PHYSIOLOGY & GENERAL
ANATOMY.

Kings

College

LONDON

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THE

HUMAN BRAIN:

STRUCTURE, PHYSIOLOGY AND DISEASES.

WITH A

DESCRIPTION OE THE TYPICAL FORMS OP BRAIN IN
THE ANIMAL KINGDOM.

By SAMUEL SOLLY, E.R.S.,

S- VIOR ASSISTANT-SURGEON TO ST. THOMAS’S HOSPITAL, AND LECTURER ON
CLINICAL SURGERY, ETC., ETC.

SECOND EDITION.

WITH NUMEROUS W O O D - E N G R A V I N G S.

LONDON:

LONGMAN, BROWN, GREEN,

PATERNOSTER

MDCCCXLV

RICHARD KINDER, PR1NTKH, GREEN

A R BOD R COURT, OLD PALLET*

TO

BENJAMIN TRAVERS, Esq., F.R.S.,

PRESIDENT OF THE ROIAL 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.

a 2

Digitized by the Internet Archive
in 2015

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PREFACE.

- In the first edition of this Work, in 1836, I remarked that
the structure and functions of the human brain are objects
of comparatively slight interest 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 struc-
ture, their functions, or even their analogies in the ner-
vous 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 dry-
ness of unconnected detail, and the obstacles to clear con-
ceptions engendered by the absence of everything like
arrangement, almost certainly deter him from attempting
to learn more than is required to prepare him for ex a*
mination for the diploma. It is unfortunate, indeed, that
candidates for this honourable certificate arc 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

VI

PltEJt’ACE.

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 essentially 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 organism.
No labour 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 consciousness and volition may be
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 myself
of his authority to assist in subduing this evil : —

“ To the mind, however, which is unfettered by preju-
dices in favour of ancient opinions, it appears singular that
the enlightened physiologists of the eighteenth century
should talk of the medullary and cortical matter of an
organ in which nothing like marrow or bark can be seen ;
and it is more extraordinary still, that the accurate dis-
tinctions which anatomy has introduced since the com-
mencement of the nineteenth century have not demon-

PREFACE.

Vll

strated 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 sliroud-
in" it under the learned denomination 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 matter cortical? The common sense ot
the present day will not hesitate to answer these ques-
tions 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
labour to augment the confusion of a department of ana-
tomy not very easy, by useless and antiquated names,
which live only to proclaim their absurdity, and the im-
propriety of finding them there. Knowledge, in the pre-
sent day, to be worth the labour of acquisition, ought to
be accurate ; the books which are to be the means of con-
veying this knowledge ought to contain no superfluous
or erroneous information.”

Foville, who has devoted so much attention to the
structure of the brain, though he has paid too little at-
tention to the labour of others, thus expresses himself in
regard to the difficulties which attend its study :* — “ If we

* Traits Complet dc 1’ Anatomic, dc la Physiologic ct dc la Pathologic
‘In Systfcme Ncrveau Cercbro-spinal, par M. Foville, p. 41.

Vlll

PREFACE.

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
carcase : 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.

I have been much disappointed with Foville’s work.
The anatomical descriptions are most tediously minute,
without any reference to physiological 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, commis-
sures and nerves. So that after having waded through a
, long description, the pons Yarolii 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 olfac-
tory 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 sepa-
rate its description from that of the nervous cords, we
ought with equal reason to separate the optic nerve, and
present it also as a particular lobe.”

Cuvier, in the report which he made to the Academie

PREFACE.

IX

Royale des Sciences de Paris, upon M. Senes’ work, De
l’Anatomie Comparee du Cerveau, remarked very forcibly on
the inconvenience of dissecting the brain from above down-
wards in the manner generally pm-sued, and he showed
that in consequence of comparative anatomists adopting
this mode of dissection, their researches into the constitu-
tion of the nervous system of the lower orders were produc-
tive of very imperfect results, in as much as the chain of re-
semblance between the lower and the higher orders of animals
was soon lost sight of; whilst M. Serres, by commencing
Math the dissection of the spinal cord, and tracing it up-
wards, 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 abstrac-
tion 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
yanglion, but I would willingly have adopted a different
title if a better one had been proposed.

I have endeavoured, 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.

J he only philosophical method of simplifying and giving
a character of general interest to the anatomy of the human

X

PREFACE.

brain, is by commencing 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 Ave shall be rewarded by finding that the encephalon,
this apparently most complicated 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 particular 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 an account of all the
various opinions which have been broached ; and, on the
other, of basing my descriptions or confining my views to
the circle of my oavii 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 Ilerschel has so concisely
stated, that “ Science is the knowledge of many, orderly
and methodically arranged and digested, so as to be attain-
able by one.”

Every honest and erudite anatomist must acknowledge
that we are indebted mainly to Gall and Spurzheim lor the

PREFACE.

XI

improvements which have been made in our mode of study-
ing the brain. For my own part, I most cheerfully acknow-
ledge, 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
labour 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 honour 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
then labours 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 manifes-
tent beaucoup de personnes, d’attribuer notres decouvertes a d’autres, par
exemple h. Beil, &c., I venture to direct your attention 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 part 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 Eoyal
College of Surgeons, nearly twenty years ago, and fell into the same mistake.
^ hat GaU has written in its refutation, may be found in the 8vo edition
ot 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 Gail and Spurzheim,” Edinburgh,
IH7, p. 50-54; in the Preface to his “Anatomy of the Brain,” 1820 ;

Xll

PREFACE.

and in his reprint of Chenevix’s article on Phrenology, from the Foreign
Quarterly Review, 1830, Appendix. I would, however, direct your
attention to the earliest notices of the discoveries and proceedings of
these illustrious men in the English medical periodicals — 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 genera-
tion 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 (Yol. iv. p. 50).
It refers, however, exclusively 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 recognising the several
Faculties and Propensities from the Construction and Form of the Head
and Skull. Mr. Geisweiler, of Parliament-street, has in his possession a
part of the manuscript and several drawings, finished in the most cinious
and elegant style, deserving the attention of the curious. The Author
intends to publish the work at the same time, both in England and
Germany.”

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 then-
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 every body 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 ; 2ndly, The Doctrine of the Skull — and gives an
abstract of both. In the March number for 1806 (Yol. xv. p. 201),
there is another notice, which states that the craniology of Dr. Gall was
the favourite 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 liis 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 Ger-
many by the writings of some of his pupils. The Doctor himself

PREFACE.

XIII

prepared a work, illustrated with copper-plates, in which all his striking
observations on comparative anatomy and the dissection of the brain were
to be laid before the public. Subscriptions for it were opened, and com-
pleted 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
scrutinize 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
1S06, will be found a»very careful but concise abstract of Gall’s Examina-
tion of the Brain, abstracted from all the psychical views of its author,
from the pen of Professor Kosenmuller of Leipsic. In the same number,
there is also a review of Professor Bischoif 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 demonstrations
of the brain, and opinions, by Professor Walter and others. Copies of the
abstract by Rosenmuller, and of the review of Bischoff, I inclose, but shall
he 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 Spurzheim’s public dissections and demonstrations of the brain
preceded those of Reil in Germany, and it is curious to observe the influ-
ence they exerted in leading Reil to publish on this subject in 1807 ;
Baron Cuvier, in France, in 1809 ; and Sir Charles Bell, whose first,
pamphlet was circulated only among private friends, and entitled, “ Idea
of a New Anatomy of the Brain.” The labours of these eminent men,
and their successors, have indeed only been successful in carrying out the
details of Gall and Spurzheim’s leading general principle, that the nervous
system was not an unit but an aggregation of systems, as numerous as the
functions, intellectual, emotional or physical, of which it is the organized
instrument.

S. So U.i/, Esq.

Believe me to remain, yours, very truly,

J. S. Streeter.

J here 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 lie lias
brought to bear on the subject are most interesting, and

XIV

PREFACE.

Ins 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
v ork more useful, and I hope it may prove so, notwith-
standing 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 con-
traiy, fiom drawings of my own, or made under my imme-
diate inspection. Some of them I drew on the wood. To
■M'1, Kearney the artist, and Mr. Branston the engraver,
my thanks are due for the trouble they have taken to exe-
cute them in accordance with my wishes.

1, St. Helen’s Place,
Aug. 25th, 1847.

CONTENTS.

Part I.— STRUCTURAL ANATOMY.
Neurine, 1 — 7

1. Grey, vesicular, pulpy, 14 — 22

a. Source of power

b. Its vascularity

c. Its phospliatic quality

d. Its intelligential agency

2. White, tubular fibrous, 7 — 14

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, 2,

19—14

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, 23
Structure of nervous centres and ganglia

Part II.— COMPARATIVE ANA-
TOMY.

1. Its object, the elucidation of the se-

veral functions, 25 — 27
Comparative anatomy of brain
Nervous system, the medium of con-
nection 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 ex-
istence of a proper nervous
system

2. The animal kingdom, 27, 28

Five divisions
1st. Cryptoneura

Nex-vous system indiscernible
2nd. Nematoneura

Nervous system, a mere thread

i. Ganglia j

ii. Commissures > rudimental

iii. Nerves J

3rd. Homo-gangliata

All the ganglia of one size
4th. Hetero-gangliata

Ganglia dispersed and separate
5tli. Myelencephala
Perfect brain and cord

1. Ascaris or intestinal worm

a. Its limited existence, 28 — 30

b. Microscopic thread of nerves

i. Law of development

ii. Egg, at the twenty-fourth hour,
incubation

2. Asterias, or star-fish

a. Locomotion for seeking food

b. Nervous cords emanating from

nervous nodules

i. A low type of the highest or-
ganizations

ii. Human brain studied in its low-
est elementary forms

iii. Rudimental development of gan-
glia, commissures, and nerves

Term ganglion, not physiologically
correct

Human brain, a series of ganglia

Nature of a ganglion

Similarity between ganglion of
the fifth aixd posterior roots of'
spinal cord

Cineritious neurine is a ganglion

“ Cortical substance” a misnomer

Peculiarity of organism implies
peculiai'ity of junction

XVI

CONTENTS.

Grey neurine a ganglion — white
neurine a nerve

Grey generates, white conducts
power : e. g. nerves and com-
missures are conductors to and
fro ; the commissures are organs
of comparison — grey neurine
the seat of judgment, &c.

Diagram of the Phaenomena of Life :
Vital Phaenomena

Sympathetic,

or

Cyclo-ganglionic

Understanding.

Man.

History of ganglionic nerves, 37

3. Articulata

a. Spinal cord, 40 — 43

Not the seat of sensation, nor of
voluntary or instinctive motion

Analogy between articulata and
vertebrata

Symmetrical nerves of Sir C. Bell,
the analogue of the spinal cord
of the vertebrata

Nervous thread of the lower is
rudimental of the spinal cord of
the higher

Whenever the rudimental thread
of the lower terminates in, or
is joined to, a grey ganglionic
centre or brain, then there is
volition

Comparative anatomy works out
the analysis of the functions in
man

4. Tunicata, 43 — 45

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 sur-
faces

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
sensation

The sphincters act from consent
or sympathy, analogous to the
sphincters in man
5. Conchifera, 46, 47
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 respi-
ratory and oral apertures

e. The smaller ganglia, analogues
of the cerebral ganglia in man
— organs of sense

2. Shell-hearing molluscae
a. Locomotion

b. Rudimental foot implies addi-
tional vesicular neurine — the
pedal ganglion

i. Brain — consciousness j

ii. Medid. oblong, excito- I
motory and respiratory f
functions

iii. Spinal or pedal ganglia
Locomotion
Gasteropoda, 48

V

7 ill

J \ <D c.

O CD

U

>

. CD

i. Cephalic

ii. Itcspiratorv

iii. Pedal

Snail, slug, limpet, &c.

a. Sense of sight and 'j
smell

b. Copulation neces- [
sary for procreation J

Individuality of ganglia not decided
by anatomical lines of demarca-
tion

i. (Esophageal ganglia x

ii. Optic and olfactory

iii. Pedal or spinal

iv. Respiratory

v. Cephalic j

c. Gustatory and manducatory or-
gans

i. Pharyngeal ganglia
Myriapoda, 50 — 61
1. Sandhopper

a. Ganglia all one size and at
equal distances

T\ Analogues / mTcICu. cbl . } S°I
J or 1 Spinal cord ) X S | S
b. Commissural connections I, ;|| g
Ana-

( Additional
ganglia

Progres-
sive deve-
lopment

i. Cerebral commis-

sures

ii. Spinnl commis-
sures

- I f Corp. call. -)

i Alia i transverse I

\hud fib/oer /

.5-3.2

~ J
z js ~

ps 2 ?

CONTENTS.

XVII

. Cymothea

a. Nerves of instinct — a distinct set
R Brain of Myriapoda and higher
articulata ' composed of four
ganglia

i. Olfactory ganglia

ii. Hemispherical and optic gan-
glia

iii. Manducatory ganglia

iv. Excito-motory or instinctive
nerves

c. Sympathetic or ganglion of vege-

tative life, large, and chiefly
distributed to the salivary
glands

Visceral ganglia relatively large
Brain and nerves of sense rela-
tively small, e. g. Iulides
In insects this is the reverse
Visceral nerves diminish in exact
proportion to the increased ac-
tivity of sense and motion.

d. Structure of cord — double, or

composed of two lateral co-
lumns with transverse fibres;
butterfly

a. Reflex phenomena

b. Fibres of reinforcement

c. Sensation and voluntary motion

d. Pedal or tarsal nerves

e. Commissural connections

f. Ganglionic enlargements

i. Upper fibres 1 Joined to ce-

ii. Under fibres J phalic ganglia
( Commis-

* < sural coll-
ie nections

g. Lateral fibres reflex only
8. Crustacea, 61

Three divisions of nervous system
a. Supra-cesophageal — sensation

i. Dorsal or spinal 1 Reflex

ii. Stomato-gastric J 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

f). Insecta, 62 — 65

Nerves decidedly concentrated

i. (Esophageal rir.g, amass \ Primor-

ii. Sensory ganglia, large !• dial

iii. Pulpy orgreyneurine J brain.

\ olition and consciousness, e. ir.

moth

iii. Transverse

iv. Lateral

fibres

10. Cephulopoda, 66 — 71

1. Pearly nautilus

Organs or ganglia of sensation
enlarged

2. Cuttle fish

a. First analogue of a skeleton for
the support and protection of
nervous centres

b. Corpus geniculatum analogized

c. Cardiac and solar plexuses ana-
logized

Imperfect development of the
nervous masses harmonises with
the low or imperfect habitudes
of animals

Sensible mantilla, the first sign of
the excito-motory system

11. Vertebrata, 71

Central masses exalted above the
peripheral nerves

Supra-oesophageal ganglia become
a brain in a brain-case
Ganglia joined in a bony canal
form a spinal cord
Brain and cord connected
Nerves or ganglia reside in appro-
priate cavities
Grey neurine enlarged
A. Pisces or Fishes, 73 — 86

i. Brain 1 True cerebro-spinal

ii. Spinal cord / axis
Weight of brain
Cord resembles human
Analogous to foetal spinal cord
Length different in different fishes
Sensory ganglia, united in man, are

separate in fishes
“ Origin q f Nerves” a misnomer
Increased size of hemispheres argues
increased intelligence
Eight cerebral ganglia enclosed in
a capacious skull
Whiting, Cod, 78

Hemispherical ganglia the analogues
of the fcetal hemispheres
Motor and sensory nerves more de-
veloped

Carp, Pike, Skate, 83 — 86
Sensory and hemispherical ganglia
still more demonstrable
Branchiogastric nerves a: alogues
of the pneiunogastric. Electric
ray

The brain more concentrated in
cartilaginous fishes
Cerebellum large in skate, shark, &c.
Hie locomotive powers of these

XV111

CONTENTS.

fishes great, and they have no
air-bag

Fifth pair of nerves visible

B. Amphibia, 87

Hemispheres, sensory and motor
nerves, and cerebellum, more
developed

C. Reptilia, 88 — 90
1. Turtle

Striking exemplification of the func-
tions of the pneumogastric

Office of the grey neurine nega-
tively proved

D. Aves, or birds, 90 — 94
Cerebro-spinal axis more decidedly

figured

Intelligence and hemispherical ganglia
increase pari passu
Convolutions begin to be seen
Why the brain is convoluted
Cerebellum large, and the reason why
Vermiform process

^Implacentalia

E.

Mam-

malia,

94.

' Placentalia

( Monotremata
\ Marsupiata
llodentia
Edentata
lluminantia
/ Pachydemiata
Cetacea
Carnivora
Insectivora

1. Implacentalia, 94
Monotremata
Cloaca of birds
Bird-like brain
Relative weight of brain
Convolutions almost absent
Marsupiata, 97

Brain relatively small
Absence of pic cental foetation typifies
low intelligence and small brain

2. Placentalia, 98
Rodentia — rabbit

All the parts of the human brain
here developed
Convolutions manifest
Pons Varolii and medulla oblongata
Edentata, 103
Brain simple
Ruminantia — sheep, 105

A more highly organised 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 rudi-
mental, but complete
Pachydermata — horse, 109
Brain of a high class
Grey and white neurine same as in
man

Medulla oblongata bold and de-
cided

Commissures and cereb Hum large
Note : — Ganglia of lingual nerves.
The motor tract (elephant) : he-
mispherical ganglia absolutely
larger in man

The intelligence of the highly
organised brain of the elephant
Cetacea — porpoise, 115

As it nurses its young, it so requires
intelligence. Its highly or-
ganised 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, 119

Olfactory nerve large
No convolutions

The chimpanzee

The figure of the brain in the mam-
malia varies

Comparative anatomy of particular
parts of the brain
Tubercles of third pair, 120 — 122
Optic thalami
Corpora striata
Corpus callosum, &c.

Ventricles

Convolutions, 122 — 132
The intelligential ganglia
Mammalia classified according to
convolutions

This classification associates animals
of corresponding faculties
The reason of the brain being con-
voluted

Four kinds of foldings in the convo-
lutions

Brain folded in the progress of de-
velopment according to a deter-
minate law

Foldings more or less according to
intelligence

CONTENTS.

XIX

An attempt at a classification of ani-
mals in groups of similar con-
volutions

Cerebral vessels, 132 — 138

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. 139—160.

Protective apparatus of the human
brain

1. Osseous, 2. Membranous, 3. Aque-
ous

Bony or osseous

i. Dermal skeleton — external de-
ciduous

ii. Ligamento-bony — internal per-
manent

Its progressive development from a
cartilaginous tube up to a j ointed
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 bifida

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
Ligamentiun denticulatum
Neurilema of nerves
Filiform process

Part IV. 161 — 174.

Weight of human brain
Horses’, elephants’ and whales’ brain
Metaphysical and physiological re-
marks on the properties of grey
and medullary neurine
Average weight of human brain

Its increase, decrease, and final decay
Men of talent — weight of their brains
Idiots — weight of t leirs
Female brain

The age at which the brain is fully de-
veloped

Tables showing the weight of the brain
Phrenological and physiological remarks

Part V. 175—196.
Configuration of encephalon
Two sin-faces

i. Convoluted or external

ii. Figurate or internal
Perpendicular section of skull

An outline of the entire brain and spinal
cord, with directions for dissect-
ing them
Convolutions

A particular description of their depth,
order, direction and foldings
Figurate surface

Dissection of hemispheres
Centrum ovale

Important post-mortem appear-
ances of this part in insanity
Lateral ventricles

Propriety of the term “ Cavity ”
Meaning of the term “ Figurate sur-
face"

Anterior cerebral ganglia or motor co-
lumns

Descriptions of the various parts brought
into view

1; 2

XX

CONTENTS.

Part VI. 197 — 283.

Dissection of the human brain and spinal
cord

Mode of hardening the brain for dissec-
tion

Spinal cord

Two halves, with anterior and posterior
fissure

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 grey neu-
rine of cord

Transverse section
An internal canal

Grey neurine within, a series of gan-
glia with commissural connec-
tions

Fibres of the cord
Motory and sensory fibres

Opinions of the older physicians, 210
Comparative anatomy of cord
Cranial division of the cerebro-spinal
axis, 212

Medulla oblongata

Grey 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 demarcation between the tracts
of sensation and motion, 222
The distinct offices of the two spinal
columns, not an anatomical
distinction

Pons Varolii — distribution of the de-
cussating fibres

Mode of dissecting medulla oblongata,
230—240

Dissection of the fibres of the motor co-
lumns

Cerebral fibres of the sensory columns
Decussation behind the pons Varolii
Mode of demonstrating it

Mode in which nervous matter is finally
appropriated to sensation and
motion, 244

Diagram of Reflex Functions.

Brain.

Grey neurine.

-A-

Volition.

Medullary neurine.
Motion. Sensation.

Spinal Cord.

U

Anterior

Column.

Motor

Nerves.

. Posterior
Column.

S§ —

O o Sensory »iv
Nerves. » *

Peripheral

surface.

The perpendicular arrows may represent the fibres of
reinforcement. The horizontal arrow may represent the
transverse commissural fibres of the cord.

Dissection of the fibres of the sensory
tract

The structure of the hemispherical gan-
glia, 246

Section of the cerebrum
Distribution of grey neurine
Medullary fibres pass into and through
grey matter

External layer of the grey 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
Commissura mollis
Pons Varolii, fornix, &c.

Inter-cerebral commissure
Arrangement of its fibres
Arbor vitas
The cerebellum, 266

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. 284—301.

Cerebral nerves

Opinions respecting their precise num-
bers

Eleven pairs described

Power.

CONTENTS.

XXI

Decussation or semi-decussation of optic
nerves
Theory of vision

Part VIII.

Cerebral circulation

Part IX. 307—325.
Development of the brain
Facts prove the law of progressive deve-
lopment

A brief outline of the passing compara-
tive anatomy of the foetal exist-
ence

Part X. 326.

Physiology of the cerebro-spinal axis
Phrenological observations

Part XI. 343.

Diseases of the brain
Arrangement

A. Ansemie affections

B. Hypersemic 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
“yof blood within the skull
A. Anjemic 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

Iks 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 anaimia of the brain ?
Idle nature of delirium tremens some-
times inflammatory

Treatment : — use of opium, stimulants,
bleeding, &c.

Diagnosis — the pulse

2. Anaemic coma, 361 — 372

i. Coma. ii. Hydrocephalus, iii. Ra-
mollissement

i. Coma from exhaustion — infants
Nature, signs, and treatment

from erysipelas capitis

Proper treatment

ii. Cerebral anaemia, 373
Effect of mental exertion
Nature, signs, and treatment

iii. Ramollissement, 374
Cause and period of accession

Its nature — hypersthenic, or asthenic ?
Remarks on the condition of the
blood-copuscles
Two kinds of ramollissement

i. Inflammatory 1 Pathology

ii. Non-inflammatory j of each

3. Atrophy of brain, 394
Arrest of development (?)

Gives rise to effusion in children

Hydrocephalus

The result of chronic inflammation
i. Fatuity

ii. Mania

iii. Old age

B. Hyperasmic affections, 396 — 398

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

examinations

Morbid signs of inflammation of the
several membranes and the
neurine

1. Inflammation of hemispherical
ganglia

Its effects and symptoms, 396
Intelligence excited or deranged
Volition impaired or exaggerated
Meningitis 1

Arachnitis > meaning of these terms
Phrenitis J
Symptoms, 411

Mama — its probable organic lesions
An account of the mental and bodily
disturbances

The great importance of attending to
the particular kind of effusion,
mania, delirium, or headache

XXII

CONTENTS.

The intellectual faculties to be well
observed and considered
Concussion, 416

Intellect deranged or abolished
Meningitis — its effects often insidious
A remote cause of insanity
Treatment

Antiphlogistic — to what extent
Fractures of the s/cull
Inflamed dura mater
Otitis or earache — its importance
Syphilitic taints
Ossifications

Causing mental irritability or in-
sanity

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, 488

An indefinite term
Pressure on the brain
Symptoms

Its real and aben-ant forms
It may resemble sleep, syncope, or
epilepsy
Three forms

i. Apoplexy with coma

ii. headaches

iii. 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., 505

thalam. nerv. opt., 508

medullary substance

Meningeal apoplexy, 510
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, 534

Of premonitory symptoms
Treatment of apoplexy itself
Sthenic or asthenic

The promptitude and decision requisite
for success

The symptoms indicating or contra-
indicating the loss of blood
Rides for the extent of bleeding
Danger of bleeding without absolute
necessity

Danger of calomel in apoplexy
Cold, croton oil, &c. & c.

The after treatment
C. Convulsive affections, 552, 577
Their seat in tubular neurine
Convulsions on one side indicate dis-
ease on the other
The result of pressure
Injuries to the head give rise to con-
vulsions

Fractures of the skull
Trephining

Opening the dura mater
Pulsatory movements of dura mater
Epilepsy, 579 — 641

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

CONTENTS.

XX111

Irritation of the excito-motory system
Two kinds of epilepsy
Centric and centripetal
Causes of epilepsy
Cerebral disease
Gastro-hepatic irritation
Generative disorders
Determinations of blood to the head — the
choroi.l plexus
Headaches in epilepsy

Theory of the pathology of epilepsy
Various opinions respecting the seat of the
disease

Hyperaemia of the brain during the epi-
leptic paroxysm
The use of digitalis
(Enanthe crocata
Effects of tying the carotid
Throbbings 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 epi-
lepsy 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, 641 —
673

Morbid growths from neurine, or the
membranes not the result of
simple hyperaemia

Tumours within the skull, 641
Mercury and its iodurets
The ordinary reports of these cases
almost valueless
Dura mater

Tumours outside of the membrane ab-
sorbing the bone and protru-
ding 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
Hsematoma of the brain
The best pathognomic 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, 662 — 673
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
hydrocephalus
The treatment

ERRATA.

Page 15, line 5, for masses read meshes.

107, last line, for fourth ganglion read projection.

108, line 4, for four ganglia read three.

11 1, in the description ot tig. 56, second line, for cage read edge.
121, in the last paragraph, for this ventricle read the lateral ven-
tricle.

124, line 10, for Tetis read Fells.

192, in description ot figure, line 4 from the bottom, for cornuae

read cornu.

193, line 20, for anterior ganglion read posterior,
line 21, for posterior ganglion read anterior.

218, for Braschet read Brachet.

344, for Encyclopaedia of Anatomy read Cyclopaedia of Pract.
Med.

347, hue 20, for effect read affect.

T II E

HUMAN B R A I N.

PART I.

STRUCTURAL ANATOMY.

Before we commence our study of the configuration and
anatomical arrangement of the human brain, we must in-
vestigate the physical, chemical, and microscopical character
of its component matter. The name of this matter is
neurine. Neurine is the substance in which the peculiar
powers of the brain and nerves reside. It is never found by
itself, for it is too dehcate in textme to retain its properties
if it were unsupported. It is always supported and pro-
tected 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. Membranous 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 mem-
branous 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 tubu-
lar 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 membra-
nous network, on which blood-vessels ramify, endowed with
the power of separating or secret ivy 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 conducting portion. In the one portion, in addition

B

2

STRUCTURAL ANATOMY.

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 re-
quired.

The essential material of the nervous system is deno-
minated 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 described much
better.

There are two kinds of neurine, differing in colour, con-
sistence, and microscopic character. They are easily recog-
nized, 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 grey or ash colour, 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 colour 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 dis-
tinctly to consist of tulies, and hence its present title, tubu-
lar 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 denominated, from its microscopic character, fila-
mentous or gelatinous neurine. Its filaments are about half
the diameter of those of the tubular, and without any dis-
tinct 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 correctuess of the view
advocated in the first edition of this work, of their relative
function. This view of the subject is now almost universally

OPINIONS.

3

admitted, but in the year 183G it was by no means an esta-
blished point in physiology. The view to which I refer is
this : that the cineritious nenrine is the source of power,
and the medullary nenrine merely the conductor of it. The
importance of establishing this position will be best under-
stood when we come to the dissection of the human brain
and spinal cord, and eudeavolu• to discover the office of its
component parts. Until this point was established, (and
even now it is not considered to be so by ah,) 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 grey substance as only a preparing
organ. Treviranus says that it prepares the blood for par-
ticular processes which go on in the medullary substance.
A ieussens, that it prepared and purified lymph as nourish-
ment 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. Diemebrouk, Rnysch, Haller, and others,
entertained the same opinion.

Meckel says* that “ the most probable hypothesis is that
which represents the grey 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 accomplishment of the
functions of the nervous system ; and that, however incon-
testable the importance of the grey matter, it does not
authorize us to believe that it is more noble than the medul-
lary : that is to say, that in this portion the spiritual
changes corresponding to the material pass into one another,
as Wenzel appeared to behove when he says, ‘ Cinerea
sin gul arum cerebri partium substantia videtur pivccipue id
esse, quo proprise cuivis istarum partium sensationes effice-
rentur ; f and that the office of the medullary is not simply
that of a conductor.”

Not, however, agreeing with Meckel, but rejoicing to

* Vol. i. p. 256.

t De I’enitiori Cerebri Structure, cnp. vi. p 6!)
a 2

4

STRUCTURAL ANATOMY.

derive support to my opinions from such, accurate observers
as the Wenzels, I shall quote the whole passage: “ Veri-
similiter itaque diversor singularum cerebri partium func-
tiones maxima saltern ex parte a cinerea, mutua autum
singularum cerebri partium conjunctio, totiusque nervus a
medullari substantia depen det; sive quod idem est : cinerea
singularum cerebri partium substantia videter pracipue id
esse, quo propria cuivis istariun partium sensationes effice-
rentur, et substantia medullaris eadem rnodo pro reliquo
cerebri ductor impressionum sive sensationum singularum
cerebri partium esse videtur, non secus nervus sensorius id
ipsum suo organo prastat.”

Willis (Anatomy of the Brain, translated by S. Pordage,
1679, p. 59,) says, “And what is chief of all, the universal
cortical or shelly substance of the brain, (to nut) 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 grey substance secretes, are circu-
lated by the medullary. Reil, (Mayo, Physiological Commen-
taries, Part II. p. 117,) speaking of the fornix, says, “Like
these, the corpus callosum- involves no grey matter, and
with them perhaps forms an apparatus for transmission
only.”

Even Gall and Spurzheim, who have done so much for
the anatomy and physiology of the brain, did not see clearly
the relation of the cineritious neurine and the medullary.
They considered the former as the womb or generator of the
medullary substance.

Ticdemann, as will be seen from the following passage,
does not consider 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 grey 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 cer-
tainly, 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

OPINIONS.

5

is deceived in saying that the grey 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 produced by the arterial blood which
it contains, and by the greater rapidity with which it
repairs the loss which the exercise of the vital action pro-
duces. I admit, then, an intimate relation betAveen 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 ( Trigla
voli tans*) are the origins of the nerves destined to the digi-
tiforrn 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 cominced for some years.
Vi e find also in the torpedo {Raia Torpedo) two large gan-
glia, 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 Ratis, Raia Pastinaca, and other spe-
cies 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
{Hit urus) 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 cnlarge-

“ * Samuel Collins has described and represented them, — System of
Anatomy, vol. ii. tab. 70, fig. 3.

f Ibis I have demonstrated in a Memoir addressed to the Academy of
Sciences at Berlin.

STRUCTURAL ANATOMY.

inents along the spinal marrow of most fishes.* Thus for
example, in the carp there are behind the cerebellum ’two
swellings, united together by a middle tubercle, and repre-
senting m 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. ”f

One of the first physiologists who decidedly advanced
the opinion that the grey neurine is positively a source of
power, was Dr. Fletcher,}: of Edinburgh. In his Lectures,
when speaking of the distinction between a plexus and a
ganglion, he says, “ The abundance of grey matter which they
contain, and which there is good reason to believe is always a
primary source of some distinct faculty or power, &c.Ӥ And
again, in another part of the same course of lectures, he says :
“It is probable that no impediment whatever is offered
to the function of a ganglionic nerve by such a division as
entirely paralyzes the cerebro-spinal. Such is the case with
the latter only ; because the white matter of the nerve,
being dependent for its energy upon the grey matter of the
central parts of this system, becomes of course inert when
separated from it : but no such line of demarcation exists
in the ganglionic system, every point of every nerve of which
contains white and grey matter intimately interwoven to-
gether, 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 de-
stroying its irritability.”

As the student advances in the study of the structure
and physiology of the brain, he will see many reasons for

“* Arsakay, loc. cit. p. 16. De posteriore Gangliorum Encephalum
constituentium Parte.

t 1 iedemann on the Foetal Brain, translated by Bennet.

+ It is with great pleasure that I embrace this opportunity of express-
ing the high opinion I entertain of the late lamented Dr. Fletcher’s talents
and philosophical mind. Dr. Fletcher had the honour of being among the
first, if not the very first lecturer in the kingdom who taught human phy-
siology on the wide and scientific basis of comparative anatomy.

§ Ryan’s Journal, April 18, 1835, page 961, note.

OPINIONS.

7

assenting to this view of the office of the cineritious neurine,
which cannot he fully appreciated without a further know-
ledge of the subject than he is supposed to possess at pre-
sent. We believe then that the peculiar power of the nervous
system resides in the cineritious portion. In short, that
the cineritious 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 woidd be useless without the other. The me-
dullary or tubular neurine appears to act simply as a passive
conductor 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.

2ndly. As a conductor of an order to act, from the brain,
to the voluntary muscles — nerve of volition.

3rdly & 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 voli-
tion ; — the excito-motory nerves of Dr. M. Hall.

5thlv. As a conducting medium between the centres of

J m O

power — the commissures.

Further explanation will be given hereafter of the func-
tion 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 di-
stinction between the power of the nervous centres and their
conducting instruments, and show that the central portion
possesses its power independent of the peripheral. A patient
may be paralytic 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 dis-
ease, 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.

8

STRUCTURAL ANATOMY.

Tubular or medullary murine, though firmer than the
cmentious neimne .nevertheless, in comparison with the
iei 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 from three-fourths up to seven-eighths of
its weight Vauquelin whose analysis, though made as long
ago as 1 8 1 a, is still referred to by all our best authorities as

TYinST. f PCmumifY r\T i

Albumen

Cerebral fat

Phosphorus
Osmazome .

Acids, salts, sulphur
Water

f Stearine
\ Elaine

4-53 V

070 J

7-00

5-23

1-50

112

575

80-00

100-00

M. John- is the only chemist who, in his analysis of the
bram, has hitherto separately examined the grey and white
matter, lie has stated that the white matter contains
moie fat, than the grey, and that its albumen is more firm.
Ihe following comparative analysis was made of the brain
of one of the insane patients who died at Salpetriere.

Entire brain (density = 1048).

Water
Albumen .

White fatty matter
Red fatty matter .

Osmazomc, lactic a
Earthy phosphates

Water .

Albumen

White fatty matter
Red fatty matter
Osmazome, &c.

Earthy phosphates

* Journal tie Cliimie Mddicalc, August 1835.

. 77-0

. 9-G

. 7-2

. 37

s .

. 2-0

•

. 17

White Substance.

Grey Substance.

73-0

S5‘0

9-9

7-5

13-9

10

0-9

37

10

1-4

1-3

1-2

TUBULAR NEUUINE.

I’oville 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 convo-
lutions.”*

He also in some cases attributes to emaciation the
peculiar appearance 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 phospho-
rus 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 globides 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 distance from one another, and
united by narrower parts which are continuous with them,
and are formed apparently of the same material.

It is now believed that this varicose appearance depends

* Trait<; complet de l’anat' de la pliys0 et de la path0 du systeme ncr-
veux cereb". 8vo, 1841, par Foville, p. 122.

10

STRUCTURAL ANATOMY.

Simply on pressure or other force used in preparing the
objects. Still m some portions of the nervous system this
beaded appearance is much more easily produced than in
others, showing that it depends on some peculiarity of
structure. It is most easily seen in those fibres which are
most centrally situated, and in all probability depends on
the greater delicacy of the protecting portion of the fibre
and also of the investing membrane. 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. They are not simply solid fibres. They

are perfect cylinders, vary-
ing in diameter from roVoth
to Tooooth of an inch. Their
average width is from-g^th
f° 400 9th of an inch. They
are all invested and support-
ed by a distinct elastic ho-
mogeneous membrane, simi-
lar to the sarcolema of the
fibres of the voluntary mus-
cles. The neurine which is
contained within this mem-
brane consists of two por-
tions, a central, which is

probably the active portion
of tubular neurine, and an
outer or investing portion,
which possibly acts merely

a. Diagram of tubular fibre of a spinal nerve. ^ lSoldtci of tile COll-

o. Axis cylinder, ft. Inner border of white sub- (I Ilfl illfT ppnfrnl a vie TLo

stance, cc. Outer border of white substance, d d. "Ug Ceil 11 ell RXIS. Llie

Tubular membrane, b. Tubular fibres, e. In a central UOVtirm IS mlWl Ivir

natural state, showing the parts, as in a. /. The Hell pul HOil IS CaM6(l Dy

white substance and axis cylinder interrupted by UoSPntTinl nnrl Pnrlrinrro
pressure, while the tubular membrane remains. JVUb0nLIml cllla 1 mklllge, tile
</. The same, with varicosities, ft. Various appear- /yWo ftilivtrlpv Tlio mitnv
ances of the white substance and axis cylinder . UtJMnWST. llie Olltei

forced out of the tubular membrane by pressure. TlOrtinn i « flip wliifp cnli

«'. Broken end of a tubular fibre, with the white I 1,1 lb lllU WrUte SUD*

substance closed over it. ft. Lateral bulging of stall CP. of Sell warm fSpp

white substance and axis cylinder from pressure. *Ud'11UtJ Ui ailll. (,Oee

g'- Various fibres of various sizes, from the cere- fio\ J 1
bellum. c. Gelatinous fibres from the solar plexus O* * '

treated with ascetic acid to exhibit their cell W'hp tlllinlflr mpmhmnp
nuclei, b and c. magnified 320 diameter. (Todd LUUlUcU mtUUUlclllC

and Bowman.) presents the same characters

Cut the white substance of

wherever it is met with.

TUBULAR NEURINE.

11

Fig. 2.

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 composi-
tion 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-cylinder of the nerve-
fibres as very distinctly 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 cliinck or a central
point. It has been suggested, that
the distinction of these two sub-
stances is merely the result of coagu-
lation or chemical agents, and that it
does not exist in the living organiza-
tion ; but Dr. Todd and Mr. Bowman,
who have paid great attention to the
microscopic anatomy of these parts,
and from whom this account is de-
rived, 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- „ . .

•, •' . -11° Pacinian corpuscle, from the

oers in connection With the nerves of mesentery of a cat, intended to

,1 . 1 show the structure of these bodies.

the hand and foot. In the mesenferv The stalk and body, the outer and

f , , .. . j inner system of capsules, with the

oi the cat, they may be seen with the fe”hal c.avity- are st'en at «• Ar-

i i i,i • terial twig, ending in capillaries,

naked eye, and under the microscope
it exhibits the appearance of fig. 2,
taken from the above work. — (Pig. 75,
p. 397, Todd and Bowman.) ...

rm v ,. . -p, \ . white substance, and stretching

i he discoverer of the i aciman cor- ai°ng the axis to the opposite end,

_ i ... , "here it is fixed hy a tubercular

puscles states that the nerve filament enlargement,
has a single contour, like the sympathetic filaments : up to
* Physiological Anatomy of Man, 1845.

which form loops in some of the
intercapsular spaces, and one pe-
netrates the central capsule, b.
The fibrous tissue of the stalk,
prolonged from the neurilemma.
n. Nerve-tube, advancing to tile
central capsule, there losing its

12

STRUCTURAL ANATOMY.

the base of the corpuscle, the contour is double j at its ter-
mination it presents a granular swelling, like the common
ganglion corpuscle. Thus it will be seen that the central
axis alone enters the central capsule. The envelope having,
Fio- 3- as it were, conducted the central

portion to the door, leaves it, and
stops outside. 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 cor-
rect.

Nerve-tubes never branch like

blood-vessels, and never inosculate
with one another ; though they form
„ loops at their origin in the nervous

Ideal representation of the nerve- 1 i i° • “viyuuo

tube entering a Pacinian corpuscle, to Cdltl'CS, aild at thClT terminations
represent more clearly the distinction , . „ T

between the central axis and the en- Ulteil aS 1 have traced tllPSe

yelope. 6 s. White substance of 1

Schwann- 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 neces-
sary to vindicate the great principle announced by Bell,
that principle upon which all accurate knowledge of the

TUBULAR NEURINE.

13

nervous system must ever repose, the individuality, namely,
and uninterrupted continuity of the primary nervous fila-
ments. 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 ex-
press our conviction, resting on repeated and careful exami-
nation, 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 then’
peripheral extremities, where, both in the muscles and in
the tactile papillae of the skin, they unite and form loops.
It has also been asserted by Valentin, that a similar dis-
position prevails in the central ends implanted in the grey
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 different, that it is surprising any comparison between
them should have been attempted. It is the office of the
blood-vessels, not merely to cany the nutritive fluids to all
parts of the body, but specially, by overcoming the repeated
obstacles which impede the circulation, to secure in the ex-
treme divisions or capillaries that uniform current which alone
is compatible with healthy nutrition. Now, how is this to be
accomplished ? Clearly by providing free intercommunica-
tions 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 innervation requires in theory what is shown by
observation, a disposition of the nervous threads, which will
make them to act as isolated conductors, so as to transmit
unmingled the mandates of the will ccntrifugally to special

14

STRUCTURAL ANATOMY.

muscles and ccntnpetally the impressions made on the
oigans of sense to the bram. In consequence of the un-
satisfactory results of many of Stilling’s researches, we have
again cautiously examined the disposition of the primitive
tubes m the spinal cord, with the express object of ascer-
taining if, m any part of the white matter of the white sub-
stance anastomosis could be detected. AH our examina-
tions 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 per-
fectly 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
o an unpractised eye, and especially when low powers are
used as was done by Stilling, they may yen, readily be
mistaken for nervous tubes, and herein, we believe, will be
found the source of the errors above noticed. The capil-
lary vessels are seen branching and uniting, but they pre-
sent physical marks, and especially nuclei in their walls
n lich aie quite distinctive : indeed, we were never more
impressed with the certainty and elucidation which micro-
scopic examination confers on the great questions of phy-
smlogy, than by thus seeing under the eye the true charac-
teristics of the vascular and nervous systems.

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 com-
pleted, after pointing out and demonstrating the physiolo-
gical necessity of isolated conductors in the peripheral por-
tion of the nervous system, both as relates to sensation and
motion, says, we conclude, as a general anatomical proposi-
tion, that all ramifications, anastomoses, and interlacements
of the nerves, are in reality only apparent, and therefore
that no true divisions nor communications similar to those in
blood-vessels exist, but merely a corresponding entrance or
exit unbranched, uninterrupted primitive fibrils ; a disposi-
tion which enables us easily to comprehend the laws of
nervous conditions.”

Vesicular or pulpy neurine is much more vascular than

VESICULAR OR PULPY NEURINE.

15

Fig. 1.

tubular. Where its capillaries are well filled with injec-
tion, it appears under the microscope like a minute network
of countless blood-vessels.

The neurine which is depo-
sited between the masses of this
intricate mass of blood-vessels
consists almost entirely of cells,
with nuclei and nucleoli, (see
fig. 4, a,) iu various stages of
development. The wall of every
vesicle consists of an exceedingly
delicate membrane, containing
a soft but tenacious, finely gra-
nular mass. They are mostly
globular, but not uniformly so.

Some are caudate, and the tail prolongations are frequently
long. In point of structure, says Messrs. Todd and Bowman,
the caudate processes are
exceedingly dehcate, and
finely granular, like the
interior of the vesicle,
with which they dis-
tinctly seem to be
tinuous. Such is
delicacy of these
cesses, that they readily
break off ; in general,
very close to the vesicle.

Sometimes, however, one
or more of them may be

a. Vesicle from the cineritious neurine
of the brain of a frog. b. Blood corpuscle
of the same animal, to show their relative
size.

