal 12mo., sheep, 
 250 cuts. 
 
 THIRD COURSE, containing Astronomy and Meteo- 
 rology. 1 very large vol., royal 12mo., 37 plates 
 and 216 wood-cuts. (Now ready.) 
 MULLER'S PHYSICS AND METEOROLOGY. 1 
 vol. Svo., over 500 beautiful cuts and two colored 
 plates, extra cloth. 
 
 NATIONAL SCHOOL MANUAL. 4 parts. 12mo. 
 ORR'S PHYSIOLOGY OF ANIMAL AND VEGE- 
 TABLE LIFE A new and popular work. 1vol. 
 royal 12mo. with illustrations. (Just Ready.) 
 SOMERVILLE S PHYSICAL GEOGRAPHY. 3d 
 and enlarged edition, with American notes. 1 large 
 vol. royal 12mo . extra cloth. 
 
 SHAW'S OUTLINES OF ENGLISH LITERA- 
 TURE. 2d ed. With Sketch of American Litera- 
 ture. By TUCKERMAN. 1 vol. royal I2mo., ext cl. 
 SCHOEDLER AND MEDLOCK'S BOOK OF NA- 
 TURE. Edited and revised. 1 large vol., crown 
 Svo., with 679 wood cuts. (Now ready.) 
 SCHMITZ AND ZUMPT'S CLASSICAL SERIES 
 FOR SCHOOLS. In neat royal 18mo. volumes, as 
 follows: 
 KALTSCHMIDT'S LATIN DICTIONARY. 
 
 Complete, handsome embossed leather. 
 SCHMITZ'S ELEMENTARY LATIN GRAM- 
 MAR AND EXERCISES. 
 
 SCHMITZ'S ADVANCED LATIN GRAMMAR. 
 ADVANCED LATIN EXERCISE BOOK, with 
 
 Selections for Reading. (Now Ready.) 
 CAESAR, extra cloth, with a Map. 
 SALLUST, extra cloth, with a Map. 
 VIRGIL, extra cloth. 
 OVID, extra cloth. 
 HORACE, extra cloth. 
 LI VY. extra cloth, two colored Maps. 
 CICERO, extra cloth. 
 
 QUINTUS CURTIUS. extra cloth, with a Map. 
 CORNELIUS NEPOS, now ready, extra cloth. 
 
 OTHER WORKS OF THE SERIES PREPARING. 
 
EC 13 1971 
 
 14 DAY USE 
 
 RETURN TO DESK FROM WHICH BORROWED 
 
 BIOLOGY LIBRARY 
 
 TEL NO. 642-2531 
 
 This book is due on the last date stamped below, or 
 
 on the date to which renewed. 
 Renewed books are subject to immediate recall. 
 
 LD 2lA-15m-2,'69 
 (J6057slO)476 A-32 
 
 General Library 
 
 University of California 
 
 Berkeley