Fig. 5.

con-

the

pro-

(Todd and Bowman, p. 212.) Nerve vesicles from
the Gasserian ganglion of the human subject, a. Glo-
bular one with a defined border. b. Its nucleus, c. Its
frorwl tn o rnn rWn Kip nucleolus, d. Caudate vesicle, e. Elongated vesicle,
iiaU/U iu a tuiioiuLiauiu with two groups of pigment particles. /. Vesicles sur-
rounded by its sheath, or capsule, of nucleated particles.
g. The same, the thread only being in focus. Magnified

distance, and null be
found to divide into two 300 diametcr-
or into three branches, which undergo a further 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 pro-
bable, 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 cerebro-spinal centres,

16

STRUCTURAL ANATOMY.

we have found the tissue in the vicinity of the caudate
vesicles fieely traversed in all directions by numerous very
delicate filaments, which seem to be the ramifications of the
caudate processes. These often exhibit considerable tenacity
and elasticity. The situations from which we may obtain
such caudate vesicles as arc best suited for examination are
the “ locus niger” in the crus cerebri, and the grey 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
micioscopical structure of this portion of the nervous system
and the secreting portion of the glandular system.

John Goodsir* lias thrown great light on the part which
the nucleated cell plays in the secreting process. It has
been already stated upon other grounds than those now to
be advanced, that the cineritious substance of the brain
stands in the same relation to the nerves that the secretin0-
portion of a gland does to its duct. This theory appears
to me now most curiously confirmed by the structure and
functions of the intestinal villi.

To understand the part which the vesicles of the villus play
in digestion, it is necessary to be. aware of certain of the
functions of the cell with which physiologists are yet un-
acquainted.

Not only are these bodies the germs of all tissues, as
determined by the laboiu’s 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, mine, in
another set of instances, if secretion be the duty assigned to
it. The only difference between the two functions being,
that in the first, the cell dissolves 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,f “The ultimate secreting

* Anatomical and Pathological Observations, by John Goodsir and
Harry Goodsir, 1845, page 7.
f P. 25, loc. cit.

VESICULAR NEURINE.

17

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 phy-
siologist, l)r. Carpenter, regarding the difference in the struc-
ture of the cortical substance 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 imperfectly
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 cortical substance, the vesicles, with their granular
coverings, are replaced by perfect ganglion-like globules
until their filamentous sheaths.

It is, then, most probable that the nucleated cells of vesi-
cular 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 secreting organs, employs that blood
in the preparation of a something. Indeed, 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 exertion — a fact first pointed
out by Dr. Prout — may be cited as supporting this view of
the analogy between the production of nervous power and
ordinary secretion.

Dr. Golding Bird, in his excellent little work on urinaiy

c

13

STRUCTURAL ANATOMY.

deposits, gives a very striking case, illustrative of this con-
nection.*

“ Where the presence of the triple phosphate is only
occasional, its connection may be traced with some cause
which lias rendered the system morbidly irritable, at the
same time that its tone or vigour has become depressed.
The simplest examples of this kind that have occurred to
me, have been in cases of individuals of nervous tempera-
ment, 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 performed
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 dys-
pepsia. The urine passed on Saturday evening, as well
as on Sunday morning, though repeatedly examined, Avas
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 com-
plete fatigue, with a painful aching sensation across the
loins, in addition to the flatulence and epigastric uneasiness
under which he always laboured. The urine voided before
retiring to rest after the severe exertions of the day, was
almost constantly 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 folloAving day, and once more
re-appeared on the Sunday evening. I had an opportunity
of observing this state of things for several AArecks, and it
idtimately disappeared by the patient relaxing from his duties
and enjoying the amusement of travelling for a feAv Aveeks.”
* Urinary Deposits, &c., by Golding Bird, M.D. 1844.

VESICULAR NEURINE.

19

I have been frequently consulted by a gentleman in
business, of a highly nervous temperament and excitable
brain, on account of a deposit of phosphorus in his urine.
In the morning this excretion is perfectly clear and healthy,
but after he has been harrassed 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 circumstances,” says Dr. Carpenter, “ 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 obser-
vations, 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 we speak
of sensation, thought, emotion, or volition, therefore, as
functions 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 Tlenle :
it is flattened, soft, and homogeneous in appearance ; con-
taining 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 gene-
rally 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 fibrillae. Acetic acid
dissolves the fibre, leaving the nuclei unchanged. These
fibres, containing nothing analogous to the white substance
oi Schwann, are devoid of that whiteness which characterizes
the tubular fibre; and it would seem that the grey colour of
certain nerves depends chiefly upon the presence of a large
pi oportion of the gelatinous fibres ; hence they arc some-
times called “ grey fibres .”

I he mode of connection of the gelatinous fibres with the
dements of the nervous centres is, as yet, quite unknown.

1 hey are found in considerable numbers, in what are called
the roots of the sympathetic, or the communications of that

20

STRUCTURAL ANATOMY.

neive 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 g-^th and the
Tooijth 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
throughout the animal organism.

Mr. Paget, in those admirable reports on physiology which
are published in the British and Foreign Quarterly Medical
Review, gives an excellent summary of the state of the
discussion at present (July 1846).

“ Bidder and Volckmann, on the one hand, have maintained
t hat 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 yrey colour 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 physiology of the nervous system this year (1846), is
from Kolliker.*

“ In the discussion of the question, Kolliker states, 1st,
that the fibres described by Remak as pecidiar to the
sympathetic nerve, and which are commonly called Remak
fibres, are, as Valentin has always held, not nerve fibres at

* Die Selbstaadig-keit und Abkangigkeit des sympatkisclien Nerveu-
system. Zurich, 1844, 4to.

VESICULAR NEURINE.

21

nil, but Neurelemma, consisting of imperfectly-developed
fibro-cellular bundles ; 2nd, lie determines that Bidder and
Volckmann are right in their description ot the structure
of tine nerve-fibres, or at least of the well-marked examples
of them, and that these are not (as Valentin maintained
that they were) Rcmak 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 distinc-
tive by Bidder and Volckmann, are neither definitely
marked, nor constant, nor essential ; that there is no real
difference 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 foimd 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 lvolliker
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 ITehnhotz,
W ill, and Hannover,* who, like him, have seen this mode of
origin; and from Bidder and Volckmann, who from another
mode of investigation concluded that fine fibres must thus
arise. Kdlliker has seen this mode of origin of nerve-fibres
in the spinal cord and in the spinal and sympathetic gan-
glia 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 Vertebrate, and
“ * Reclierehes Microse surle systerac Nerveux ; C'opeTihntjue, 1 844, 4lo.

STRUCTURAL ANATOM V.

0 0
<v .v

m many Invertebrata, in the brain and spinal cord, and in
all kinds of ganglia; neither has he observed any other

0r^n ^es^c^es this. The description given by
Kolliker, of the spinal ganglia of the frog, is, that they con-
tain 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 process. This process, like the
corpuscles, is pale and finely granular ; it is from Tiroooth
t° ToooToth of an inch in diameter, and after proceeding
about x o\> oth of an inch, it rather suddenly acquires a dark
contour and slightly granular contents : it is, in short, be-
coming 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 and
V olckmann, 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 ganglion 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 con-
cludes, from his own and other observations, that — 1st, The
nerves of voluntary muscles contain in their trunks a ma-
jority of large fibres, but in their peripheral distribution
either only or a majority of fine fibres. 2nd, 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. 3rd,
The nerves of sensitive mucous membrane are, in this re-
spect, like those of the skin, except that in the nerves of the
teeth pulps and the gums there is a great majority of large

“ * 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. Volckmann, in Art.
Nerven Physiologic, l. c.

GELATINOUS FIB1U5<

23

fibres. 4th, In the nerves of involuntary muscles, and of
the less sensitive or insensible mucous membranes, there is
a great preponderance of fine fibres.”*

From the above facts, it may be concluded that nerve-
jib res 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 pro-
tected, and hence the absence of this protecting matter. We
can easily understand what contrivance must be necessary
to protect the delicate 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
injury, is due to its investing membrane and the
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 commonly called pins and
needles, or live blood, as the nerve-fibres recover
their power, and the nervous current is re-
established.

Sometimes when you are examining the nerve-
tubes under the microscope, from the spinal
cord of the frog, you will see the two kinds of tubes most
distinct. The accompanying figure represents two of the
* British and Foreign Quarterly Medical Review, j>. 273.

resisting

presence

Fig. 6.

Gelatinous nerve-
fibres in the frog.

24

STRUCTURAL ANATOMY.

gelatinous fibres, one twisted round the other. They were
exactly the size of the axis cylinder of the ordinary fibres
as seen m the same field. This sketch was taken with Ur.

Fig. 7. Carpenter, through whose glass

I observed them. — (Fig. 6.)

The nervous centres, or
ganglion, consist of the vesicu-
lar neurine traversed by the
tubular neurine. — (See fig. 7.)
This represents very well the
appearance exhibited by a gan-
glion or nervous centre. * Let
it then be remembered that

(Todd and Bowman, after Valentin.) — A ^®®^ulai’ lieiUTlie doCS UOt
sHjfhtly 1com°presMd0|iCshowfngb?e ^iifterlace- ^ ^ tlle ^TVCS, and that

SXr?f theinternalflbre,,and,heveMcuiar when these cords present a
. . greyish appearance, as in the

fubsCe of sir ^ t0 thC °f the White

( 25 )

PART II.

COMPARATIVE ANATOMY.

The naturalist who devotes his time to observing the habits
and instincts of animals, then’ external form and general
appearance, pursues a branch of science which has unfolded
a multitude of facts highly interesting 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 for-
ward his researches to their internal organism, noth 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 execution of those acts which are exhibited
to us by living beings. By such investigations the physio-
logist, 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 ob-
servation like physiology is capable of affording, that they
stand in the relation of cause and effect.

On this principle, I consider that the study of the ana-
tomy and physiology of the human brain coidd not be intro-
duced 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,

26

COMPARATIVE ANATOMY.

independent of the service which it thus is capable of ren-
dering to the student in medicine.

The celebrated Haller, who thoroughly felt the value of
comparative anatomy m the study of human physiology

thed wimP fnCe °f tWs C0Urse> when reasoning on
the functions of a nervous system, after observing that a

biam and medulla spinalis are met with in animals with a
head and with eyes, says, “ Neque credo aut oculos absque
cbi o, aut absque ocuhs cerebrum in ullo animale reperhi
Mint 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. And when, in our dis-
section of some of the inferior orders of annuals in whom
there is an evident susceptibility to receive impressions from
external nature, and to re-act 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 absent, but developed in such minute
quantity and so transparent that it escapes our observation.

lhe presence of a nervous system is not necessarily a
proof of consciousness on the part of the animal in whom it
is found. The invaluable and philosophic researches of Hr
Marshall Hall have quite established this most important
tact, that all the actions which take place in man and ani-
mals m general, independent of volition, are as much excited
and guided by the nervous power as those which are di-
rected 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 im-
portant discoveries of Ur. 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 re-
gret I feel, that the most important contribution to physical
science since the discovery ot Bell, should have been passed
by unnoticed and unknown by that scientific society, whose
object is to promote science and reward real merit. These
researches of Ur. Flail have been rendered still more valua-
ble by those of Mr. Grainger, Ur. Carpenter, Mr. Newport,
and others, who have shown that one of the most important

DIVISIONS OF THE ANIMAL KINGDOM.

27

functions of a nervous system, as regards the vital existence
of an animal, is to receive impressions, and to re-act on such
impressions, independent of the consciousness or the will of
the individual. This fact will be found universal in its ap-
plication. Wherever the wants of an animal require a con-
sent 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 stomach for digest-
ing 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 nervous
system; so that, in fact, the size and complexity of the
nervous system are a good criterion of the endowments of
the animal, aud 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 divisions, or subkingdoms, and named in accordance
with the form and arrangement of the nervous system.

1st. The Cryptoneura of Ruclolphi, or the Acrita of
MacLeay.

2nd. The Nematoneura of Owen, Cycloneurose of Grant,
Radiata of Cuvier.

3rd. 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,
Vert eb rata of Cuvier.

In the first of these divisions the nervous system is in-
discernible, and neurine, if existing at all, is so minute
in quantity, and so transparent, that it cannot be demon-
strated 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 applicable only as designating the appearance, and

28

COMPARATIVE ANATOMY.

not the actual structure; for in these animals Gandia
Commissures, and Nerves, the three elementary portions of
every nervous system though scarcely visible,

ctly formed as m the highest animals. Thirdly. In the
Homo-Ganghata the ganglia arc generally of nearly equal
£7 decidedly exceeding any of the rest. Fourthly. The

in which "lit1 " arrS° named from the ^ar manner
twi Vni Lg?lgha are .scattcred through the body.
n , . le Myelencephala include all animals until a per-
fect brain and spinal cord. ^

It will generally be found that the Nematoneura are
mostsimpte ; the Homo-Gangliata the next, and so oil.
Hut 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-Gan diate
division But it is not improbable that the simplicity in
ns instance arises solely from its being imperfectly de-
veloped or in a rudimentary state, and may perhaps there-
01 e be considered as affording an imperfect type of a ner-
vous system.

As my present object in alluding to the nervous organi-
zation 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
1 shall confine myself to the description of the most promi-
nent featimes in each division.

llic most simple form in which we find the nervous
matter arranged so completely as to constitute a distinct
nervous system is in the Ascaris, a species of intestinal
worm ; we can scarcely conceive an animal having its rela-
tions 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 neces-
sity for a nervous system, and we find it accordingly but
imperfectly developed. Jules Cloquet has given us the best
account of the nervous system in these animals : it is from
a work published by him on this subject, in 1824, that the
following account and drawing were derived. Two white
cords, rather thicker in the middle of the body than at the ex-
tremities, composed of a series of small lines united at angles,

ASCARIS.

2!)

Fit/. 8.

or, as it were, broken and slightly swollen at each angle, send-
ing to the right and left, filaments so thin that they escape
the eve, except when seen through a magni-
fying lens, constitute their nervous system.

These cords are situated within the plane of
the muscular fibres, and descend, the one
on the abdominal, the oilier on the dorsal,
surface of the alimentary canal. The abdo-
minal 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 considering 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 indi-
vidual it has been arrested in its -develop-
ment at a period corresponding to one of
the regular stages through which the ner-
vous system passes in the higher orders, in
whom we know that the nerves are deve-
loped 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 development 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 re-

1* Female Ascaris seen
on its abdominal sur-
face. a Mouth su Hound-
ed by three tubercles, b.
The anus. c. Contracted
portion found at the union
of the anterior third of the
body, with the two poste-
rior thirds. 1. Abdomi-
nal nerve. 2. Vulva.

2* An enlarged view of
a transverse section of the
same worm. a. The skin,
u. Two muscular layers,
c. Cavity of the stomach.
1. Dorsal nerve. 2. Ab-
dominal nerve.

30

COMPARATIVE ANATOMY.

Fig. 9.

tlie

Ovum of
chick, 24th hour.
(After Dr. Allen

tamed by the lower orders. About the twenty-fourth hour
after incubation has commenced in the egg of the common
fowl, the rudiment of the spinal cord may be
seen in the form of two white lines (see fig. 9),
perfectly similar in appearance 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
w hitc* line ^ repre- of volition or not, they are evidently regulated,
merit ofThe'ner-' an(i not accidental. It has the power of locomo-
vous system. tion, 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 accordance with this power
of apparently commanding the execution of certain offices
in different portions of its frame, we detect nervous cords
Fig. io. emanating from nervous

nodules, we are induced to
regard them as instruments
employed in the produc-
tion of these phenomena. —
Tiedemann was the first to
prove decidedly the exist-
ence of a nervous system in
the star-fish. His account
was published in 1816,*
accompanied with a beauti-
ful drawing of it, repre-
senting a ring surrounding
the oesophagus, giving off a
filament to each ray, besides
ten smaller ones, which he
believes to descend to the
stomach ; at the same time
he observes that he could
not discover anything like ganglia. Their existence has
however been since distinctly proved ; and in an excellent

* Anatomie der Rdhren-IIolothurie des Pomeranzfarbigen Seesterns
und Stein.

Nervous system of the star-fish, drawn from a
preparation in King's College Museum. 1,2, 3.
Nerves distributed to three of the rays. 4. One of
the twelve ganglia. 5. One of the commissures.

NEMATONEURA.

31

preparation of the twelve-rayed star-fish in the Museum of
King’s College, twelve little nodules of ncurine 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, slioidd pecu-
liarly 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 perplexing obscurity, which seldom fails to dis-
gust 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 gan-
glia.

The cords which pass between the different ganglia, and
thus connect them together, are the commissures, or appa-
ratuses 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 designation of this portion of the nervous system,
as merely signifying a knot : it only characterizes its exter-
nal appearance, without in the slightest degree implying its
function as distinguished from the nerves and commis-
sures.

Rut as it seldom answers to attempt a decided change
in the nomenclature of a science like anatomy, which has
existed for so many years, it will perhaps be better to em-
ploy the same term in the comprehensive meaning which
comparative anatomy justifies us in adopting.

Human anatomists have been too much in the habit of

32

COMPARATIVE ANATOMY.

considering a peculiar rounded form essential to the consti
tut, on of a true ganglion, not usually, therefore a, X ^
tho term ganglion to a collection of cineritious mal
unless moulded into a knotted form and supported bv a
dense membrane : thus the medical student has been led
o imagine hat the neurine which is contained with! he
human skull is altogether different from the gangha of ti e
ower orders of animals, merely because it dilersCmlhem
so much m its outward appearance

But the fact ready is, that if the term ganglion be cor
rect as applied to the nodules of neurine ov centres of
power u! the lowest animals, it is equally correct to apply
t to those of the highest • and it therefore follows that the
human brain is but a series of large ganglia. Their close
connection and the great size of the coLnissures, give tit
1 ■ 9&1 e6°f complication which we can only unravel by
seizing the thread at this simple though perfect type of a
nervous system, and never dropping itliltt has conducted
us through all the various additions made to its funda-

tioTin trttbPeta°g.the Pel'feCt bU‘ C°mpleX °rganiza-

That a peculiar form is not indispensable to the consti-

in X f a S+an+gll°n’- 0Ven ^cording to the confined sense
m v Inch that term is used m the descriptive anatomy of

the human body, is proved by the fact, that a simple layer
of cineritious neurine of a semilunar form, lying between
le 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
o 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, tliere-
f ore, that we are justified in extending the term ganglion •
and I am quite sure that it would enable us very consider-
ably to simplify the anatomy of the human brain, if we
weie to apply it thus to any collection of cineritious neurine
into a circumscribed mass, whatever form or arrangement
it may assume : for instance, the cineritious neurine which
forms the convoluted surface of the hemispheres of the

GANGLIA.

33

human brain, I should denominate the Hemispherical Gan-
o-lia ; for the convoluted appearance arises solely from the
circumstance, 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 ol
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
lnunan 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 hemi-
spherical, 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 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 intended 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

n

34

COMPARATIVE ANATOMY.

circ^atmg system. The grey or pulpy neurine is always
met with m a ganglion, and the fibrous alone enters into
the composition of a nerve, while the commissures are
occasionally 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 neimne,
would be almost conclusive.

■}! 'I, be „true’ thaJ the cineritious matter alone is endowed
i 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 m fact all those commissures into whose texture the
medullary neurine alone enters, must necessarily be con-
ductors and not originators of the peculiar powers by which
the neivous system is distinguished from every other Is it
not then extremely probable that the office of the commis-
sures 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 hu la-
ment, memory, &c. ? *' D

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
then individual existence, and the re-production of their spe-
cies ; while the other class of phenomena bring them into re-
lation with the external world, informs them of the existence
of siu rounding 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 nutrition and growth of individuals and the re-
production 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 mani-
festation of which proves to us that the individual is capable
of receiving impressions from external nature, and of re-

CYCLO-GAN GL1 ON I C SYSTEM.

35

acting upon these impressions, showing thereby a conscious-
ness of their existence, is peculiar to animals.

All true physiologists, even from the time of Aristotle,
have observed more or less accurately the distinction between
these two classes of phenomena, and arranged them accord-
ing v. 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.

Galen adopted the same arrangement, but added the
hvpothesis that these functions were superintended or con-
trolled 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 predeces-
sors, under two heads ; but instead of referring the power,
which appears to regidate and preside over these phenomena,
to some mysterious spirit, he considered 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 sympathetic 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 gan-
glionic system, — a name which I think objectionable, in as
much as it might lead the student to imagine that those
nodules of neurine 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

n 2

30

COMPARATIVE ANATOMY.

ttttorw8 SySte/m ‘n '* W°’lld bc better t0 designate

Physiologists were divided in opinion as to which of the
two systems» the sympathetic or the cerebro-spinal the
nei vous 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 verv
naturally considered as corresponding to the cerebro-spinal/

Hut alter the sympathetic system was admitted to be
independent m its powers in man and the higher animals
physiologists, looking only to resemblance in outward ap-
pearance, and not to analogy of function, began to maintain
that the nervous system of the lower orders corresponded
exactly to this, the system of vegetative life of the upper

It is now, however, generally believed that where a dis-
tinct 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 ner-
vous systems : °

1st. Ihe cerebral or brain system.

2nd. The true spinal or excito-motory system of Dr M
Hall.

3rd. 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, in many of the lower animals to demonstrate
the existence of the nervous 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 demon-
strated in many of the lower orders where its presence was
not previously even suspected.

Dr. Grant, in speaking of the nervous system as deve-
loped 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

CYCLO-GANGLIONIC SYSTEM.

37

slow and regular movements of organic life, form a more
isolated system, and these three systems are developed
together, almost from the lowest animals.”*

°The following literary history, from Dr. Fletcher’s Lec-
tures, of the opinions held concerning the uses of the gan-
glionic nerves from Galen to Bracket, is so excellent and
comprehensive, that I think its introduction in this place
will he 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 gene-
rally 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 descriptions of them and in his curious
diagrams of then- distribution, as growing upon the latter
‘ ut frutex super alio frutice.’ And this notion having been
adopted by Vieussens (Neurograph, 1684), Lancisi (Opera
Omnia, 1745), Meckel senior (Memories de Berlin, 1745),
Zinn (ditto, 1753), Hoare (De Ganglia Nervorum, 1772),
Scarpa (De Nerv. Gangl. 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 nume-
rous 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 ;

* Outlines of Comparative Anatomy, Part II.

38

COMPARATIVE ANATOMY.

by " libs as a kind of diverticula to the animal snirits
received from the brain, and also as a means of kecpiS up

a sympathy between distant organs : Vieussens and Meckd
adopted the same opinion.

Lancisi looked upon them as forcing-pumps adapted to
propel the animal spirits along the nerves. 1

The doctrine ot the independence of the ganglionic
system was espoused by Cuvier (Le9ons d’Anat. Comp.
t/JJ), and particularly insisted on, with his accustomed
eloquence by Bichat (Sup la Vie et la Mort, 1802) who

mrtfcnl ACd f ^ gailgh0ns °f this system ^ 1 des centres

root vv fSide V1G 0r^am?Ue’ anal°S^s an grand et unique
ccntic 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 ot such nerve was independent of all the
rest, and constituted, per se, a distinct focus of nervous
influence.

“ Richerand (Pliys. 1804) and Gall (Anat. et Pliys du
Syst. Aerv. 1810) adopted similar tenets; and they are
further inculcated by Wutzer (De Corp. Hum. Gangl 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
tor 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 Ponctions du
Syst. Nerv. Gangl. 1823) distinctly represents the ganglionic
system of nerves 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 de-
velopment of the nervous system bears to the manifestations
of consciousness in each individual of the animal kingdom,
it is interesting to observe the relative position which the

RAD I AT A.

39

nervous system, in its simplest form, holds to the alimentary
canal : we must not, however, attempt to account lor this
circumstance by supposing that the presence of a nervous
system is necessary to the solution, digestion, and assimila-
tion of the alimentary matter ; for these processes are per-
fectly executed by the freshwater Polypus, or Hydra vindis,
in which there is not the slightest trace of a nervous system.
Almost the whole existence of the lowest order of animals
appears devoted to the acquirement of food and the repro-
duction of then1 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 then' vital energies being devoted to this
object, we cannot be surprised that those organs which are
expressly constructed for its fulfilment shoidd be sur-
rounded by, and thus intimately connected with, that sys-
tem (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-fisli,
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 annual. But, let it be remembered, it
does not follow that such motions necessarily indicate any
volition or consciousness on the part of the animal execut-
ing 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 the incident and the reflex ;
the motor nerves arising in the ganglia, and distributed to
the arms, — the exCitor arising round the mouth, and
terminating in the ganglia. In this individual all the gan-
glia 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.
'1 hey will also, after seeing these ganglia scattered about the

40

COMPARATIVE ANATOMY.

7— ehd r 1 in a m°re

clue to their analogies in tlm u % . ^ lus receive a

presented in a more concentrated” nn^"'*’

equally mot'^

rating fr„m the irritability o4e “ ££?

Ilmt there is a series of incident exciter nerves and of

the? ZZ riS;tonskSe the f” *?*? “ as

i”Snl exSted6 ThW

md'thafrf Zf'fr^T aUd mUiti'V’ “d “ respiration,
ana Unit oi the sphincters, continually depends inxm the

pznal marrow md certain excitor and motor nerves*

he eyelids close when the eyelash is touched through

sp?Z^ °f *“"■ a‘ld ■ «h of L

obloS?irai\nrflbeen Sht0W?‘° dePend UP°“ «*> medulla
oblongata. But this part of the spinal marrow has been

S?fe°UJ-y suPP°sed to t,e the source and primum mobile of

SSJdtSTti Whel'eaS Dr' 11 M believes he has ascer-
tamed that the pneumo-gastric is that primum mobile as
the pimcipal excitor nerve of respiration .-

“ The action of the ejaculators obviously depends upon
the same excito-motory or true spinal system

I he fourth ot Dr. Hall’s views is, “ That the true spinal
system is the exclusive seat of convulsive diseases ” 1

The fifth is, “ That the same system is the seat of action
of ceitam causes of disease and of certain remedial agents, ”
Legalloisf and Mr. Mayof have shown “that distinct

“ * In order to see the proofs of this remark, the reader need onlv turn
to the justiy popular works of Mayo, “Physiology,” ed. 3. pp. 113 114

I’ ; mi0i Magendie, ed. 3. & 11. pp. 65-68, 132 &c ’

f CEuvres, Pans, 1824, p. 62, &c. ’

+ On Human Physiology, pp. 230, 231.

ARTICULATA.

41

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 elucidation of the physiology of the nervous system of
the lower animals. 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 ex-
presses himself : “ The anatomical characters of the in-
vertebrated animals afford, however, the most striking
evidence of the time 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 anato-
mical 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 grey substance,
but* hitherto the true relations existing on the one hand
between 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, graduated
scale which is formed by the nervous system in the animal
kingdom, consecpiently demonstrates that the Articulata
possess parts which are the exact analogues of the struc-
tures 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, con-
stituting 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 Verte-
brata, nor have I been hitherto able to detect such an

42

COMPARATIVE ANATOMY.

arrangement ; but, when we consider the remarkable in-
tncacy and minuteness of the whole structure in these
animals, and recollect how lately even the two roots them-
seives have been discovered, it may be well permitted us to
doubt if the entn’e 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
lemselves connected by a few delicate longitudinal threads
which also extend from the uppermost ganglion to the
bram . how from the analogy of the vertebrated animals,
1 may be assumed that these threads consist in part of
longitudinal commissures, by which the ganglia are com-
nned m their functions, and in part of true sensiferous and
volition filaments, which terminate in the brain. In de-
scending the scale, from the most perfect animal to the
lov est 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
tei inmate in the substance of the spinal cord, and fewer cere-
bral. 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 grey mass
in the head, however minute, which corresponds in office
with the brain, a connection with the nerves through the
medium of the spinal cord is indispensable to the exercise
of that voluntary control over the motions of the body
which in these instances always exists.

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 innume-
rable varieties of form, but in every instance the essential
structures have a real existence. f

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

* Fletcher’s 'Rudiments of Physiology, PI. 2 b. p 87.
t Observations on the Structure and Functions of the Spinal Cord, bv
R. D. Grainger. 1837.

TUNICATA.

43

subject. Dr. ’Carpenter enunciated bis views in bis inau-
gural Thesis, printed in 1839.*

I shall avail myself largely of its contents in the follow-
ins: observations on this subject. In bis Introductory Re-
marks be says, “ One of the principal objects which the
author has kept in view, has been to ascertain how far
Dr. M. Hall’s doctrine, regarding the distinctness of the
ecvcito-motor from the sensor i volitional system of nerves,
accords with the data furnished by comparative anatomy.”

One great advantage to be gained by studying the ner-
vous 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 what organs, or
sets of organs, each nervous centre presides.

Our next illustration shall be selected from the Mollus-
cous 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 Tux i cat a ; in external appearance they seem
but little raised above the Sponges, the greater part of them
pass then 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 bran-
chial, 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

* Physiological Inferences to be deduced from the Nervous System of
the Invertebrated class of Animals.

44

COMPARATIVE ANATOMY.

openings are bounded by distinct circular sphincters with
w uch radiating muscular filaments are intermixed’ that

B™Mnal baDds °Ver the of the t

SS 4h r„?'TV lhe branchial sac- “O'1 tlms of
j ctmg, with considerable force, a part of the water it

contains ; whilst the elasticity of the external tmT™.

taneously restores its usual dimensions when the contract-

g powcr ls lnactive. No movements of this kind how-
ever, are commonly employed either for the respiratory pro-
cess 01 for the prehension of food. ^

A continuous and equable current of fluid enters the

and,ls 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 respira-
tory 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 pro-
pagation of its race, and as these appear contrived simply
for the passive evolution of germs, no powers of active mo-
tion are called into exercise by the performance of this func-
tion.

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 witnessed, 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 locks, 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 con-
tracting throws out a quantity of water. We find accord-

TUNICATA.

45

ingly, on examining into the characters of the nervous
system, that it is most simple in its structure and distribu-
tion. We have here no repetition of parts, as in the Radiata,
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 Fia- 11 •

ganglia and the distribution of its filaments
in Ascidia mammillata. The nervous filaments
which pass to the branchial orifice, 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 filaments which fringe the in-
terior of the branchial orifice. Although no-
thing is absolutely known of their function, it Ascidia mammillata,

with nervous system.

would not seem improbable tliat they are (Cuvier.) a. Branch-

.•-iif* * r i i ial orifice, b. Anal.

susceptible ot mipressions Irom substances c Ganglion, with ra-

• i j i • i diating filaments.

entenng with the respnmory 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 injurious bodies. Should this be
the case, we can hardly regard the action as of more than a
sympathetic character, since the closure of the sphincters in
the higher animals is, in like manner, independent of the
impulse of volition, although capable of being influenced by
it. It would seem probable, too, that by the same sphinc-
ters is regulated the quantity of water which shall enter for
the supply of the respiratory and digestive organs, in accord-
ance with their requirements, communicated in like manner
through the ganglion, and the ciliary movements would ap-
pear to be under the same control (although 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 animalcule, they stop and re-commence in such a
manner as to prevent the observer from assigning any other
cause to their variations.

46

COMPARATIVE ANATOMY,

Fig. 12.

vanPXf P°f'ype- ikc Moll«sk to «» » little ad-

chained to t ! r? a cxlstence- ™d which, though still

dlmng lts whole existence, has some

It hasPuoTo f cognizance — we refer to the oyster,

it has no locomotive power; almost the only muscular

1Sr iat ft Which 11 closes its sbed> its open-
bemg accon^plished by the elasticity of a ligamentous

?•, s?; ° r has stated tbat distinct, though very

the man°tirnSTt0l 'T™ T7 be observed 011 the margin of
shadow of \ / !aS bng been known t0 fishermen that the

t em to nl t PaTg 0Ver a bed of asters will cause

them to close their shells : this we can hardly sunnose

would occur, if they were not supplied with some form of
the apparatus of vision.

J^oTTT tont,acula fllich 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,
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 may be called the pos-
terior ganglion ; it is the analogue
of the ganglion in the creature we
have just been examining, (the
Ascidia,) and, like it, receives its
command from the respiratory sur-
face and the mouth, by the excito,
or afferent nerves, which arise
there, and terminate in the ganglion.

Nervous system of oyster. (Garner) ^ ^ Stimulates to Contraction

o^\ra“Xniiona- in?obedoste0r!°r tbe adductor muscle of the shell.

rfS'ctnneet^gtrunks: “! Transverse ItS analogUe 111 mail aild the Vei'-

/Xcroter’^sophague."10' ganelia- tebrata generally, is the medulla

oblongata, in which the ganglia of
the pneumogastric nerves are situated. In addition to
this ganglion, there are two small ganglia (a) situated near

* Linnean Transactions, vol. xvii. part iv. p. 485.

CONCHIFERA.

47

to the mouth, and the rudimentary organs of sense which
guard the alimentary canal. Whatever consciousness this
animal enjoys of external nature, is most probably depen-
dent 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 instruments of progression ; but
in the same class, the Conchiferse, or shell-bearing Mol-
lusks, 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 muscular 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 mo-
tion 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.

“ W herever the foot exists in the Conchiferse,” says Dr.
Carpenter, “ we find an additional ganglion in close rela-
tion with it, being usually situated at its base, and following
its changes of position, as well as corresponding with it
in degree of development,” — th q 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 re-
spiratory ganglion, or medulla oblongata, belonging to
the excito-motory system, directing the respiratory move-
ments ; 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 composing the
jointed cord in insects. “ It is important to remark,” says
Dr. Carpenter, “ that whilst the pedal ganglion and the re-
spiratory ganglion are always connected with the anterior
ganglia, or cerebral ganglia, they are never immediately
connected with each other. This would seem to indicate

48

COMPARATIVE ANATOMY.

partiy dependent

to^ clfaSSnof Mollusca, the Gasteropoda, are known

Inn not Tl" ” f01'mS °f the snail> slug and the
limpet The creatures are much advanced, in their rela-
tions to the external world, above the oyster and the
conchiferous Mollusks we have just been considering. They
enjoy the sense of sight and smell, and having thus the
power of distinguishing their food, have a more perfect
oigan of locomotion to enable them to seek and select it.
ihe union of two individuals is necessary for the re-produc-
tion of then- species, and we find, in accordance with higher
powers, larger and more numerous ganglia for their executing
then- motions. In some of the species, as in the limpet
01 instance, we find these centres of power very distinct
while m others, as in the common 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 inn
poitant bearing on the anatomy of the human body, and
teaches us that we must not there look for an anatomical
line of demarcation as necessary to decide on the individu-
ality 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
observing the connection of their nerves.
The auditory and pneumo-gastric ganglia
are here referred to. In the patella, or
limpet, (see fig. 13,) ive observe at the
base of the tentacula, and rather anterior
Nervous system of the therefore to the oesophagus, a pair of

patella, or limpet. (Gar- ____v / \ l-r •i.-i 1

ner.) a a. Cephalic gan- ganglia (a a), which evidently correspond
c c* ped<u. d. Pharyngeal! to the anterior ganglia in the Conchifera,

e. Labial l * l ^ *

Munch are connected by a commissural band
passing over the oesophagus. These, however, not only
send nerves to the tentacula, but are also connected with
their eyes, which are situated at their base. Beneath the
oesophagus, and connected by two trunks with each of the

Fiy. 13.

GASTEROPODA.

49

Fig. 14.

cephalic ganglia, we find a broad mass, which, on examina-
tion, appears to consist of four lobes placed in a line.

The two inner ones (c c) send nerves to the foot, and are
thus analogous 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 connected 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 con-
nected with a very important set of organs, the gustatory
and the mandicatory, which are but slightly shadowed out
among the Concliifera. In these animals we find the oeso-
phagus dilated at its commencement into a muscular cavity,
with a curious rasp-like tongue, which
serves to reduce the food, often sup-
ported upon cartilages, and sometimes
furnished with horny maxillae. The
nerves which supply these do not pro-
ceed directly from the cephalic gan-
glia, but are part of a distinct sys-
tem, which sends its ramifications
along the oesophagus and stomach, and
which is occasionally connected with
the first by inosculating filaments.

In the Lirnax ater, or common slug,
we find the cephalic ganglia (a a)
united into one large bilobed mass,
lying completely above the oesopha-
gus. 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
distinct

having

Nervous system of the common
slug. ( Ilaly. ) a a. Cephalic gan-
glia. b u. Branchial, c. Pedal,
n. Pharyngeal.

two pairs of nerves,
functions. The branches from the outer

* Garner, loq. cit.

50

COMPARATIVE ANATOMY.

portion (b) are principally distributed to the respiratory sac
and tins will, therefore, be analogous to the outer or bran-
chial portion of the ganglionic mass in the patella, being
like it, connected immediately with the cephalic by a trunk
oi its own. The inner portion (c) does not send its branches
to the foot m particular, but to the general muscular sur-
face m which this organ is, as it were, lost, and of which
Fig. is. Fig. ic. the whole body is concerned, in the
progressive movement of the body.
Hence we may fairly regard this as a
locomotive ganglion. Two small pha-
ryngeal ganglia are found within the
principal ring, connected 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 Ar-
ticulated 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, represents the nervous sys-

15. From Grant s Outlines of tdll of tllC 00111111011 SaildllOPPei', 01'
Comparative Anatomy. Nervous m ;■< t . , . -n i ’

system of the Talitrm LocuHa, or ICllltTUS JuOCUStO, j aild it Will be Seeil
Common sandhopper. All the +i < i i-i ■ ,, . , ..

ganglia, eleven in number, are of til at 1161 e, IlKCWlSe, ail the ffOllClia ai'e
nearly equal size; the two first, e i , ° ,

which are the supra-cesophageai, oi nearly equal size, and nearly at

scarcely exceeding in dimensions ,1 • , rrn , , . '

any of the others. The oesophagus G( jUai { I ! ,St tllK'CS . 1 i 1C C6pliallC £T( 111-

runs between the two first pairs -A* „„„ ji , , • 1 , °

of ganglia glia are the most anterior, and are a

Ac., presents the nervous system little larger than the rest \ the respi-

of the Cymothaea. The oesopha- v , i • , 1 ,

geal ring very distinct, but the lUtOiy ganglia ai'e Oil the Side, Rlld

de vei< ,ped!p hThe 1 ' w^i onghudi'n detached ; and the pedal ganglia,

cords with the pairs of ganglia ___!*•■ 1, _ • . ° . i .

united so as to form a uniform ^ lllCll cll6 HTIH16r01IS, QT6 SltllcitCCl 111

C01"' the separate segments of this jointed

body. It will be seen that the cerebral and spinal ganglia
placed on the same side the mesial line ai'e connected together

* Dr. Carpenter, op. cit.

MYR1AP0DA.

51

by two sets of longitudinal fibres, cerebral columns ot voli-
tion and sensation. The fibres which connect corresponding
ganglia on opposite sides of the mesial 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 step onwards in the evolution ot 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 arrangement of the
ganglia of the Mollusca confirms Dr. M. Hall’s theory of an
excito-motory system of nerves. But the 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 dis-
coveries 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 same simple arrangement
in the structure of the spinal cord of all vertebrate 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 fami-
liar example, have several cephalic ganglia situated at the
anterior extremity of the body, and connected with the organs
of sense, the eyes, antennae, &c. Mr. Newport states,* that
in the embryo of Necroph. leophagus (Geopliilus), longicornis
(Leach), at the moment of bursting its shell, the brain is
composed of four double ganglia, the centres of a correspond-
ing number of segments, which are then becoming aggregated
together, so as to form this single moveable portion of the
head of the perfect animal ; so that the brain of the Myria-
poda, and probably of all the higher Articulata, is in reality
composed of at least four pairs of ganglia. The first gan-
glia being devoted to the nerves of the antennae, may, I
think, be regarded as analogous to those which we shall see
* Phil. Trans. 1843, p. 248.

£ 2

52

COMPARATIVE ANATOMY.

in the Vcrtebrata devoted to the olfactory nerves The next
mass m the perfect insect, as in the embryo, I conclude con-
sists 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 understood by the
student when we come to the brain of the Fish. It is very
c ear that it is not solely the optic ganglion, in as much as it
exists even when the organs of vision are entirely wanting as
m the whole of an extensive family of Chdognatha,— the
Polydesmda. The next pah- supply the mandibles and
maxillae Emanating from these ganglia, there are nervous
coicls, 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 con-
siders, 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, consti-
tuting 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 mail, arc also very fully developed •
distributed in a great part to the salivary glands.

lhe i isceral ganglia in lulus are of most extraordinary size,
being nearly half as large as the brain itself. There are
four on each side the oesophagus, closely connected in one
series, extended along the oesophagus 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 appear-
ance of grey nervous matter inclosed in a distinct theca.

They communicate with the vagus nerve, which, after
passing beneath the brain, forms a minute ganglion imme-
diately behind it, which is also connected to the lateral gan-
glia by a very minute branch on either side. It then passes
along the oesophagus, and forms the second larger rounded
ganglion first mentioned as connected to the last of the
lateral ganglia. After this it continues its course backwards,

MYRIAPOD A.

53

half way along the oesophagus, and then divides into two
branches, which are given oil, as in insects, to the postenoi
part of this organ, and to the cardiac extremity oi the stomach.

One of the most interesting circumstances connected
with the development 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 distri-
buted 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
earned to their greatest extent — as in Volant insects, the
gregarious Ilymenoptera, 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 rela-
tively, but actually, increased in size during the changes
from the larva to the perfect state ; thus leading to the in-
ference, that the importance of the visceral nerves is gra-
dually diminished in proportion as those of active volition
and active existence become augmented.”*

“ The spinal cord in the Myriapoda is extended from its
commencement in the crura of the brain, and medulla ob-
longata, or first suboesophageal ganglion, to the antepenul-
timate segment of the body, and is almost uniform in size
throughout its whole length. It is slightly larger than
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 ganglionic enlargements situated
entirely on the under surface of the cord, and so closely ap-
proximated 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

* Op. cit.

COMPARATIVE ANATOMY.

to the legs, and the other, on the lateral and superior surface

vnnshCtSK iS °r he b?dy ; s? that the whole ™mber of nerl

rhl fr°m the TOrd’ inchldi"S those from the me-

ilia oblongata, is mnety-four pairs to the head and sides of

Whole lRfiand nmetyiT P™s *° tho legs> making in the
hole 166 pairs, or 372 nervous trunks from the cord, ex-
clusive of those which belong more immediately to the brain.

ach enlargement of the cord gives off at its upper and
lateial surface a single nervous trunk, which passes out-
wards some distance as a single nerve, but which in reality in-
cludes two distinct sets of nerves, that separate as principal
trunks at the inner side of the great longitudinal series of
abdominal muscles.”

Ihe anterior of these trunks is the analogue of the re-
spiratory nerves of insects, and passes across the upper
layer of these muscles, on their visceral surface, giving off
to them many minute branches.

Ihe Structure of the Cord is thus described by Mr. New-
port : ‘ ihe formation of the great abdominal cord in the
Iulidae, by the lateral approximation of two distinct por-
tions, is indicated on its upper surface by a slight median
sulcus, and on its under surface by a slight longitudinal di-
vision between the two approximate ganglia that form each
of its enlargements. Each of these lateral divisions of the
cold 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 honour 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 in-
dicated 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. Car-
penter in other Articulata, and applied to explain some of
the reflex phenomena of the nervous system, in accordance

MYRIAPODA.

55

with the theory promulgated hy Dr. M. Hall. But besides
these two sets of longitudinal libres, and the series that pass
transversely through the ganglia, there are other structures
in the cord that have hitherto been Fig. 17.

entirely overlooked. These are the
fibres that run longitudinally, 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 re-

inforcement of the cord!' — (Tig. 17,/.) W *'?"?■ <Ne"P°r‘-L »• c°-

Fig. 18.

Upper surface of the cord in
'piro streplus. (Newport.) b. Co-
vering of the cord, e c. Superior

The superior longitudinal set of 121) t /. f: b/Z r mnrorce-
fibres of the cord, which I formerly ment '• Com,mssural-
described as the motor tract, and to which the function of
volition seems still to be accorded by Valentin, Carpenter,
and Baly, is extended in lulus, as in other Articulata, as a
separate fasciculus 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
interesting in reference to its presumed function. On a ciu-
sorv inspection it does not appear to give off any branches,
but seems to pursue its course uninterruptedly along the
whole length of the cord.

It does not indeed give off
filaments to the nerves from
a ganglion immediately op-
posite their origin, while
passing over that ganglion,
but immediately it has
passed one ganglion it gives
off' the filaments that pro-
ceed to the nerves from the
next ganglion. These fila-
ments seem almost imme-
diately to join with others

that belong to the sides of under surface of the cord in Spiro streplus.
.1 1 J 1 , . , , (Newport.) a. Inferior longitudinal fibres— sen-

tne core!, and pass out with scry tract. b. Fibres of reinforcement, c. Nerves.
,1 . . . , 1 „ <1 • Commissural fibres.

them into the nerve from

the next ganglion along its anterior surface.”

1 his is almost precisely the manner in which the filaments

56

COMPARATIVE ANATOMY.

fioni tliG aganghomc column in +Ur> n *

with those from the gamrlionif Crustacea are united

description of the nerfes in2cwTTWh0™ “
the lateral fibres of the cor 1 1 , T When *he of

ft foZ6ra tar? «? " hok ^

Sm whtch ft r^fhyrfoT# ^ “d
transversely through the

composition of the nerves from the ganglion on either side

appeal s also to receive filaments from the upper series
and perhaps others are sent from it to the upper thus dc’
cussatmg each other in the middle substance1 of the cord
hen these two longitudinal series are in close apposition-
since it is almost impossible, even in the large nervous cord
of bcolopendra to separate the two tracts from each other
although then- distinctness is evinced in their relative size
and longitudinal lines of separation.”

“ But there is one fact of great interest in regard to these
gang-home senes of fibres. Almost the whole of the fibres
of which it is composed are traceable in the Iulidse directly
through each enlargement of the cord, which they mainly

thf1*! ° ?lm' f i Vri an^'er*01' Part each enlargement,

1 v °f cac 1 or fasciculus of fibres, appears to

e s lghtly increased, and its structure becomes more soft and
delicate. While passing through these ganglionic enlarge-
ments, occasioned chiefly by their own increased diameter,
the fibres take a slightly-curved direction outwards, and then
inwards, but are reduced to then- 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 m Iulidae and Polydesmidm, as I shall here-
atter again have occasion to refer to more especially, with
reference to the true structure of ganglia. The fibres are
traceable most distinctly in the Iulidae (fig. 19, i),

1 liesc ui e the structures to which I formerly assigned the
function of voluntary motion and sensation, and to which I

MYRIAPODA.

57

am still inclined to believe they minister, since the fibres of
which both are composed are traceable to the crura ot the
brain. Whether these functions are restricted separately to
the two structures as 1 first imagined, the one to the upper,
the other to the inferior scries, or whether they are admi-
nistered to conjointly by both, through an interchange of
fibres, it is almost impossible to determine by any decisive
experiment on these animals, although the structures them-
selves 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 feeling far beyond what has of late
been adjudged to them by some physiologists.”

“ In some of the gigantic Spirostrepti and Spiroboli the
legs are adapted for climbing up the trunks and branches
of trees, bv 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 distribu-
tion 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 communication 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, y ; 18, cl,) 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 reinforce-
ment 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 communication between two
nerves that originate from the cord at a greater or less dis-
tance ; and form part of the cord in the interval between
these nerves, and bear the same relation to the segments,

58

COMPARATIVE ANATOMY.

TW WlliCll thp f,0rd itself does t0 the whole body,

y onu a part of the nervous trunks which come off

from its upper or aganghonic tract, as well as of those

i 1C 1 Proceed b’om tlle ganglionic enlargements in the
lower, and m each instance they bound the posterior side of
one nerve and the anterior of another, to which they pro-
ceed 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, m the structures of the external
suiface of the body, inwards along the course of the nerves
on their posterior surface to the cord, where its direction is
altcied 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 dis-
tributed, and along which it again passes transversely out-
wards, bounding the anterior surface of the nerve to its dis-
tribution on the lateral surface of the body. These fibres
of reinforcement form a large proportion 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
mf ei 101 surface on their again proceeding outwards. In this
manner these fibres of reinforcement connect all the nerves
of the coid on one side of the body, as the corresponding
hbies 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 pro-
ceed 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 communications independent
of the brain. But these communications exist 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 re-
inforcement do the same sides of two separate segments.”

“ Every nerve from a ganglionic enlargement of the cord
is thus composed of four sets of fibres, an upper and an
under one, which communicate with the cephalic ganglia ; a
transverse or commissural, that communicate only with the

MYRIAPODA.

59

Fig. 19.

corresponding nerves on the opposite side of the body ; and
a lateral set that communicate only with 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
then- anterior extremity, a circumstance readily understood
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 exist-
ence is indicated chiefly at the
postero-lateral margin of the gan-
glia, (fig. 19, /,) where they are
seen to form part of the nerves and
cord without passing upwards to
the brain. In other parts of their Ganglion and nerves of the spinal

, 1 , v j • -rir cord of Polydesmutt maculatus. (Nerv-

course they are not distinguishable port.) *. covering of the cord.

r 1 1 1 1 c. Nerves to muscles, d d. Posterior

by colour, and very rarely by any nerves. /. Fibres of reinforcement,
longitudinal line of separation, from inferior or ganglionic tract passing
the fibres which form the inferior the vesicles (*,.

longitudinal series, or portion of the cord to which they
are approximated ; but from which they are believed to be
distinct, from the fact that they do not descend with them
to 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 move-

00

COMPARATIVE ANATOMY.

t postt;rior to m m. 0„

ne same side of the body, as the commissural ones do tl.o

is irritated ° rn° paitS °n th<J side °PPosite to that which
j C j !he presence of fibres in the cord of
insects I had long suspected from the curved direction of

the fibres that formed the ganglia, and from that Tthl

in ' mv°ff ^ neiVeS’ fl’°m the a§an»honic tract, as figured

thisZiS^to rP"’l aitll0Ugh 1 had commimicated
opinion to a friend several years ago, I have never until

“ T hi 8Pe 1° Sfify mysclf of »» correctness.”

ns uncertainty of the existence of any structure in the
cord that seemed sufficient to explain the reflected move
ments on the same side of the body, independent of the
bram and the nerves of volition and sensatioli, W tabled
me to withhold my assent now received respecting these
phenomena. Although the fibres that pass transversely

MrS?1? Tgif eXplahl- the fect Produced on one
Side ol the body by the irritation of a .corresponding part

on the other there seemed no anatomical structure* to

account for the movements of distant parts, anterior or

posterior to a given point, if the doctrine long received that

coTOct”5 end0wed with but one sPecid function,

Now therefore that we find an anatomical structure in
the cord that seems to account for these phenomena I
ought m justice to state that Dr. Hall, -to whom-is due the
iugh ciecht of collecting, comparing and arranging in one
system numerous facts connected with the reflected move-
ments of animals, as observed by Wliytt, Blane, and others
and also by himself,— adopting the principle established by
our distinguished countryman, Sir Charles Bell, that every
ncivous fibre is continued unbroken, from its origin to its
termination, and is capable only of administering to one
special function, conceived the necessity of the existence
oi special nerves for the reflected movements, and that at
the period when I was engaged with Dr. Hall in his experi-
ments 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 1 differed from him in attributing the reflected

CRUSTACEA.

01

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 ot the
acuteness and perception of one who has done much for
physiological science.”

Professor Owen’s testimony on this subject is most im-
portant and satisfactory.* After describing the nervous
system of the Crustacea, he says, “ Three principal divisions
of the nervous system maybe defined, according to the views
which I entertain of their functions. Thus admitting from
analogy, that the supra-cesophageal ganglionic centre is that
in which true sensation and volition reside, then those
nervous filaments 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 ter-
minating 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 Yertebrata. 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 facts of Comparative Anatomy,
which in the Hunterian Lectures of 1842 were for the first
time brought to bear upon this interesting problem.”

From these most interesting discoveries of Mr. Newport,
and the important 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
* Owen’s Lectures, vol. i. p. 173.

62

COMPARATIVE ANATOMY.

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
gemmated by the ganglia or centres, corresponds in the spe-
cimens 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 indivi-
dual where optic nerves exist, and so of ah the other centres
01 ganglia, which m the higher tribes of animals, especially
are found so closely united that the whole mass appears
bu as one when it is called the brain. On the same prin-
ciple, m 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 Myria-
poda 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. ’
llie anterior of these ganglia, the supra - cesoph age al or
brain, is small as compared with the posterior; for the
organs of sense, whose nerves terminate
in this centre of power, are as yet but im-
perfectly 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 posterior by two slender nervous threads,
volitional and sensory filaments which, pass-
ing on each side of the oesophagus, form
Nervous system of the with the ganglia the same oesophageal rino-

iinglia. UX-. 1 1 a °

Fig. 20.

..... ... oho oauu

crab. a. Cerebral ganglia. i in, ,

i ganglia, or spinal we nave before observed.

b. Pedal ganglia, or spinal ,

. ' 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 veiy de-
cided step towards the concentration of the higher orders ;

INSECTA.

G3

for the nervous ring round the commencement of the
alimentary canal receives additional ganglia on its superior
surface until the whole mass formed by the union of these
nervous centres, or instruments of consciousness, assumes
the appearance, and seems entitled to the appellation, of a
brain.

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 impres-
sions 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 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 re-
lation to the function of neurine, that the brain of the perfect
insect or imago is very much larger than that of the cater-
pillar. 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 important office
of reproduction : its organs of vision are large and com-
plicated. 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 deve-
lopment of larger nervous centres and a more highly-
endowed animal. By reference to these wood-cuts, the stu-
dent will observe in fig. 21 the two little cerebral ganglia {a),
scarcely larger than the infra-oesophageal or respiratory (1).

AV ithout following out each different stage in the gra-
dually progressive change which the nervous system of the
larva and pupa undergoes previous 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

64

COMPARATIVE ANATOMY.

the imS? n ^ tUm+ to fig’ 23’ wllcn lie wil1 see il in
tne imago or perfect insect.

i- “• -r

branches from the transverse plexus from Ihe third /,• Second nair Worn th0I1feCt^h 3 S° «llh

(Fmm NewpmtV^^d™ thirty days after changing to the pupa state,

five tostead of seven eaneH- f S££‘blt! theib<lominal cords their shortened state, with only
Avitlwhe fm.rth T e i ’•thP,,lftllandslxth having passed onwards and become continuous
nerves 'which1 in the lana •*?,"“ a"d ?' nV t0 the ™6a are enlarged ; “and "hose

from the cords while thL firsf ^n ! P soc?" ganglion, are also enlarged, and now originate
The ‘ , ,st eangl on has advanced very near to the superior lobes of the brain

The terminal ganglion exhibits a very peculiar structure.

ne^es^^Th^^ffures^frVtnHi1*16 perfeot '"spot Sphinx Ligiutri. A. Cerebral ganglia, b. Optic
erves. Ihe figures lefer to the number of the ganglia, o o o o. Respiratory nerves.

Fig. 22.

Fig. 21.

The cerebral ganglia are now extended transversely, and
form, with the first sub-cesophageal ganglion, and the en-

INSECTA.

05

larged crura which connect them, one continuous mass
around the oesophagus 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 immediately give off the
nerves that belong to the seventh ganglion, which, with part
of the cord that existed between the sixth and seventh gan-
glia, is also obliterated. The cords are then continued
in a direct line along the abdomen, the 8th, 9th, 10th and
11th 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 condition 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 impres-
sions 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 Medusae and lowest
forms of animal existence, we are prepared to appreciate
similar changes in some of the higher Mollusca, and to
inquire how far the nervous organization of these creatures
will countenance the opinion that there is an intimate rela-
tion between the bulk of cineritious neurine in which each
individual nerve of sense terminates, and the perfection of
flic organ of sense from which that nerve arises.

Y

GG

COMPARATIVE ANATOMY.

Fig. 21.

Nervous system of the Pearly Nautilus, (Owen.) The head and anterior muscular nnrt nf tin.
body of the Pearly Nautilus (Nautilus Pompilius, Linn.), laid open from above or behind, and the
head' »S»ST11 < ,Sp aycd,' “ /he cutcdfc'ts of the musculo-ligamentous disc which covers the
nnen' .he pen « tl,e dlS'«a‘,ons- c- Four of the digital tentacles exposed by laving

fSeeid e? .h • -w.lnch the,L ar? !?dged- dd- Tlle anterior ophthalmic tentacles similarly
exposed at their origins, e. The left external labial process. (The corresponding one on the
nght side has been removed.) /. The external labial tentacles, o. The internal lahfal tentacles.
A. The olfactory laminae. «. the internal labial tentacles of the left side similarly exposed.
k. The origin, on the left side, of the muscle which protrudes the jaws. 1. The inner concave
surface of the great sliell-muscles. m. The termination of the right muscle i Offices by
which the \eiia cava communicates with the abdominal cavity, o. The eye laid open, n The
pedicle q. The pupil seen from within, r. The cut-edge of the sclerotic, s' The retina.
t. file dark pigment deposited on its anterior surface, and lining the cavily of the globe. 1. The
supra-cesophageal ganglion or brain. It is in tile nautilus in the form of a simple cord or com-
t0 . e extremities of which are connected (2 2) the anterior subccsophagcaJ ganglia.
3 J. I he optic ganglia. 4 4. The posterior suboesophageal ganglia. 5. Buccal and pharyngeal
nerves. 6 G. The nerves which supply the digital tentacles, and in the cuttle-fish the acetabuli-
ferous arms. 77. Ihe nerves passing to 8 8, tile internal labial ganglions. 9 9. The branches to
the internal labial tentacles. 10 10. The nerves supplying the olfactory lamina*. 11 11 The
nerves which supply the infundibulum. 12 12. The nerves of the external labial tentacula.
13. Ihe nerves of the great muscles of attachment. 14. The nerves corresponding to the par
vc gum. 15. The branchial nerves. 10. The ganglions communicating with the visceral or
sympathetic nerves, and supplying the heart, venous follicles, and abdominal viscera.

CEFIIALOPODA.

67

However much we may have had reason to be gratified
with the evidence which our investigations into the deve-
lopment 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 pro-
gress of this work.

he 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 dis-
played than in the former.

^ “ The brain or supra-oesopliageal mass in the Nautilus
(fig. 24) consists of a transverse cord-like ganglion, from
the ends of which three nervous trunks are continued on
each side. The anterior pail1 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 oeso-
phagus 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

Memoir on tlie Pearly Nautilus ( Nautilus Pctmpilius, Linn.), by
Richard Owen, Esq.; published by direction of the Royal Colleo-e of
Surgeons in London, 1832.

t Descriptive and Illustrated Catalogue of the Physiological Series of
Comparative Anatomy contained in the Museum of the Royal College of
Curgeons in London; Vol. III. Part I. Nervous System and Organs of
Sense, 1335 Prom one or other of these publications the following par-
ticulars, and the figures 24 & 25, are entirely derived. °

F 2

68

COMPARATIVE ANATOMY.

by the side of the great perforated vein, and are analogous
m their distribution to the sympathetic nerves and par
vagum.”

Piy- 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 brain 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 spherical body, probably analogous to the corpus geniculatum, is appended
to the peduncle of the optic ganglion on cither side.

“ As the supra- oesophageal 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 bigeminal 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. Tile brain, corresponding to the central commissure of the Nautilus. 2 2. The anterior sub-
oesophageal mass, or pcs amerinus, giving off (5 5) the nerves to the arms. 3 3. The great reni-
form, or ophthalmic ganglions. 4 4. The posterior suboesophageal mass giving off (6 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.

The organization of the Sepia officinalis, or cuttle-fish
(fig. 25), is peculiarly interesting, not only from the fact
that it offers to our notice the first appearance of an inter-
nal skeleton, an apparatus, which in the Vertebrata is con-
structed 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 dimensions, and a nervous system very highly de-
veloped in many of its parts. In its general arrangement,
however, the nervous system differs but little except in the

CEPHALOPODA.

09

quantity of neurine composing the cerebral ganglia from that
of the Nautilus, as will be apparent by turning to fig 18, m
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 oesophagus, around which the nervous

masses are aggregated. j}

“ As the supra-cesophageal cerebral mass, says Mr.
Owen, “ is principally in communication with, and is deve-
loped ’ to receive the impressions transferred by, the optic
nerves, it must be considered as analogous to the bigeminal
bodies in the brain of Vertebrata; which parts are fiist de-
veloped m all the higher classes, and from their constancy
and magnitude in the cold-blooded A ertebrata, are ei i-
dently among the most important parts of the cerebral
or a;an. ” A small spherical body, considered by Mr. Owen
as probably analogous to the corpus geniculatum, is ap-
pended to the peduncle of the optic ganglion on either
side.

“ The medulla oblongata, from which the auditory and
respirator}7 nerves are given off, is, in the cuttle-fish, situated
below the oesophagus.

“ The anterior subcesophageal ganglia give off nerves to
the brachial and labial processes ; the posterior subcesopha-
geal gangha 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 distribution of its
filaments, is termed ganglion stellatum.” In addition to
these there are a pair of nerves which, like those in the
Aplvsia, descend to the region of the heart, and there form
a plexus for the supply of the organs of digestion and cir-
culation, and exhibit a very perfect analogy to the cardiac
and solar plexuses of the sympathetic nerve in man.

This very general review of the nervous system in these
two members of the cephalopodous class of Mollnsca shows
us, in the first place, that the supra-cesophageal ganglion in
the Nautilus has no cranial cavity constructed for its protec-
tion, 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 flic oesophagus. These facts by them-

70

COMPARATIVE ANATOMY.

^hes would be of little value as affording data for reasoning
on the offices and relations of the nervous system, did wf
not discover this comparative imperfection in the struc-

ment°0f die' ^ TT1™*"8 with imperfect deveS", -
mmt of the organs of locomotion and sensation generally

I he peculiarities m the structure of the Nautilus are in coin-

Mr ‘ Z?' %wlththis principle. “The eye/’ observes
sti ; ,° e“’ . 1S faJ' 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 simplest 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 ad-
mitted 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 achnission
and modify the direction of the impinging rays are entirely
deficient. I his 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
hncl 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 cor-
respondence with the simplicity of the brain. If, as I be-
lieve, a distinct organ for the latter sense is altogether want-
ing, the Pearly \ autilus exhibits, in this respect, an obvious
approximation to the inferior Mollusks.

“As the Pearly N autilus, 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 deduce 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 exist-
ence ? ”

The following difference in the distribution of the nerves

MYEL0NCEP11 ALA.

71

of the Nautilus Pompilius and Sepia officinalis is also 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 ganglion, which, as in the
posterior roots of the spinal nerves in the Vertebrata, is in-
terposed on the cord which brings them into communica-
tion with the central mass. In the Nautilus, on the con-
trarv, 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
spinal nerves, pass into the muscles directly from the brain
without the interposition of any such ganglion.” *

The nervous system in the Myeloncephala, or verte-
brated class of animals, which derive theh 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 includes
Fishes, Amphibious animals, Birds, Reptiles, and the Mam-
malia.

In these annuals the whole skeleton is developed in rela-
tion 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-cesophageal gan-
glion now having an appropriate organ, the cranium or skull,
for its protection, uniformly passes by the name of brain ;
while the remaining 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

* Memoir, kc. p. 51.

72

COMPARATIVE ANATOMY.

i pau al)0ve the esophagus which we saw in the sand-
hopper, 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 m the Vertebrata, whose organs of sense the
instruments by which the individual is brought into relation

lth1t le ext®rnal Yorld» are so much more perfectly developed
we do not find that the brain is separated from the spmai
coi d by any other line of demarcation than that of a greater
c ^proportion m the size of the ganglia composing it. The

the adVan^ln??ef WC meet With fresh Proofs that

t c bimn, even °i the highest order of animals, is no more

than a senes of ganglia or collections of cineritious neurine
though without any peculiar uniformity of size in which the
nerves from the different organs of sense terminate, and
“om 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
ot their functions. These organs, from the high office they
ha\e to fulfil in the sphere of animal life, appear to require
a laige quantity of cineritious matter to accomplish then’
functions ; in consequence of winch 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.

In Fishes the common division of the nervous system into
a biain 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 con-
siderable than that of the brain or cerebral ganglia. Leuret

pisces. 73

states that the proportion of the weight of the brain of the
fish to its body is as 1 to 566 lb.”*

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 inferior grooves which separate the
cord into two lateral portions are much deeper. The
superior groove indeed is so deep that it forms an imperfect
canal, the internal surface of which is covered with a layer
of grey 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 vesi-
cular neurine, as in the higher animals, but there is so
little difference of colour that it easily escapes observa-
tion. 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 an-
terior and posterior 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 of fish
very much in correspondence with the shape of their bodies.
In the Tetodron 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, auditory, &c., in the Butterfly and Sepia, terminate,
and which in these animals, when fully developed, is col-
lected into one rounded mass, the supra-ccsopliageal ganglion,
in the fish is divided into several separate masses, so that
almost every nerve terminates in a distinct and appropriate
ganglion; hence the peculiar appearance, as compared with
that of man, which the brain of the fish presents.

* Anatomic compare de systeme ncrveux considerdc dans scs rapports
avec intelligence par Fr. Leuret, tom j. p. 164. (1839.)

COMPARATIVE ANATOMY.

There is m fact no set of organs in the human being
winch have less resemblance to the corresponding ones of
the fish, m mere external appearance, than the masses of

toTsUertCth\MTd WltlU? the Cranillm ; and 1 wiU venture
to assert that there are few circumstances more startling to

the anatomist who has confined his attention solely to^he

—7 °f thf 7man 7ain> than the first appearance
w Inch the brain of a large fish presents to his view on re-
moving the upper surface of the skull. Its minuteness as
compared with the great size of the body, the number of
i s component parts and them want of that concentration
which is so peculiarly striking in the human brain,— a con-
centration, let it be remembered, deeply interesting, but
which can only be duly appreciated by him who traces with
attention the structure of the nervous system through the
chain of beings,— all give a mystery and confusion to the
subject which can only be solved by seriously considering
and carefully drawing inferences from those facts which rest
upon comparative as well as human anatomy for their sup-

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
physiology ought to be called its termination ; for the term
origin is not merely incorrect as regards the function of the
nci v es of sensation, but also as regards them 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 embryo, 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

l’ISCES.

75

enveloped 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 advance-
ment, 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 opera-
tions of man, such as judgment, of course extremely limited
in its nature, remembrance of sensations, &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 re-
port 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 impressions 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 men-
tioned hereafter, there can be little doubt that it is in some
way or other connected with the production of that com-
bined action of the muscles which is essential to progressive
motion, and which would seem to require appropriate ner-
vous parts for its direction and control.

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 ani-
mals, instead of assisting us in unravelling the structure

76

COMPARATIVE ANATOMY.

cuities *Uman brain’ WOuld 01lly Plun8e us into fresh diffi-

Serresf was well aware of the backward state of informa-
tion m 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 m nature : it is the most complicated in
our writings ; it is an inextricable labyrinth in our books.
VV hy this contradiction between nature and our writings P
/ here exists 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

!-r if' ,r!TeS, 110t °nly from family t0 family, but essen-
tially 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 posi-
tion, 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 advan-
tageously be regarded.

One leason lor this is, that in most of his descriptions
and illustrations he omits al together the olfactory tubercles,
unless they are very large, as in the skates and sharks, or
close to the hemispherical ganglia, as in the eel ; conse-
quently, repeatedly confounds the two.

Leuret enumerates eight cerebral ganglia: 1. Olfactory;
2. Cerebral; 3. Optic; 4. Quadrigeminal; 5. Cerebellum j
6. Ganglia of the trifacial; 7. Ganglia of the seventh and
eighth; S. 1 hose 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

Tt is giatifying to the author to find that tliis view of the liomolo°*y
and physiology of the cerebral ganglia of the fish, which was first enunci-
ated in the first edition of this work in 1836, is now almost universally
adopted. J

t Anatomic Comparee du Cerveau, tom. i. p. 184.

nscES.

77

brain of the cod-fish, the olfactory ganglion and the ce-
rebral are united so as to form only one, and in Plate II.
he gives the brain of the cod-fish, omitting the olfactory
ganglion altogether, and calling the hemispherical gan-
glion, “ 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 complicated. 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, tins 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 cartilagi-
nous 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 cod-fish which
are brought to London are almost always fractured and the
brain injured. The fishermen always stun them by a blow on

78

COMPARATIVE ANATOMY.

the head. The student, before he removes the brain had

thth S dj hgi dS(5 he WiU commit the samc error
which Serres and Lcuret have done, and some physiological

^.26. writers who have copied their plates without

dissecting the fish, and describe the termination

ot the olfactory commissures in the hemispheres

as the olfactory ganglia; as they either leave

them m the skull when they remove the brain,

or if they examine the brain in situ , they neglect

to uncover the ganglia.

Ike whiting. — It 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 triangular-shaped me-
Brain of the dullary leaflet which overlaps that fissure of the
of 1 ufef ' seen s 'on cord called the foiu’th ventricle.
a. olfactory gan- 1 lie first pair are the olfactory ganglia lying
spherical ^gan- the cribriform plate of the ethmoid bone,
ganglion. E.c’e- where they are joined by the olfactory nerves,
refennm. . as they are in man. They are about the size
of large pins’ heads, and then’ being situated at some
distance from the rest of the cerebral mass, is, I sup-
pose, the reason they have escaped the observation of
most anatomists, and are not included by Serres in his
description of the component parts of the brain in this
fish. To me they nevertheless appear to be as decidedly
a portion of the cerebral mass as the optic tubercles or
ganglia, in which the optic nerves terminate, and which are
always included in the description of the fish’s brain.
The commissure or apparatus of union which connects this
ganglion with the rest of the encephalon is thin and thread-
like, resembling a nerve in its appearance, and about an
inch in length. Some authors have stated that the olfac-
tory 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 small pea, are ana-
logous to the human hemispheres, and may be designated the
hemispherical ganglia : they are connected together by a
transverse commissure, the anterior commissure. It is parti-

PISCES.

79

cularly interesting to observe how closely these hemispherical
ganglia of the whiting correspond with the cerebral hemi-
spheres of the human embryo at the seventh week. These
bodies, however, are described by Tiedemann* as analogous
to the corpora striata rather than to the hemispheres of the
brain, and by Desmoulins to the optic thalami. With all
deference to the talented authors .of these opinions, I must
say that I do not imagine either of these analogies to be
founded in fact. The corpora striata and optic thalami in
man and the Mammalia, are structures formed so entirely
of fibres intermingled with cineritious neurine, either ter-
minating in, or arising from, the hemispheres, that I cannot
conceive how they should exist if the hemispheres them-
selves, 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 tuber-
cles, analogous to the tubercula quadrigemina in man.f

* Tiedemann on the Foetal Brain; translated by Bennet, p. 230.

f By the translator of Carus’s Comparative Anatomy (Mr. It. 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 pro-
gress of formation of the same parts in the foetus of man and other Mam-
malia. In the early periods of the existence of the human foetus, the cor-
pora 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 Sylvius. This ventricle is covered over by two
thin medullary laminae, in contact with each other, though not united,
along the mesial line, and contains elevations or ganglia similar to those
here described. (Tiedemann, l. c., 186.) According to him, however,
they represent not merely the anterior, but rather both pair's of the cor-
pora quadrigemina. Their size is directly proportioned to that of the
eyes and optic nerves, being small in the conger eel and burbot, of mode-
rate size in rays and sharks, and considerably larger than the first cerebral
mass in the trout, pike, garpike, salmon, carp, uranoscopus, sparus, scor-
pcene, perch, &c. In the genera Sparus, Scorpsena, Clupea, Mugil, Scomber,
Zeus, Trigla, &c., the optic nerve, arising on each side from the middle
cerebral mass or optic tubercles, consists of a membranous expansion, dis-
posed in longitudinal folds like the leaves of a closed fan, though inclosed
witliin a cylindrical neurilema, which, however, adheres so loosely as to
allow the folds to glide one upon another. In the Trarhlnus Draco, where
the diameter of the nerve is about a line, there are nine or ten folds, which,

80

COMPARATIVE ANATOMY.

mons wtlA 1S n0t,empl°? the term optic lobes as synony.
"r !l!eT a quadrigemina, which most anatomists

tubercles. 7 m considering the true optic

These are his words:* “ Optic Ganglia.— Haller Vic d’Azvr
and Cams, have called them thalami optici , Camper cere-
bial hemispheres ; Scarpa, great tubercles of the brain • Trc-

srv°ri0r lemisPlleres ; Cuvier, hollow lobes • M
Seires, M Desmoulins, M. Gottsche, optic lobes. In some

’ 111 "Inch the optic ganglia arc tile largest there is
always that white appearance which belongs to a medullary
substance. In osseous fishes they are always uncovered
m the skate and the shark there is a portion concealed by
a prolongation of the cerebellum. At first sight and

isXo^JhonrtTmed aftCl hehlg m Sphit’ theh' aPPearance
mo t ? f 'f SfT’ bllt 111 a fresh state ^ 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 propor-
tion to the size of the eyes : Gottsche has observed in those
which have the eyes of unequal size, in the Pleuronectes, for
example, sole, turbot, &c., that the optic lobes are unequally

when expanded, form a membrane eighteen or twenty lines wide. In the
pleuronectes, muraena?, rays, sturgeons, &c., the optic nerve is almost in a
rudimentary state, its ength and the thickness of the neurilema being pro-
portionally 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 heiiA
foimed by neurilema. In the Ammocetus the nerve is wanting, though
there is a rudiment of the eye. (Desmoulins, l. c., p. 325, &c.) In the
Cyclopterus Lumptis, the nerve on each side consists of from twentv-five or
hirty parallel filaments, each covered by a separate neurilema, and collec-
tively inclosed within a common cylindrical sheath so loosely as to allow
of motion one upon the other. The most remarkable circumstance, how-
eI«V 1S m at *? cerc ji a termination of each nerve is continuous with that
ot the other ; the extremity of the neurilema of each filament and the ends
of the common sheath of each inosculating, as it were, together. The
point of union of the common sheaths of the filaments of each side is con-
nected with the brain merely by very fine cellular tissue, without the inter-
position of any medullary matter, and"so loosely as to aebnit of bein<"
separated by the least effort. (Demoulins, l. c., 330, Plate IX. fm. 3.)
fhe nerves in this case do not decussate.

* Op. cit. p. 140.

PISCES.

SI

developed. If we divide these lobes, we see that they do
not constitute really a ganglion, but that they are formed
bv a very tine fibrous lamina. The optic laminae on one
side is adherent on the internal surface to the corresponding
laminae on the opposite side, and at the point of this adhe-
rence 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 interven-
tricular lamina or septum lucidum of superior animals.
The interior of these ventricles presents different appear-
ances, according to whether it belongs to an osseous or
cartilaginous fish. In the former, Ave perceive first a white
commissure which unites the anterior portion of the tAvo
optic lobes ; behind this commissure, the anterior prolonga-
tions of the spinal cord, which is found beloAV all the cere-
bral ganglia, to which they serve as the base, leaving betAveen
them the infundibulum or loAver part of the third ventricle
of the mammiferae ; behind the infundibulum, another or
posterior commissure, analogous to the preceding ; at length,
above this commissure, a tubercle, flattened, bilobed, furnish-
ed with two long appendages of a medullary substance of
a whitish grey. The bilobed tubercle represents the tuber-
cula quadrigemina, and below is the aqueduct of Sylvius,
which forms a communication betAveen the cavity of the
optic ventricles and another ventricle placed under the cere-
bellum. On each side, the ventricle of the optic lobe pre-
sents a small tubercle (tori semicirculares of Haller, the
semicircular collar of Cuvier, the anterior internal ganglions
of Cams), which is analogous to the corpus striatum.”

“ In cartilaginous fish, the cavity formed by the optic
lamina does not present any commissure, nor the tubercula
quadrigemina very distinctly, but only the infundibulum
and the commencement of the aqueduct of Sylvius.”*

M. Serres thus describes the optic tubercles in fish, con-
sidering them analogous to the tubercula quadrigemina in
man. His Avords are, — “ Thus Ave see the tubercula quadri-
gemina exist in osseous fish: they are in direct communication

* P. 142, op. oil.

O

82

COMPARATIVE ANATOMY.

Fig. 27.

by their posterior extremity with the cerebellum, and there

IB a true jinwesw « cerebelh ad testes: by their anterior

uey,fare “ntmued ;nt° a long lamina, which curves

he hmfn ’fTlC °°VerS “ lalge portlou- When ™ examine
the brain of the car]), we see behind and within these optic

gangha two oblong bodies, which are nothing but the folded
extremity ot these laminae.”

m Jif If"1 dliisi°n °l t!ie whitinS’s brain is tbe triangular
leaflet, the analogue of the cerebellum or little brain in man

ihese parts comprise the whole of the nervous masses
winch can be observed by merely looking 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 bv
liming . bacb> we observe two small rounded projec-
tions, which appear to be merely continuous portions of the
same gangha, bearing some resemblance to the posterior of
the quadrigeminal 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
Brain of the ?ee" afterwards by reference to other fishes, it
Tebenlri ‘“befog 1S Probable that they correspond to the

tthel,branUehiogaa’sd l)0stenor Pyramidal bodies or auditory ganglia,
piayedangIia dis' togetber with the ganglia of the pneumogastric

o. Pneuraogastric J!Crvcs man> tbc branchiogastric nerve in the
ganglion. fish taking its rise from, or being in direct com-
munication with, them.

If the whole encephalic mass of the whiting, having
been lemoved from the skull, be reversed, and the under
surface exposed, two oval-shaped cineritious bodies may
be observed. “These bodies,” says Spurzheim,* “pro-
bably correspond to the grey tubercle (tuber cinereum)
of Mammalia. Ibis tubercle, in the higher classes of animals,

* Anatomy of tlie Brain, 182G, p. 38.

nscES.

83

always sends fibres to the optic nerves, which after this
accession advance in their course of increased size.” Cams
entertained 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 drawing (after Serres), to show the
optic ganglia turned back (fig. 28), exhibiting the connection
of the olfactory nerves with the hemispherical ganglia, and
with the continuous fibres of the spinal cord.

Fig. 28.

Fig. 29.

Fig. 23.— mom Serres' Anatomic Compart du Ccrvcau.) The brain of the cod-fish, unfolded
toexpose the mntinuation of the spinal cord and its connection with olfactory nerves, n Ilemi.
spheral ganglion, c Optic ganglion z. Cerebellum. „ Spinal cord, m. Corpus striatum

2 ' hrain of the carp, removed from the skull, and seen from above, a. Olfactory gan-
f r Kanghon- c. 0ptic ganglkm. D. Teste8i or posterior optic ganglion

giand ^.TorpL miauim. gang ,0n- °' Vneumogastric ganglion, it. Spinal cord j. Pituitary

Ue Carp (fig. 29).— On first exposing the brain of the
carp, we are struck with the great dissimilarity which it

c 2

84

COM P ARATIVE a X ATOM Y .

InsteadV n, lthf ‘ A*- spccics of fish last described
fcwc? 1 lyfour d‘™10ns. w here distinctly observe no
fevvei than seven. A little consideration howevc „n

eonvmee us that there is no essential difference teW
the brain of the wlnting and that of the carp but that the

unbroken Pt?ffl“d ““ Yf st“ ^**4 *

first pan of nodules, which are small are the

the eUnLnl ’if la' a?d' hke, those of the "'hiti"g, situated on

encenhSon Tl’ S01“ *Stanoe from the remainder of the
encephalon. The commissure connecting them in a earn

seven mches in length was a little more than an i h loni

The second pan- are the cerebral hemispheres, but extremefv

fishfs “Cff Tfh ‘if f"-e Parts in the cartilaginous
, I he tliir d and fourth divisions evidently belong to the

1 lc ganglia, and not to the hemispherical, for we find the

pineal gland situated between the two. The optic ganglia

are ho °w m all fish, as we have seen in the codfbX t

caip the covering is imperfect, as we see in fig. 29, repre-

, < n :mS tlle brain as seen from above : letter c runs to this

amina, and n to the internal portion. At the base of the

bulumma The °bSerfid a la,T PituitaiT gland and infundi-
brh 3 if Th®cere^m is the next mass, and immediately
bchmd t 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
bianchiogastric nerves arise, analogous to
the pneumogastric ganglia, which are
placed to the inner side of the restiform
bodies in the human subject. These bo-
dies are stated by Cruveilhier * to be of
enormous size in the Electric Ray, in whom
the bianchiogastric nerve is so amazingly
developed. The hemispheres, though
seen from above. lh a. o'- consist ot two portions, the exterior

misp7eri?afgangiion.Hci or cortical substance, the hemispherical
^nglia, 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 grey neurine. — (See fig. 30.)

* Op. tit.

Fig. 30.

PISCES.

85

It is identical with the corpus striatum of the human
brain.

In the common eel we have an appearance of variety,
which simply arises from the circumstance of the olfactory
tubercles (which in the whiting, carp, &c., Fig 31
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 hemispheres ;
this, and also their being slightly grooved
transversely on their upper surface, gives to
the whole cerebral mass the appearance of a
Iona; chain of tubercles, which have no
resemblance 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 be-
tween them perfect ; the only real differ-
ence consists in their relative size and the
chstance 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 Drain or the pike. a.
enlargement, passing through a mem- SSS^^ngite!:
brane which corresponds to the cribriform cerfbetiium®anSH0nsninli
plate of the ethmoid.— (See fig. 31.) pe*;e t™?ng“ri-

In the cartilaginous fishes the form of »yeJ“

the brain approaches so much more nearly enlargement-
to that of the higher orders of animals, that at first sight
the cerebral mass in one of the Rays, as the common
skate ffigs. 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,
however, no essential distinction ; the difference arising
solely from the greater concentration of similar or nearly
similar parts.

86

COMPARATIVE ANATOMY.

Fig. 32.

J^ctory ga,].glia hl the skate are extremely lame, as
c seen by referring to the diagram (fig. 32). The

peduncles are long, and the ce-
rebral hemispheres form a more
considerable mass, slightly ir-
regular upon its surface, and
thus assuming an approach to
a convoluted arrangement of
the superficies. These hemi-
spheres are solid, as we have
seen in the carp ; the white
fibres may be seen entering at
the posterior extremity, and
separated by grey neurine in
like manner. The optic tuber-
cles have also increased in size,
and are connected with the
hemispheres by distinct me-

dulIaiy bands

e. ceMbe{iu^caof^neiSSlojj8tetelg«^ton!n* But the cerebellum is found

est alteration of any part; for it i^rfongefa gmere
tnangular leaflet, but is divided into lobes, and partly over-
laps the optic tubercles. But the hemispherical ganglia
aie not yet separated from the corpora striata by any inter-
space or ventricle. This covering is first found in the
fig 39) 1 16 transverse commissure is very distinct (see

in the sharks, the cerebellum is much larger and more
comphcated than in any other fish. It very much resem-
bJes that ol the bird, consisting of transverse lamime.

I he advance in the size and complexity of the cerebellum
is interesting when we remember the great locomotive
powers of these fish; and the fact that they are entirely de-
pendent 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 considerable
portion of the branchiogastric nerve arises. It is the ana-

amphibia.

87

Fig 33.

logue of the respiratory ganglia in the Mollusca. &c. and
the pneumogas trie or restiform ganglia m man;
also find a portion of the nerve corre-
sponding to the fifth nerve ot Mam-
malia connected with it (o). Leuret
describes it as partly the branemo-
o-astric oranglion and partly a ganglion
of the fifth pair. Serres considers
this structure as forming a portion 01
the cerebellum. Spurzheim does not
agree with him, though lie does not
form the same conclusion which I
have done.

On reversing the position ot the
brain (fig. 38), we observe the two
small tubercles (i) of medullary neu-
rine, 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 under surface
of the homology of these ganglia,
which I enunciated in my first edition. The pituitary
Hand (J) is large in this fish, and seen distinctly in fig. 33.

From the Fish, let us direct our attention to some specimens
of the cerebro- spinal axis in Amphibia. The most familiar
example of this class is our common fiog.

Brain of the skate seen on its
under surface. i. Tuber cine-
reum. J. Pituitary gland.

Fig. 34.

the hmin of the frog. A. Olfactory ganglion. a. Hemispherical ganglion,
c Id Ortic ganglion —When c and n 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 hemispheres, as in the eel (sec fig. 30), instead of
beim/ at some distance, and connected by long peduncles, as
in most other fish. The hemispheres (b), larger in proportion
than in fish, are nearly double the size ol the optic ganglia.

88

COMPARATIVE ANATOMY.

They are hollow, and contain within a dWinnt

atum, or anterior cerebml m> a distinct corpus stri-

seen and better understood 8in ?h°n’ i'V Uch J111 be better
pliibia. The op&^S c and r ^ the Am‘
vered with a dark membrane Th > ‘1C flstlnc*> and co-
but distinct. The cerebellum i* P1lne1al Sland ls small

=|5p&3?£«

Rephha.— Prom this class we may select the t„rfl„

2^ Mrtrr? ■ and ^

situated on fc„v, olfact,0^ «“glla. instead of being

SS as ?n ft 1 ^0rmTfte of the <*hmoid bone, art
1 acctl, as in the eel, almost close to the hemispheres and

short XT”8 COnneCt“g. them we therefore1 extremely
short they communicate internally with the ventricles^

hi olfactory nerves pass towards the cribriform plate of

the ethmoid, but there is no bulbous enlargement a? that

spo . hey split into small filaments, which pass through

separate foramina. The cerebral lobes or hemSem” me

than “ the Am>dnbia

Fig. 35.

Side view of the brain of the turtle, a. Olfac
giand gang 0n- E- Cerebe'lunl- o. Pneumoga

ganglion.

ganglion.

b. Hemispherical ganglion.
H. Spinal cord. j. Pituitary

These ganglia are hollowed, and when opened (see fio- 36)
the corpus striatum or anterior cerebral ganglion (m) may
be seen : it is of large size. A section of this ganghon ex^

UEPT1LI A.

80

to that in the
the ventricle is

Fig. 3G.

hibits a striated appearance very similar
human being ; posterior and external to
another enlargement (k), which I sup-
pose is the analogue ot the thalamus
or posterior cerebral ganglion.

Leuret designates this enlargement
in the ventricle ot 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 im-
mediately behind the optic thalamus.

The hemispheres are joined to the
cerebellum by two medullary pro-
cesses, the analogues of which in the
human brain are called the processus
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 de-
scription of it in the human brain,
called it the inter-cerebral commis-
sure. It is from this part that the
fourth pair of nerves arise both in man

and the Vertebrata generally. Be- U . UUUV/LUl J Ubl •».# «• V/'*MV»V. j
tween the opticle tubercles and the glion. c&d. Optic ganglion, e.

hemisphere is the pineal gland, of an g^n’^’ul’spinai cm-<iht k' fha-
elon gated form, soft, consisting only “ glandCorpus
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 slightly
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 peculiarly dull, and, in the
second place, the “besoin de respircr,” as the Trench ex-
press it, is not the violent, uncontrollable sensation which
is evidently experienced by fishes and the higher order of

Brain of the turtle seen from
above, lateral ventricle opened.
a. Olfactory nerve, a. Olfactory

90

COMPARATIVE ANATOMY.

oca , ana it is therefore very evident tint nn tw

Srato7»w-n""’.the h^h degree of sensibility JS

The deficiency iif tP °lgans 1? tPe lnSller animals depends,
le aenciency m these animals of that perfectly-develoned

system of respiratory muscles found in most of the Verte

bata, viewed m connection with the diminutive size of these

that fro°m ^ thelf b’ th? °pillion advanced elsewhere,

mulks To act " ““ OTdCTS for »Pi»W

It is worthy of remark, in confirmation of the views re-
gaicling the office of the cmeritious neurine, which I have
aid before the reader elsewhere, that the spinal cord of the
tuitleis nnmensely enlarged opposite to the anterior and
postenor extremities the muscles of which are supplied by
Avllllst between these points it is contracted to a mere
i fiGa le intercostal system of muscles being entirely
deficient, and instead of an extensive surface of skin requhv
mg a supply of nerves of sensation, as in man and the Mam-
unha generally, there is a hard, insensible carapace.

In all the Reptiha the hemispheres are much alike in
their smallness and simplicity. They vary a little in shape.

n 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 m the serpents, the cerebellum is very
small and very simple. J

Birds. The brain and spinal cord in birds are developed
after one uniform type, notwithstanding the amazing diver-
sity 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 any thing we have met
with m the preceding classes. The different ganglia com-

AYES.

91

posing the encephalic mass are not placed one after another,
as in 'the sknll of fishes and reptiles, 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 cere-
brum, and the cerebellum ; in some instances the cerebrum
is so large as even partly to overlap the cerebellum (fig- 37).

Fig. 37.

Fig. 38.

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 fur-
rowed. In the duck and woodpecker
this is distinct (fig. 38) ; and “ in the
paiToquet it is more distinct (says

Leuret) than in any bird I have ex- ew»n. e. cerebellum, h. sPmai
amined.”* The cerebral hemispheres
are not hollow, as in fish and reptiles. And let it be re-
membered, that this convoluted arrangement is adopted
simply for the purpose of obtaining a larger surface of

* Leuret, p. 277.

92

COMPARATIVE ANATOMY.

cmeritious neurme in a smaller space. The amount of sur
face 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 correspond^
lng dimensions to contain it, with proportionally lame
muscles to move the head. Folded backwards and forwards
ion e\ ei , in the beautiful manner in which we find the
bram arranged m man and the Mammalia generally it

nmll 2 bUtr 16 rm’ and 18 PackGd mt0 a comparatively

Twer of’l W 11 V °GS DOt then mterfere the active
poveis of locomotion, so important to all the higher animals

m maintaining their relations with the external world.

tJrirbfmi!im bu’ds is 'Peculiarly large— a fact which
, t 1 C01lfil’m 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
rasuit ; for the perfection which the organs of locomotion
attain m this class very far surpasses all that we have yet
observed among fishes and reptiles, and equals at least the
degree of development exhibited by the same organs in any
other species or class of living beings ; the cerebellum is
divided by transverse furrows into laminse varying in number
from iO to 20. Leuret names 12 in the partridge, 15 in
the duck 16 m the parroquet, 20 in the male magpie.

.Nevertheless the cerebellum of the Bir d differs from the
same organ m the Mammalia in one important particular:
the lateral lobes of the cerebellum are almost wholly defi-
cient m birds ; in man they are so much developed that the
central portion, consisting of the superior and inferior ver-
miform processes, has even been described by Red as con-
stituting a mere commissure. The cerebellum of the Bird
consists, m many species, of little more than the middle lobe,
which, corresponding to the vermiform processes of the
Mammalia, proves that these processes, instead of constitut-
ing a commissure, form the fundamental, and consequently,
we may suppose, the most essential portion of a cerebellum!
Serres* remarks, that this analogy, which was first observed
by llallei , was rejected by Malacame, and neglected by
most subsequent anatomists. The lateral hemispheres,

* Anatomie Comparee du Cerveau, vol. ii. p. 372.

AVES.

93

observes the same author, in some birds are so small as
scarcely to be visible; for instance, in the common fowl, the
cluck, the goose, the wren, canary-bird, and sparrow : but
they are very distinct in partridges, pigeons, swallows, buds
of prey, the ostrich, the cassowary and the storks. In
creneral, in birds which elevate and sustain themselves a
fono- 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 ^.39.

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 hemispheres.

The optic tubercles, on the
contrary, are very large, as
are also the nerves which arise
from them.

The medulla oblongata is

more than double the size of
the spinal cord, both in width

The brain of the goose laid open. (From Spurz-
heim.) On the right-hand side may be seen

A jicuii.i vyj* nit ngui nuiiu , .

and depth; the corpora pyra- BUTtc;hitt^fi^i^h^e^cet

midalia, the olivary bodies and « mthe

Ttrvns; Vnrnlii fl l'P. absent sphere has been made, below that called the

pons V dlOlll cue Ciuseni. /n|rn ovale in the human brain ; it lays open

TllP hemiSTlhereS ot the the lateral ventricle, exposing the corpus stria-

ine HLUliSpilLlCO ui 111V, tum (M) and the thalamus (A). The sniaU
brain are connected together transverse commissure, analogous to the an-

^ . terior commissure in man, is divided (r).

bv a small transverse comnus- There is no corpus callosum. a. Olfactory

Jj a . . . . nerve, b. Optic nerve. n. Hemispherical

sure consisting of CmentlOUS ganglion, c. Optic ganglion. e. Cerebellum.

i o v Auditory ganglion, n. Longitudinal com-

matter on the exterior, ot lila- musure,

rnmmiKR

or fornix, r r. Great transverse
commissure.

ments of medullary matter, of
the size of a thread, in the interior ; the analogue of the
anterior transverse commissure in man, (see fig. 39, r,)
which represents the two divided ends of it. It has been
cut in separating the hemispheres. On the internal surface
of the hemispheres (those two surfaces which are opposed

94

COMPARATIVE ANATOMY.

to each other, and in the human brain are separated bvthe
falx major) we observe some diverging fibres of medidln-v
neunne, which present themselves!*! sTo(foMk7t
he under part of the hemispheres, but really oZence b ‘
two portions, the one from the outer edge of “actus

«hthe°o f T the innCr- That wllich takes its
tiem ,!d! ti t6i Z 'S connected with the tractus op-

cinereum J TK “f™?1 aPPears to terminate in the tuber
leieum. This structure appears to me analogous to flip
fornix m man.— (See letter n, fig. 39.) °

111 the brain of the Bird we again distinctly observe those
collections of cmentious neurine through which the fibres of
the a”tenor and posterior columns of the spinal cord pro-

snW T1lr paasaf1t0wards their termination in the hemi-
spheie. 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 se-
parating tie hemispheres and breaking down the commis-
sure which connects them. They will then be observed
paitly covered by the optic tubercles. In birds the corpora
striata are very large, the thalami small. As they are more
perfectly developed m all the genera of the succeeding class,

exhibit ^ ^ preSent dwe11 lonSer upon the character they

Brain and Spinal Cord in the Mammalia. —The division
ot tins class into two sub-classes, the Placentalia and Impla-
centaha, by Professor Owen, and the pliilosophical researches
ot this admirable anatomist, into the organization of the
implacentalia, necessitates 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 Varolii and corpus callosum are peculiar to
tlie Mammalia, is not applicable 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 bavin o- a
common opening for faical evacuation and the generative
function, like the birds : the ornithorhynchus, or duck-billed
platypus, is our most familiar example. The brain of this
animal is extremely simple ; the hemispheres are small and

MAM MAM A.

05

smooth like tlit' bird, I ho whole bruin only bearing a propor-
tion to the body ot 1 to 150.

The optic tubercles are covered more completely than in
the Bird, and they are purtially divided, shadowing forth I he

complete division into four bodies, which we meet within the
placental Mammalia. “ The posterior bigeminal body, says
Owen, (Art. Monotremata, Cyo. Aunt. vol. iii. p- d84,j “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 deficiency 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 Marsu-
piate Animals, published in the Philosophical I ransactions,
Part I., 1847, 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 rudimentary fornix. In the rodent, oi
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 rnarsupiatc animals, however, it is very different,
for the great transverse commissure, or corf ms 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 Dasyureit is as l to 820, in the Wombat as 1 to 01 4,
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
marsupial Mammalia.

* Kncyd. of Anatomy, p. H'J.

06

COMPARATIVE ANATOMY.

hibits th th / Ct t Tat. t lc cerebral organ is that which ex-
b b ts the most marked degradation of structure in the class
of warm-blooded vertebrate animals, which are charactered
by an oviparous generation, I was induced to suspect after

b^ds 1 inTeL mod 7 Cl°S7 the M^rsupiata approached
lonf 7 le ° gcncnitlon> that the brain might pre-

sent m them some corresponding inferiority of structure as
compared with the placental Mammalia. '

Fig. 40.

Fig. 41.

Fif,. 40.— Upper surface of the brain of the beaver, reduced one half (()««■ i
hemispheres, a. Olfactory ganglion, c. Cerebellum. nan. (Owen.)

UPl)er ®H.rlact! t,le brain of the wombat, reduced one-half (Owen \
hemispheres, o. Olfactory ganglion, n. Optic ganglion. c. Cerebellum < 0

a. Cerebral
a. Cerebral

Ail attentive study of the manners of different marsupials
in confinement, 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 inferiority of intelligence, and
a low development of the cerebral organ, as being the cir-
cumstances in the habits and structure of these singular
animals which were most constantly 'associated with the
peculiarities of their generative economy. I have since the
most satisfactory confirmation of this coincidence, from re-
peated dissections of the brains of marsupials 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

MARSUFIATA.

97

evidence of it will be acceptable both to the physiologist and

the naturalist.” . , ,

Mr. Owen compared, step by step, the brain ol the Mar-
supial Wombat and the Rodent Beaver ; and though these
creatures are so alike in outward 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 ot the
wombat appears more highly organized than that of the
beaver, as it presents some appearance of convolutions,
while the brain of the beaver is cpiite 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 tubercles, which they do not completely in
the wombat.

Fig. 42. Fig. 43.

Fig. 42. — Brain of the beaver, with the substance of the hemispheres removed to the level of
the corpus callosum : reduced one-half. (Owen.) b. Optic ganglia, c. Cerebellum. 1. Corpus
callosum, u. Pineal gland.

Fig. 13. — Brain of the wombat, with the substance of the hemispheres removed to the level of
the lornix, except on the right aide, where part of the thin internal wrall of the lateral ventricle is
lett; reduced one-l alf. (Owen.) h. Optic ganglia, a. Olfactory ganglia, m. Fornix, n Hippo-
campus major, o. Anterior fibres of the tamia 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.

On separating the hemispheres of the brainTn the beaver,
we bring into view a broad and distinctly fibrous commis-
sure— the great transverse 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

H

JO COMPARATIVE ANATOMY.

hemispheres of the wombat, there is no such commissure :
not only are optic tubercles and pineal glands uncovered as
m the beaver, but the optic thalami 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
1 ti. Owen, in the brain of the Great and Bush Kangaroos,
the Vulpine Phalanger, the Ursine and Mangles Dasyures,’
and the Virginian Opossum, it is most probably characteristic
of the marsupial division of Mammalia.”

It is stated in the last edition (1845) of Cuvier’s Legons,
in reference to the commissural apparatus in the Mar-
supiata, that at the same time that the great transverse
commissure diminishes, the anterior commissure 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 herbivo-
rous and two of carnivorous Marsupiata, to show the indica-
tions of superior development which distinguish the brain
of the herbivora, in the greater proportional development of
the cerebrum, its convoluted surface, and the smaller pro-
portional 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 indi-
cating the approach to the oviparous type of cerebral struc-
ture. It is associated with a corresponding diminution of
the pons Varolii.

Mammalia Placcntalia. — 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

RODENTIA.

99

Fig. 44-

be procured, end because I am sure that whoever will take
the trouble to dissect it, before attempting that ot the
human brain, will find his path much
facilitated by the knowledge and the
manual dexterity lie will have ac-
quired.

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 struc-
ture.

When the upper part of the skull of
the rabbit is removed, we observe that
the cerebral mass consists of three

errand divisions : the first and smallest Brain of the rabbit, upper 6Ur-

O • ,1 ir X , 1 face. A. Olfactory ganglion, b.

ot these comprises the oilactory tuber- Hemispherical ganglion, e. ce-
des ; the second, the hemispheres; rebell“m' Spl"alc .
the third, the cerebellum ; the other ganglia remain entirely
concealed. The hemispheres are slightly marked on the
surface, but not at all convoluted. —

(See fig. 44.) On separating the
hemispheres we find them con-
necting together by a band of me-
dullary neurine, called in the human
subject the great transverse com-
missure or corpus callosum.

If the great transverse commis-
sure be now divided, and the hemi-
spheres separated from each other,
several parts of importance beneath

it will be CXpOSed (see fig- 4o). Brain of the rabbit; hemispheres

Commencing from the posterior [“"^StticSaZironZ'l.giT:
part, we observe just in front of the 1 e ) .1 i l u d i n a 1 T 1 u r ’ey.

cerebellum four rounded bodies, the
posterior (d) of which are small,

,v„„..Uu commissure.

a. Olfactory ganglion n. Hemispheri-
cal ganglion, c. Optic ganglion, d.
Testes, or posterior optic ganglion.
, N , , £. Cerebellum, k. Thalamus nervi

not being more than a fourth part SaL,”

as large as the anterior (c). These l,ua‘’ orformx-

four bodies are analogous to the single pair of optic

H 2

100

COMPARATIVE ANATOMY.

tubercles in the bird, and in man are called the tubercula
quadric/ emma, or the posterior the testes, and the anterior
the nates. Immediately anterior to these bodies we find
two other rounded projections, the anterior of which is the
huger. lhe posterior (k) is formed by a body which in

ie 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.

ns projection, though principally formed by the optic
thalamus, is not solely formed by it; for covering the
thalamus, we find a thm 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 lonqitu-
dinal commissure, consists of two sets of fibres : one set ap-
peals to correspond to the tenia semicircular is in man, ly in o-
between the thalamus and corpus striatum ; the other
comes from the under and back part of the brain. It rises
up from tins part, covering in its course a large internal
com olution, the hippocampal lobe — hippocampus major.
k rom this part, ive find it passing forwards and inwards,
and winding over the surface of the thalamus, and, running
m front of it, dips down to the under part of the brain, form-
ing the anterior pillars of the fornix, and terminates partly
in that portion of the spinal cord which in the human sub-
ject 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 por-
tions 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 ex-
posed.

The projection which is immediately anterior to the tha-
lamus is analogous to the corpus striatum of the human
brain, a part that has received its name from the striated

RODENTIA.

101

appearance it presents on a section being made oi its sub-
stance ; the cineritious neurine being deposited in striae
between the white tibres which are passing from the hemi-
spheres to the anterior columns ot the spinal cord, lhe
corpus striatum and thalamus are, therefore, deposits of
neurine, through which the component fibres of the anterior
and posterior columns ot the spinal cord pass in their com se
from and to the hemispheres, and have been characterised,

I think advisedly, by Spurzheim, as ganglia. The corpus
striatum should be entitled the anterior, and the thalamus
the posterior, cerebral ganglion oi the cord. Running near
the edsje of the thalami, towards the nates, are two white
hues, which, turning ofl 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 may be 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 commis-
sure, immediately in front of which is a middle band of
cineritious neurine, and still further forward is another ;
these are respectively called the anterior and middle com-
missures of the brain, in distinction to the posterior commis-
sure.

The hemispheres having been completely turned back in
the performance 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 admirable contrivance by which the immense quan-
tity 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, reversed so
as to expose the under surface (sec 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

102

COMPARATIVE ANATOMY.

within the vertebral canal. This thickened portion of the
coh is called the medulla oblongata , and contains within its
Fig. 46. substance the olivary bodies, the pneu-

mogastric ganglia, and the posterior
pyramidal or auditory ganglia. Cross-
ing the medulla oblongata transversely
is a band of medullary neurine, which,
running from one side of the cere-
bellum to the opposite, forms the
commissure of that part, and is usually
known by the name of the pons Va-
rolii or tuber annulare (p v ). The spinal
cord beyond this commissure splits
into two portions, which, running to
the two corresponding hemispheres,
are called the crura, or legs of the

cBera(Leureth! Z- kfa*n (? c)- Between them is the col-

lection of cineritious neurine called
the tuber cinereum, and immediately
anterior to it the commissure of the
optic nerves. The hemispheres ap-
pear divided into two lobes on each
side, and the fissure of separation is
called the fissura Sglvii. The commis-
sure between the olfactory ganglia and the hemispheres is of
considerable width, consisting of cineritious and medullary
neurine, but it is short when compared with that of the

face (Leuret.) a. Olfactory gan- -i .• ^ J . .

glion. i. The inferior part of the leCtlOll Oi CllientlOUS
internal convolution or lobe of the
hippocampus, to which phrenolo-
gists have appropriated the organ
of alimentativeness. o. Optic
nerve, m. Common motor nerves
of the eyes, or motores oculorum.
e m. Corpus mammillare. p c.

Crus cerebri, p v. Pons Varolii.
b t. Corpus trapezoidum. p a. An-
terior pyramidal body, c r. Cor-
pus resti forme.

Fig 47.

carp and whiting.

The under part
of the hippocampal
lobes are now dis-
tinctly seen, and the
great size should
be observed.

In the porcupine
and agouti the au-
ditory ganglia are
of great size. In
the squirrel the hemispheres are smooth (fig. 47), the olfac-
tory ganglia large, as also the cerebellum, so "that, on a lateral

Side view of the head and brain of a squirrel, a. Olfactory
ganglion, n. Hemispherical ganglion, e. Cerebellum, u.
Spinal cord.

EDENTATA.

103

Fig. 48.

Brain of tlie squirrel: hemi-
spheres separated, exposing the

view, the whole encephalon bears much resemblance to that
of the bird : when this brain is dissected (fig. 4b), the
small size of the hemispherical ganglia, m proportion to the
other cerebral ganglia, is well seen.

Next to the Rodentia, in the class
Mammalia, is the order Edentata, or
toothless animals. This order includes
the sloths and the extinct genera of gi-
gantic sloths, such as the megatherium.

The brain is simple, and affords no pe-
culiarities of physiological interest.

We next come to the order Rumi-
nant ici, of which the Sheep is a familiar
illustration.

The facility of procuring the brain
of the sheep, and the slight cost at

• t it* • • C ' x. spheres separate.-, * ~

which multiplied dissections ot it may cerebral ganglia of the cord.

, . 1 1 B. Hemispherical ganglion, c.

be made, induce me to bring it unciei Optio ganglion, d. Testes, or

• n ,i j 1 i. #U«/-livArv posterior optic ganglion, e. Cere-

the notice of the student, as attorning bellum. k. Thalamus nervi op-

, . t -i i • tici. M. Corpus striatum.

another characteristic link m the chain

of cerebral complication, from the lower to the higher tnbes
of creation and its termination in man. Investigations ot
this kind, indeed, ought to be pursued through as exten-
sive 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 or-
ganized existence. The minute description which has been
given of the anatomy of the brain of the rabbit, makes it
unnecessary to dwell with the same attention to detail on
each point in that of the sheep ; so that I shall merely men-
tion those particulars in which they differ, and thus point

104

COMPARATIVE ANATOMY.

Sh-P «es

fig. 49.

EBcTre\elflum.BheeP' ^ (LeUrCt') A' OIf“tory ganglion. ». Hemispherical ganglion.

The upper surface of the cerebral mass of the sheep pre-
sents, 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 hemi-
spheres, 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 hemispheres 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

ruminantia.

105

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
the folding up of a soft but tenacious substance, Ihe ceic
helium is not much changed in appearance ; it is only some-
what larger in proportion to the cerebrum. _

The oreat transverse commissure lias increased m accord-
ance with the greater development of the hemispheres ; and
when we divide it in the middle, and turn either halt 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, anc
the under siu-face of the hemispheres, has been described
in the human brain, under the name of lateral ventricle ,
as if it were a cavity or chamber scooped out of the sub-
stance of the brain. But it must be evident to every one
who has followed the gradual development of the hemi-
spheres 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 digitate. We find, in fact, that the spaces deno-
minated lateral ventricles are the necessary effect of the
drawing back, if I may so express it, 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 coid (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 elsewiiere, to
the nodulated head of a walking-stick, over and around
which a piece of cloth has been tied, and then reflected for-
wards upon itself.

The edge of the fornix or longitudinal commissure may
be seen lying in the groove between the anterior and pos-
terior 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

106

COMPARATIVE ANATOMY.

pr,srte^F^«=

commissiu'e, will also be brought into view.

Fig. 50.

factory gangHon^n.’ uTmlsplieHral'gLg^Ion. “s'* Cerebelhrm upl>e”“rfac.e' size of life. a. 01-
k. Eleventh, lingual, x. Pons Varoliif' ' ‘ ’ B l,haryngcal- 1- ’I'cntli, par vagum.

ii ?ii thelfbafe °r unf!er surface of to® brain ive observe
that the olfactory ganglia or tubercles (see fig. 50) are verv

uglily 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 m 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 tu-
bercle and the point where they are united to the under
surface of the hemispheres. These commissures 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 denominating analogous parts in the
human being, nerves. The olfactory ganglia themselves are
composed of medullary and cineritious neurine.

The pons Varolii (x), or tuber annulare of Willis, is small
in the sheep compared with the same part in man : here it

RUMINANTIA.

107

is not more than three lines in breadth. The corpora mam-
millaria are united so as to appear like a single body,
tuber cinereum is not particularly distinct; tlnough it
centre we find a sort of funnel-shaped tube passing, called
the infundibulum , which joins a Fig. si.

rounded structure situated on
the sphenoid bone, called the
pituitary yland. The character
or analogy of the last -mentioned
parts is extremely obscure, and
there is a mystery here which has
not yet been unravelled. The
medulla oblongata, like that of
the rabbit, is very thick in com-
parison with the spinal coicl.

The anatomy of the medulla
oblongata presents many points
of interest. But in order to
understand them it is necessaiy
to anticipate a little. If the
reader will refer to my descrip-
tion of the part in man, he will
find that the surface, viewed an- . .

teriorly and externally, presents those projections named,
from their shape, the corpus pyramidale, the corpus olivare
and corpus restiforme. 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 perpen-
dicularly on the same side, but they cross over to the
opposite side, decussating until their fellows ; the corpora
pvramidalia in the sheep are small. The corpus olivare
is a true ganglion — a collection of cineritious neuiine. I he
corpus restiforme contains a ganglion which is connected
with the pneumogastric nerve ; it is the homologue of the
branchiogastric ganglion in fish. It may be called the
pneumogastric or restiforme ganglion.

If the posterior surface of the medulla is examined, a
fourth ganglion may be seen projecting on each side of the

Medulla oblongata and pons Varoln 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 trapezuidum.

108

COMPARATIVE ANATOMY.

mesml line, of a pyramidal form— the posterior pyramidal
bodies, or auditory ganglia (r p) ^

iss; SKt sassaa

*• — » -

rile distinction between these last-named ganglia is better
seen in some o the lower Mammalia, after mala 1 1 tram
verse section than in man. I believe that in ah the Mam.
nalia, except the monkey, the elephant, and the porpoise

the ° 1Vam d° 110t ProJect 011 the surface, and hence

the assertion by some anatomists, that they are wanting m
most of the Mammalia. I * 3 warning in

Longet says, p. 390,* “The olivary bodies attain their
highest development m the human species ; it is often im-
possible 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 ”

Cams affirms “that they are wholly absent in most Mam-
malia, or at least that they do not present the arborescent
appearance of white and grey nenrine which they do in

I have found these ganglia in the sheep, horse, calf and cat
and I have no doubt but that they exist in all Mammalia.

trail, says Longet, “has certainly exaggerated their
volume in the calf; they are sufficiently apparent in the
apes, but especially in porpoises 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 represents the appear-
ance they exhibit. It is taken from a drawing which
I made with Mr. Grainger. We afterwards examined it
under the microscope, and found the ganglionic corpuscles
very beautifully distinct. Its exact longitudinal extent I

. Anatomic et Physiologic du systeme Nerveux de l’homme et des
animaux V ertdbrds, par F. A. Longet, Laureat de l’lnstitute de France,
Academie des Sciences, Doct. en Medecine de la Faculty de Paris, Prof.'
d’Anatomic et de Physiologie, Chirurgeon de la Maison Royale de Saint
Dennis, &c., 1842. J

HUM IN ANTI A.

109

cannot assert, but there was no appearance of it in a section
made just above s, No. 3 ; Hg. 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 occupy
nearly one inch in breadth. The au-
ditory and pneumogastric ganglia are
also very distinct (same fig., F and g).

Finally ; There is an appearance on
the surface of the medulla to which
there is nothing analogous in the hu-
man brain. This is produced by a
transverse fibrous band running just m af llt

VipIow and narallel to, tne pons v a- 0t>iongita of the sheep.— see fig.

.. » d .... 1, T j.1,„ 51- F p- Auditory ganglion, o.

rolii from the restilorm oouies to me pneumogastric ganglion, s s.
edge of the anterior columns (see fig. 01ivary body'

Si” : y is called the corpus trapezoidum. It is met with in all
Mammalia, 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 bram for assistance 111 disci 11111-
nating several of the particular pairs of nerves.

We have now seen enough of the anatomy of the brain
of the lower animals to understand liow we ought to study
it in man ; we have traced it from a most simple form up
to what would have appeared a very complex one if we had
not seen all the connecting links. The study of these links
must assist us in the study of the human brain. In a mere
anatomical point of view we might abandon our compara-
tive anatomy and proceed at once to man ; but in a physio-
logical and philosophical point of view we shall find it in-
terest in" to glance at the characteristic features of the brains
of those Mammalia which remain undescribed between the
Ruminantia and the human race.

The P achy dermal a or thick-skinned animals arc the next
in order, of which the Horse is our most familiar example ;
fir r 53 is taken from Leuret. At one glance the student

D

110

COMPARATIVE ANATOMY.

will perceive that the brain
drawing is reduced one half.)

is of a high character.
The cerebrum is larg

e,

(The

and

Fiy. 53.

e

is Sunil ^ThMe^^res which^are6^!0"6!1^1!' (Lcuret'> •• **»« Sylvii, which
of the anterior convolutions ; ami 1. II I I IV ‘h* “r,Ura Sy,vli indie;ite each

+ Point of re-union of the posteriw convolu^^ ,th°.f<\ur P°8terior convolutions,

o. Supra orbital convolution. 1 h. HippocaZaT lobe or .P„ JJ ‘ beh¥ld the of Sylvius,

volution, c g. Corpus geniculatum. 1,2 3 indicate the t ,rlen?riPr0Jertl?n 01 the lllternaI con'
factory ganglion. „. Optic nerve, m Third nafr l l'" ?l'°b.ef »f the cerebellum, c. Ol-
ditto. /. Seventh, facial. 1. Eighth auditory « Ninth n-V>Urt \‘ ltt0' t' Flflh d,tt0- “-Sixth
h. Eleventh, lingual, s. Twelfth, sPrnai ac^ss'ory.^x.’ lon8S VaroM"6^' ^ T-nth. P- *«£»».

Fid. 54.

sm,? 'vrr ??*■

centre, co. Commissura mollis. op. The lettefs afe on the nnM 1C‘‘1,0SUT, di,v:i<led in t,le

tahrbo?ivTig,and- "• 0ptic

the convolutions are numerous. It is rounder and more
elevated than that of the ox, though in both there is more
brain anterior to the corpus callosum than behind it. It

PACIIYDEUMATA.

Ill

covers the tuberciila quadrigemina and a part of the cere-
bellum. The internal parts arc the same as in the sheep. The

Fig. 55.

Fig. 56.

Fig 55 — 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 pyramidale. w. Corpus restiforme. u. Crus 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 corpus 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 cage of the section to the right
instead it to the left, as in Nos. 2 and 3. a. Pneumogastric ganglion, f. Auditory ganglion
s. Olivary body.

arrangement of cineritious and medullary neurine in the
cerebellum is the same as in man. A perpendicular section
exhibits the appearance called the arbor vitsc, and shows an
immense surface of cineritious neurine. The olfactory gan-
glia are of great size, as also their commissures and the hip-
pocampal convolutions. The medulla oblongata is large
(see tig. 55). The pyramidal eminences are distinct; there

112

COMPARATIVE ANATOMY.

is no appearance of corpora olivaria on the surface, but a

wTth° thoset S ti l “I • This P°sition’ « compared

whh those in the human being, is curiously altered (see

g. 06, TV os. 2 and 3) This fact is to me a convincing proof
that they are imbedded m the motor tract, and that they do
not form any line of physiological demarcation. I have
taken a great deal of pains to work this matter out, and
ascertain what is the homology of these bodies. The con-
clusion I have arrived at is, that they are the ganglia of the
ingual nerves, and that the great extent of cineritious
neurme which exists m them in man has relation to the
multiplied movements of the organ of speech.

There are objections to this theory, and among others
them great external size in the elephant (see fig. 57). In
t ns figure the great projection they form on the surface of
the medulla is very well shown ; and it is most likely that
tins projection is caused by a great quantity of ganglionic
neurme within : but without a section this cannot be posi-
tively asserted. Again, their large size in an animal whose
intelligence approaches nearer to that of the human beino-
than that of any of the lower animals, is curious and in-
teresting. The olivary bodies are very distinct in the apes ;
but m some Carnivora, as the bears, they are not so well
formed ; m others, as the lynx, badger, and seal, the in-
ternal border is 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 cere-
brum 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.

l'ACHYDERMATA.

113

“ The hemispheres are broad and short, with a considerable
development of the natiform protuberance. The convolu-
tions are comparatively small and numerous. The anfrac-
tuosities arc also deep, extending in some cases moie than

Medulla oblongata of the elephant; sketched from a preparation in the College of Surgeons.
». Corpus olivare. t. Corpus pyramidale. w. Corpus restilorme. x. Pons Varolii. c. Third
pair of nerves, e. Pifth ditto, tj. Seventh, facial. A. Eighth, auditory, i. Ninth, glosso-pharyn-
geal. j. Tenth, par vagura. k. Eleventh, lingual.

Fig. 57.

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

i

114

COMPARATIVE ANATOMY.

the olfactory bulb . The cerebellum is of con siderable width ,
and its surface increased by numerous and complex anfrac-
tuosities. The tuber annulare corresponds 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 then’ prodigious size : whilst the optic nerves,
and those which supply the muscles of the eye, are as re-
markable for their small size.”

The brain of the Cetacea, 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 intel-
lectual 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
developed 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 convo-
lutions are smaller, the sulci between them are of consider-
able 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 comparison with those of the
cerebrum, the whole cerebellum bearing a proportion to one
hemisphere of the cerebrum as two to two and a half. This
is owing to the great size of the lateral lobes : the middle
lobe or processus vermifonnis is small, as will be seen by
fig. 58. The posterior lobes appear to be wanting, as

CETACEA.

115

Fig. 58.

in the sheep, by which the cerebellum is left partly un-
covered.

The great transverse commissure or corpus callosum (G) is
strikingly short from before backwards, measuring a little more
than one fourth
of the whole
length of the
hemisphere, if we
except that por-
tion which curves
downwards in
front, and which
is about a third
of the length of
the horizontal
portion, so that
the tubercula
quadrigemina or
optic tubercles
(4 and 5) are en-
tirely uncovered
by it, and on re-
movingthe arach-
noid and pia ma-
ter are to be observed between its posterior edge and the
cerebellum, nearly a third larger than those in the human
brain ; the posterior pair, or testes (5), are nearly double the
size of the anterior or nates (4).

Brain of the porpoise, half of the left hemisphere removed,
opening the lateral ventricle. 1. Section of the left hemisphere,
exposing the left ventricle; containing — 2. Corpus striatum, or ante-
rior 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 quadrigeminal bodies, optic tubercles, or testes.

6. Great transverse commissure, or corpus callosum. 7. Cerebellum.
8. Spinal cord. 9. Pineal gland.

In the brains of the Mammalia we have already examined,
the Rodentia, Ruminantia, Pachydermata, we found the rela-
tive size of the optic tubercles the same as in man, viz. the
anterior larger than the posterior ; but generally in the Ceta-
cea and Carnivora the posterior are the largest. The kan-
garoos resemble the herbivorous Mammalia 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 commissure 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

116

COMPARATIVE ANATOMY.

a fourth part as large as the former. The fornix, which is
small, has been divided, and with the exception of its an-
terior pillars and the septum lucidum, removed in making
the above section. There is no posterior cornu to the lateral
ventricle.

The plexus clioroides 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 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 pyramidalia, 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 corpora
olivaria be carefully elevated, the anterior columns of the
spinal cord will be seen decussating beneath and posterior
to them.

The arrangement of the fibres of the anterior and poste-
rior columns, as regards their course towards the cerebellum,

CETACEA.

117

Fig. 59.

and the share they take in the formation ot the corpora
restiformia, is perfectly identical with the disposition ol the
same parts in the human brain, which will be found de-
scribed so fully further on, that it will be unnecessary to dwell
upon it here. The
accordance is,
nevertheless, ex-
tremely interest-
ing as confirming
those views 1
have advanced on
the subject of the
communications
between certain
parts of the me-
dulla oblongata
and the cerebel-
lum.

Origin of the
Nerves in the
Porpoise. — The
olfactory nerves
are entirely ab-
sent.

The optic are
smaller than those of man ; their origin is the same.

The 3rd, 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 1 Oth, or par vagrnn, is at least double the size it
presents in man.

The spinal accessory is rather small. Its
same as in man.

Base of the brain of the porpoise. (Leuret.) This figure exhibits
the absence of olfactory nerves, the large size of the pons Varolii,
also tlie olivary bodies, and their juxtaposition on the mesial line,
oo. Orbital convolution, pc. Crus cerebri. p v. Pons Varolii.
s. Fissura Sylvii. la. Anterior portion of the antero-posterior
convolutions, ip. Posterior ditto, h. Olivary bodies, o. Optic
nerve.

origin

is

the

The 11th, or Ungual, is rather large. Its

origin

is from

the anterior columns of the cord close to the corpora oli-

vana.

In the different genera of Whales, John Hunter tells us
that the brain differs much in size. The thalami are large,

118

COMPARATIVE ANATOMY.

but the corpora striata are small. The fibrous neurinc 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 king-
dom, consisting of the bears, martens, dogs, cats, and seals.
Ihe number of ganglia and commissures constituting the
encephalon of these animals is the same in all. There is no
gieat peculiarity as regards their relative size. In the
common cat (see fig. 60) the olfactory ganglia (e), as we

Fiy. 60.

Side view of the brain of the common cat. (Leuret.) e. Olfactory ganglia, o Optic nerve
AAA. Anterior port.on of longitudinal convolutions, rrr, Posterior of ditto sis opposite

o OrS convolution."6 ^ 6 ^ two SetS of involutions. + Union of So!

might expect, are enormous. The hippocampal lobes are
also large. The hemispheres 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 cerebellum, which is large, especially its lateral
lobes. The corpora olivaria maintain the same central po-
sition as in the porpoise, but they do not project on the
surface. The corpus trapezoiclum, that oblong portion of

1NSECT1 VORA.

1 1!)

tlie

61,

Fig. 61.

Side view of the brain of the
hedgehog, a. Olfactory ganglion.
b. Hemispherical ganglion, e. Ce-
rebellum. n. Spinal cord.

the medulla oblongata running transversely inferior and
parallel to the pons Varolii, between the fibres of which
facial and auditory nerves emerge, is of remarkable size in

all the genus Felts. — (Owen.)

In the group Insectivora, hedgehogs, moles, &c.,
brain retrogrades, as will be seen by referring to fig.
which represents the brain of the
hedgehog. The olfactory ganglia (a)
are enormous compared with the he-
mispheres. The hippocampal lobes
are very large, corresponding with the
olfactory ganglia. The hemispherical
ganglia are quite smooth and free from
convolutions ; the cerebellum is large
and well developed.

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) Fi9. 62.

are very small and smooth ; the cere-
bellum is peculiarly large.

Next to the Cheiroptera below, and
to Man above, we have the Quadru-
mana, 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, approaches
nearlv to that of man ; while some of the lowest appear to
be little raised above those of the rodents and insectivora,

Side view of the brain of the
bat. a. Olfactory ganglion, b.
Hemispherical ganglion, e Cere-
bellum. h. Spinal cord.

as regards the convolution of its surface.

Mr. Owen, in his paper on the Marsupiata, already re-
ferred to, gives a drawing of the brain of a monkey ( Midas
rvfimanvs ) ; the surface of whose brain is smooth, with the
exception of one short longitudinal fissure extending but a
short distance on the hemisphere from before backwards : at
the same time it must be stated that this brain is above
that of the rodents, &c., inasmuch as it covers the cere-
bellum.

'The outline of the brain of Mammalia, as viewed from

120

COMPARATIVE ANATOMY.

above, presents three principal varieties. In one it is almost
circular— this includes the our an g outang, the seal, and the
porpmse. In another it is oval, more or less elongated, as in
the lion beaver, and sheep. While in a third it is almost
tnangular or heart-shaped, the anterior lobes being remark-
ably narrow, as in the ferret, in the opossum, and in the
rabbit, riie forms have no relation to the different orders

of the Mammalia, as the examples which have been men-
tioned 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 gehiculata. — 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 of the other pairs ; but
they are small or scarcely visible in the Ruminantia. 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 thalami. In the
monkeys, especially in the ourang outang and the baboon, we
find the corpora geniculata interna 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 interna, 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 tha-
lami, 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 dif-
ference. It is sometimes elongated into a cylinder, as in
the ox and the seal; sometimes triangular, prismatic, or
cordiform, as in the sheep and the horse ; or conical, as in
* Cuvier, Le(;ons, 2nd Ed. 1 845.

VENTRICLES.

121

the monkey : it is generally small m the Carnivora. Its
fasciculi, from their origin on the upper surface o . the optic
thalami to the anterior commissure, may be distinctly traced.
In the opossum, the fasciculi at the origin of the gland are
laro-e 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, m 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 is lodged the tcenici semicircular is and the
pillar of the fornix, and them size is in general very similar
to that of the optic thalami. In the dolphin, however, the
disproportion is considerable ; the corpus striatum is much
less prominent and less voluminous than the optic tha-
lamus. .

Corpus callosum, fornix, and hippocampal lobe. — ihe
corpus callosum and the fornix, like the striated bodies,
do not differ much in size. The hippocampal lobes are
generally larger m proportion in jMammalia, but then
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 proportionally small and
thin corpus callosum, and a very moderately-sized corpus
striatum.

Ventricles. — There is no digital cavity in the lateral or
anterior ventricles, 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.

This ventricle, in most Mammalia, is continued anteriorly
into the hollow tube of the olfactory commissure, the
third and fourth ventricles not presenting any remarkable
difference.

The mammary tubercles are often very distinct, as in the

122

COMPARATIVE ANATOMY.

Callitrix, one of the squirrel-monkeys, the lion and the
l,yn\ : they are more frequently blended into one, as in
the hyrax, stag and lama.*

It has been already explained that the convoluted hemi-
spherical ganglia are the parts with which the intellectual
powers are more immediately connected- and as the ganglia
increase m size, they become altered from mere rounded
points, like peas, to folded surfaces. The principal change
which we have to observe m 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 convolutions of the
Mammalia are alike in the same animal, and that the
Mammalia may be classified by the similitude of tliefr cere-
bral 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 convolutions 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 con-
volutions ; 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 investi-
gate 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 con-
voluted surface of the brain assumes in different animals,
we will suppose the hemispheres to be a fiat 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

* Cuvier, Lesons, vol. iii. p. 99, 2nd Ed. 1845.
f Op. cit., vol. i. p. 451.

CONVOLUTIONS.

123

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 longitu-
dinal furrow (tig. G3). We may now cut the cloth a little
larger than the box, and one very slight fold is sufficient to
o-ef 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 longitudinally. Still rising in the
scale, the brain goes on increasing; we must now, there-
fore, as the additional size is given by additional length,
make transverse as well as longitudinal folds. Suppose a
surface to have been folded thus,
like the upper figure, but which
cannot be packed in the box be-
cause it is a little too long for it ;
we then bend it a little in the op-
posite 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 under-
stood 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 coimse of the con-
volutions and their variety in different species, we may con-
sider the longitudinal foldings as the result of pressure from
above and below ; the transverse foldings, from before and
behind.

It is a curious coincidence, to say the least of it, that as

124

COMPARATIVE ANATOMY.

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 length-
ening the biain, 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 Zoolo-
gical Society as far back as 1833, began a classification of
the convolutions of the brain. His paper was simply en-
titled, “ The Anatomy of the Cheetah, Tetis jubata.” He
confined Ins observations to the feline and canme race.
They are very clear, and point out the same longitudinal
furrowing which was afterwards described by Leuret, as
wiU 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 con-
volutions, as to their form, extent, and symmetrical arrange-
ment, argues strongly in favour of the conclusion that the
folding of the hemispherical substance in the progress of
development follows a determinate law.

A classification of animals in relation to then’ convolu-
tions will be found to accord with the extent of their in-
telligence ; animals may be divided into groups, in ac-
cordance with the form of their convolutions.

The first group includes animals taken from different
families, viz. the Cheiroptera or Bats (fig. 62), the Insecti-
vora (61), the Marsupiata (fig. 40), the Monotremata, and
especially the Rodentia (41, 47). They correspond, as re-
gards 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 ap-
proach. The animals which compose this group are from
the Rodentia, the Insectivora, and the Marsupiata. Besides
the fissura Sylvii, which is here more prominent than in the
first group, there are depressions upon the cerebral lobe
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

CONVOLUTIONS.

125

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. 04), exhibiting the external face of
the right hemisphere of the brain : s, marks a deep furrow,
passing obliquely upwards and backwards the fissura Sylvii.
There is a rounded body surrounding this fissure this is the
first convolution ; 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-orbital. lhe
sixth, and last (i), forms at the under part of the middle
lobe the hippocampal convolution. If we compare this brain
with that of the bear, we find that the fissura Sylvii 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 appeal’s

126

COMPARATIVE ANATOMY.

r*, Fig',65, rePresenting the uppct surface of

the biain of the fox, shows the completion of the fourth
convolution, of which fig. 64 shows the internal and pos-

Fis- terior part.

The third group
contains the fox,
wolf, &c. The con-
volutions of the
brain of the wolf are
the same in number
as those of the fox,
only there are more
numerous depres-
sions, and a very

nerve.'" Orb: ta? con volution . prolonged flllTOW

Postenor ditto. s s. Fissura SylviS. 1 2. Cerebellum. ' third ex-

ternal convolution, in the spot where in the fox there is
only a rudiment of a depression. Leuret states that he has
Fig.6s, compared the brains of

dogs of different species,
and he has always found
the same type, the same
convolutions, without
any difference but in the
number of the depres-
sions, and extent of the
..s undulations; this differ-
ence corresponds 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
(Leuret.) 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 wolfs, and the cats. In these latter (fig. 60) we

Upper surface of the brain of the fox
s s. Fissura Sylvii.

CONVOLUTIONS.

127

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, 1 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 com-
mon 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 remains 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.

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. VieAving 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 Y. The convolution in front of this fissure, which
forms the anterior point of the brain, is a portion of the in-
ternal convolution, which, commencing at the hippocampal
lobe, runs backwards, 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.

rJbe seventh group includes the two-toed sloth, the ai or

123

COMPARATIVE ANATOMY.

three-toed sloth, the African anteater, phascolomys or
wombat, and the hyrax or coney. In none of the animals

composing this group do we meet with a single transverse
i arrow.

The eighth group includes the pteropus, or fox-like bat
kangaroo, orycteropus.

Ninth group.— The brain of the genus Sheep, including
the Rummantia (figs. 49 and 50), which forms the ninth
gioup, have in reality only four convolutions; one internal,
one infra-orbital, two external, which have numerous divi-
sions, 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 resemble those of the foxes, cats, or bears; they
have more analogy to the convolutions in the human brain.
Viewed above, we observe the longitudinal foldings much
doubled up, so as to produce many transverse folds.

We cannot attempt to follow out all the minute varieties
in the convolutions of the tenth, eleventh, and twelfth groups
of M. Lcuret, which includes the pigs, the seals, and the
Cetacea, but proceed to the thirteenth group. With the ex-
ception of suborbital convolutions, the convolutions 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 soldering 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, cutting the lon-
gitudinal convolutions into two parts, and dividing them
into anterior and posterior convolutions. This division of
the longitudinal convolutions, this addition of new convolu-
tions, is found only in the elephant, the apes, and in man
(see figs. 6G and 67, and the descriptions).

Fourteenth group. — In the apes, and especially the mon-
kies, the convolutions 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 ex-
tent and degree of inclination of the fissura Sylvii, form a

CONVOLUTIONS.

129

brain as an embryonic perfectioning of the brain of man,
whilst the brain of the elephant, and especially that ol the
whale, considered in their different relations, descend to-
wards the form of the brain of other Mammalia.

Fig. G6.

Internal surface of the right hemisphere of the Indian elephant. (Leuret.) c c. Corpus
callosum, is i i. Internal convolution. This convolution, above and behind the corpus callosum,
sends a prolongation, +, which is united to the superior convolutions, s s s s. Leuret states
that he has never met with this disposition of the convolutions, except in man, the ape, and in
the elephant. This portion cuts the antero-posterior convolutions into two portions, of which
some are anterior and the others posterior m.p, m.p Third posterior convolution, iv.p, iv.p.
Fourth posterior convolution, iii.a. Third anterior convolution, iv. Fourth anterior convolu-
ti'-n. “ 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
convolutions of the brain of the Ruminants and Solipedes.” Reduced one half.

The ape has three anterior convolutions (i. a, ii. a, iii. a,
fig. OS), three posterior (i. r, n. p, hi. p, fig. 08), two supe-
rior (s s, s s,), one internal, and the supra-orbital convo-
lutions, also corresponding to those in man (figs. 73-4-5).
The orbital convolutions always exist ; they arc larger and

K

130

COMPARATIVE ANATOMY.

better divided than in the inferior animals, but they do not
show the same regularity as the others.

Fig. 67.

The cerebral surface of the right lobe of the brain of the Indian elephant. (Leuret.) ss. Fis-
sura Sylvii. i.a, ii a, hi. 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 convolutions, sss, intercept the continuity of
the anterior w'th the posterior convolutions, i.r, 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, ii. p, ii r. Second posterior convolution. m.p. Third posterior convolution,
o o. Supra-orbital convolution. Leuret states that lie has taken great pains to have the size of
the drawing accurate. The cut is reduced one-half.

“ The brain of the chimpanzee,” says Mr. Owen, “ in the
relative proportions of the different parts, and the disposi-
tion 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 compara-
tive 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 trape-
zoidum (see College preparation 133S), which, I observe,

CONVOLUTIONS.

131

exists in the brain of many of the apes, though I cannot
affirm that the chimpanzee is the only exception.

Fig. G8.

S R

Left side of the brain of the baboon {Singe Papio ). (Leuret.) s s. Fissure of Sylvius, running
obliquely from before, backwards, s r. Fissure of Rolando, sss, s' s' s'. The two superior
convolutions, i.a, ii.a, iii. a. First, second, and third anterior convolutions, arising all three
from the same superior convolution, i.r, ii.p iii.p. First, second, and third posterior convolu-
tions. The first, long, 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 con-
volutions. The second and third convolutions are carried 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 convolution. 2. Lateral lobe of the
cerebellum. 3. Third lobe of the cerebellum, or flocons.

“ The number, form, arrangement, and relations of the
cerebral convolutions,” says Leuret,* “ are not formed at
hazard : every family of animals has a brain formed in a de-
terminate manner, and 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 manifestations of intelligence
operate, to which is attributed the instincts and passions,
has not a fixed organization, and as invariable as that of
other parts. Each group of brains has a type which is

* Op. nit., p. 399.

132

COMPARATIVE ANATOMY.

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 the divisions are less, but still the forms are fixed
and very simple ; in the bears and martens there is a ten-
dency to another form, complete preservation of some con-
volutions, which 1 have called primitive, on account of their
simplicity, and disposition of some of the others to unite
and present undulations. In the next type, the funda-
mental separations are less numerous and of greater va-
riety 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 incom-
plete and rudimentary.”

“ 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 Aveazel, the
ferret, the roebuck, the peccary, each represent the first
step of a scale, at the summit of which is the dog, the lion,
the otter, the liyrax, and the boar. In its class the ele-
phant is at the summit ; but I knoAv of no animal which
can be placed at the opposite end. In its oavu class the
lemur is very Ioav, 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 intermediate degrees,”
modestly says Leurct, “ betAveen all these brains ? are there
any forms of brain different from those that I have de-
scribed? Observations more extended can alone resolve
these questions, which are of the deepest interest for anatomy
and psychology.”

Cerebral Vessels. — In the Mammalia, beloAv the human
subject, the brain is not supplied by the same set of blood-
vessels. In man, we find the tAAro internal carotid and two
vertebral arteries, distributing their branches almost entirely
to the brain ; but it is by no means invariably the case

CEREBRAL VESSELS.

13:3

throughout the class of mammals. A3 itliout pretending to
give a minute account ot 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 beautifid 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 per-
pendicidar to an horizontal course. In some of the lower
animals, — the cat, for instance, — the vertebral artery is
tiuned as in man. But, in addition to this arrangement
of these vessels, we meet with another of great physiolo-
gical interest, and evidently intended to serve the same pur-
pose. 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 viira-
bile, — and well has it been thus named. It was first dis-
covered and described by Galen. A trunk is formed by
the union of these vessels, which supplies the brain. We
shall have occasion to consider the formation of tliis 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 maintain-
ing 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 whose 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
* Cuvier, 7.090ns, Etl. 1830, T. vi.

J 34

COMPARATIVE ANATOMY.

in the Carnivora, Rodentia, Ruminantia, 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 rotundum and foramen orbitare superius,
the other through the foramen ovale. In the pig, the
largest of the two vessels passes through the foramen
lacermn basis cranii, and a smaller one through an anterior
portion of the same foramen. The carotid 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 re-
gard 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
ligatm’es on the internal carotids and the deductions from
them in relation to the physiology of the brain.

Professor Rapp, of Tubingen, f states, that “ the verte-
bral arteries do not reach the brain in all those animals
that possess a rete mirabile.” In Ruminants, the verte-
bral arteries usually enter the spinal canal, between 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

* Cuvier, Ed. 1839. Yol. vi. p. 118.
f Meckel’s Archives for 1827, p. 5.

CEREBRAL VESSELS.

135

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 blanch
of the external 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 ex-
plains why, in an animal in whom no blood is carried 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 anasto-
mosis between the rete mirabile, the condyloid artery, and
a vessel in which the anterior spinal artery terminates ;
the anastomosing branch passing through the jugular fora-
men 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 ot 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.

This rete mirabile has a different appearance in different
animals, so that when separated from the skull it cannot be
recognised 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 cha-
mois 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.
Wre have a good preparation of it, from this animal, in the
Museum of St. Thomas’s Hospital, made by Sir Astley
Cooper. In the foetus it is comparatively larger than in
the full-grown animal, corresponding with the size of the
brain.

13G

COMPARATIVE ANATOMY.

Piofessor Rapp found tlie vessels slightly atrophied in
cases of partial destruction of the brain by the coenurus
cerebialis, ihe 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
ciicle arises a vessel, which has erroneously been called

the basilary, but is really the anterior artery of the spinal
cord.

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. i>. Branches of the vertebral arteries passing
forwards under the dura mater to anastomose with the arteria condyloidea, forming thus a
plexus which is connected to the rete mirabile. e. Arteria condyloidea.

Rapp found this plexus in the stag, roe, the fallow-deer,
chamois, the goat, sheep, and calf, and oxen. He considers

CEREBRAL VESSELS.

137

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 certainly 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. Ac-
cording to Cams 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,
Aveazel, 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 mirabile 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 beautiful in the sheep, and smaller in the goat.
In the horse the carotids do not cuter through a carotid
canal, but through a foramen laccrum, 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 bend-
ings 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

138

COMPARATIVE ANATOMY.

connection with the mode in which this animal obtains its
toocl from the branches of trees, instead of stooping to crop
it from the ground, was considered an additional argument
m favour of Harwood’s opinion. Mr. Quekett, of the
College of Surgeons, has however succeeded in injecting
and clearly demonstrating its existence.

1

( 139 )

PART III.

PROTECTIVE APPARATUS OP THE HUMAN BRAIN.

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 lor 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 in-
stance, in many insects, in the lobster and crab tribes, &c.,
is formed by a simple hardening of the general covering or
internment of the body ; and the skeleton which is thus
formed is called a dermal or skill skeleton. I he incon-
venience 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 coverings, 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 condi-
tion, an easy prey to its enemies.

In the higher animals the skeleton is as much a part of
the living creature 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 com-
plicated, and performs, with its connecting ligaments and
attendant muscles, so many and such various offices, as pre-
hension, mastication, locomotion, &c., in the simple form
in which it first appears in the animal kingdom, is first a
t«ube of cartilage, or a jointed column enclosing the spinal
c*ord, without appendages or limbs for other functions.
This is called the vertebral column. Its presence in the

140

HUMAN BRAIN.

animal kingdom is so clear a mark of a comparatively
lngli development of the nervous system, that physiologists
as we have already seen, divide animals into two great
groups, the Invertebrata, or creatures without vertebras ;
and the Vertebrata, or animals possessing a vertebral
column. It would not be consistent with the plan of this
uoik to enter into a description ot 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 diffi-
cult 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. 4 he difference in the dimensions of
the two portions of this canal 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 ap-
pearance, 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 contains them, we shall find that the bones com-
posing the human skull are simply vertebrae 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.*

* This opinion, that the cranium is formed by a series of vertebra,
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
d’Etudes Mddicales, Paris, 1803, tome i. p. 16); and was afterwards
espoused by Kielmeyer (Ulrich, Annotationes qiiBedam de Sensu ac Signi-
ficatione Ossium Capitis, Berlin, 1816, p. 4), Dumeril (Magazine Encyclo-
pedique, tome iii. 1808), and Goethe (Zur Natunvissenschaft, Band i.
p. 250), and more or less fully illustrated by Oken (Ueber die Bedeu-
tung der Schiidelknocken, Jena, 1807; Isis, 1820, No. YI. p. 552), Spix
(Cepbalogenesis, Munich, 1815), I)e Blainville (Bulletin de la Soc. Philom.
1816, p. Ill, and 1817), Geolfroy St. Hilaire (Philosophie Anatomique,
Paris, 1818-22), Cams (Lehrbuch der Zootomie, Leipzig, 1818, p. 164),
Meckel (Beytrage zur Yergleichenden Anatomie, Band ii. Stuck ii.) Schultz
(De Primordiis Systematis Ossium, &c., Halle, 1818, p. 13,) Bojanus (Isis,

MEMBRANES, ETC.

141

The student, in considering the relation of this osseous
envelope to the brain, must bear in mind its vital proper-
ties— that the skvdl, which so beautifully protects this
delicate organ by its physical hardness, is modelled 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 illus-
trating 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 oppo-
nents of phrenology ridicule the idea of the soft brain pro-
ducing any impression on the hard skull.

As the following description of the anatomy of the cere-
bro-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, ex-
tending 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 poste-
rior 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 anteriorly, 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

1818, p. 301 ; 1819, p. 13(54), and Burdach (Vierter Bericht von der
Anatornischen Anstalt zu Koenigsberg, Leipzig, 1821). Arnold also
adopts this principle, but confines himself to the views given by Oken,
Cuvier, Cams, Spix, and Meckel, considering that the cranium con-
sists of three vertebra only ; not, therefore, agreeing with Geoffrey
St. Hilaire, vho believes that he can there demonstrate the parts of nine
vertebra.

142

HUMAN BRAIN.

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.

Ihe skull-cap being removed, a dense fibrous membrane
is peiceived 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 mater ,
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 founded
bodies, which certainly were undeserving of notice if they
had not received the grand title of glandules Pacchioni. \
These are scarcely observable in the young subject, and in
the old are most probably a morbid appearance. The dura
mater should next be cut through carefully all round with a

* Portal, iv. 2. The membranes of the brain, by the Greeks, were
railed meninges, the Greek word n^viyi 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., tonieiv.) acknowledges our ignorance of their
nature, but scarcely regards them as a morbid production : their seat is in
the subarachnoid cellular tissue.

Wengel, (De penitiori structura cerebri liominis et brutorum,) p. 17,
1812, says, after detailing the opinion of Malacarne in support of that of
Pacchionus, “ Eorum ortus absque dubio a morboso statu, inconstans
incertus, ex octate aliisque fortuito accidentibus circumstantiis 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 excitement 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.”

MEMBRANES, ETC.

143

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
cerebralis or investiem, in contradistinction to that portion
which lines the dura mater and is called the tunica arach-
noidea 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
Mill 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 inter-
nal periosteum of the bones of the skull. The separation
between these two portions is perfect 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 vascu-
larity of the external layer is very striking, as in certain
Cetacea — the Rorqual, for example — where there is a per-
fectly distinct vascular layer between the dura mater,
properly so called, and the Calvarium. This is not sur-
prising, when we consider the vast thickness of the bones
of the skull in these creatures.

* Portal, iv. 2. The arachnoid derives its name from its extreme
delicacy and its resemblance to a cobweb ; it was first described as a
special membrane in 1565, by the Dutch Society, among the members of
which was Swammerdam, the celebrated nnturalist.

144

human brain.

Processes of the dura mater. — The internal layer is in-
flected downwards between the two symmetrical halves of the
bram, forming what has been called, from its sickle-like ap-
pearance, the falx major of the dura mater (f m, figs. 70 and
71). 1 his stiucture may be said to commence 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 passage, 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 attached poste-
riorly 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 it.sell 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 hemispheres rest ; and by which the
cerebellum, which is situated beneath, is protected from the
superincumbent pressure of the brain (fig. 71): consequently,
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 analo-
gous 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 magnum.

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 dura mater over deep grooves in the bone,
and by the mechanism of the falciform processes and tento-

SINl'SES.

145

riuni 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 drawing shows almost all the various sinuses
of the brain, the falx major, and the tentorium of the dura mater. 1 . Su-
perior longitudinal sinus. 2. Inferior ditto. 3. Straight sinus. 4. La-
teral 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 com-
municates 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 ; be-
fore with the transverse sinuses on the basilary process of the occipital
bone ; posteriorly with the posterior occipital sinuses ; lastly, they termi-
nate 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. 11. Vena magua Galeni. 12. An-
terior longitudinal sinus of the vertebral canal. 13. Pterygoid venous
plexus, pm. Falx major, t. Tentorium.

L

140

HUMAN BRAIN.

The superior longitudinal (1, fig. 70), which is the largest,
commences 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, anil
the openings of the veins, which enter contrary to the course
of the blood within it, may be distinctly seen on the in-
terior. 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 con-
gestion of the brain. Running parallel with the supe-
rior longitudinal sinus, but along the inferior edge of the
falx, we find a much smaller sinus, called the inferior longi-
tudinal (2, fig. 70). This also terminates generally in the
left lateral sinus (4, fig. 7 0) ; 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 pressure 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 mastoidcum,
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 caver-
nous sinus ; this cavity is not, however, constructed solely
for the protection of the venous circulation. 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.

SINUSES.

147

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 superior petrosal sinus
(6, fig. 7 0) 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 ter-
minate at the point where the straight sinus and lateral
sinus become conjoined; the triangidar 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 pharyn-
geal 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 penetrates the skidl
at the foramen spinosum. of the sphenoid bone : this
winds through a deep groove in the sphenoid and parietal
bones up to the top ot 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, Wrisberg, and Lobstein, denied the existence of any
nerves to the dura mater, while Yieussens, Winslow, Lieu-
taud, Portal, Valsalva, and others, say that they observed
some, but without giving a very satisfactory description.

148

IIUMAX BRAIN.

Cruveilhier states lie recognised on each side of the me-
sial line two nervous filaments, extending from the fifth
pair up to the vicinity of the superior longitudinal sinus ;
a third nervous filament occupying the thickness of the
tentorium cercbelli, but whose origin could not be demon-
strated.

Arnold has also described and delineated, and Pappen-
hein (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 maxil-
lary division of the fifth, and the Vidian.

The arachnoid membrane lines the dura mater, and
covers the convoluted surface- of the brain without dipping
between the convolutions. It also covers the figurate
surface* at the point where these two portions are conti-
nuous, as at the foramen of Bichat, as it is called, after
the justly-celebrated man who first described it. The
situation of this opening is between the anterior and
superior portion of the cerebellum, and the under and
posterior part of the cerebrum, as will be better understood
when these parts have been described and the relations of
the arachnoid explained.

F. Arnold, in a paper translated by R. Knox, with
commentaries, loc. cit., after quoting various opinions on
this subject, says — “ 1 entirely assent to the accuracy of
Bichat’s description, and think that the arachnoid 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,

* The difference between the two surfaces of the brain will be
thoroughly explained hereafter.

MEMBRANES, ETC.

149

merely unites with the epithelium ut the ventiicles. llus
union of different mend) runes happens in woman, in lcspect.
to the peritoneum, and in birds and fishes. The nature
of the ventricular epithelium is ever opposed to that of
serous membranes, as being perforated by numerous blood-
vessels.” And Dr. Knox, eodem loco , says : — “ The con-
nection 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 convolutions. 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 a short canal, precisely in the
situation of, and around, the vena magna Galeni. IIow far
this canal penetrates it is somewhat difficult to determine ;
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, unquestionable 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 convolutions and anfractuosities. For
first, a portion of it passes directly across the fissure ;
secondly, a process is sent inwards, to form the choroid
plexuses and velum interposition ; and, thirdly, at the
edges of the fissure the pia mater, besides adhering very
closely at the edge, transmits a perfectly transparent and
extremely delicate layer, filamentous and cellular, but

150

human brain.

not vascular, which, investing the opposing surfaces of the
ventricular walls, constitutes the proper ventricular mem-
brane ; in short, the processes of the pia mater, which dip
in between the convolutions, might almost be considered as
analogous to the choroid plexuses, so similar are they in
their arrangement, and perhaps, also, in their functions.
A similar analogy subsists between the ventricular lining
membrane 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 exist-
ence 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 ap-
pears to be so, is rather to be considered as a sheath
(Gefasscheide) derived from it. \

The reflected or parietal portion of the arachnoid is
closely attached to the dura mater, but the tissue cellulo-
vasculaire or sub-arachnoid is interposed 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-arachnoidcal cavity, for this
contains the important cerebro-spinal fluid. The cerebral
portion of the arachnoid adheres very intimately to the pia
mater at certain points, leaving in the intervals a consider-
able 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. lu the same way, at the
base of the brain, it passes over the fissura Sylvii, and
diamond-shaped space.

* Op. cit. t. iv. p. 700.

f Page 24, vol. ii. op. cit.

t 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.

MEMBRANES, ETC.

151

Beneath the arachnoid is situated the pia mater, a mem-
brane which is constructed solely lor the puipose of sup-
porting the vessels distributed to the superficies of the cen-
tral 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 ol
slicing the brain from above downwards, appear as if they
formed the walls of cavities in the interior, and in some ot
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 anastomoses 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 veiy distinct when acted upon by acetic
acid. As its particles 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 spini-
form formations to which he alludes, which look like the
remains of former vibratile cilia.”

Otto, in his Compendium of Pathological Anatomy, f states

* Jj)C. cil.

f Translated by M. I. F. South, p. 373, note i.

15.2

HUMAN 13 RAIN.

m general, that these two membranes, the arachnoid and
pia mater, are inseparably 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
fibro-mucous tissue of various length.

It will be instructive to dwell for a few moments upon
t ie admix able adaptation of these three cerebral membranes
to the ends of their formation. The dura mater forms a
support which is sufficiently firm and unyielding to retain
the brain accurately in its normal position, while its pro-
cesses are still capable of yielding to a certain extent, like
the strong springs of a carriage, under any violent’ con-
cussion.

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 membranes with their lubri-
cating secretion in the various joints of the body, for the
brain is never in a quiescent state, but is constantly rising
and hilling with a slight pulsating motion.

The immediate agents in the production of these move-
ments appear to be the circulating and respiratory systems,
and the motions are 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. tom. i. p. 113; Lorry, Sur les Mouve-
rnents du Cerveau et de la Dure-mbre, same collection,
tom. iii., Mem. i. p. 277, Mem. ii. p. 344; Haller, Ex-
perim. ad Motum Cerebri a Reflu xu Sanguinis natum, in
his Opusc. Phys. tom. i. p. 231 ; Lamure, Sur la Cause
des Mouvements du Cerveau, in the Mein, de Paris, 1753 ;
Richard, in the Jour, de Med. tom. xxix., 17G8, Aout,

CEREBROSPINAL FLUID.

153

p 140 ; Raviua, De Motu Cerebri, in the M6m. de Turin,
1811; Portal, Mem. sur un Mouvement qu’on pent ob-
server dans la Moelle epini&re, in his Mem. sur plus.
Maladies, tom. ii. p. 81 ; Magendie, Sur un Mouvement
de la Moelle epiniere isochrone h la Respiration, in his Jour,
de Phys. Exper. tom. 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 neurilema, or investing membrane
of the nerves, does to these organs in their extended course
through all parts of the body.

The cerebrospinal fluid next deserves our attention.
The existence and situation of the fluid was first discovered
by Haller ;* it was more clearly described by Cotunnius,
in a memoir entitled, “ De Ischiade Nervosa Commenta-
rium,” and published subsequently by Sandifort, among
other theses. This anatomist was struck with the dispro-
portion of the spinal canal and its contents, and revolved
in his own mind how the space was occupied. These
statements must have been almost forgotten. Magendie
has, however, entered more minutely into the whole phy-
siology of the matter. Pie first published his discoveries
in 1827, in his Journal de Physiologie, and more fully
subsequently in 1842, as a separate quarto treatise, with
plates. He has shown that if during life the arches of the
vertebrae 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 after death the same may be observed, but in
a few hours the greater part of the fluid is imbibed by the
surrounding tissues.

The student must have already seen that the brain does
not completely 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 con-
volutions are narrow, and shrunk. The digital fossae are
* Element Fhysiolog. vol. iv. p. 87.

154

HUMAN BHAIN.

large, and contain fluid. The seat of this fluid is not in the
cavity of the arachnoid ; there are two distinct localities •
hirst m the interspace between the arachnoid and pia
matei. Second in the cavities of the cerebrum and cere-
bellum in the human subject; and likewise in those of
the olfactory nerves, optic lobes, and spinal cord, of some
annuals.

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 pericardium does to
the heart, it is separated from the brain by a tolerably
wide interspace, in Avhich 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 different 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 separate 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 quantities that they may be called confluences.

1st. The largest and most posterior, situated below and
behind the cerebellum.

2nd. The inferior — Between the crura cerebri.

3rd. 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 paff.

It is still a question whether there is any communication
between the fluid of the ventricles and the sub-araclmoid.
Magendie states “ that there is an opening of communica-
tion at the calamus scriptorius.” Dr. Todd does not
believe in the existence of this opening : he says, “ It is not
* British and Foreign Medical Quarterly Review, October, 1842.

CEUEBRO-SPIN AL FLUID.

155

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 Dis-
orders of the Cerebral Circulation, &c., 1846,) “ Patholo-
gical states of the spinal column in children, and experiments
upon animals, afford opportunities for observing the changes
in the site of the cerebro-spinal fluid under various modifi-
cations of pressure. In spina bifida it may be remarked
that the spinal tumour swells and becomes tense during
prolonged expiration, as also during fits of coughing and
crying. If a graduated pressure be made upon the tumour
with one hand, and the fontanelles of the child be examined
with the other, in proportion as the spinal swelling de-
creases, 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 encephalon ; seldom less
than two ounces, and often amounting to five. In old age,
with atrophy 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 humours of the eye, being completely
secreted again in twenty-four horns .

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. I low different would be the condition
of the brain without this soft cushion, or the cord if it
hung within the spinal canal, without such a yielding and
protecting wall. The poor invalid, whose bones from
emaciation are nearly through his skiu, will bear his testi-
mony to the value of a fluid couch, if he has had the ad-

HUMAN BRAIN.

1 5G

vantage 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 Cerebrospinal Fluid ,

by Zassaiyne.

Water 98-564

Albumen 0'088

Osmazome . 0474

Hydrochlorate of soda and potass . . 0 801

Animal matter and phosphate of soda . 0 036

Carbonate of soda and phosphate of lime 0 01 7

99-980

Bern oval 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 mill a very
sharp knife or pail* 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
under the anterior clinoid processes, and cjuitting the skull
at the optic foramina, where they may be divided, as well
as the internal carotid arteries, which are situated imme-
diately on their outer side. The next are the third or
common oculo-muscidar 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.

157

REMOVAL 01'' THE BRAIN ANI) SPINAL CORD.

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
thev are divided. The tentorium itself must next be cut
through ; and the nerves situated in the fossae of the 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, penetrating 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-pliaryngeal, and parvagum,
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 conveniently
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 vertebrae
ori 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

* These last directions only apply in those cases where the pupil is
unavoidably prevented removing the spinal cord in connection with the
brain.

158

HUMAN BRAIN.

wiU observe the dura mater completely investing the cord
'™t .“ contact with the arches of the vertebra fom

which it is separated by a layer of soft reddish fat, which is
most abundant m the sacral region. The spinal plexus of
veins is lodged m tins soft bed. 1 1

The dura mater forms a complete canal for the medulla
spinahs and also branches off with each of the spinal nerves
winch it accompanies as far as the vertebral foramina, to
the edges of which it is attached, each attachment perform-
ing to the whole the office of ligaments, which retain the
coid accurately m its normal situation. At the lower ex-
tremity of the vertebral canal in the sacrum, it ends in a
bluntish point by fibrous processes 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.

Ihe Arteries , which are very numerous, are derived
rom the vertebral 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 Breschct ; anteriorly they form on
the bodies of the vertebrae large sinuses, long known as the
longitudinal spinal sinuses. The cross 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 m two layers of the dura mater.

Ihe cord may next be removed in connection with the
biain by cutting 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

MEMBRANES OE TI1E CORD.

159

nerves, called, from its appearance, the ligamentum denti-
culatum. This structure is considered by R 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 con-
sidered as analogous to certain tendinous shining cords
connecting the cerebral arachnoid to the pia mater, lo 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 in-
vesting the cortical structure of the brain, that some anato-
mists have considered it as a distinct membrane. When,
however, we consider that the exterior of the cord is formed
of medullary, 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 neurilema 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. “ 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
elasticity ; 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 pro-

* Lon. fit.

160

HUMAN BllAIX.

duced are very well calculated to deceive, and Dr. Macartney
must have founded his opinion upon that experiment alone,
omitting to tiy the effect of stretching a detached portion
of the process. The fact is, that when the cord is sus-
pended 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
pievious state until it again stretches the pia mater and
becomes once more flattened, producing a degree of reaction
which favours its elevation, but which alone would be in-
sufficient for that purpose.”

Thus, it appeared that the elastic reaction which Dr.
Macartney attributed 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.

»

( 101 )

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 lbs. ; and, accord-
ing to Rudolphi, that of a whale, 75 feet long, ( B alarm
mysticetus,) weighed 5 lbs. 10J oz., but that of a narwhal,
17 to 18 feet long, {Monodon monocero-s,) only 2 lbs. 3 oz.

It is to be remembered that these observations apply to
the encephalon, the whole brain, and not to the hemisphe-
rical ganglia, which we believe to be the portion imme-
diately connected with the intellectual powers.

Agreeing with Professor Muller, that all the primitive
fibres of the nerves of volition and of sensation are ac-
tually 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 mem-
branous envelopes to each fibre, and not solely of neurine.
lhe increase of size which is thus given to a nerve is well
seen m the portio dura or lacial 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-mas-
toid foramen. J

Many observations have been made on the weight of the

M

162

HUMAN BRAIN.

human brain from the time of Haller to the present period ;
the latest and most extensive are by that indefatigable and
excellent physiologist, Dr. John Reid, published in the
London and Edinburgh Monthly Journal of Medical Science
for April 1843. Dr. Sims, who has an excellent paper on
Atrophy and Hypertrophy of the Brain, in Yol. xix. of the
Medico-Chirurgical Transactions, after giving the conclusions
of Haller, Soemmerring, and Sir Wm. Hamilton, gives tables
of his own. Erom these sources we learn that the average
weight of the adult human male brain is about 3 lbs.
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 ;
after 50 to old age the brain gradually decreases in weight.
Tiedemann, in his paper on the brain of the negro,* states
that the brain of the adult male varies between 3 lbs. 2 oz.
and 4 lbs. 6 oz. The brain of men who have distinguished
themselves by their talents is often large ; the brain of
Cuvier weighed 4 lbs. 11 oz. 4 dr. 30 gr. troy weight;
that of Dupuytren 4 lbs. 10 oz. troy weight. The brain of
an idiot, 50 years of age, weighed only 1 lb. 6 oz. 4 dr.; and
another, 40 years of age, weighed but 1 lb. 11 oz. 4 dr.
The female brain usually is lighter than the male. It varies
between 2 lbs. 6 oz. and 3 lbs. 11 oz. Tiedemann never met
with a female brain that weighed 4 lbs. The female brain
weighs on an average from 4 to 6 ounces less than that of
the male ; and this difference 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 fol-
lowing 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
development in point both of form and weight, and its
several parts now represent the relations which they pre-
serve through the whole of after-life.” Dr. AY lllis has the
following excellent observations on this passage : — “ This is
surely a physiological error ; on taking measurements of
the heads of fifteen children, between 7 and 8 years of age,
* Phil. Trans. 1836. f Op. cii., p. 616.

WEIGHT OF THE BRAIN.

103

I find the mean circumference to be 204 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 214 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 difference 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 consi-
derable difference, that the sizes of youths of 7, 8, and 9,
were what are designated the 64, 6f, and 6§ sizes, whilst
for grown men the mean average size is about 7, or from
that to 7-g-. 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
frill dimensions in accordance with the bodily frame. I fix
the utmost limit my experience 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.

164

HUMAN BRAIN.

TABLE I.

Weight used Avoirdupois.

Exhibiting the Heaviest, Lightest, and the Average Weight of Encephalon, Cere-
bellum, 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 individual male brains, yet as the average male brain
is several ounces heavier than the average female brain, it is necessary that these
he ranged in separate tables ; — the more especially when the number of brains
at different ages, weighed in the two cases, do not correspond.

a>

.C

to

Heaviest.

Lightest,

Average.

Age.

<V

*

l-l

a>

.c

B

O

73

.S

a

V

i

3

©

JS

©

3

33 O ~L

?5 E

B

O

3

•C

P<

©

1

"S

ebellum
h pons
medulla.

B

o

rt

M

O,

a

3

a

0)

«Q

s ®
3 i.|

£■5 E

a

W

0)

U

©

U

*1

cfl

a

W

HI

o

0)

O

* c
ea

u

B

M

u

3

O

5 ’> a

Years.

OZ.

dr.

07.

dr.

oz.

dr.

oz.

dr.

OZ

dr.

OZ.

dr.

oz

dr.

oz.

dr.

1—4

5

45

4

4

10

5

6

27

8

2

8

3

0

39

4*

3

13*

4

6*

5—7

3

47

101

5

l

6

0

40

12

4

0

4

9

43

10

4

7

5

6

7—10

6

52

14

5

0

5

11

40

12

4

0

4

10

46

2*

4

10*

5

10*

12'

10—13

3

51

2

5

2

6

2

43

8

4

9

5

6

18

7*

4

14

5

13—16

5

50

2

5

8

6

8

43

10

0

0

5

10

47

8*

6

1*

16—20

6

56

0

6

1

7

2

48

0

4

8

5

8

52

10*

5

4*

6

6 A

20—30

25

58

0

6

0

7

0

45

8

4

12

5

4

50

9^

5

3*

6

2

30—40

23

62

8

5

14

8

8

40

10

4

6

5

1

51

15*

5

3*

6

4-V

40—50

34

53

8

6

4

7

10

34

0

4

8

5

6

48

13*

5

3*

6

4A

50—60

29

59

0

7

0

8

4

39

0

4

8

5

4

50

2

5

5*

6

2*’q

60—70

8

60

4

6

3

7

4

40

0

4

2

5

2

50

6*

5

0

6

2

70 and

1 „

10

upwards

/7

54

5

8

6

8

43

8

4

8

5

4

48

4f

4

14

5

14*

Total male ^

brains \
weighed J

154

2—4

6

42

0

4

0

4

10

32

0

3

5

3

15

37

9

3

4

5

5—7

3

41

8

4

0

4

8

36

0

3

5

4

0

39

3

11

4

8*

7—8

3

43

14

4

10

5

9

10

8

4

4

5

0

42

74

4

7*

5

5

10—13

1

43

8

5

2

6

2

—

13—16

1

41

0

4

8

5

8

—

16—20

8

49

12

5

8

6

4

41

8

4

12

5

6

44

11*

4

14*

5

11*4

20—30

18

50

0

5

2

6

2

39

2

4

0

4

12

45

2*

1*

4

11*

5

9*

30—40

23

51

0

5

8

6

8

39

14

4

2

5

0

44

4

13*

5

11

40—50

18

50

6

6

0

7

0

36

12

3

12

4

4

44

10*

4

14

5

144-

50—60

5

48

6

4

12

5

15

43

4

4

4

5

2

45

4*

4

7*

5

84

60—70

11

16

10

5

2

6

0

36

2

4

2

5

0

42

14414

ioa

5

9

70 and
upwards

\ 2
)

16

0

5

1

6

0

31

1

3

10

4

5

38

84

4

5*

5

2*

Total

female 1
brains j
weighed J

99

3

< \

WEIGHT OF THE BRAIN.

105

TABLE II.

Relative Weight of Encephalon to Cerebellum, and to Cerebellum with Pons
Varolii and Medulla Oblongata, at. different ages, in 172 bodies.*

MALES.

FEMALES,

Cerebel-

Cerebel-

Number

lum

with

Number

Cerebel-

Number

lum with

Number

Ages.

Cerebellum.

weighed.

pons Varo-

weighed

lum.

weighed

pons and

weighed.

Hi and

medulla

medulla.

oblongata.

1 to 5 years

1 to 104

5

1 toS-f-ji-

5

1 to9yy

4

1 toSff

5

5

7 „

1

Q 9

3

l

H

3

1

10-^

2

l

84

3

/

10 „

1

Q 5

5

l

8tV

5

1

9-j

3

1

8

3

10

13 „

1

9? 0

3

l

8-f\

3

—

—

—

—

13

15 ,,

1

9-rr

1

l

7-44

4

.

.

—

16

20 „

1

Olf

4

l

4

1

9-rV

5

1

* T

5

20

SO „

1

Q l i

13

l

&G-

13

1

9*

12

1

8

12

30

40 „

1

q i 5

11

l

s,v

11

1

q o

JTT

15

1

8Ty

15

•10

50 „

1

q 8

‘'T'ff

23

l

8

23

1

0 ir

9

1

7f?

9

50

60 „

1

17

i

Si

17

1

10

4

1

8f

4

60

70 „

1

J0A

5

l

84

8

1

q 8

11

1

7 sir

11

70 & upwards

1

5

l

84

7

1

8ff

2

1

00

2

9 i

years

—

1

l°,v

4

1

-h

00

4f

4 months

1

ii

1

l

0 1
Jir

1

—

—

—

—

1

year

1

q i 5

1

l

8 1 5
°T 8

1

—

—

—

—

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 doubt,
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 mea-
surements we have made of the length of the corpus callosum, the depth of the grey matter,
the length, breadth, and depth of the corpus striatum and thalamus, we would be 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 befwre 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 cannot fail to experience some surprise at the difference between the average weight of
that organ in the male, between 16 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 inci-
dent to insufficient data. In the group between 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 cir-
cumstance 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 sat:s-
fied, 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,
however, 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.

* 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 as-
certaining the relative weight of the cerebellum with pons and medulla oblongata to the ence-
phalon.

t Three of the youngest cases included in the above Table given separately.

TABLE III.

Relative Weight of entire Body to Encephalon, Cerebrum, Cerebellum, Cerebellum with Pons Varolii and Medulla Oblongata, Heart, and
Liver, in 92 Bodies. In this and in all other similar Tables, I have selected those cases only in which all the organs whose relative
weight is given were weighed in the same individual.

166

HUMAN BRAIN

One of these was above 70 years of age.

WEIGHT OF THE BRAIN.

167

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.

Male.

( 50

3j, or 1 44

•}

Female,
dr.

81, or

Difference In favour
of the Mole,
oz. dr-

5 11

Cerebrum,

43

15J

3S

12

5

n

Cerebellum,

5

4

4

12*

0

7$

Cerebellum with pons }
and medulla oblongata, S

6

n

5

124

0

74 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.

Relative weight of Encephalon to cerebellum, - - as 1 to 9} as 1 to 9|

Encephalon to cerebellum with pons and medulla 1 S>t3 1 'in
From this Table it would appear that, in the female, the average cerebellum is
relative to the encephalon, a little heavier 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.

Male,

F emale,

Encephalon.

as 1 to 374
1 35

Number

weighed.

33

15

Heart.

as 1 to 1694
1 176

Number

weighed.

37

12

Liver.

as 1 to 351
1 39

Number

weighed.

31

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 somewhat 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, and who
had been previously in good health, the following results were obtained :

Average weight of
body (9 weighed).

9st81bs, 3£oz.,or
134 lbs. 34 oz.

Average of encepha-

Average of cerebel-

Average of cerebellum with

lon (6 weighed).

lum (4 weighed).

pons and medulla (5 weighed).

oz. dr.

oz. dr.

oz. dr.

52 4|, or

5 74

6 6

31bs. 4oz. 4jdr.

or taking the average of the
four cases only in which the

cerebellum was taken.

6oz. 7§dr.

Average of heart
(9 weighed),
oz. dr.

12 6

Relative weight of body to encephalon (6 weighed) - - - as 1 to

. . . . to heart (9 weighed) 1

. . encephalon to cerebellum (4 weighed) 1

to cerebellum with pons and medulla (5 weighed) 1

401

173J

91

8f;j

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 body, in those emaciated by disease than in those cut off while in possession of
health and muscular vigour, 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.

1G8

HUMAN BRAIN.

My friend and colleague, Ur. T. B. Peacock, has also
pub hshed some admirable tables in the Monthly Journal of
Medical Science tor 1846, from which he draws the follow-
ing conclusions : —

1st, Ihe encephalon in the adult male weighs, on an
average, 50 oz. 3*25 dr., or 3 lb. 2 oz. and 3#- drachms
avoirdupois and exceeds in weight that of the female by
o oz 4- Jo dr., the latter weighing on an average 44 oz.
and 14 3 dr., or 2 lb. 12 oz. 14ff dr.

131 male brains weighed, the heaviest was 62 oz.

~ cr-» or 12 oz. 8*75 dr. above the mean; the lightest
was 34 oz., or 16 oz. 3*25 dr. below it.

“ 0f 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.

“ °f tIle male encephala, 8 3 per cent, were under 45 oz.
m weight, 74 04 per cent, weighed between 45 and 55 oz.,
and 17*5 per cent, exceeded 55 oz. in weight.

01 the female encephala, 54 per cent, weighed under
45 oz., 45*9 per cent, were between 45 and 55 oz. in
weight, and none exceeded 55 oz.

“ Note. — A comparison of these averages with those
deduced by l)r. 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 esti-
mated the weight of the adult male encephalon at 3 lb.

8 oz. troy, and the female at 3 lb. 4 oz., which are nearly
48 oz. 5 dr., and 43 oz. 15 dr. avoirdupois. On calcu-
lating the weights ot the brain in the two sexes separately,
from the observations published by Dr. Sims, 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 per-
sons, 44 oz. and 10 dr. Dr. Clendenning 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 between 45f oz. and 50^ oz. for the male, and 41|-
oz. and nearly 45 oz. for the female.

WEIGHT OF THE BRAIN.

109

“ 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 lb. 2 oz. and 4 lb. 0 oz. troy, or 41 oz. 12 dr. and 59 oz.
5 dr. avoirdupois, and in the female, between 2 lb. 8 oz.
and 3 lb. 11 oz. troy, or 35 oz. 2 clr. and 51 oz. 11 dr.
avoirdupois.

“ 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, —
‘ Cerebrum et cerebellum, resecta medulla spinali statim
pone nervum lingualem medium pondo sunt librarum
duarum ad tres libras ; sunt enim alia cerebra pondere
librarum duarum et unciarum quinque cum dimidia, alia
librarum trium et unciarum trium cum tribus quartis.
Aliis (referring to the weights of brain assigned by Haller,
Elementa Physiologiae, t. 4, p. 10) observata sunt cerebra
libras unius cum dimidia, aliis pondus librarum quinque
superantia, quod posterius vero hand verisimile videtur,
nisi forte diverso hexagio res rite interpretari possit.’ (De
corporis humani fabrica, t. 4, f. 38.) He adds, in a note,
‘ In universum quidem Hallerus cerebrum pondere esse
librarum quinque autmnat, rectius certe quatnor, si de
pondere pharmaceutico Germanico sermo est. Certe enim
inter plura quam ducenta cerebra a me disquisita nullum
inveni quod quatuor sit librarum.’ Erom this it appears
that Soemmerring employed the German or Nuremberg
pound of 5524*8 grains, and the weights which he gives
consequently vary between 31 oz. and 41 oz. 14 dr. avoir-
dupois, 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 j — ‘ Pondus encephali humani, quale id de quinto
vitae anno ad suminam usque hominis senectutem plcrum-
“ * Phil. Trans, vol. 127, p. 4fJ7.

170

HUMAN BRAIN.

que invenitur, pondus viginti quatuor millium granorum
non superat. * * * Totius cerebri pondus inter

viginti et viginti duo millia ; cerebri strictius dicti inter
octodecem et viginti millia granorum plerumque variat.’

(Do penitiori structura Cerebri Hominis et Hrutorum,
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 ol the encephalon is esti-
mated by Portal at 48 oz. 3^ 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.

“ 2nd, 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 decrease 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 7 th year.
Though it may occasionally happen that the brain of a
person in early life shall be found as heavy as are ordina-
rily 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 age.J

“ Note. — The gradual increase in the weight of the ence-
phalon up to adult age, accords with the conclusions of Dr.
Sims, and with the views of Gall and Spurzheim. Soem-

“ * Gazette Medicale de Paris, 2me serie, t. v., 1837, p. 146.

“f Ibid. See also M. Parchappe’s Memoir, t. x., 1842,2). 650, where
he gives the weight of the encephalon in males, 1352 grammes; and in
females, 1229.

“ % 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 .

171

raerring, however, from one observation, inferred that the
brain attained its full weight at 3 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 ot the
brain. The present observations further confirm the in-
ference, that contrary to the supposition of the Wenzels
and Sir W. Hamilton, the encephalon decreases in weight
in advanced life. In reference to Sir W. Hamilton’s
observations, 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.

“ 3rd, 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 conclu-
sions 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 cere-
brum of the male therefore exceeds in weight that of the
female by 5 oz. OT dr.

“ 5th, The cerebellum, with the pons Varolii, and medulla
oblongata, averages in adult males, 6 oz. 40’ 5 dr. ; in
females, 5 oz. Iff 5 dr. — the excess in the male being
9 55 dr.

“ fith, The cerebellum alone, calculated from Professor
Reid’s observations, averages in the adult male 5 oz. 2'G dr.,
and in the female 4 oz. 12 ’4 dr. — the difference being
6 2 dr.

“ * 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' a Anatomy of the Brain, 1831.

172

HUMAN BRAIN.

/tli, It has been seen that the encephalon may be
regarded as attaining its maximum of development at from
the 20th to the 2oth year, and declines in weight in ad-
vanced life. 1 he same law obtains in reference to the
development and decline of its several portions. It would,
however, appear probable that the cerebellum, with the
pons A arolii and medulla oblongata, arrive at their full
giowth 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, however, unfavourable
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 Professor 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 portions of the brain, — the cerebrum,
the cerebellum, with the pons Varolii and medulla oblon-
gata, and the cerebellum alone, being uniformly heavier 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 favour 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, 1 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 T. It will be
seen that, as before remarked by the Wenzels and Tiede-
mann, the female brain, though absolutely lighter than that

WEIGHT OE THE BRAIN.

173

of the male, maintains a higher proportion relatively to the
weight of the body.

“10th, The proportions, relatively to the whole body, of
the cerebellum with the pons Varolii and medulla oblongata,
and of the cerebellum alone (as shown by Dr. Reid’s obser-
vations), also gradually decrease from infancy, and at adult
age the former averaged in males 1 to 277 T, 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 2 13 3.

“ Tiedemaun found the relative proportion of the ence-
phalon 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.

“11th, The proportion which, in the adult, the cere-
bellum 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
86 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, rela-

174

HUMAN BRAIN.

lively to that of the whole encephalon, somewhat higher in
females than in males. This inference is not, however,
confirmed by the observations of M. Parchappe ; and the
difference 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 persons, they render it most probable
that the ratio of the cerebellum alone, or with the pons
Varolii and medulla oblongata, to the cerebrum and ence-
phalon, 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 pre-
sent recorded are, however, opposed to the surmise, that
the cerebellum attains its complete state of development at
a peiiod much anterior to that of the rest of the brain.”

( 175 )

PART V.

CONFIGURATION OF THE ENCEPHALON.

Before the student begins to trace the medullary fibres of
the cerebro-spinal axis, in order to ascertain the connections
and relations of one part with another, as well as those of
the cineritious with the medullary neurine, it will be de-
sirable 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 depres-
sions observable on its surface. Our predecessors, till lately,
confined their attention almost entirely to external appear-
ances, 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 un-
philosophical. We must only be on our guard at the same
time not to confound the study of mere outward configura-
tion 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 por-
tions, the one external and convoluted , the other internal,
which presents appearances of so precise a form that it may
be called th zfigurate ; the convoluted, as will be explained
afterwards, forming a sort of envelope or wrapper to the
figurate.

The relative position 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

176

IIDMAN BRAIN.

through their appropriate foramina, 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
eoul we mean all that portion of the cerebro-spmal axis
which is contained within the vertebral canal, and which it
will be seen occupies the whole of the cervical and dorsal
i egions ; but in the sacral and the lower portion of the

Fig. 71.

Side view of a mesial section of the human skull, nasal, oral, and laryn-
geal cavities, the vertebral canal and brain, b. Hemispherical ganglion,
or convoluted surface of the brain, e. Cerebellum, showing the arbor
vitae, 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 raammillare!
H. Spinal cord. k. Thalamus nervi optici; above the letter is the com-
missura mollis, n. Septum lucidum, winch conceals the corpus striatum ;
the white line behind the letter is the anterior pillar of fornix, p. Corpus
callosum, x. Pons Varolii.

SPINAL CORl).

177

lumbar, its place in the canal is occupied by the nerves sup-
plying the lower part of the trunk and the inferior extremi-
ties. ^ The appearance produced by the collection of the
large nerves in the interior of the canal, from its resem-
blance to a horse’s tail, is called the cauda equina (see fig.
81). The size of the cord varies : in the cervical region it is
widest, and in the middle of the dorsal narrowest, widen-
ing again at the lower part of the dorsal, and then gradu-
ally tapering off to a point opposite the second lumbar
vertebra, where it appears to terminate in a single nerve,
the ligamentum filaforme, just described. Anatomists have
rather differed in opinion as to the exact limits of the cord
superiorly : physiologically speaking, it extends to the he-
mispheres ; but guided by its external configuration we
may describe its superior boundary as formed by the cor-
pus olivare, with which the medulla oblongata commences.
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 medulla 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 structure is attached laterally,
and which lies beneath the tentorium when in its normal
situation in the skull (see fig. 71).

At the upper edge of the commissiue of the cerebellum
we observe two rounded bands, about half an inch in
thickness, emerging from behind 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 them-
selves go by the name of the tractus optici. The line from
e crosses this band on the left side. A space is thus left

N

178

HUMAN BRAIN.

between the divergence of the crura cerebri and the con-
vergence of the tractus optici, of a diamond shape, within
which we observe two white rounded bodies, called, from
leu appearance, the corpora mammillaria seu albicantia
(c), anterior to which bodies, and partly surrounding them
we observe a layer of cineritious neurine, the tuber cinereum
or pons Tarim (a), m the centre of which is a funnel-shaped
bod> the infundibulum , or pituitary process, by which it is
attached to the pituitary gland (see fig. 71, j).

Behind the corpora mammillaria is a layer of medullary

Fig. 72.

Base of tlie human brain. A portion of the middle lobe on the left side
has been removed to show the tractus opticus and crus cerebri, ar. Three
roots of olfactory nerve. 1. Optic nerve. I q. Locus quadratus. c. Cor-
pora albicantia ; the white, funnel-like body in front of these is the infundi-
bulum. 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. Orbital- convolution, e. Cerebel-
lum. a. Spinal cord. s. Olivary body. T. Pyramidal ditto, u. Crus
cerebri, x. Pons Yarolii. a l. Anterior lobe, in l. Middle lobe, p l. Pos-
terior lobe. F s. Fissura Sylvii.

BASE OF T11E BRAIN.

179

neurine, called the substantia perforata posterior, from its
being perforated for the passage of vessels, and posterior to
another similar spot ; it cannot be seen in this figure. On
either side of the diamond-shaped space described, we ob-
serve 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 l ) and the middle lobe {m l ) is well
marked by a fissure, called the fissura Sylvii (f s), which cor-
responds to the lesser wings of the sphenoid bone. This
fissure may be traced to the outer surface of the hemi-
spheres, 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 p erj 'or at us ante-
rior, or locus quadrilateral is (/ q). The division between
the middle and posterior lobe (p l) 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 unneces-
sary to dwell upon them now.

The dissector may now reverse the position of the brain by
placing it upon the base ; he will then observe the upper sur-
face 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 1 shall follow Leuret
and Foville ; though I cannot attempt the minuteness of
this latter author, who devotes forty pages to his description.

N 2

180

HUMAN BRAIN.

All the convolutions may be said to spring from that, spot
at the base of the brain which, situated in the fissura Sylvii
18 calledthe quadrilateral spot, or substantia perforata ante-
rior. 11ns fact is interesting when we revert to the deve-
lopment of the hemispherical ganglion ; whether we trace the
permanent forms it assumes in the various genera of animals,
01 in its transient forms during the evolution of the human
embryo. At th is 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 lateral 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 m the longitudinal foldings, which in the human
biain assume a crescentic figure, but in the transverse or
anastomosing foldings.

Ihe convolutions are not even exactly alike on both sides
of the brain. Curiously enough, we find them almost in
exact correspondence in the 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 described as commencing anteriorly from the
substantia perforata anterior, or the quadrilateral perforated
spot — locus perforatus quadr ilater alls ; a b the commence-
ment of this convolution, and i/ 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, terminating close to where
it began, namely, at the opposite border of the fissura Sylvii,
and therefore without crossing it.

CONVOLUTIONS.

181

Fig. 73.

Internal surface of the left hemisphere of the brain. The great trans-
verse commissure divided in the mesial line. (Foville.) crfT. Corpus
callosum, e. Septum lucidum. v. Anterior pillar of the fornix, z. An-
terior commissure divided, t. Convex surface of the optic thalamus,
w. Aquaeductus Sylvii. s. Pineal gland, x. Peduncle of pineal gland.
N. Section of crus cerebri. M. Corpus mammillare. K K Tuber cinereum.
k. Section of the chiasma of the optic nerves. L. Optic nerve, i. Ol-
factory nerve, a. Quadrilateral perforated space, a. Internal part of
the quadrilateral space, where the septum lucidum is united to it.
B, bbb', is', o'. Vertical section of the convolution de Pom-let (superior
longitudinal commissure), b. Beginning of this convolution. T>f. Its
termination, named the temporal tuberosity, is K Crotchet of this tubero-
sity. D", ddbdb, d d, d, i) ' ' '. First convolution of the second order,
forming the eccentrie circumference of the internal surface of the hemi-
sphere, of which the convolution de l’ourlet forms the concentric circum-
ference. irf'. The origin of the great convolution of the second order.
v'". Indicates the termination of this convolution in the summit of the
temporal lobe, c c c c. Convolutional branches of the third order crossing
the internal surface of the hemisphere, uniting the convolution de Pourlet
to the great convolution of the second order, e e. Branch of the third
order, uniting the convolution de l’ourlet to the great convolution of the
second order in the quadrilateral group, r r. Branch of the third order,
forming the peduncle of the triangular group, extending from the convolu-
tion de l’ourlet to the great convolution of the second order, g y. Last
branch of the third order, uniting the convolution de l’ourlet to the great
convolution of the second order in the cerebello temporal zone of the
hemisphere, a. Aiifractuosity of the internal surface running up to the
eccentric border of the hemisphere, a'. Anfractuosity of the same kind,
forming a fissure between the crossing group and the quadrilateral group.
p. Fissure posterior to the quadrilateral group.

182

HUMAN BRAIN.

In following this convolution, the student will find tint
its course is exactly similar to that which the whole hemi-
spheres take as will be described in my explanation of the
formation of to ventricles of the Inin (^“9 and

f °’ 1 , ;J5)- 1 hls convolution contains within it the superior
longitudinal commissure, and marks its direction. It is

the hem or owlet of Foville. This convolution he calls le
circonvolution cle l ourlet.

We have already seen this as one of the primary convo-
lutions of the brain of the fox. i j

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
- a b™nch- The convolution ddd, p, d, d d,
(fig. 73,) forms the external margin of the circle of the he-
misphere just as the first convolutions form the internal
margin of the circle ; this is the great convolution. It mav
be said to run from the fissura Sylvii to the anterior ex-
tremity ol 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 /, dg,bg,dg ,qq,o-
fig. 7 (), aaacia , d , g g g). 22

Iu the bram of new-born infants, and particularly in
foetuses of seven months, this line of convolution is without
any sinuosity. Iu this respect it resembles the simple lon-
gitudinal convolutions of the lower animals. 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). 1

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 fissuie of the external border of the orbital’ triangle
delineated horizontally ; it is moderately winding, and ter-
minates 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).

CONVOLUTIONS.

183

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 ol the hemisphere, and in the internal poi-
tion of the fissura Sylvii. They form a sort of anasto-
mosis between the convolutions of the first and second
order (fig. 73, ccc, e, f, g, y, ee, 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 in-
duced Rolando to call it processo crista to. 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
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 enor-
mous 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 circum-
ference of a circle. They may be partly seen in fig. 74
(ccc); but better seen in fig. 75 (ccc c).

Convolutions of the fourth order. — The distinctive charac-
ter 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.

184

HUMAN BRAIN.

Fig. 74.

rFovi'llo the external surface of a cerebral hemisphere,

(o i lie.) J lus hemisphere is remarkable for the rich development of its

nv olutions. e', y, k, i, p, v, e, indicate the convolution encircling the
fissura Sylvn-second convolution of the second order, c c c The con!
volutionary folds of the insula seen between the lips of this fissure, which
are slightly separated, x, », a, n", U, D, G, b, n ', V, g, a q, o' indicate the

Snd order All ,the llemisPterc— first convolution of the se-

. ’ L 11 t¥+C0UV0lutl0f 011 the convexity of the hemisphere

lun from the convolution around the fissura Sylvii to that convolution

wiih thTTsfr 16 11ie™ISPhere- The convolutions which join the second
W ™ C011V?,kt!0n belonS to the fourth order. Independently of

, connection with the two convolutions of the second order they anas-
tomose sometimes together, y, l", h, a. Transverse supraciliary convolu-
ti i tunning from the antenor angle of the fissura Sylvii to the internal
pait of the posterior extremity of the hemispheres, i, i. Transverse me-
dio-pai letal convolution extending from the second curve of the convolu-
lou around the fissure of Sylvius to the twist in the great convolution of
the second order, corresponding to the anfractuosity which on the internal
suitace of the hemisphere separates those crossing from the quadrilateral
gioup. P, ppd . transverse occipital convolution extending from the
sharp angle of the fissure of Sylvius to the posterior extremity of the he-
misphere. k k, k. Anterior transverse parietal convolution situated im-
mediately in front of the transverse medio-parietal. s, s, l, l'. A branch
extending anterior from k, k, k, and anastomosing, a, l , l\ with the great
convolutionary band— first convolution of the second order. l', s', l". A
branch which running from K, k, k, anastomose with the transverse supra-
ciliarv convolution. + . A small branch joining the two above-named
branches, u, r. Posterior transverse parietal, o, o, o. Short convolu-
tions 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.

CONVOLUTIONS.

185

In order to understand these convolutions it is neces-
sary to consider them as prolongations of the convolu-
tions of the third order, below the two convolutions of the
second order (see figs. 74 and 7b, nn, i i, kk, ll); and
in fig. 7G, 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 insula. (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 l’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, 1" , n a),
and behind by a line extending from the posterior angle of
the fissure of Sylvius to the posterior point of the hemi-
sphere (see fig. 74, pppd').

Lastly, the third region, also slightly convex, extends
from this line to the extremity of the temporal lobe (see
fig. 74, i)', v, o').

This fourth order is especially characteristic of the hu-
man brain, from their transverse direction, and their being
supplementary to the longitudinal foldings.

186

human brain.

Fig 76.

n,itSv"PT rJa“ °f ‘.he f cerebral ¥“isl>ta-e. !>. Anterior extre-
y- . Postenor extremity, d ,a,a,a. Superior segment or middle
of the great convolution of the second order, e, i, g'. Small fragment of
the convolution which encircles the fissura Sylvii-second convolution of
the second order, i, i. Tranverse medio-parietal convolution, u H li &
Transverse supraciliary convolution. G> g, g. Transverse occipital ’ Ali
these transverse convolutions come from the encircling convolution of the
.sum Sylvn to the great convolution of the second order, k Anterior
incomplete transverse convolution, s. Posterior ditto, f f' f" Simnle
convolutional line on the side of the fissure divided by its course from
without to within, and joining by its branch F', the great convolution of
le second order; and by its branch f", the transverse supraciliary convo-
u ion. 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.)

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 hemisphere,) cutting from
the mesial fissure horizontally outwards : the portion re-
moved must not be thrown away. This section exhibits
what is called the centrum ovale , and exhibits the dis-
position of cineritious and medullary neurine in this por-
tion 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, bbbb).
This cortical substance is, in fact, the hemispherical gan-
glion, the analogue of which the student will remember as
a mere rounded point in the fish, in man enormously deve-
loped.

FI GU RATE SURFACE.

1S7

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 commis-
sure, showing the centrum ovale. The great transverse commissure, p p,
has been left in the mesial line, and extending a little on the right side.
On this side the centre of the lateral ventricle, l v, is opened, and the
anterior cornu, a c. On the left side, the posterior cornu, p v, and the
commencement of the descending cornu, d e, are also exposed. In the
body of the lateral ventricle, on the left side, may be seen on the outside the
corpus striatum, M M ; next to it, taenia semicircularis, t c, partly covering
the vena Galeni, v rj ; next to this is the thalamus nervi optici, K, from the
surface of which the plexus ehoroides has been removed, but still partly
covered bv the central portion 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 ehoroides ; on the right side
the ventricle is partially covered by the corpus callosum, and the body of
the fornix is concealed, but the plexus ehoroides, p c, has been left. The
vena Galeni, v g, is uncovered by the partial removal of the tfenia semi-
circularis.

Fig. 77.

188

HUMAN BRAIN.

In making an examination of the brain for pathological
observation, this section is one of great importance, ex.

Snfb„Ctef^t, r?l0Ur °f,this Sa"SIio"; a‘»l it is
opul that, foi the future, medical men will not omit in

their accounts of post-mortem, appearances, a detail of’ the

condition of this ganglion. It is, indeed, extraordinary,

hat 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 colour of this ganglion

though all physiological evidence proves that it is the nor-

tion of the bram with which the intellect is immediately
connected. J

The next step in the dissection is to make a longitudinal
incision as represented on the right side of the mesial
line m fig. 77, commencing a little posterior to the ante-
rior edge of the corpus callosum, and extending backwards
m a line parallel to the mesial line as far as the posterior
edge of this commissure. This great transverse commis-
sure 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 (fm. 77
l v). T his space must not, however, be viewed by the

student in the light of a cell or cavity, situated in the inte-
noi 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 convoluted 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 rjuite 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

F I GU RATE SURFACE.

189

power of containing fluid arises simply from the mode in
which the arachnoid membrane is reflected from the figu-
rate surface on to the convoluted surface. It is in this
wav 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 exten-
sive fissure, analogous, in all respects, to the fissures be-
tween the different convolutions of the cerebrum. Though
it may not, perhaps, 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 cavi-
ties, whose walls are wholly formed by the substance of
the organ itself. The term 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 contra-
distinction to the convoluted surface, from the projections
which compose it presenting regular forms and having
received individual names, generally derived 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 ex-
posed by the removal of a portion of the transverse com-
missure, 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 observa-
tion 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 gan-

190

HUMAN BRAIN.

glion is a deeper portion of the ventricle, the anterior
cornn (a c) : it is separated from its fellow on the opposite
side by a portion of the longitudinal commissure called the
septum lucidum (si, fig. 77— No. 1, fig. 78). Between the
Bvo layers of the septum lucidum is the fifth ventricle (5v).
.Posterior to this anterior cerebral or motory ganglion is a
vascular membrane, the plexus choroides (pc); this mem-
brane, notwithstanding its grand name, is merely the con-
tinuation of the pia mater, as will be seen a little further
on; if this membrane is raised (see the left side of fig.
/7), another large ganglion may be seen (the posterior cere-
bral), presenting a white surface, and rounded from the tha-
lamus nervi optici (k), through which the posterior or
sensoiy columns pass previously to their expansion in the
hemisphere and termination in the hemispherical ganglion

The whole of the thalamus is not yet exposed, the pos-
terior portion being covered by the fornix (seethe left side).
The thalamus nervi optici is larger in man than in any
other animal, and as Ave have traced it upwards Ave 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.
Iliese tAvo 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 tAvo ganglia is situated a narrow band of
medullary rieurine, called, from its appearance, the taenia
semicircularis (fig. 77, tc, fig. 78, 4) ; the fibres composing
the band are connected with the superior longitudinal com-
missure, 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, s). Beneath the taenia semi-
circularis is a large vein, the vena Galeni, so called after
Galen (fig. 77, v g ; 78, 3). At the posterior extremity of
the thalamus, and extending rather beneath this ganglion,
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 beiieve that they

nor RATE SURFACE.

191

ave merely in opposition. They will be better seen in a
farther stage of the dissection.

Overlapping the internal and posterior part of the pos-
terior cerebral ganglion or thalamus, there is a sharp band
of medullary neurine ; this structure is a portion of the infe-
rior longitudinal commissure or fornix (figs. 77, 78, n, 101, e).
The connections and precise character of this commissure
1 shall not describe at present, being anxious to give a
connected and uninterrupted view of the figurate surface,
merely remarking 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 trans-
verse about one-third from its posterior edge in the direc-
tion 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, taenia
semicircularis, thalamus nervi optici, plexus choroides,
and fornix. On removing the rest of the transverse com-
missure, 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 outwards, the concavity forwards and in-
wards. As the student is still required 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 commissures. The contents of this cornu all take
the curve of the cavity, and may be described from within
outwards : — A slight projection ; 1st. Emminentia collate-
ralis (9); 2ncUy. Hippocampus major (6), terminating
below in — 3rclly. A club-like extremity of the body — Pes
hippocampi ; 4thly. Taenia hippocampi (7), a continuation
of the fornix, on raising which the grey neurine of the con-
voluted surface at the base of the brain may be seen
serrated by the entrance of blood-vessels ; 5thly. Fascia

192

HUMAN BRAIN.

dentnta (9) ; Gtlily. Plexus choroides, lying over all these.
Ihe lateral ventricle also extends backwards, the posterior
cornu forming a curve, convex outwardly, concave internallv •
the projection on its inner wall is called the Hippocampi
minor (10). J

Fig. 73.

Iii 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 exhibited 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 ven-
triculum. Thus is shown the posterior fissure of the cord, p p, suddenly
dilated, 1st, into the fourth ventricle, 4,A v, or calamus scriptorius ;

VENTRICLES.

193

2mllv into the iter a quarto ad tertium ventriculum ; Srdly, into the third
ventricle 3rti 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, lhe iter a
quarto ad tertium ventriculum is first bounded above by the inter-cerebi at
commissure, i & o; Sadly, by the optic tubercles, p c, carrying the pineal
eland u The bristle emerges in the third ventricle, bounded above by
the fornix, which is removed, and laterally by the optic thulium, K, on the
edo-es of which may be seen the peduncles of the pineal gland. Anteriorly
the third ventricle is bounded by two rounded cords, N N, the anterior
pillars of the inferior longitudinal commissure — fornix. In front ol 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 longitu-
dinal commissure which is called the septum lucidum. On either side of
the mesial fissure are the lateral ventricles, 2 2, with their cornua, antenoi,
a u, middle descending, d e, and posterior, p o. b b. Hemispherical gan-
glion, or cortical substance ot the brain, c. Anterior optic ganglion, nates ;
d. Posterior ditto, testes — covering the iter a tertio ad quartmn ventriculum.
f. Auditory ganglion in the fourth ventricle, 4^ v. n. Spinal coid.
k. Thalamus nervi optici, anterior cerebral ganglion. MM. Corpus stri-
atum, posterior cerebral ganglion. o. Pineal commissure, n. Pineal
gland. i & c. Inter-cerebral commissure, or processus e cerebello ad
Testes, covering the iter a tertio. s c. Soft commissure, commissura
mollis’, lv. Lateral ventricles. 3rd v. Third ventricle; 4"' v. Fourth
ditto ; 5 v. Fifth ditto. These three are all dilatations of r F, posterior
fissure of the spinal cord. 1. Septum lucidum, a portion of the inferior
longitudinal commissure or fomix. This is represented much too thick.
2. Anterior pillars of fornix divided. 3. Vena Galeni. 4. laenia semi-
eircularis. 5. Corpus striatum divided. 6. Hippocampal lobe, or hippo-
campus major. 7. Taenia hippocampi, or descending pillar ot the fornix.
S. Corpus dentatum. 9. Emminentia collateralis. All these last arc situ-
ated in the descending cornu of the lateral ventricle. 10. Hippocampus
minor in the posterior cornu of the lateral ventricles, d. lourtli pair of
nerves, pathetic, h. Eighth pair, or auditory.

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 mater, and a view of the
exact point where it ([nits the convoluted to join the fg urate
surface; the convoluted surface, 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 cerebellum, is called the foramen of Bichat, and the

o

194

HUMAN BRAIN.

J)ia mater m this situation is known by the name of velum
f/X Tins membrane, the velum interpositum, mu
now be vci 7 carefully raised, and immediately underneath

about°thpeCted Wfth 11 WlH be f0Und a smaU rounded body
about the size of a pea, consisting of cineritious neur^

the pineal gland r, and frequently containing in its interior

tncr^fl gl’ltt? _matter called the acervulus cerebri ; it forms
to ether with two white bands, hitherto known by the title
of the peduncles (o) of pineal gland, connected to it a
commissure between the optic thalami. The whole struc-
ture may be called the pineal commissure. Beneath this
commissure are situated the optic tubercles, which in man
as we have seen m the Mammalia generally, are four in
number, instead of being simply binary, as in fishes; these
tubercles arc usually known by the term corpora quadri-

Thf antenor of these are the largest, and are
cawed 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
oi 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 described
elsewhere (fig. 106.)

By gently raising the anterior edge of the cerebellum
with Ins knife, (and this must be done with great care to
avoid injuring the fourth pair of nerves (d), which lie imme-
diately beneath,) the student will observe, passing from the
optic tubercles backwards and downwards to the cerebellum,
a broad band of medullary neurine, thick laterally, but
extiemely thin in the centre; so great is the difference in
the texture of these two portions, that the central has been
called the Valve of Vieussens ; the direction of the com-
ponent fibres is, however, the same in both. This structure
in the aggregate must be regarded as a commissure, con-
necting the cerebrum and cerebellum, and I have desig-
nated it, therefore, the inter-cerebral commissure (i & c, see
fig. 78). A more minute description of its fibres will be
found under the head of commissures. This view of the
figurate surface of the brain will remind the student of the
tubercular form of the brain of the fish, to which it bears

FIGURATE SURFACE.

195

some resemblance, exhibiting— 1st. Corpus striatum, the
anterior — the motor ganglion of the spinal cord. ~nd. 1 1m-

lamus nervi optici — the posterior or sensory ganglion of the
spinal cord. 3rd. The inter-cerebral commissure and cere-
bellum. The olfactory tubercles which in the fish are
exposed, the hemispheres being too small to cover them
are concealed in tins view ot the human brain, as indeed
were the rest, until the hemispheres 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 forwaids
then upwards, then backwards to the posterior extremity,
and then forwards again under the striated bodies to the
fissura Sylvii.

Fig. 79. F>3- 80-

F'uj. 79. — a. Medulla oblongata. b. Pons Varolii. c. Tubercula
quadrigemina, with the fibres of the posterior columns passing in front.
d. Cm3 cerebri, fibres of the anterior columns. E. Thalamus, or poste-
rior striated body. f. Anterior striated body. g. Substance of the he-
misphere, springing out from the front of the anterior corpus striatum.
a. Space between the striated bodies and the hemispheres caused by the
introduction of a small piece of wood. I. The two surfaces, being in
contact in the 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.

We may thus compare the corpus striatum and thalamus
nervi optici, or anterior and posterior cerebral ganglia, to

o 2

19G

HUMAN BRAIN.

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 surface),
which is first drawn forwards, next turned backwards, and
again brought forwards so as to form a complete covering
to the head. b

( 197 )

PART VI.

DISSECTION OF THE HUMAN BRAIN AND SPINAL CORD.

i Spixjl 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 struc-
ture 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 demonstration of the progressive development
of the nervous system by tracing it in some of the simplest
animals, we shall commence this division of our labours
with an account of the configuration and structure of that
portion 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

* 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 : Goettingmn, 1741), and that it served as the basis of the
labours of Haller.

198

HUMAN BRAIN.

designated the anterior and posterior fissures of the spinal

The anterior fissure differs from the posterior in beinn
wider more distinct, and therefore more easily demon®
stiated, though it is not so deep at the upper part of the
spmal cord as the posterior; it deepens, however as we

endCofdt'hend 'l th?ndeePer of tho two towards the sacral

envd V ? lhe Pla mater> which closely invests the
coid, dips into the anterior fissure, but nevertheless requires

to be carefully dissected off before the cleft can be dis-
inc y s lown. s the sides of the posterior fissure are in
closer contact than those of the anterior, more difficulty is
met with m 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 as to the character of these fis-
sures, Haller almost doubting the existence of the anterior
one, whilst Chaussier states that it is deeper than the pos-
tenor; and Gordon and others, again, stating that in point
ot depth there is scarcely any difference between them
Connected with the spinal cord, there are thirty-one
pans of nerves, each nerve being in communication with
the medulla spinalis by two sets of filaments, which,
in the ordinary language of anatomists, are called the
anterior and posterior roots

of

fig.

nerves (see
viewing the

the spinal
81). But

connection of these nerves
with the cord in strict accord-
ance with the functions which
they severally perform, it
would be more correct to
say that the anterior fila-
ments alone arise from the
cord, and that the posterior
terminate there ; for the an-
terior filaments have been
proved by Sir Charles Bell
and Magendie to be the

Fig SI.

Section opposite the root of the fifth
spinal nerve, a. Anterior or motor
root of the spinal nerves, p. Pos-
terior or sensory root of the spinal
nerves, with its ganglion.

conductors of the will to the voluntary muscles : they are,

SPINAL COltl).

109

in fact, the instruments of volition, the experiments of the
physiologists named having proved, that, after the division
of the anterior filaments, the limb to which their continua-
tion as nerves is transmitted becomes perfectly paralytic as

regards voluntary motion. ,

The posterior roots again convey sensation through the
medium of the cord to the scat of consciousness, the cere-
bral 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 grey
neurine which is contained in its interior, as will be de-
scribed a little further on.

Transverse section. — A transverse section of the cord de-
monstrates clearly that, with the exception of the anterior
and posterior fissures, it is solid throughout. Nevertheless
different anatomists have maintained that there was a canal
in the interior of it, some not giving it any precise situa-
tion, 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, de-
scribed 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 m 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 commencing from the concave internal sur-
face anteriorly, and being continued till this surface becomes
level and the whole cord solid.

1 am glad to find that, notwithstanding the opinions of

* In the Anatomy of the Brain, 8vo, London, 1820, translated by Dr.
Willis.

200

human brain.

IS supported by the observations ll Dr To

to see it ”-prV,M%™SberIeSS experimcnts- been able

n»?t^rp^STfilMt th0.COrd which exto-

its interior a considerable deposit “

3ttS! it?.S &■£*?*£

something resenrbling two C's placed back to back and
connected by a narrow line thus 'i ( . • ,

do not reach the surface 7thc cord but the nnT- ^
tending completely through its substance, attain tl,e surface
at those points where the posterior roots of the S
nerves are connected with the cord (see fig. 82 No 1?

a TSt b° regal'<,c<1 as constituting

i , p &t la» ailc^ llot as one continnons ganglion •
each set of spinal nerves having its own individual nervous
cn le corresponding to its osseous centre or vertebra It
°n ]y hY thus regarding the composition of the cord that
we can account for the uniformity in the number of the
cervical vertebrae m Mammalia ; the number of the bones

urotf f1'egU atrr<] the Immber of nervous centres requiring
pi o tec t ion. 1 he reason that these are uniform in Mann

naha is, that m this class only is there a perfect muscular
diaphragm with a phrenic nerve, having its specific number
of loots and corresponding number of ganglia. The ana-
tomical continuity of this grey matter, and its physiological
or functional separation into distinct ganglia or centres, is
another fact of importance to show that we must not look
tor anatomical lines of separation in order to establish dis-
tinction of function.

l // 7 attemPj to divide the medullary neurine of each
Hail ot the cord into two portions or columns, the separa-

DISSECTION OF T1IE SPINAL CORD.

201

tion may be easily made without the slightest division of
its fibrous ueurine ; and iu order to facilitate the descrip-
tion 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 posterior columns, as
these names seem calculated to excite attention to the exact
relative position of these two tracts of medullary neurine.

Fig. 82.

Sections of the spinal cord. 1. Opposite the third cervical vertebra,
with the anterior and posterior roots of the spinal nerves, and the white
transverse commissure. 2. Opposite the fourth ditto. 3. Opposite 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 re-
gion ; 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.

202

HUMAN BRAIN.

llie 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 propor-
tion of the antero-lateral and posterior columns varies
however in different portions of the cord. In the cervical
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 obseive a set ol medullary fibres, which, running hori-
zontally 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 analogy
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 con-
nection of the anterior and posterior roots of the spinal
nerves with the grey matter of the cord ; but he must not
expect to dissect this easily himself, as it can only be dis-
covered when the animal has not been dead more than
an hour or two, and we have therefore no chance of ex-
hibiting it in the human subject. Gall was the first to
assert that the spinal nerves are connected with the grey
matter.

Beflingeri was, I believe, the first who demonstrated the
double origin of the spinal nerves from the grey 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 : Beflingeri

believed that the filaments of the posterior roots of the
spinal nerves have in the human subject at least three
different origins, viz. — from the posterior peaks of grey
matter, from the posterior lateral fissures, and from the
posterior columns of the cord. The anterior roots, he

HOOTS OF TILE SPINAL NERVES.

203

columns, but he does not clearly make out their connec-
tion with the cineritious ncurine.

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, “ Obser-
vations 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 con-
nected with the grey matter of the cord.

Rolando entertains some curious opinions regarding the
arrangement of the medullary fibres, describing them as if
they constituted an extensive surface folded up ; and he
gives a drawing of its supposed appearance in a bullock.
Cruveilhier considers it to be laminated, but that each
lamina is separate from its neighbour, — an observation which
he remarks is confirmed by pathological analogy.*

Mr. Grainger says — “ In considering the interesting
phenomena related 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
satisfied myself that each was connected both with the
external fibrous part of the cord, and the internal grey
substance. The following is what appears to be the struc-
ture : — After the two roots have perforated the theca verte-
bralis, 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 arc
found to continue their course, nearly in a right angle with
the spinal cord itself, as far as the grey substance in which
they arc lost. But this arrangement has no resemblance
to the distinct division into fasciculi depicted by Mr. Mayo ;
on the contrary, it is with crreat care onlv Mint smnll

204

human brain.

traced, dipping into the lateral fissure, and at length joining

whilflW' <lifliculty is °™g t0 «» fci that

u list the fibres on the outer surface of the pia mater

adhere very intimately with that strong membrane, on its

thTth^fiT6 1 f neUril?ma, becomes 80 extremely delicate
that the fibres lose much of their firmness, and break on

the application of the least force ; an accident which always
appi ns if the pia mater be raised from the surface of the
spiial cord beyond the point where the nerves are attached.
VY hen the filaments have penetrated into the fissure, they
ose their rounded figure and become flattened, and are
then seen passing to the grey substance at a right angle to
the longitudinal fibres of the cord. It is extremely difficult
ovmg to the delicacy of the parts, to determine the exact
relations which exist between the above filaments and the
grey matter; but in a few dissections I have been able to
see these fibrils running like delicate striae in the grey
substance In one instance, the fibres being more distinct
than usual an appearance was presented having a remark-
able resemblance to that which is seen on making a section
ol 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
nom the anterior root of the nerve; and there were some
otliei fibies derived from the same root, which were not so
plainly seen.

hrom numerous examinations I am induced to believe,
that whenever the white fibres of the nervous system
become connected with the grey 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 grey 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

DISSECTION OE SPINAL COUD.

205

recent state, so that the natural structure was entirely pre-
served. The method of Red, 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 scepticism, or rather disbelief, as to the alleged con-
nection uitli the grey matter, more especially as regards the
anterior root, that I very carefully repeated the dissections
several times with the aid of an excellent anatomist, Pro-
fessor Bischoff, of Heidelberg, 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 favour-
able for examination, I distinctly traced the connection of
both roots until the grey substance; and it is very satis-
factory 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 liis own examinations, that
the structure above described really exists.

“ Prom careful dissection, I am convinced that it is only a
part of the fibres belonging to the two roots which are
attached to the grey 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, “ 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.”

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

* P. U, op. cit.

206

HUMAN BRAIN.

accuracy of Mr. Grainger’s account, p. 660. “ This ques

Bon respecting the precise relation of the roots of the nerves
o le cord, is one of those in which physiology in a certain
sense takes the lead m 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 ex-
tremities, it is likewise capable of acting as an independent
nervous centre, and that movements of a very definite
character may be produced in parts connected with it even
alter all communication between it and the brain has been
cut off. And it has been supposed by one of the zealous
labourers m 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 to the anatomical problem which
aiosc 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 judice, and that further research
is necessary to prove unequivocally, that of the fibres com-
posing the roots of the nerves some pass upwards and enter
the brain, and others do not pass beyond the grey matter
of the spinal cord, and this inquiry demands more than
ordinary care, for the mind of an observer would be easily
biassed 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 physiolo-
gical science, has published, 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. Pig. 83 is from two drawings made at
one time from thin slices of the cord of the frog with
the spinal nerve. It strikingly corresponds 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 inde-
pendent testimony. Dr. Budge quotes the observations

DISSECTION OF SPINAL CORD.

207

of Drs. Gall, Keuffel, a pupil of Rcil, Bellingcri, Rolando,
Weber, Valentin, and Stilling, to show that though they
had discovered the connection of the roots of the spinal
nerves with the grey 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 acknow-
ledges the great difficulty of tracing these fibres, he satisfied
himself by repeated dissections, that the nervous fibres
do not run, as Stilling asserts, transversely, but go forwards
towards the brain.

Fig. S3. F iff- 84.

T'kj. 83. — Anterior root of the spinal nerve of the frog, showing the
twisted arrangement of the fibres at their junction with the cord, and the
continuity of fibre towards the brain, a. Spinal nerve, h. Spinal cord.
of. Cerebral fibres, sf. Spinal ditto, v in. Vesicular neurino.

Fig. 34. — Portion ot the spinal cord and nerve. (Budge.) Magnified
300 times, d. Tenth spinal nerve, a. The upper portion, dividing into
two fasciculi, cerebral fibres, h. 1 lie lower fasciculus, curving through the
vesicular neurine of the spinal cord, spinal filaments.

He generally took the conus terminalis of the frog’s cord,
on account of its tenuity. He found a change in the
colour of the fibres fromablueish grey to a yellowish grey •
also in size from *foyth of a line, to tb and
Hiese changes are, no doubt, owing to the attenuation of
trie supporting membrane, as the tubules enter into the
composition of the cord, where the presence of the mem-

208

HUMAN BRATN.

branc is not required, as in the nerves. This change in
ie 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
soit of twisted curve, and then ascends towards the brain
(See figs. 83 and 84.) The deeper plunges into the
giey 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 has arisen the doubts which have been lately
thrown 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 arc all the dis-
coveries of Sir Charles Bell impotent and inconclusive.
But they are not so Nature never contradicts herself; and
I maintain that even if we could not detect it with our
dissecting knives and magnifying lenses, the simple patho-
logical 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: — “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 con-
sider 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,
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

* P. 13G, op. cit.

CONNECTION OF THE SPINAL NERVES.

20!)

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 colour, 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 grey colour,
semi-transparent, across which we see a part of the nervous
roots penetrate a certain depth, and contrast their perfect
white colour with clear grey semi-transparent tint of the
matter they traverse ; but by looking with attention, aided
by the microscope, an extremely tine white layer covering
the grey. Besides, in plunging obliquely a stylet into the
thickness of this grey substance, and raising it in the direc-
tion of the origins of the nerves, the white nervous layer
which covers the subjacent grey 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.” He states 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 grey 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 sub-
stance and partly with the grey. 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 accordance 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 fascicu-
lus; 3. Nerves of the middle fasciculus. He divides the
nerves of the posterior 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

p

210

HUMAN BRAIN.

and cerebellum ; the auditory and trigeminal for the cere-
bellum; the optic and olfactory for the cerebrum. He
c escribes the spinal accessory as belonging to the lateral

column of the cord, and the trigeminal and pathetic to it
m the cranium.*

Iiom the statement which has been made regarding the
different functions of the anterior and posterior roots of the
spinal nerves, the one being destined for motion, the other
tor sensation, it follows as a necessary consequence that tire
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 pos-
terior portions of the cord are themselves implicated the
one m the production of motion, the other in the conduc-
tion of what is called common sensation.

.These two portions of the cord are, however, so closely
united together 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 m the vascular ; the motor columns of the spinal cord,
m fact, commencing from the cineritious matter which
foil us 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 extending 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, f from
the fact of his dissecting the brains of serpents and

* Foville, op. cit., p. 493.

f See Cmveifhier, p. 50.

STRUCTURE OF THE SPINAL CORD. ~ I I

fishes, regarding the brain as a production of the spinal
cord ; while later authors, Hippocrates, Vesalius, Willis,
Varohus, Haller, Zinn, Sabatier, A\ mslow, 1 oital, Chaus-
sier, and Cuvier, have maintained the opposite opinion.
On the other hand, we find Tiedemann and Serres maintain-
ing, 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 consequence of the cord arriving more rapidly at a state
of perfection from the greater simplicity of its structure.
As a third opinion, I may mention 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
;ire, 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
posterior 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 enlargements 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 in man.

The grey matter in the interior of the cord is quite suffi-
cient in itself to establish their identity, and the reason why
this grey matter or ganglionic 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 grey
matter thus arranged would oiler a greater diameter, and,
consequently, require a much wider canal, a more bulky

Fig. 85.

919

HUMAN BRAIN.

vertebral column, and a larger muscular apparatus to move

B1ut Natyrc’ m thls ^stance, as in every other concen
riates her instruments of power, and husbands her mate-

Cranial division -of the cerebrospinal axis. — The spinal

Zn Sfr Mowed into tl/e skull, and its couT

luce w , the mvestigated. In strict accord-

once with the course of the nervous influence, we ought to

TOrfs tud'tho UnftM7 °r T‘OTy Strands from abOTe dotn-
waids, and those for sensation, or the sensory, from below

upwards. But as this mode of proceeding, even Ttlm
exact line of demarcation between them had been ascer-
tained would greatly increase the difficulties which un-
avoidably surround every mode of study in this complicated
organ we must not attempt, a plan which, however correct
m a physiological point of view, would not assist us in our
endeavours 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 con-
nected with the cerebrum and
cerebellum, 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 me-
dulla oblongata (see fig. 85).
This will be found upon sec-
tion to be entirely altered as regards the arrangement of
the cmeritious 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

Medulla oblongata, s. Olivary
ganglion, t. Pyramidal eminence,
w. The restiform body to t he outer
side of the last-mentioned.

STRUCTURE OE THE MEDULLA OBLONGATA.

213

system in separate and isolated points or masses, a circum-
stance which does not appear to me to have received the

attention which 1 cannot
help thinking it deserves. The
view I am inclined to take
of the character of the parts
comprising the medulla ob-
longata is simply this : in ad-
dition to the columns lor
motion and sensation, there
are here deposited, and im-
bedded to a certain extent in
its substance, six ganglia,
three on each side, anterior,
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 Mam-
malia, though not always
“ cropping out on the sur-
face,” as the geologist would
say. The lateral are the
ganglia of the pneumogastric
nerves {y an glia restiformia).
We have seen them in the
Vertebrata generally, and
more distinctly separated
from the posterior in some
of the more bulky Mamma-
lia, where the motor and
sensory columns are larger
than in man.

The posterior ganglia are
found in the fissure at the
back part of the cord, which is
known by the name of the
fourth ventricle (see fig. 80).

Fig. 86.

Sections of tlie medulla oblongata
at the situations indicated by trans-
verse lines in fig. 85. F. Auditory
ganglion, or posterior pyramidal
body. g. Pneumogastric ganglion,
s. Olivary ganglion. The grey
matter in sections 5, 6, and 7,
show the gradual deposit of the
anterior and posterior peaks of the
grey matter of the spinal cord.

They form two projections of

214

HUMAN BRAIN.

LET" (S6e fig' I8> F>' In th™ terminate the

1 >• - 01 eighth pair ot nerves — posterior pyramidal

bodies or audit™ ganglia. They have been remarked
the fish under the title of tubercles of the fourth ventricle, f

Fig. 87.

Ihe special object of tins drawing is to show the relative course of the
pyramidal and olivary portions of the motor tract through the pons
Varolii and crus cerebri, as exhibited by a longitudinal section. It
also shows a most important point in the anatomy of the medulla oblon-
gata,—namely, the connection of the motor root of the fifth nerve, me,
"ith the olivary tract, c. Anterior optic tubercle, d. Posterior ditto.
e. C erebellum, k. Optic thalamus, m. Corpus striatum, p. Corpus cal-
losum. s Olivary body. t. Pyramidal ditto, x. Pons Varolii. i & c.

I i iter-cerebral commissure, or processus h cerebello ad testes, bb. Optic
nerves, e. Third pair. 1 71. Locus niger. m e. Motor root of the fifth
pair, ot, ot, ot. Olivary tract, one portion running up to the optic
tubercles ; another running through the pons Varolii. pt,pt. Pyramidal
tract running through the pons Varolii, the continuation of which through
the corpus striatum is marked m t.

L ite 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

* Ruysch describes the restiform bodies under the name of posterior
pyramidal; and Rolando describes the internal lamina of the restiform
bodies by that name, and even warns the reader against confounding them
with the restiform bodies.

f Foville says, “ The restiform body is incontestibly a prolongation of
the posterior fasciculus of the spinal cord. The olivary body and small

215

STRUCTURE OF THE

MEDULLA OBLONGATA.

in the arrangement of the cineritious neurine in this gan-
glion 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 (tm. 87) still shows a waving line, but the convexity
outwards, °the concavity inwards. This arrangement is ot
exactly the same kind as that employed m the hemisphe-
rical ganglia, namely, a contrivance by which an extensive
surface of neurine is packed into the smallest space, ihe
cineritious neurine of this ganglion appears, indeed, as it
it were crumpled up to accommodate it to its confined

situation. , V1

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, ot). These fibres consti-
tuting 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 cerebri these olivary columns
appear to divide into two portions, the one passing forwards
above the locus niger, the other ascending to the tubercyila
quadrigemina andthalami nervi optici; but this description
is not physiologically correct. The greater part of the
olivarv column, for reasons stated further on, must be con-
sidered a part of the motor tract.

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, pneumo-

filamcnts in the interval of which it is situated are evidently continuous
with the antero-lateral columns of the spinal cord.” — P.312. “The
olivarv 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 ot the olivary bodies may be
easily traced to the superior parts of the lateral fasciculus.” This author
does not propound any theory of the probable office on this ganglion.

* 1847. I have again and again dissected these parts, and I am quite
convinced of the accuracy of iny description, though in opposition to
some high authorities.

216

human uuain.

rves- Th- «*»-

™}' supposition regarding their office "cl?' ganglla r™der
If it is their- office to mlsl? ov^ StlU more P^bable.
tongue as an oro-an of I L tllc m°venieuts of the

necessity of its being closely e " ° ^ un(^crstan(l the
of especial sensatio^ J Wlth aU ganglia

the ofhH the °!1Vuiry columns constitute

*

olivary yth“g, i? ?' °

the the Pedu“deS *

%sIU53 ^dlfir t^t’T6’ the C"lf> and the Cftt- 1 find (see

tlfe ve,; centre of fl , ™ “ “ "'“W1,™ of W ™tter in

the Some ofllil PUS PI'ramldale- »Wd« is clearly
. analogne of the corpus obvare in man. In the no/

poise as already mentioned, this deposit of grey matter

olds the same situation, only that it forms a prelection on

e surface winch rt does not in the horse JndCf

the horse it is some distance from the pons Varolii and

Zt2S” Th °T °f theflingUal nC1Ve th“ «» pn“
logastnc. I lie difference of its position in the human

subject I conceive simply arises from the difference in its
“ “an " S° ^ that if is Pushed upwards to

Dr- Jolln Reid,f in an interesting paper, entitled “ On

w°!seiPbertS mtltlle/llat°my °f the MeduUa Oblongata,”
Avas, 1 bebeve, the first to point out that “ the olivaiy is a

motoi column. I have carefully investigated this point

since my first edition: I fully agree with him,- also in the

important fact that the motor root of the fifth pan- arises

1:1 Yem Struttura del Cervello, 2nd edit. vol. i. p. 53.
i Edinburgh Medical and Surgical Journal, January 1846, vol. Iv. p. 15.

STRUCTURE OF THE MEDULLA OBLONGATA. 217

from it, which I made out, without being aware that lie
had previously discovered 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 descrip-
tion in most anatomical works. One of the latest and
more carefully detailed is by Dr. B. Alcock, of Dublin, in
the Encyclopaedia of Anatomy ; it is too long to extract as a
whole, lie traces both roots down to the medulla oblon-
gata, saying that “ 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 marrow,” one portion
hi to 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 dissection.

The ganglia restiformia, or the ganglia of the pneumo-
gastric nerves, which form such a prominence in the skates
and some other 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 restiformia ;
their relative situation, and the anatomical line of demarca-
tion between them and the auditory ganglia, may be seen
distinctly in a transverse section of the medulla oblongata
at this part (fig. 86).

The ganglion rcstiforinc (g) I have little doubt is an im-
portant organ in the function of respiration, for the pneu-
rnogastric nerve, which both terminates in it and arises
from it, like the spinal nerves, is a compound nerve ; it is a
nerve of sensation in relation to the sensibility of the lining
membrane of the respiratory organs, — the “ besoin do rc-
spirer” is dependent upon it ; it is also a nerve of motion,
in as much as the muscles of the larynx and the muscular

218

HUMAN BRAIN.

tissue of the trachea, bronchi, and stomach, is under its con-
troi bo far, then, the opinion of Mayo, referred to further
on, that nerves of sensation and motion supplying the 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 grey matter at the pos-
terior part of the cord (g) is a central point, from whence
emanates that peculiar power which the system of respira-
tory nerves conduct, and by which they call the respiratory
muscles into action independently of volition. In support
ot the opinion that the respiratory muscles are dependent
on this portion of the medulla oblongata for their stimulus
to conti action, the results of two or three experiments may
be related. J

A section of the spinal cord made above the origin of the
mtei costal nerves simply annihilates, as regards the respira-
tmy movement, the power of the intercostal muscles. A
section above the phrenic nerve induces paralysis of the dia-
phragm 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 re-
spiratory action can take place.

for the proofs that the sensibility of the air-passages
are dependent on their connection with the encephalon
through the intervention of the par vagum, I must refer
my readers to Braschet’s* researches on this interesting
subject.

I he 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 con-
nection with the cerebral mass.

* Eecherches Experimentales sur les Fonctions ilu Systeme Nerveux
Ganglionaire, par J. L. Braschet, 1834, p. 135.

STRUCTURE OF THE MEDULLA OBLONGATA.

210

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 me-
dian fissure obliquely from one side ot the cord to the
other ; these bands belong to the anterior columns : and this
crossing of their fibres from one side to the other is tech-
nically "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 ot view, ex-
plaining, 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 versd. Hippocrates, himself,
mentions the fact, that lesions on one side of the head were
often observed to occasion palsy on the opposite side ot the
body ; but Aretseus 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
decussation of the cerebral nerves and spinal cord ; but
with him the subject dropt, and the attention of the medical
world was only recalled to the fact in 1581, by Fabricius
Ilildanus. 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
pyramidal bodies. Many others, among the number Fro-

220

HUMAN BRAIN.

chaska, Bartkez, Sabatier, Boyer, Dumas, Bichat and
Uiaussier, have m the most positive terms denied the de-
cussation of the pyramidal bundles altogether, as we have
shown m our reply to the Report of the Committee of the
rench 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 pyramidal bodies must not be con-
sidered as a division of the principal cords of the spinal
marrow, since these fasciculi of medullary fibres arc not in
cany 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 decussation 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 marrow.” 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
lie derives from the foor 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
superior edge of this commissure of the cord is distinct im-
mediately 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

* See Spurzheim’s Anatomy, p. 147.

f Yom Bauc und Leben des Gehirns. Leipsic, 1822, vol. ii. p. 31.

PYRAMIDAL 1I0DIES.

221

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.*

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 grey
matter. Ascending from this position in the cord towards
the mesial line to decussate with their fellows on the op-
posite 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
Yarolii to the cerebrum ; but encountering the olivary bodies
in their way, they are split by them, and, forming an enve-
lope for them, have been called byBurdach, Hiillenstrange,
or envelope, 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 cor-
pus pyraraidale, 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 projec-
tion of the corpus olivare, by the addition of fresh masses of
cithci cineritious, or medullary neurine as supposed by
Kolando. 1 hough the term pyramidal body is objection-
able as implying the existence of an independent or distinct
structure, nevertheless, as the term has been so long sanc-
tioned, we must continue to employ it, at the same time

Craveillner, who admits the decussation of the pyramidal bodies
ne^thelesH denies that they arc continuous with the anterior columns!

f ■' ’ 'Y he sa-v*- les pyramides antericures ue sont en nucunc

iacon.i continue nuxs cordons auterieiires de la Moellc.”

222

HUMAN BRAIN.

considering it merely an appearance necessarily produced
by the oblique overlaying of certain constituent fibres of
the cord.

I he decussating fibres of the spinal cord are therefore not
merely the fibres of the anterior columns, but also those of the
lateial columns : the posterior surface of these decussating
fibies 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
pyramidal bodies which Sir Charles Bell mistook for a true
decussation of the posterior columns. For 1 have looked
frequently, but in vain, for any such decussation of the pos-
terior 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 grey matter (see Nos. 5 and 6
figs. 85 and 86).

Line of demarcation 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 Avhose 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
demarcation between them. Sir Charles Bell, 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 sensa-
tion, and I have no doubt of its correctness. The circum-
stance of there being no decided anatomical line of division
between the two columns is not of itself an argument against
the correctness of this view ; for it is quite possible that
perfect distinctness of parts, as regards then’ function, with-
out any visible line of separation between them, may exist.
We must always bear in mind that the neurine which com-
poses 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

MKDULLA OBLONGATA.

223

lit'urine endowed with distinct powers, and ordained by
nature to execute distinct offices from each other, as any
tissure however wide, or membrane however thick. The
presence of such gross and palpable partitions, it is true,
would save us some trouble in discovering the line of de-
marcation, 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 than a
nerve of motion is one of sensation because we are incapable
of unraveling the fibres of each from their common invest-
ing membrane.

That the boundary line between the two organs of sen-
sation and voluntary motion comprised within the spinal
cord cannot be formed by the posterior peak of grey matter,
is very decidedly proved by the fact that a portion of the
fifth pah- of nerves, which we know to be a nerve of sensa-
tion from the beautiful experiments 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 bodies divide the
motor from the sensory columns ; 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 im-
bedded 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.

1 he antero-lateral columns within the spinal 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) be taken in
the forceps, it splits up without any difficulty, and the
fibres themselves do not appear to be torn, but merely the
membrane connecting them. If this mode of proceeding,
however, be attempted on the medulla oblongata, we
find, that the fibres, 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

224

HUMAN BRAIN.

better digest the following outline of their course and
destination. Each lateral halt of the spinal cord con-
sists ot a posterior column
and an antero-lateral column.
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 divi-
sible, viz. into two columns,
the pyramidal and olivary.
Both of these give fibres to
the cerebrum and cerebellum.
Besides these fibres of the

This drawing exhibits an un- antero-lateral columns, which
usual, but instructive, separation of may be described under the

the fibres of the pyramidal body by title of cerebral and cerebellar
the ohvary body, ami their jttlla- fibres of the anterior or mQ.

tory columns, there is another
set which in the spinal cord
occupies a completely lateral
position, being separatedfrom
the posterior columns by the
posterior peaks of grey mat-
ter. These are regarded by
Sir Charles Bell as the cerebral strands of sensation ; cere-

position again in the pons Yarolii.
s. Olivary body. t. Pyramidal
body. w. Restiform body, some
of the cerebellar fibres of the an-
terior columns seen on the surface,
x. Pons Varolii. /. Glosso-pharyn-
geal nerve turned out of its natural
course.

bral, because, as will be explained a little further on, they
terminate in the cerebrum • of sensation, because the poste-
rior 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 pos-
terior 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

CEREBELLAR FIBRES OF THE SPINAL CORD. .225

be traced to the cerebrum. Both these portions ot the
sensory tract will be traced to the cerebrum after the de-
scription of the course ot the anterior columns is concluded.

Let us first follow the fibres of the spinal cord which go
to the cerebellum. 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 derived 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 gene-
rally 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 pyrami-
dalia, and I have no doubt that they actually decussate
with their fellows of the opposite side, forming in fact part
of the apparatus of decussation, though I have not yet posi-
tively 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 cerebellum, are the most posterior of the whole mass of
fibres composing this portion of the spinal cord. They are
separated from the posterior columns by the posterior
fissure, from which the posterior roots of the spinal nerves
emerge ; this fissure they cross in their passage to the cere-
bellum, obliterating it entirely.

Thus it will be perceived that one portion of the antero-
lateral columns, — for there is yet another portion of these
columns to be described, — on reaching to within a small dis-
tance 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 entitled the superficial cerebellar fibres of
the anterior columns, passing over the surface of the me-
dulla oblongata, are usually seen without dissection.

Q

226

HUMAN BRAIN.

Fig. 89.

Fig. 90.

Fig. 89. — This figure exhibits those fibres from the anterior columns
which, ascending to the cerebellum, connect the motor tract with that portion
of the cerebral mass. e. Cerebellum, x. Pons Yarolii. t. Pyramidal
eminences, s. Olivary bodies, w w. Corpus restiforme, its surface having
been carefully scraped, in order to show the superficial cerebellar fibres
of the anterior columns. They are represented rather more distinct
and thicker 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 cerebellar
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, designating the sensory
root of the fifth pah of nerves, and p, which designates the fibres from
the posterior column forming part of the restiform bodies, or processus
e cerebello ad medullam oblongatam.

CEREBELLAR FIBRES OF THE ANTERIOR COLUMNS. 227

Rolando* describes the superficial cerebellar fibres of the
anterior columns, those which are seen without dissection,
(the processus arciformes of Santorini,) under the name of
“ filament! arciformi,” saying, “ 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 pene-
trate into its centre. The filamenti arciformi nevertheless
descend and partly cover the above-mentioned cords, ex-
panding on the corpora olivaria, and extending 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, proceeding 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,f are described as passing also to the cerebellum.
In a paper which was read before the Royal Society in May

* Op. cit., vol. i. p. 147.

f 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
qnadrigemina. Mr. Mayo is almost the only author who points out the
fart, 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 Physiology, 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 3rd edition.

Q 2

228

HUMAN BRAIN.

1830, and published in their Transactions, part 2nd, for
1836, I proved that they were connected with the cerebel-
lum as well as with the cerebrum, as allowed by Mr. Mayo
and Mr. Owen, to whom my preparations 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 Sur-
geons. Ihe corpora restiformia, or the processus e ce-
rebello 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
consisting 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 columns with the cerebellum, and
yet have just fallen short of understanding 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 contact with the superior surface of the peduncles of
the cerebellum. Maiacarne 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 spi-
nalis. This omission appears to me to have arisen from
their not having paid sufficient attention to the direction of
the fibres and filaments of which these are composed. If
the anterior cords of the medulla spinalis be carefully ex-
amined a little below the pyramids, we see that they send

CEREBELLAR FIBRES OF THE ANTERIOR COLUMNS. 229

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 pre-
viously expanded become convergent, and are found com-
pressed between the pyramidal bodies and the cineritious
tubercles ■* and following them upwards, they are found
strongly compressed, and, as it were, hidden between the
corpora olivaria and the inferior peduncles of the cerebellum,
on which account they have eluded the minute investiga-
tions 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 sepa-
rate 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 extremities of the olivary bodies and the pyra-
mids, 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 peduncles 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 : “ 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. Never-
theless, 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 cineritious tubercles are described as bodies situated on the lower
part of the restiform bodies,
t Op. cil., p. 149.

230

HUMAN BRAIN.

I lie best method of dissecting the medulla oblongata
with a view of demonstrating clearly the existence of those
fibres which connect the anterior columns with the cerebel-
lum, is, either to split the posterior column from the antero-
ateral column by raising only the posterior columns, or, in
othei w orcls, 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 towards the cerebellum, the dissector will
mid 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
neives, 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 resti-
forme. The second, or deep, set of the cerebellar fibres
are represented cut through in their passage to the cerebel-
lum 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 in-
teresting 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 fol-
lowed by paralysis, all tend to prove that the cerebellum is
in some way or other connected with the regulation of mus-
cular 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

FUNCTION OF TIIE CEREBELLUM.

231

enable us to stand, walk, &c. Even Broussais, in his lec-
ture 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 presence also proves the weakness of Mr. A\ alker s
theory of the function of the posterior columns as derived
from the supposed fact that the posterior columns alone are
connected with the cerebellum.

This circumstance is also at variance with the opinions of
M. Eoville, who reasoris that the cerebellum must be con-
cerned 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 foun-
dation upon what he considers an established fact in ana-
tomy, 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 noth 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 verte-
brated animals belong respectively to the two principal
functions of animal life, which are, first, sensation, conscious
perception, and the physical phenomena related to intelli-
gence ; and, secondly, those of voluntary motion. This,
however, can only be considered as a probable opinion.
Such it has long been thought by many physiologists ; and
though the grounds on which this conclusion rests appear
to be more secure than they formerly were, the proof is still
defective.”

* Diet, de Mdd. et de Chirurg. Prat., tome vii. p. 202, art. Ence-
phale. “ Or nous voyons les cordons posterieurs de la moelle, affeetds a
la sensibility, se prolonger dans le cervelet ; les cordons anterieurs, affect4s
au mouvement, s’entrecrosier dans les pyramides, poursuivre apres cet en-
trecroisement leur marche vers le cerveau, dans l’epaisseur duquel ils p6ne-
trent tr£s profondement ; et nous trouvons ainsi une raison anatomique de
supposer que le cervelet doit avoir il remplir un role tres-important dans
le3 phynomfcnes relatifs a la sensibility, tandis que le cerveau jouirait
d une influence directe et centrale sur la production des mouvements volon-
taires.”

232

HUMAN BRAIN.

This 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 exposed continuously
from the pyramidal body (t), through the pons Varolii (x), which has been
partly removed on that side, forming (u) the under part of the crus cerebri,
plunging to the corpus striatum (m), emerging (mmmm) from thence, and
running forwards, forwards and outwards, outwards and backwards, to the
whole extent of the hemispherical ganglion (b b b). The course of some of

The anterior portion of the anterior columns, that which
is usually called the corpus pyramidale (t, fig. 72, 85) mav
be now traced through the pons Varolii ; but before doing
so, the student had better make himself acquainted with
the structure of the commissure : for this purpose let him
refer to the description of the commissures.

Fig. 91.

MOTOR TRACT.

233

the fibres of the superior longitudinal commissure, and also some of the
fibres of the great commissure, are shown, bbb. 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. mm. Corpora striata, n. Anterior pillars of the fornix run-
ning 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 lobes. a p. Anterior extremity of ditto,
s. Corpus olivare. t. Corpus pyramid ale. u u. Crura cerebri, w w.
Corpus restiforme. x x. Pons Yarolii, 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, c. Third pair of nerves, fs, fs. Fissura Sylvii. h n. De-
scending fibres of the fornix over the hippocampal convolution.

If the student pull upwards by means of a scoop director
the inferior edge of the pons Y arolii from the anterior
column or corpus pyrcmidale, he will find it contracted as
it enters tins commissure to a small, strong, rounded cord.

Following this cord behind (see fig. 91, and description)
the most superficial fibres of the pons Yarolii, 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 important 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 con-
vexity forwards ; otherwise he will be liable to tear them
by going too deep at the centre part of their course, taking
them from above to below.

I he fibres thus traversing this body (for, as I have men-
tioned elsewhere, it cannot be considered a mere apparatus
of transmission or commissure ) 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).

1 he crura cerebri thus viewed from below appear to be
mere round flattened cords, consisting only of fibrous
m urine derived from the anterior columns. A perpendi-

234

HUMAN BRAIN.

culai section (as represented in fig. 92, In) demonstrates the
presence of some very dark pulpy neurine • this has been
calied the locus mger • I would rather designate it the ganglion
of the thud pair of nerves , for a portion of the central
extremity of this nerve traverses this grey matter, and is
split by i into five or six filaments, which become con-
nected 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.

Ihese 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 between the medulla oblongata.

In making sections of the pons Varolii, it is a curious
fact that those parts which appear grey on a transverse
section, are white on a longitudinal, and vice versd.

ihe next step in the dissection is to remove the arach-
n°id and pia mater from the fissura Sylvii, through which
fissui e the dissector may insert his fingers, and raising the
middle lobe tear through its connections 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. 7 2, on the left side) ; this band is called the tractus
opticus, 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 overlaps 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,
lie will expose some medullary fibres running from before
backwards ; these belong to the great transverse commis-
sure or corpus callosum. On removing these he will come
to a large deposit or bed (mm), if we may so express it,

MOTOR TRACT.

235

of ciueritious 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-temporal 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 (m m). 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 (ni, m, m, m ) will be exposed. In the
course of scraping the cineritious neurine away, a rounded
band of medullary neurine will be exposed, taking its
course from the circumference of the brain forwards and
inwards : this band is the commencement of the anterior
commissure ( ac ).

The motory fibres, which are thus traced into the sub-
stance 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 hemi-
spheres, the hemispherical ganglia, fig. 91, bbb.

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 tlieh 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 direc-
tion indicated by the dotted line, a b, in fig. 91. The
appearance which this section exhibits is represented in
fig. 92. Ihis 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 Spurzhcim
have given a very beautiful representation of this tract, as
viewed from below, in their larger work on the brain.

Craveilhier* describes these columns as passing through
* Op. cit., p. 716.

23G

HUMAN BRAIN.

the thalami nervorum opticorum in addition to the corpora
, stunt a. The same author also refutes the opinion of lleil
Uall, and Spurzheim, that these fibres are reinforced as it
were or augmented by their passage through the corpora

Fig. 92.

The brain is laid on its upper surface, and a section lias been made
longitudinally through the medulla oblongata, pons Varolii, cerebellum
anterior and posterior cerebral ganglia, fornix and corpus callosum, ante-
1101 commissure and left hemisphere of the brain, in the direction indicated
by the dotted line in fig. 91. i & c. Inter-cerebral commissure, c D.
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, a c. Anterior commissure, o t. Olivary tract, n i. Pyramidal
tract, s t, st. 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 :* —
“ Utrum cinerea substantia quae in exteriore cerebri am-
bitu reperitur, cum ilia ex qua partes in interiore cerebro
sitae constant, cohaerent nec ne?” He sums up his obser-
vations as follows :f — “ Substantia cinerea interiorum cere-
bri partium, nominatim striatorum corporum, et collicu-
lorum nervorum opticorum nullo totius sui ambitus loco,

* Op. cit., p. 64.

f Op. cit., p. 69.

MOTOR TRACT. 237

cum ea quae ad exteriorem cerebri ambitum pertinet sub-
stantia cinerea immediata cohaerent.”

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 cere-
bellum; 2ndly. Forming the inferior part of the crus
cerebri ; 3rdly. Plunging 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 division in its upward course from the olivary
bodies through the pons Varolii to the cerebrum, forming
in its course connections with the optic tubercles and
thalami.

The student, after he has traced these fibres of the ante-
rior 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 olivary bodies (figs. 87, 92, s), surrounded by the fasciculi
of white fibres, one set passing before and one behind them.
These two fasciculi reuniting at the upper edge of the
olivary bodies, pass through the pons Varolii (o t, o t),
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 Varolii. 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 u portion of the outer part of the crus ce-
rebri. These fibres run partly behind, partly on the out-
side, 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).

238

HUMAN BRAIN.

This fasciculus has been described by Red* 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 portions ; 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 descrip-
tion does not altogether accord with my own dissection : 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 continuous 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 tear-
ing this piece downwards, commencing the rent in front of
the fillet, and thus separating it from the pons Varolii, its
fibres may be traced continuous 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 thalami, 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,) describes 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 grey matter of the olive.

This author points out more clearly, I believe, than any
* Op. cit., p. 94, part ii.

OLIVARY COLUMNS.

239

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
functional connection between the fibres and the olivary
bodies, that they do not stream through the vesicular neu-
rine as the motor tract does through the corpus striatum,
&c. Mayo, in his beautiful plates of the brain, though he
exhibits these columns (wliicli 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, sufficient evidence to show that the position of the
olivary bodies varies considerably, and in some animals they
are even imbedded in the pyramidal 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 anterior 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. "W e 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 attached 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 external 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 in-
ternal margin of the same band of fibres when it has
ascended the processus 6 cerebello ad testes and is about to

240

HUMAN BRAIN.

enter the optic lobes.”* He also describes the connection of
the portio dura, lingual and abductor nerves with the infe-
rior portion of it.

I he 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 physiologically
a portion of the pyramidal tract.

Dr. Reid describes, and I think justly, the pyramidal
columns as passing into the middle columns after their de-
cussation ; 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 por-
tion of the cord and cerebellum, which I consider an im-
portant anatomical discovery alone due to me.

We must now return to the medulla oblongata for the
purpose of tracing those tracts of neurine which Sir Charles
Bell has proved to be employed in conducting sensation.
It has been already stated that in the composition of the
spinal cord we can observe no line of demarcation by which
the tract of sensation may be distinguished from that of
motion, but that a portion of the cord anterior to the pos-
terior fissure is distinctly ascertained to be appropriated to
this function ; I shall assume, therefore, that the line of de-
marcation 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 re-
ferred to, and consequently named the posterior column, the
other anterior to it, constituting part of the antero-lateral
column. These two portions had better be traced sepa-
rately. 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 an-
terior columns, viz. the corpora restiformia.

In their passage to the cerebellum, as a portion of the
* Ed. Med. and Surg. Journal, Jan. 1, 1841.

SENSORY TRACT.

241

Fig. 93.

constituent fibres of these bodies, they are partly overlapped
by, and partly interlace with, those fibres from the anterior
columns which, ascending to the cerebellum, connect the
motor or voluntary tract of the spinal cord with the cere-
bellum 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 sensory columns.

— The remaining
portion of the tract
of sensation, or that
portion of the sen-
sory column which in
the spinal cord is
anterior to the fis-
sure, from which the
posterior roots of the
spinal nerves emerge,
and whose line of de-
marcation from the
motor tract is about
the middle of the
lateral aspect of the
cord, must next be
traced to its destina-
tion. In the first
place we find it
sending a few fibres,
like the posterior co-
lumns, to the cere-
bellum ; the rest of its fibres ascend principally to the ce-
rebrum.

I he proof that the columns, which we are now about to
trace to the cerebrum, form a portion of the tract of sensation,

R

This drawing is from a dissection made on a
pieceof brain whichhad been hardened in spirit .
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 connected with them. c. Anterior optic
tubercle, d. Posterior ditto, i & c. Inter-
cerebral commissure, or processus h. cerebello
ad testes, h. Spinal cord. k. Thalamus
optici. m. Corpus striatum, u. Crus cerebri,
w. Corpus restiforme. x x. Pons Yarolii.
b. Optic nerve, c. Third pair, b c. Locus niger.
P t. Pyramidal, or motor tract. st,ft,st.
Sensory tract, — the posterior third of the an-
tero-latcral column, sc. Sensory root of the
fifth pair of nerves.

242

HUMAN BRAIN.

is derived from the fact that the sensory root of the fifth
pair of nerves arise from it (see 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 gan-
glia, or posterior pyramidal bodies. From this part they
ascend behind the pons Varolii, where they form the floor

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 re-
spective tracts have been removed, and the posterior part of the cord left.
D p. Decussation of the pyramidal bodies, u s. Decussation of the cere-
bral sensory tract, or posterior tim'd of the antero-lateral column, i & c.
Inter-cerebral commissure divided. K. Posterior extremity of the thala-
mus nervi optici. K k. Divided end of the same. g. Corpus geniculatum
externum, u. Crus cerebri, u u. Divided end of the same. w. w. Cor-
pora restiformia. c. Third pair of nerves, ca. Corpora albicantia.
e s. Sensory root of the fifth pair. I n. Locus niger. s t. Cerebral sen-
sory tract, p v. Dotted lines marking the situation and width of the
pons Varolii, behind which the decussation takes place.

* I am delighted to find that Stilling, in his new work on the Pons
Varolii, has accurately figured all these fibres.

SENSORY TRACT.

243

of the iter a tertio a quarto ventriculo. In this situation
they decussate with their corresponding fibres on the op-
posite side (see fig. 94).

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 decussation. The best mode of
demonstrating this interlacement is first to separate the
medulla oblongata, with the pons Varolii, crura cerebri,
and optic thalami, from the rest of the brain. Secondly,
divide the pons Varolii anteriorly, in a longitudinal direc-
tion, through the centre to the depth of half an inch ; divide
the pyramidal decussation j then take the 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 liga-
ture 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 demonstrated ante-
riorly, 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 crus cerebri, separated in that body

* Foville does not describe any decussation of the posterior columns,
but he figures this decussation, though, as it appears to me, in an exagge-
rated manner. “ PI. 2 (Foville), fig. 4. f. Point of the calamus : from
this point, up to c', may be observed the mitre cromemeiit 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 decussa-
tion of the pyramids. Tint in separating the posterior median fissure of
the bulb and protuberance just below the tubcrcula quadrigeminn,
M. F oville has pointed out a superior interlacement, which, without doubt,'
effer-ts in part, a union between those fibres of the antero-lateral columns
which Rolando described, and Cruveilhier designated the fasciculus of
reinforcement of the bulb, or fnitrmu invonuf”

R 2

244

HUMAN BRAIN.

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 tuber-
cles and the inter-cerebral 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 optici.

4 he 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 cineritious; the two
appear more intimately mingled. From the outer side of
the posterior cerebral ganglion the medullary fibres issue
forth, spreading in every direction until, meeting with the
convoluted surface of the brain or the cineritious neurine of
the hemispherical ganglia, their progress is arrested and
their course terminated.

A side view of the course of this tract through the pos-
terior 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 appro-
priate 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 striae
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 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 repre-
sent the final distribution of the portions of the nervous
matter which are dedicated to sensation and volition.”

SENSORY TRACT.

245

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 corre-
sponding 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. Commencing 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 Yarolii , 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
cam 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 pos-
terior being the testes, the anterior the nates.

The structure which has been likened to the stalk of the
tree, will be recognised as the commissure connecting the
greater cerebral mass to the lesser, in other words, the
cerebrum to the cerebellum ; this is,

246

HUMAN BRAIN.

5. The inter -cerebral commissure.

Beneath the optic tubercles we observe, rising up, as it
weie, fiom the pons Varolii, a structure previously men-
tioned, namely,

6. The crus cerebri. A section of this part shows it to
consist of medullary neurine above and below, with cineri-
tious interposed between the two. The medullarv 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 considerable size, being about the same
dimensions as the pons Varolii, called,

7. The thalamus nervi optici by anatomists of the old
school, the posterior cerebral ga?iglion of the cord by more
modern teachers.

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 longitudinal 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, ancl 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
horizontal section (figs. 77 and 78) and perpendicular section
(fig. 95).

These ganglia do not consist of one single layer of cine-
ritious 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 strati-

HEMISPHERICAL GANGLION.

247

fication is still more evident after disease. When the corti-
cal substance has been long the subject of chronic inflam-
mation, 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 upper surface is unnaturally flattened. It exhibits
a transverse section of the brain taken a little posterior to 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 motor tract, 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 light side of the figure between the two B b.

To the superficial observer this ganglion appears to con-
sist 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 grey 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
inore distinct in the posterior than in the anterior convolu-
tions. \'icfj d’Azyr first pointed this out in the posterior
portion of the brain, and Casanviclh demonstrated its exist-

248

human B11A1N.

ence throughout the whole* M. Baillarger, in 1840
stated that under the microscope, this ganglion will be

lound to consist of six layers, three of grey alternating with
three of white. °

The first, going from within to without, is grey: the
second white ; the third grey ; the fourth white ; the fifth

grey ; and the sixth white (see fig. 96, left half of the
drawing).

Fig. 96.

Fig. 97.

Fig. 98

Fig. 97.— Magnified representation of the cortical substance of the brain
ol the sheep. (Baillarger.) The left half is seen as an opaque object ; the
rujht as a transparent one. Left half. — b. Tubular neurine of the hemi-
spheres. 1, 2, 3, 4, 5, 6. The six alternate layers of grey and white
neurine. Jiight half. — 1 he white substance looks dark, and the grey
neurine light. The numbers the same.

Fig. 98. — Convolution from the human brain, single aspect ; six alter-
nate layers.

Fig. 99. — 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 grey being transparent, and the white opaque (see the
right side of fig. 96).

This author states that he has examined the grey sub-
stance of the hippocampus, and that he has found it strati-
fied like that of the convolutions, 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
* M6m. de l’Acad. de M6d., tom. viii., 1840.

COMMISSURES.

249

summit of the convolutions, become shorter and more scanty
at their base. At the bottom of the antifractuosities, 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 grey, as has been usually supposed.
This colour is most evident 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, 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 gan-
glion. In the brain of the bud 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 stu-
dent must remember that the commissures or apparatuses
of union can only be thoroughly understood, and their
exact connections and relations appreciated, after a diligent
consideration of the exact relative position of the different
ganglia which it is the office of these commissures to con-
nect together.

Spurzheim confines the word commissure to designate
structures which connect corresponding parts, and applies
the term instruments of communication 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 convolutions, as
well as the general exact correspondence or symmetry of

* Supposing the student only to have one brain at his disposal, lie
must replace the portion of the right hemisphere which he removed when
directed to make the section exposing the centrum ovate.

250

HUMAN BRAIN.

the hemispheres of the brain, be remarked. The great
fissure separating them longitudinally is deep; at the bot-
tom of it a broad band of fibrous or medullary neurine
will be observed : this is the great transverse commissure, or
corpus callosum (figs. 77, 92, 95, 99, 100, p, the same letter
m ail). .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 shail consider
under the head of commissures all those collections of me-
dullaiy 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 hemispheres;
or different organs on the same side, as the various con-
volutions of each hemisphere ; or two distinct structures, as
the two grand divisions of the encephalon, the cerebrum
and cerebellum ; thus following out to its fullest extent the
principles which have been laid down elsewhere, 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 im-
mense size connected together by commissures of corre-
sponding dimensions.

Transverse Commissure. — The great transverse commis-
sure* or corpus callosum, is a body consisting of fibres
of medullary neurine, the extremities of which are every-
where in contact with the internal or central surface of the
cineritious layer which forms the convolutions of the hemi-
spheres,— the hemispherical ganglia. These fibres conse-
quently establish a communication between the cineritious

* Yicq d’Azyr was the first anatomist who described the corpus cal-
losum as a commissure, while, on the other hand, Rolando denies that it
is entitled to the name of a commissure ; for, says he, “ laying toge-
ther 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. cit., p. 72.

COMMISSURES.

251

neurine of the whole convoluted surface of both sides of
the cerebrum.

Fig. 99.

1 his figure I sketched from a dissection which I made in company with
my friend Mr. Grainger, whose testimony of 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 commissure of the hemispheres or corpus callosum. The dis-
section has only been earned into the right hemisphere. It will be seen
that these fibres ascend to the convolutions above the mesial line, ppp,
fibres of the corpus callosum radiating into the hemispherical ganglion.
B. Left hemispherical ganglion, undissected, 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 torn off was traced
most carefully into the convoluted surface of the brain.

Strictly speaking, the fibres of the great transverse com-
missure do not commence on one side more than another ;
but with the hope of assisting the mental eye in following
their course from hemisphere to hemisphere, these fibres
shall be described as originating on the right side and
crossing oveT to the left. The fibres from the front, sides

252

HUMAN BRAIN.

and superior 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 cerebrum, 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 situa-
tion the fibres are folded one upon another ; so that on a
transverse section of the commissure the anterior edge ap-
pears thicker than the centre, though it is not so thick as
the posterior edge (see fig. 100).

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 sur-
face of the posterior 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 commis-
sure.*

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

* M. Eoville, op. cit., gives a very different account of tlie nature of
tlie 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 commis-
sure between the two crura cerebri of a vaulted form. Mayo, in his Out-
lines of Physiology, has very clearly proved the manner in which that mis-
take has occurred, and shown that Eoville 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 commissural fibres
and then follows the columnal fibres in then- course to the striated bodies.
Eolando advances the same opinion regarding the composition of this
commissure as Eoville, 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.

COM MISSURES.

253

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
originate or which they connect, ought not to deceive us as
to then 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 commis-
sure recommended will open the lateral ventricle, as pre-
viously 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 dif-
ferent surfaces of the brain. The external surface of the an-
terior 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 systematic works we do not find any mention what-
ever 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 ex-
hibited 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 he

254

HUMAN BRAIN.

easily seen by removing the surface of the convolutions
Avnere they form the lower part of the outer Avail of the
above fissure.

Fig. 100.

This figure represents longitudinal fibres placed above the great trans-
verse commissure corresponding with those which we have just observed
below it — the 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 arc traced, ascending forwards, from the locus
quadratus, which is anterior to the fissura Sylvii, and then, curving back-
wards and winding round the front of the great transverse commissure (p),
receiving fibres from all the convolutions at the upper and sides of the hemi-
spheres, 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 mammil-
lare, formed by the twist of the fornix, c m. 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.

COMMISSURES.

255

The divided end of the fornix is turned towards us. p. c. Posterior com-
missure. s. T tenia semicircularis joining the fornix at the same point.
This letter is placed in the anterior cornu of the lateral ventricle on the cor-
pus 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, p. Iter a tertio ad quartum ventri-
culum. u. Posterior commissure.

The convolution which is opened to show this commissure
is the “ convolution de V outlet” 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 and back part of the anterior lobe, are placed close
to the locu-s quadratics, in front of the Jissura 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 poste-
rior fibres run backwards in the same manner in which the
anterior rim forwards, terminating in like manner in the
convolutions at the under part of the hemispheres, running
across the fissura Sylvii to the locus quadratics, where we
traced the anterior. No one, I think, can trace this longi-
tudinal commissure without acknowledging the justice of
Spurzheim’s observation, when, after describing and reason-
ing on the composition of the fornix, and the apparatuses of
communication in the brains of the lower annuals, he says,

“ Thus, the especial pains which nature has taken to esta-
blish communications between cerebral parts cannot be
overlooked, and it is this arrangement which enables us to
understand the mutual influence of their functions respec-
tiw-lv. 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 188. The student will again observe a structure,
already briefly noticed, namely, the fornix. In pursuing
trie dissection of this commissure, where we have not more
than one brain at our command, a difficulty arises from its

256

HUMAN BRAIN.

lying ovei and concealing from view the transverse com-
missures 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 commissure,
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 know-
ledge of its complicated relations. The longitudinal commis-
sure must now be divided in the middle, just opposite the di-
vided end of the transverse commissure, but not removed, as
we must return to the study of it j this being done, the poste-
rior portion 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 entirely of cineritious neurine. It con-
nects the two thalami together. This corresponds with
the grey 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 medullary neurine will be
perceived ; this is the posterior commissure ; its fibres may
be traced in the thalami on each side (fig. 100, p c).

Anterior commissure. — The whole extent of this com-
missure 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 ventricle,
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 commis-

COMMISSURES.

257

sure 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 conducted at the base of the brain, where it
M ill 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
hemispheres to pass through the substance of the corpus
striatum or anterior cerebral ganglion, apparently receiving
additional fibres from the cineritious neurine of the most
external portion of this ganglion ; near to the internal edge
of the ganglion, however, the anterior commissure becomes
Cjuite distinct from it, and crosses over to the corresponding-
ganglion of the opposite side, in front of the anterior pillars
of the longitudinal commissure. From the outer part of
this commissure some fibres may be traced to the olfactory
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 dis-
sected ; 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 charac-
ter. But if we make a section through it ure find, in
addition to medullary fibres, there is a large quantity of the

* Ghanssier arid Iiedemann 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 conti-
nuity of fibre between the peduncles of the brain and the anterior
commissure.

S

258

HUMAN BRAIN.

vesicular or cineritious nomine. The presence of this
neurine gives to it a ganglionic character. This grey
matter is not found in the anterior portion of the commis-
sure, but in the posterior division, where the fibres of the
cord traverse it. Burdacli saw immediately the importance
of this fact, and concludes that its presence has some
relation to the formation of the longitudinal fibres. The
connection of the commissural fibres to the cerebellum will
be given in the description of this organ.

Inferior longitudinal commissure , or fornix * — The com-
missure to which we must next direct our attention is the
inferior longitudinal commissure or fornix (see fig. 101), which
having been divided in its centre in the course of the pre-
ceding 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 the inferior longitudinal commissure or
fornix, which may he described as commencing in the centre of the thala-
mus nervi optiei (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

* Cruveilhier, when speaking of the fornix, p. 720, says, “ Shall it be
considered as an anterior posterior commissure? ” As a circumstance favour-
able to this view, I recal to mind that I have seen the right half of this
vault atrophied in a case of destruction of those cerebral convolutions which
lie on the tentorium cord.

COMMISSURES.

259

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, constituting that portion which is called the body of
the fornix (e) ; descending again at the back pail of the brain it forms the
descending or posterior pillar of the fornix l cent a hippocampi (f), some
of its fibres running back to be connected with the posterior lobes (i) ;
others crossing the projection called hippocampus major (g), to be con-
nected with the middle lobe, and others again passing over the pes hippo-
campi (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
commissure, and on the same side of the mesial line. a. Fibres of the
inferior longitudinal commissure, or fornix, from the locus niger. b. Cor-
pus mammillare. c. Anterior pillars of inferior longitudinal commissure,
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 hippocampus major.
H. Fibres covering the pes hippocampi, i. Fibres covering the hippo-
campus minor, k. Great transverse commissure divided in the mesial
line. s. Posterior cerebral ganglion, or thalamus. 1. Anterior commissure.
5. Section of the eras cerebri. 6. Locus niger. 7. Anterior cerebral
ganglion, or corpus striatum, partially scraped away.

This part lias not been generally described in the light of a
commissure. By Vieussens it was considered simply as the
under surface of the corpus callosum ; but the direction of
its fibres being so entirely different, that is, being longitu-
dinal instead of transverse, it is impossible to agree with
that celebrated author in this view of the relations of the
fornix. Ihe 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 inferiorly,
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 description considerably elucidated.

I he general form of the fornix may be described as that
of a vaulted roof supported upon four pillars, which, unlike
pillars in general, arc bent nearly double, the anterior pair
presenting their concavity forwards, the posterior pair theirs
backwards. Its real character, and the direction of the
fibres composing it, will be ascertained by making a section

s 2

200

HUMAN BRAIN.

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
cpiite close to the inner side of that ganglion, the incision
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 dis-
section 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 cere-
bri, 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 lon-
gitudinal commissure may be traced to the corpora rnarn-
millaria, 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. 100, 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 thalamus, first runs directly inwards,
then turns suddenly forwards and forms a sort of knot, such
as we can imitate exactly by means of our handkerchief or
soft cloth. This arrangement is very well delineated in
Langenbeck’s Plates of the Brain ; it has been described
and designed by Vicq d’Azyr. Red was also aware of its
existence. Cruveilliier states that he has traced it to a con-
nection 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

COMMISSURES.

2GI

used to be called the anterior pillars of the fornix, 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 tcenia semicircularis — running in
a groove between the thalamus and corpus striatum ; the
tcenia semicircularis commences (see fig. 100, s ) from the
middle lobe in the descending cornu of the lateral ventricle,
and is continued through the body of the lateral ventricle
into the anterior 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 passage backwards under
the great commissure (corpus callosum), to which it is at-
tached, 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 hippocampus 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 (Observationes
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, “ pro fornicis ipsius cruribus.”
Haller referred them to the corpus callosum, considering
them as continuous with its structure, saying (Commentaria
ad prselectiones academicas, H. Boerhaave, tome ii. , Tau-
rino 1743,-4, p. 509), “Nobis imprimis taeniae continuae
videntur fomici tubera fornix ad tantum horurn corpora m
molem, neque posteriores pedes hippocampi facere possit.”

I believe that I was the first to describe the septum Tucidum as con-
sisting of longitudinal fibres, and thus forming a portion of the longitudinal
commissure.

t 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 con-
struction, and the fornix as a whole he views ns merely a portion of the
corpus callosum.

262

human brain.

Gunz (Prolusio, Observations anatomicas de cerebri

that the corpus fimbriatum, as it is
pillar of the fornix.

In this division of our subject it will, I think, be ad-
visable to inquire into the real character of these hippocampi
and the relation they bear to other parts of the brain.

it 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 bv
a thm layer of medullary fibres. The cineritious neurine
is on the same plane, and continuous with the convolutions
at the base of the brain, and is in reality a true convolu-
tion ; the medullary fibres come from the under part of the
cerebrum m various directions, and being collected at the
mnei edge of this body, form what have usually been called
the posterior pillars of the fornix, or the taenia hippocampi,
but which we must regard as the posterior descending
extremity 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 con-
tinuation 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 longitu-
dinal 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 proba-
bility it has its peculiar and individual office to perforin in
relation to the sense of smell.

TV enzel was aware of its real character, justly observing,
(p. 141,) “ Hippocampus ergo, manifesti nihil aliud est, nisi
continuatio superficii cerebri intro flexa, sive in imam late-
ralium ventriculorum partem ; sive hippocampus nil est nisi
unius gyrorum in superficii cerebri sitorum in interius cere-
bri prolongatio.”

The hippocampus minor is in some respects analogous to

COM MISSUUES.

203

the hippocampus 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 poste-
rior 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 peripheral surface, as is the case in the hippo-
campus major.

This account of the fibres which enter into the compo-
sition of the inferior longitudinal commissure will prove to
the student that this structure 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 between
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 favour of the opinion, that this ganglion, though anato-
mically 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 descriptions 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-cerebcllo commissure.
— The remaining commissure which demands our attention

264

HUMAN BRAIN.

consists of medullary fibres connecting the two great cere-

ia masses, the cerebrum and the cerebellum, together as
well also as the optic tubercles and the cerebellum; 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).

. constituent fibres of this commissure are not so
simply arranged as we might in the first instance be in-
clined to suspect. To me they appear to be divisible into
three sets ; and as they are all collected together at the
point where they enter the cerebellum, we shafi describe
them from that point forwards.

1st, I lie most superior, those in fact which form the
surface of the processus b cerebello ad testes, and the
valve of Vieussens, may be traced distinctly to the optic
tubercles.

2ndly, The external : these form the external surface of
the processus b cerebello ad testes, and may be traced to
the side of the optic tubercles, and thence to the optic
thalami, and as far as I can discover, though I cannot
speak decidedly, through that ganglion to the hemispheres.

3rdly, 1 lie third and last set are the deep or descending
fibres : these may be seen by first dividing the cerebellum
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 commissure, it will be
found that some of its fibres descend, and in so doing in-
terlace 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 commis-
sure or fornix which takes its origin at that point. See
fig. 107, i & c, representing the relation of the fifth pah*
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

COMMISSURES.

265

time that beautiful appearance, which from its resemblance
to the branches of a tree is called the arbor \itce, observed
distinctly exposed.

Fig. 102.

c. Anterior optic tubercle. D. Posterior ditto. E. Cerebellum divided,
showing the arbor vitae. F. The decending fibres of the inter-cerebral
commissure, i & c. Another portion of the same commissure, u. Crus
cerebri, x. Commissure of the cerebellum divided, z. Portion of the
olivary tract and restiform body, divided from the cerebellum, and raised
so as to show the motor origin of the fifth pair of nerves (e). c. Third
pair of nerves, d. Pourth pan- 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 longitudinal.

The transverse commissures, six in number.

1. The great transverse commissure of the hemi-

spheres, or the corpus callosum.

2. The pineal commissure.

3. The posterior commissure, or commissure of the

posterior cerebral ganglia, or tlialami nervorum
opticorurn.

4. The soft commissure, or commissure also of the

posterior cerebral ganglia.

5. The anterior commissure, or commissure of the

anterior cerebral ganglia or corpora striata.

6. The commissure of the cerebellum, or pons Varolii.

266

HUMAN BRAIN.

longitudinal commissures, four in number
I. ihe superior longitudinal commissure.

- o’ ri!ie mferior 'ong'ludinal commissure, or fornix.

i 6 ^n^er‘cere^ral commissure, or processus e cere-
r ^ bello ad testes, with the valve of Vieussens.

4. i'lie olivary commissure.

Ike cerebellum- This portion of the encephalon is situ-
ated in the posterior division of the skull beneath the cere-
brum. In the human subject it is more completely over-
apped by the cerebrum than in any other animal.

The portion of the skull in which it is contained is bounded
supenoily by the tentorium, by which it is separated from
the posterior lobes of the cerebrum, posteriorly and infe-
i loily 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 occipital bone, and thus to its position in the neck,
is very clearly exhibited in fig. 71, e, and should be re-
flected upon by the student before he removes the cerebel-
lum from the cerebrum, in order to study its external con-
figuration and dissect the course of its fibres. Tor he can-
not 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 rnater and arachnoid must next be carefully and
entirely dissected from every portion of it, as well as from
the pons Varolii and medulla oblongata.* This having

* The following directions are given by Kcil, for the preparation of the ce-
rebellum. “ 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 inflammation of
the brain has existed, the membranes are not easily separable. The cere-
bellum may be detached by dividing the crura cerebri above, and the me-
dulla oblongata below ; it should then be placed in a basin under water,
and the membranes removed with the forceps ; the membranes are pre-
vented 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

CEREBELLUM.

2fi7

been done, and its superior face observed, it will be found
to consist of innumerable laminae, separated by furrows
which take a curved direction, the concavity forwards, and
convexity 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. cl. Internal part
of the inferior semilunar lobe. eSs /. Superior vermiform process, g.
Commencement of the valley, k. 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 Red
as a commissure, but it does not appear to me to be an

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 sub-
stituted, 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
greyish colour, 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.”

268

HUMAN BRAIN.

apparatus of union, but rather a centre of power placed in
the mesial line, and connected laterally with the two hemi-
spheres, perfectly analogous to the cerebellum of all animals
below the Mammalia. Reil, himself, states that in the
biain 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 laminae of it
curve forwards, while those of the lateral lobes on each side
ciu've backwards.

Viewing the superior surface of the cerebellum, we ob-
serve the lateral lobes are again subdivided (103) by a deep
fissure, into a lobe of a square shape (b), situated anteriorly ;
and a semicircular-shaped lobe (c) on the posterior margin.
The lobul us quadra tus is bounded by the fissure of the an-
terior margin, the semilunar fissure of Reil, in which is
situated the pons Varolii.

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 fissure, cl. In-
ferior semilunar lobe. e. Slender lobe. /. Biventral lobe. cj. 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 cere-
bellum. o o. Crura cerebelli.

At the posterior extremity of the superior surface a deep
and wide notch also occupying the mesial line may be ob-

■ CEREBELLUM.

209

sewed. 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 l>v 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 and medulla oblongata when they are re-
moved 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 ob-
serve another worm-like process, the processus vermiformis
inferior, connecting the two lateral lob eg, and partly filling
up the valley. This vermiform process is laminated in the
same manner as the lateral lobes ; it is divided by Red 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 back-
wards, cutting so deeply into its substance that Reil has de-
scribed 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 smallest ;
it is more separated than the rest, and stands out from the
inferior edge of the pons Varolii close to the corpus resti-
forme, like a cauliflower on a stalk. This first lobe is called
by Reil the flock (fig. 104, hi), and stated to be absent in the
lower animals. Immediately behind the flock, lying in con-
tact with the restiform bodies of the medulla oblongata, is
the tonsil-shaped lobe, or amygdala of Reil (y) ; 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 semilunar
lobes (</).

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 configu-
ration the student must proceed to the more difficult and
important question of its internal structure. First, the nr-

270

HUMAN BRAIN.

rangement of its grey neurine which forms its ganglionic
portion.. The arrangement of the grey neurine in the cere-
bellum 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 hemispheres, is of
immense extent, requiring in the same manner to be folded
UP 111 or(ier to pack it into the small space devoted to its
reception. Ihe term laminated ganglion of the cerebellum
might be advantageously employed to designate it.

Fig. 105.
/

(t

Posterior surface of the cerebellum and spinal cord. a. Spinal cord.
e. Amygdala, f. Biventral lobe, g . Slender lobe. li. Inferior semilunar
lobe. i. Superior semilunar lobe. k. Square lobe. I & m. Superior ver-
miform 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 perpendicular and horizontal sections, as directed
further on.

The only grey 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 horizontal 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, kernel of the cerebellum , &c., was denominated by
Spurzheim the ganglion of the cerebellum.

“ Vicq d’Azyr,” says this author (see p. 121), “believed

CEREBELLUM.

271

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 colour 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 colour pos-
sessed 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.

Red (p. 33, Mayo’s Physiol. Com.) compares the lami-
nated arrangement of the medullary and cineritious matter
of the cerebellum to the “ plates of a voltaic pile.” I do
not see the correctness of this simile. Indeed, this arrange-
ment seems rather a necessary part of that admirable con-
trivance which we observed carried out in the hemispheres
of the cerebrum, for obtaining an extensive surface of grey
neurine placed upon and in close connection with a corre-
sponding amount of white fibres ; inasmuch as the grey
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 cere-
bellum merely anatomically, reserving for future considera-
tion the physiological question, which of them belong to
the motor, sensoiy, 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.

I lie collected bundles from which we arc supposing them
to emanate external to the cerebellum, arc described as the
peduncles of the cerebellum, and named from their position,
/superior, inferior, and middle peduncles. These terms’
though un physiological, it is, perhaps, convenient to retain.

rlhe great transverse commissure of the cerebellum, or
pons Varolii, had better first engage the student’s attention.

272

HUMAN BRAIN.

n his pievious dissections he has observed how*the anterior
and posterior columns of the cord traverse its central por-
tion. 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 A arolii upon its under surface, and raise with the
nngeis all those laminae of the cerebellum which overlap it
as it enters this ganglion. And by taking a pinch, if I
may so say, of these laminae, and tearing them upwards 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 cere-
bellum on which I feel more certain thaji another, it is the
fact that the fibres of the pons Abarolii are in connection with
the whole of the laminated ganglion or cirfferitious surface
of the cerebellum.

They do not appear so intimately connected with the
dentiform ganglion 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 6 cerebello ad medullam oblongatam, consist-
ing, as before stated, of motor and sensory fibres. The
best mode of following them to their destination 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 two 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
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 direction of fibres.

The student should next divide the whole of the trails-

CEREBELLUM.

273

verse commissure or crus cerebelli, carefully avoiding the
inferior peduncle, or restiforni body ; and tearing this com-
missure in the same direction as before, upwards and
inwards, the fibres of the restiform body will be seen
running 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 posi-
tively the extent of the connections of the fibres of the res-
tiform bodies ; but my belief is that they do not pass late-
rally, 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 animals 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 com-
missural, 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 sub-
stance of the cerebellum by first raising those laminae of its
superior vermiform process, 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 dentifonne of the cerebellum to the
posterior laminae, 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
f rom the outer side of the cerebellum to the superior vermi-
form 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.

T

274

HUMAN BRAIN.

I hose fibres ol this peduncle, which arc apparently de-
rived from the motor tract, will be most clearly demon-
strated by dividing the cerebellum into two halves, then
dividing close to the cerebellum that portion of the pons
Varolii called the eras cerebelii, and the corpus restiforme.
It the cerebellum be now raised, tearing up the inter-cere-
bral 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.

The physiological analysis of the cerebellar fibres is simple :
First, there are transverse commissural fibres in the shape of
the pons Varolii, or great transverse commissure, connecting
the whole corresponding surface of the ganglion of thecerebel-
lic hemispheres. Secondly, longitudinal commissural fibres,
the inter-cerebral commissure connecting the cerebrum and
cerebellum. Thirdly, motor fibres passing from the cere-
brum in common with the rest of the motor tract through
the corpus striatum, or crus cerebri, entering into the compo-
sition of the superior peduncle and terminating in the supe-
rior and inferior vermiform 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
cerebcllic fibres of the anterior columns. Fifthly, and lastly,
sensory fibres from the posterior columns of the cord, form-
ing likewise a portion of the restiform bodies, and termi-
nating in the two vermiform processes.

Let the student now call to mind the simple form in
which the cerebellum 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 Rcil, p. 205, whose
account of the development of this organ I have followed
almost literally, and which will be found peculiarly interesting

CEREBELLUM.

to the student after he has thoroughly mastered its anatomy
in the human subject,) “ represents indeed a vermiform
process alone, and wants the lateral parts, which are super-
added 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 (Fliigeln) 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 im-
provement in the cerebellum takes place at its anterior and
upper sm-face ; while on its under surface the parts remain
contracted and shrunken. The vermiform processes predo-
minate 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 pro-
cesses, with their wings, constitute one whole, between the
parts of which the freest communication seems to exist,'
which the employment of offsets would interrupt.

<! In the brain of the hare there is little more than a
vermiform process: 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
<>be in order is broad, of some length and depth, but has
laterally short projections, not equal in their breadth to

t 2

276

HUMAN BRAIN.

half the length of the vermiform process ; these, however,
may be viewed as wings. In the third lobe the organ is
contracted, and lias 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 oblon-
gata, 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 exchanged for the lobes of the
inferior surface, which unite with the inferior vermiform
process. The whole cerebellum seems indeed pressed
backwards, as its parts become more complex ; so that the
central lobe continually 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 compressed from above down-
wards. The next lobes of the vermiform process 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 then’ 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

CEREBELLUM.

277

the central primary portion ; to which new processes, as
wings or offsets, are continually 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 cere-
bellum 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 cerebellum, 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 vermiform
process on either side. It is remarkable that the human
cerebellum, the most complex in its structure of any, should
yet exhibit a resemblance of the clearest kind to the primi-
tive and elementary form. When the human cerebellum
is placed with its usually horizontal axis in a vertical direc-
tion, it may be rigorously compared with the cerebellum of
birds : what in the latter case is a single lamina, is here
subdivided, 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 project on each side,
like the fin -like feet from under the shell of the turtle.

“ I*1 proportion as the lateral parts increase in the shape
of offsets or wings, the vermiform processes become smaller,
as if compressed towards the cejitre. This circumstance is
most apparent in the human brain : the vermiform pro-
cesses are there comparatively diminutive in every dimen-
sion, in length, breadth, and depth : before them spring
out the horns of the semilunar fissure, behind them tho
projecting margin of the purse-like fissure: within the
latter, and at the place of the spigot and nodule, the infe-
rior vermiform process is scarcely a few lines in breadth.
In animals the vermiform processes overtop the lateral
portions ; in rnan the upper surface of the general commis-
sure is only on a level with the hemispheres, while below it
is contracted and shrunken to the bottom of the valley.

278

HUMAN BRAIN.

I his compression of the general commissure on all sides in
the human brain, accounts for the difference observable in
its structure as compared with that of the hemispheres ; a
difference 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 vertical and horizontal process, where the
nucleus of the general commissure 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 ot the superior vermiform process
there arc 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 lamime
of the superior vermiform process looks forward. In these
furrows, by which the lateral limits of the superior vermi-
form process are defined, blood-vessels are lodged : these
furrows 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 median 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
constitute the whole of the cerebellum, and in quadrupeds
the principal portion ; in human beings, where then- rela-
tive 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 con-

IMTUITARV (1LANU.

27!)

sidered as the general commissure, by which the lateral
portions are intimately united. , ,

Tuber cine-re ton, infundibulum, und pituitary gland. Jhc
only parts of the brain which now remain to be noticed
are situated at its base, namely, the tuber cinereum, in-
fundibulum, 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 substance, and the longi-
tudinal commissure deriving several from it, 1 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 situated 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 sphenoid 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 tissue accompanies
the blood-vessels, which are found in it in great numbers.
Its substance is soft, but not so soft as the cerebral matter,
and when pressed between the fingers is reduced to a
greyish pulp, like the substance of an absorbent gland in
an early stage of suppuration.

280

HUMAN BRAIN.

It is larger in the infant than in the adult, and more
developed m some of the Vertebrata than in man We
have already observed its great size in fish. Some ana-
tomists have supposed that the pituitary body is the cere-
bial ganglion of the sympathetic nerve; and to me this
appears a very probable hypothesis.

Di. iodd does not consider it a ganglion, but says, “ It
limy with more propriety be classed with the glands without
c erent ducts ; and from its numerous vessels and close
relation to part of the venous system within the cranium
it may be connected with the process of absorption 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, uuth their ganglia, constitute the brain or ence-
phalon, being now concluded, it will I think be useful to
take a general review of the subject, by a recapitulation of
what has been stated in detail separately; and we will
revei se the order of our observations, proceeding from
above downwards instead ol from below upwards.

In the first place, we have an extensive surface of cine-
ritious 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.

l hese 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
anterior columns of the cord, as previously described — the
motor tract : 2nd, others commencing in the nerves of sensa-
tion, and after passing through the pons Varolii, and emerg-
ing from the substance of the thalamus, terminate in the
same neurine that gave origin to the last ; this is the sen-
sory tract : 3rd, 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

RECAPITULATION.

281

mass, form between the hemispheres that wide bridge, if 1
mav so call it, the great transverse commissure, or corpus
callosum : 4thly and lastly, in contact with all the convo-
lutions are the fibres of the superior and inferior longitu-
dinal commissures, which, connecting together those con-
volutions which are situated on the same side of the mesial
hue, or different portions of the same hemispherical ganglion,
so far differ from the transverse commissure, which connects
those situated on opposite sides, or the two distinct but
corresponding gangha.

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 how-
ever, in then 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 converg-
ing 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 appropriately 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 restiforme ganglia, the olivary bodies or lingual
ganglia ; the others being the motory and sensory ganglia,
as the corpora striata and tlialami 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
ganglion within the cranium, so that on first removing the
skull-cap nothing 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

282

HUMAN BRAIN.

inmehT twTt1 Sh0Ul? ac3uirc regarding its composition,

amely, that it consists of corresponding or symmetrical

JETt? °f thefmeSial A «& tha/instcad “!•
egarchng the fissures of separation between its different

hS Xir frTS V“S °r cavities> lle must fi^ect

his attention to the ganglia which bound the fissure, and

tolt wr CifeCi COmmissJures’ which> connecting them
• g?I 5 cross the fissure and necessarily alter its character
different points, masking it, it is true, but not at any

thiG ^fUre into a tme baS or circumscribed
/ y*, The third, the iter a tertio ad quartum ventricu-

um, the fourth, and fifth ventricles, we have already seen
are in truth no more than the successive dilatations 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 dissecting the brain, but which seem ne-
cessary and obvious where its parts are traced in connec-
tion 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 com-
ponent parts of the encephalon will really simplify the
whole of its anatomy, and materially assist the student in
acqumng a knowledge of its true character. I wish that
custom did not require the student to burthen his memory
with fanciful and unmeaning names, and that instead of
learning a long catalogue of the contents of the lateral ven-
tricles as they are erroneously designated, and puzzling
himself with the absmxl titles of hippocampus major and
minor, pes hippocampi, taenia hippocampi, cornu Arnmo-
nis, &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 envelope this
bulbous extremity of the spinal cord. In the same way
the third ventricle should be described as a fissure sepa-
rating the two halves of the brain, his particular attention
being directed to the commissures which pass across it to

RECAPITULATION.

283

connect 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.

2S4

HUMAN U11A1N.

PART VII.

CEREBRAL NERVES.

Having thus considered both individually and collectively
the various centres of power which constitute the encepha-
lon m man, we shall next direct our attention to the con-
nections of the cerebral nerves, organs which conduct the
mandates of the will outwards and the different perceptions

Connected with the encephalic ganglia and that portion
of the motory and sensory tract which is contained within
the skull, there are, according 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 ad-
dition 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, Avhose office was analo-
gous although their distribution might be different ; 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 distinguishing 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 instance 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

CEREBRAL NERVES.

285

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 pneumoyastric , and the second division is constantly
spoken of by the name of the ylosso-pharynyeal when they
have passed out of the cranium, it seems important that
the two should still be distinguished 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
altogether satisfied of the correctness, in a strictly physio-
logical 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,
and to describe the two together by the name of the common
oculo-mmcidar : for the circumstance of the commissure of
the cerebellum separating their roots is merely accidental
to their arrangement in a physiological point of view ; but
the fact of then- being described as if they were distinct
nerves has frecpiently 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 pecu-
liar nerve, while the other muscles, 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 re-
sulted 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 appropriate 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 Spurzheim ne-
glected to enforce.

If, after this statement regarding the most correct method

286

HUMAN BRAIN.

in a physiological point of view of describing the connection
of the cerebral nerves with the encephalon, the student is

he Inf flXt°f lnf°i“atl01’ ,Up0n 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

ongm,— -more properly point of emergence from, or of en-

tiance of the nerve between the fibres of the cerebral mass

and the actual point, of union between the neuiine of the

nerve and that of the cerebral mass itself.

pair°f nerves> olfactory.— The first pair of nerves
( e numeration commencing at the anterior part of the
biam) encountered are the olfactory or nerves of smell-
they originate on the lining membrane of the nose, and’
entd mg the skull through the cribriform plate of the
ethmoid bone, terminate in the olfactory tubercles or
ganglia, which arc situated in the cribriform fossae of the
same lone. In man these ganglia, whose minuteness as
compared with those of the horse, sheep, cat, dog, indeed
most of the Mammalia, is interesting in a physiological
pom of view, are entirely concealed by the enormously
developed hemispheres. f Each ganglion is connected to
ne 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
tiiese, \v Inch is also the longest, and distinctly medullary
urns down the fissura Sylvii to be connected with the
anterior extremity of the middle lobe : this portion of the
olfactory peduncle is connected with the anterior commis-
sure, as described by Malacarne in his Encephalotomie et
Microceplialotomie, by Rolando, and by Gall and Spurzheim

* MM. de BlainviUe 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 retrograded from the know-
ledge of the ancients, who never described them by the title of nerves.
M illis appears to have been the first to speak of them in connection with
the cerebral 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.

287

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 pos-
terior 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
anatomists. Tieclemann 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 com-
mence in the globe of the eye, from a nervous expansion
called the retina. After penetrating the choroid and scle-
rotic 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, 1
believe, the first who demonstrated by dissection this pecu-
liar arrangement.

rITie object of this contrivance is explicable on the fob

288

HUMAN BRAIN.

Fig. IOC.

lowing principles.* 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 ar-
rangement just depicted to
be correct, (and there is no
reason for supposing it to be
otherwise,) it follows as a
necessary consecpience, that
the outer and inner side of
each opposite retina is formed
by one and the same nerve,
a peculiarity of structure that
goes far to account for the
circumstance so often rea-
soned upon, viz. that a sin-
gle impression is conveyed to
the sensorium, though each
eye receives the impression.
Whether this mode of ac-
counting for it be satisfac-
tory or not, the following
facts are extremely interest-
ing, and not sufficiently
known, viz. that in those

This figure represents that curious
and beautiful arrangement of the
fibres of the commissure in the op-
tic nerve which has been particularly
dwelt upon in the body of the work ;
it is taken, as well as every other
drawing of my own, from prepara-
tions in my possession ; it will not,
however, be the less valuable from
its corresponding, in the representa-
tion of the fibres, to that of Mr.
Mayo’s in his folio work. 1. Other
fibres entering into the composition
of the commissure, mex-ely running
from one side of the brain to the
other, and wholly unconnected with
the retina. 2. Fibres from each
retina crossing over at the commis-
sure to join those on the opposite
side.

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
retinae, as, for instance, in the cod and haddock, the optic
nerves, instead of forming any union or commissure, cross

* 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 pheno-
mena 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, I have been led, by the casual observation of a few in-
stances of diseased vision, to draw some inferences respecting the texture
of that part which has been called the decussation of the optic nerves,
upon which I feel myself warranted to speak with some confidence.”

CEREBRAL NERVES.

289

each other completely, having a membrane interposed be-
tween them : in those tishes, again, whose eyes are situ-
ated so that even a small portion of their retinae correspond,
as in the carp, we find a few commissural fibres ; and in
those whose retinae correspond in every point, as in the
skate, we find the commissure as complete as in the hu-
man being. While engaged in the investigation of this
interesting subject, by the dissection of those animals which
I thought would best, elucidate it, I was informed by Mr.
Wheatstone, Professor of Natural Philosophy at King’s
College, that Professor Muller, of Berlin, had given great
attention to the same subject, and had carried his obser-
vations much 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 derived from the retina of the eye ; for, in addi-
tion 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 concave 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 bv
many authors described as entirely wanting, these commis-
sural fibres are found distinctly crossing the base of the
biam, opposite the usual situation of the optic commis-
sure ; while the small black speck, evidently the rudiment
of the eye, is supplied by a minute branch from the fifth
pair.

W enzel, who enters very fully into the question regarding
the composition of the optic commissure, sums up in the
following words (p. 126) : - — “ Partialis ergo nervorum
opticorurn decussatio, ct evidcns autopsia patens non ex
solis nervorum opticorurn, sed et cxistorum loci unionis
ipsorum, et ex collicorurn nervorum opticorurn, ex simul
surnptorum morbosis affectionibus colligitur : quamquam
sileant hac de re Scemmering, Ackermann et Michcalis.

u

290

HUMAN BRAIN.

Conclusio ista unica et sola ex tarn nmltis observationibus
Cjiias attulimus extra omne dubium esse, nobis videtur.”

In the paper already referred to by Dr. Wollaston, I find
that he supports 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 dissec-
tions of this part. d. 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. wr. 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 {y y) 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-muscular, arising by two roots like the spinal roots of the spinal
nerves, the upper from the grey 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

CEREBRAL NERVES.

2!) I

commissure (i c), but really plunging clown to the olivary tract (o i) as it
ascends to the optic tubercles, e m. Motor or non-ganglionic root of
the fifth pair, arising from the posterior edge of the olivary 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.
(j. 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 anterior columns as they ascend on the corpus restiforme, w.
h. Eighth pair, portio mollis, or auditory nerve, with its two roots embra-
cing the restiform body. i. Ninth pair, or glosso-pharyngeal, and /.Tenth
pair, or par vagum, pluuging into the restiform ganglion, j j. Fibres of
the optic nerve plunging into the thalamus : immediately below these
letters is the corpus geniculatum externum, k. Eleventh pair, or lingual
uerve; the olivary body has been nearly sliced off and turned out of
its natural position : some of the filaments of the lingual nerve are traced
into the deeper portion of this ganglion, which is left in its situation ;
others which are the highest are evidently connected with the pyramidal
tract.

M. P. G. Pelletan, “ Memoire sur la speciality cles nerves
ties 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
ot a millimetre, the band or chiasma being about six times
as large.”

The same author recommends the dissection of either
toetal moles or very young ones, in whom the optic foramen
fttill distinct. “ When 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.”

Ihe mole,” says Muller, (Elements of Physiology, trans-
lated by Dr. Paly, p. 707,) “ has an uncommonly small

optic nerve, and a very delicate chiasma, as Dr. ITenle has
shown me.”

fracing the fibres of the optic nerve in man from its
commissure, we find it a flattened band, which has been
f esignated the tractus opticus. The tractus opticus passes
backwards and outwards, running along the external mar-
gin of the grey matter (tuber cinereum, figs. 72 and 107 i)
winch surrounds the infundibulum. The optic nerve either
transmits or receives a few fibres from this cineritious ncu-
nne, and, travelling backwards, becomes still more flattened

t: 9.

HUMAN BRAIN.

909,

c+> U .<•/

as it passes beneath (the brain being supposed to be in its
natural position within the skull) the crus cerebri (fig. 72, u\
just at the point where that body plunges into the hemi-
spheres. 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
I lie 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 hippocampus 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 thalamus (fig. 106, k). On reaching the posterior
part ot the crus cerebri, the internal margin of this band
diminishes, and great care is required in tracing it to its ulti-
mate cerebral connections. The external surface of the optic
nerve now becomes much widened ; some of its filaments,
vi 'L. those forming the internal margin, run inwards and
become connected with those little nodules of the optic
thalami called the corpora geniculata ; other fibres pass
still further inwards, ultimately terminating in the tuber-
cula 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 gan-
glion or optic thalamus may be distinctly and easily de-
monstrated 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 remaining 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 por-

CEREBRAL NERVES.

29:5

tion is placed beneath the other, and plunges into the sub-
stance of the thalamus (fig. 106, gg), where it terminates.
[ 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, by
making a section longitudinally through the tractus opticus
and thalamus nervorum opticorum (fig. 107).

It must be evident from this description, that, notwith-
standing the assertion of Spurzheim that “ it was a great
error to consider the eminences called optic thalcmi 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 quaclri-
gemina, asserting that they take their origin from the tha-
lamus alone. f This statement is altogether untenable with
the parts before us.

Third pair, or common ocvlo-muscular nerve. — 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 explained, are con-
tinuous with the motory tract of the spinal cord. This is
not, however, the real origin of this nerve ; for if it be
traced carefully, 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 portions : 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 grey neurine, present a

[)<; Tlialarno ct origins nervi optici, &c. Hauiiiae, 1833.
t I’age 'J2, op. eit.

294

HUMAN BRAIN.

beautiful appearance in a fresh brain (see fig. 107, c ).
Mr. Grainger first demonstrated this arrangement to’ me.
lhese filaments, after traversing this deposit of cineritions
matter, reach those fibres which the motor tract sends
tin ougli 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 midway be-
tween the anterior and posterior clinoid processes, where it
enters a space left between the under surface of the dura
mater ami the side of the sella turcica, which wre have seen
constitutes the cavernous sinus. It runs along the upper
part of this sinus, quitting the cavity of the skull at the
foramen laecrum orbitale, and thus entering the orbit,
within which it is distributed to the levator palpebrse, and
to the levator, abductor, and depressor oculi. The more
particular distribution of these nerves will be found de-
scribed 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-wuscular . — The fourth pair of
nerves, also called the pathetic, and the smallest of the
cerebral nerves, emerges from the surface of the inter-cere-
bral commissure, close to the optic tubercles. 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 foramen laccrum
orbitale, they cross above the third pair, and, on then-
entrance into the orbit, are situated to the inner side of
the third pair : they supply the superior oblique muscle ot
the eye.

* Let. me here particularly recommend the excellent practical manual
of my friend and colleague Mr. F. Le Gros Clark.

CEREBRAL NERVES.

2 13 5

Fifth pair, or trigeminal. — The fifth or trigeminal con-
sists of two portions, the one for sensation and the other
for motion. The sensory portion commences by numerous
filaments from the surface of the mucous 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 foramen lace-
nun 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, penetrate 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 below 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 consi-
ders 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 distinct from
it (see figs. 94, 107).

The rnotory portion of the fifth nerve, again, does not
arise, as usually described, from the continuation of the
anterior columns or rnotory tract while passing through the
pons Varolii or commissure of the cerebellum, but passing
beneath the inter-cerebral commissure, very close to the
cerebellum, as designated in fig. 107, runs from this point
downwards to the olivary portion of the motor tract, as it

206

HUMAN BRAIN.

ascends to the optic tubercles. This root of the fifth pair

aLr'L1Sth^mP by Pm Alc°ck’ in his ad^ble

of Annin? ^ 0 ~Nerves ” in the Encyclopaedia

Anatomy parts xi and xn., as arising from the anterior
cokunns of the spinal cord, where they form part of the
nedulla oblongata. I have not yet succeeded in tracing it
so low down as that point. The motor root emerges from

le pons arolii, almost close to the spot where the sensory
division enters it, after which it is applied to the sensory
portion of the nerve. As it then passes through the same
oramen in the dura mater, and enters the temporo-sphe-
noidal fossa, it slides behind the semilunar ganglion to
which it is connected by membrane, but not by neurine.
it quits the skid! at the foramen ovale, and is then distri-
buted to the muscles concerned in the motions of mastica-
tion, viz. the masseter, temporal, pterygoid, and buccinator.

Io 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 sepa-
rated from the sensory portion by a bundle of fibres of the
pons A arolii, 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 ■
upwaids, towards the inter-cerebral commissure or processus
& cerebello ad testes, behind the fibres of which it descends,
until it reaches the medulla oblongata.

Sixth pair, or abduoentes. — 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

CEREBRAL NERVES.

297

some filaments from the sympathetic nerve or cyclo-gan-
gliated 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 trans-
verse 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
pan- 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 physio-
logical 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 pyra-
midale 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 tivo 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 \ arolii, the other division proceeding outwards to be
connected with that portion 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-mastoid canal, it quits the skull at the
inferior orifice ot this canal, where, becoming external, it is
finally distributed to several of the muscles takum’ their
me from the styloid process of the temporal bone,°to the
platysma myoides, and to all the muscles of the face.

hirjh th pair, audi t ary, or portio mollis. — The eighth or audi-
org nerve commences from the pulp which lines the labyrinth

298

HUMAN BRAIN.

f 16 T ' a °1)k:ngata’ beinS connected to the facial nerve
y cellular membrane. On reaching the medulla oblongata
opposite the inferior edge of the pons Varolii, where the facial
nerve emerges, the auditory splits into two portions (fig. 1 08).

riiis figure exhibits the origin of the facial, not as it is usually described,
but as I found it on three preparations which I dissected in succession.
1 lie origin of the auditory, split by the restiform body (w) by two rools,
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 ana-
tomists, but is not usually described so in most systematic writers.

One of these passes through the substance of the medulla
oblongata anterior to the corpus restiforme, and plunges
into its appropriate ganglion,"* the posterior pyramidal body
(fig. 78). The other, which is the posterior division of

* 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 posle-

Fig. 108.

CE11EBUAL NERVES.

299

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
ventricle, forms by its separation three or four white lines,
which are usually very 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
sfrite as not merely the roots of the auditory nerve, but as
connected both with the trigeminal and pneumogastric
nerves.

Ninth pah, or glosso-pharyngeal nerve. — The ninth pah,
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 forwards
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 ; and passing-
down the stylo-pliaryngeal muscle is finally distributed to
the muscles of the pharynx and tongue.

Tenth pair, or pneumogastric. — The tenth pair, the pneu-
mogastric 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

rior roots of tlic nerves, seems to us to differ essentially from them, and
that the ruban grin, or the grey matter on the posterior fasciculus! and
uniter! to the auditory nerve, might (piite as legitimately be assimilated to
a spinal ganglion. We consider the ruban grin as a part of the grey
substance of the posterior fasciculus spread upon the surface of the cere-
bellar ventricle, and concurring to form the roots of the auditory nerve.

I he true ganglia of the auditory and trigeminal arc to us the cerebellar
hemispheres and the vermiform eminences.”

* Anatomic, tome ii. p. 61 4, n.

300

HUMAN BRAIN.

close upon the posterior edge of the corpus olivarc, from
which these filaments probably arise, we have no difficulty
m reconciling the fact of one portion of the nerve behm
destmed for voluntary and the remainder for involuntary
motion and sensation, as the constitution of this nerve is
pioA cd to be by the most accurate experiments and observa-
tions 11ns nerve lias two origins or central attachments,
one to the cerebellic fibres of the anterior columns as they
oim part of the restiform body ; the other may be traced
hiougli the fibres of the restiform body into some grey
matter at the posterior surface of the cord, the restiform
ganglion (fig. 107). This deposit of mentions 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). Stilling
describes this grey matter as the ganglion of the pneumo-
gastric 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 oi the skull by the foramen magnum, and adding
itself as it were to the glosso-pharyngeal and pneumo-
gastric, is from this circumstance called the spinal acces-
sory*

Eleventh pair , or lingual none. —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 co-
lumns of the medulla oblongata usually designated the
Pyramidal bodies, and the corpora olivaria. I believe that
its origin, like all the spinal nerves, is double, one set of
fibres being connected with the brain through anterior
columns of the cord, and the other with the grey matter ;

* “In the medulla oblongata,” says Fovillc (p. 500), “the nerves of
the posterior fasciculus are grouped into two distinct cords of great im-
portance— the pneumogastric and glosso-pharyngeal.” His description
of their origin is most meagre and unsatisfactory. He states that the
arciforin 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 flip roots of the pneumogastric and glosso-pharyngeal nerves.”

CEREBRAL NERVES.

301

the olivary body being to this nerve what the anterior
peaks of grey matter are to the other spinal nerves. Mayo
states* that some of the “fasciculi of the lingual nerve
penetrate to the grey capsule in the olivary body.” It com-
mences by several filaments, which being collected together,
the nerve they compose quits the skull at the foramen con-
ch loideum anterius. It is distributed to the muscles of the
•/

tongue and also to those of the os hyoides, viz. the omo-
hyoideus and sterno-hyoideus, which fix the bone inferiorly.

Regal-ding the origin of this nerve, Foville states really
nothing, lie says f it is detached from the medulla ob-
longa between the corpus pyramidale and olivary body, but
not one word regarding its connection with the interior of
the medulla. Stilling | traces it to the posterior surface of
the cord into what I have described as the auditory gan-
glion ; but I think he is mistaken.

* Plates of the Brain, VII. fig. 2. f P. 527.

i P. 21, op. cit.

302

HUMAN BRAIN.

PART VIII.

VESSELS EMPLOYED IN THE CEREBRAL CIRCULATION.

As the brain receives one fifth of the whole amount of
blood circulating in the body, the student will not be sur-
prised to find it supplied with this fluid by four large ar-
teries, the internal carotids and the vertebrals.

1 he 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 externum and carotid canal.
I he course of the vessel in this canal is worthy of observa-
tion. 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 for-
wards 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 cerebral cavity. It is
impossible to follow the two carotid arteries in this way
without the peculiarity of their course forcing itself upon
the attention. 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 pro-
duce had the tube been perfectly 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

C E RE B R A L CIRCULATION.

303

of that complicated plexus of vessels, called the rete mirabile ,
emanating from the internal carotid artery, and situated at
the base of the brain. This beautiful arrangement of the
carotid arteries is to be remembered in connection 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 vertebral 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 valuable work which for years has
issued from the press of this country, 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 anterior
part of the median fissure between the two lateral hemi-
spheres, giving off numerous branches in its course, winding
round the great transverse commissure, and running back”
wards on its upper surface, where it receives the name of
artery of the corpus callosum.

I he middle cerebral runs deeply within the fissura Sylvii,
through which it continues its course, and ultimately reaches
the upper surface of the hemispheres.

1 lie thild branch of the carotid, called the communicating
a>. < rd' 1S srna'l *mt interesting ; for running backwards, and
joining with the posterior artery of the cerebrum, a branch
o the basilary artery to be described further on, it connects
these large arterial channels together, and lessens the
clanger of accident to the brain from obstruction to the
circulation 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
ayml OTclc Will he observed to he formed, the side.,' being
it"tc(l },y t,l(‘ communicating artery, the posterior part

304

HUMAN BRAIN.

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 im-
portance 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 scalcni 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 ligamen-
tous canal, bored, as it were, for it in the transverse pro-
cesses of the cervical vertebrae. This vessel, 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
foramen in the transverse process of the first cervical verte-
bra, the artery courses round the articulating process of
that bone, and, like the carotid, taking a horizontal direc-
tion, 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 inosculate 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, run the whole
length of the vertebral canal to the os coccygis, giving oft*
numerous branches in their course. Then’ calibre however
is almost undiminished even to their termination, in conse-
quence of their being reinforced by frequent anastomoses
with the branches of the deep cervical, intercostal, anti
lumbar in particular.

The branch to the cerebellum is called the ■inferior ar-

CEREBRAL CIRCULATION.

305

tery of the cerebellum, 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 internal ear. Of the other two, one
supplies the cerebellum, called, in distinction to the last-
mentioned cerebellic artery, the superior artery of the cere-
bellum ; the other is distributed to the cerebrum supplying
the posterior 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. Simon, * have, I think, fully established this view
of its office. The following are Mr. Simon’s conclusions.

1. The thyroid gland, or an organ representing its place
and office, may be found in all vertebrate animals.

~. 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 then organization, but seems to have
a particmai reference to that specific character which binds
t cm together as a natural section of the animal kingdom,
—namely, the aggregation and more perfect development
ol then nervous centres ; for

3. I he gland, shifting its position most variously, yet
always maintains an intimate relation to the vascular sup-
P y of the brain, always is so nourished that it can alter-
nate a greater or less nutrition, according to the activity or
repose of that nervous centre.

motf 1 1'° °rga,n )vlli?h in certain fishes represents a rndi-
mentai form of the thyroid, is plainly a mere diverticulum to
the cerebral circulation ; m the remaining fishes (where a
more perfect thyroid exists), as likewise in the ascending
frnrn t ammals’ there is no essential change

simffi! iLVa'SC r ^amZati°n 0f the branchiola, — there is

[ y the superaddition of a glandular structure. The

• * Phil. Trans., Part. If. 1844.

30G

HUMAN BRAIN.

thyroid is but a higher development of the branchiola.
What was a mere capillary plexus now has gland-cells
intermingled with its texture.

Probably, then, the use of the secretory actions occur-
ring in the thyroid 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.

( 307 )

PART IX.

DEVELOPMENT OF THE BRAIN.

The development of tlie human brain is a subject which
every philosophical 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 eveiy 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 its legitimate rank among the natural
sciences, we ought to recognize with especial gratitude the
well-digested store of interesting facts contained in the
works of Tiedemann, Serres, the Wenzels, and Doellinger
on the evolution of the brain. Newton, whose vast dis-
co\enes in another of the realms of nature have raised
Jmn so far above Ins fellow mortals that we almost reve-
rencehis name, showed us that true philosophy 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 S3!
edge we possess of the laws by which the Creator governs

it tha^Cod T- Ti P0rcer- "? Dr' Paley «»ely expresses
it, Hut God has been pleased to prescribe limits to Ids

-n," povver; fnd to his ends within those limits

theteSL r3 Tma!tCr ''aV0- PerhaPs' ««> nature of
llrmts : ,lts .mertla> lts reaction, the laws which govern
the communication of motion, of light, of heat 0fZH

'Sm' eleetncity, and probably of others yet undiscovered

x 2

308

HUMAN BRAIN.

Iliese are general laws, and when a particular purpose is
to be effected, it is not by making them Avind and bend
and yield to the occasion, (for Nature with great steadiness
adheres to and supports them,) but it is, as Ave observe
in the structure of the eye, by the interposition of an
apparatus corresponding Avith those laws, and suited to the
inquiry which results from them, that the purpose is at
length effected.”*

This simple vieAv of the existence of fixed laAvs, esta-
blished by the Almighty, is not, however, confined to
mere matter and its properties ; the scientific physiologist
has reason to believe that there are similar Ibavs which
regulate vital phenomena, and produce results, without the
constant and immediate agency of the Supreme Being.

It is told of Newton, that one day when meditating
on the simplicity and harmony of the Iravs which regulate
the universe, and struck particularly with the relations and
uniformity of the masses of the planetary system, his
thoughts reverting thence to the animal kingdom, whose
Avonderful organization attests in no less degree the su-
preme wisdom and poAvcr of a creating Providence, he
exclaimed, “ I doubt not that animals are subjected to the
same uniformity.” The only true philosophical plan upon
which any branch of physiology can be studied is to folloAv
out this idea of Newton, and strive to discover such an
harmonious arrangement among its objects ; for example,
to attain a knoAvledge of the great principle which is in
operation during the life, or Avhich presides over and regu-
lates 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 knoAvledge of
the ultimate cause of vital phenomena; Ave 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 studying physi-
ology 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 therapeutics.

* Natural Theology, chap. iii.

DEVELOPMENT.

300

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 then- 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 physiology, and the mean rank which it holds in
comparison with the other branches of natural philosophy,
we have only to refer to contemporary 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 impenetrable veil, and
the pride of philosophy is humbled by the spectacle of the
physiologist bending in fruitless ardour 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 labours 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 inquire 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 jeither na-
tural philosophy or physiology is to study the mutual
relations in which phenomena stand to one another,
and thus to trace their connection and possible depend-
Ihe mature human frame, which in its perfect adapta-

310

HUMAN BRAIN.

tion to fulfil the ends of its existence strikes the philoso-
phical anatomist with admiration, does not result from the
gradual increase of an exact though minute representa-
1011 oi its perfect form; but. during the course of its
eye opment, and while gradually progressing towards
i s ultimate perfection, its constitution temporarily as-
sumes many forms which are permanently retained bv

one or other of the members among the lower orders of
creation.

lhe facts which prove the existence of this law of pro-
gressive development are derived from observation of the
dinerent organs at different periods of the foetal existence ;
and m no set of organs is its truth more clearly shown
than m the various component parts of the nervous system,
as the reader will discover by giving his attention to the
observations on its development which follow. The same
thing may also be said in regard to the law which governs
the development of the vascular system ; and as the cir-
cumstances 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 the
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, con-
sisting merely of an auricle for the reception 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 commu-
nicates Avith 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

development of the nervous system.

311

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 towards 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 appear-
ance of trachea or bronchial 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 correspond-
ence with it, branchial apertures on the sides of the neck,
the aorta giving off a regular set of branchial arteries which
take then- 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.

Tor a clear, simple, and accurate account of the pheno-
mena 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 opakc ; the opacity is called the germinal

312

HUMAN BRAIN.

space— areagenntmtiva. The nucleated cells of this snot
at first uniformly arranged, so that the whole is obscure’
soon begin to accumulate on the circumference, leaving a
clear space in the centre. The transparent spk assumes
an oval lunar form, transversely to the ovum. If we examine

find ttrterial 0frthe germinal sPot at

find that it consists of two layers. The superior is the

Z famJeWTl i ■ fr0m ? a11 the or«ans °f Ke

from it ■« f ie inf1^11'jr ls the vegetative or mucous layer;

“ lf a“; f°rm?d aI> tbe organs of vegetative life. The
transparent line is confined to the animal layer ; the vege-
tative layer is opake throughout. b

n rZ-f™7 i1GXt °bse1rVf that tllis transParent tract assumes
* I ^rm shape, and the edges becoming elevated, a groove
01 gutter is formed.. The edges of this gutter gradually
approximate, at first m 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 supe-
rior, anterior, or cephalic extremity, they are separated, so as
to form dilatations piaccd consecutively to one another, the
dimensions of winch increase 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 tiie future vertebras.

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
foi 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 proved
that the brain consists first of three cells, which are after-

t du Devel°Pement (lc PHomrae et ties Mammiferes par T.

too ®lsch°ff traduit de PAllemand par A, J. L. Joimlan. 1843,

p. 182. <

DEVELOPMENT OE THE NERVOUS SYSTEM.

313

wards divided into five. This tertiary division of the ence-
phalic portion of the cerebro-spinal axis accords with the
tertiary division of the skull. The skull, as mentioned else-
where, consists of vertebrae, just like the cervical, dorsal,
and lumbar portions of the vertebral column. The number
of cranial or encephalic vertebrae 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 fissure appears on the ante-
rior and posterior cell, which thus divide the three cells into
five. The anterior and superior wall of the anterior cell
increases on both sides of the mesial fine with more rapi-
dity than the posterior ; so that when we look at it from
above it represents first a double vesicle, with a feeble me-
dian depression, dividing it into two lateral halves. The
two anterior represent the olfactory ganglia and hemi-
spheres ; the two middle, the optic ganglia ; and the pos-
terior, the cerebellum : the spinal marrow is represented by
a long canal communicating with the cerebral vesicles,
which in reality are but swellings of a single sac. The de-
scription 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 instance ; the embryos of the rabbit or cat are, perhaps,
the best that the student can select for his own observation.
Rolando gives a very accurate account of the vesicular form
of the fcetal brain in Mammalia and in birds.

The peculiar form and general ap-
pearance of the foetus at the seventh
week will be easily comprehended by
referring to fig. 109, taken from
Tiedernann, who represents it as an
oblongated mass slightly curved up-
on itself, gelatinous, and semitrans-
parent.

In this embryo, which was about
seven lines in length, and about seven weeks old Tiede-
rnann was enabled distinctly to observe the structure and
disposition of the brain and spinal cord.

Fig. 109.

Foetus of seven weeks.
a. Projection of the neck.

314

HUMAN BIIAIN.

cavity provided for the cord was situated imme-
diately 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 sub-
stance of brain and spinal cord, that it was difficult to detach
it without destroying the inclosed pulp, the general form of
which may be clearly understood by referring to figs 110
and 111.

Fig. 110.

Fig. 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
ventricle, a thin narrow plate
or flattened fasciculus oPneu-
rine arose' from either side,
and inclining inwards, touch-
ed, without uniting with, its
fellow; thus forming a sort of
arch over the fourth ventricle,
and constituting the rudi-
ment of the cerebellum (c,
figs. 110 and 1 1 1), about one
line andtwo-thirds in breadth .

In front of the cerebellum
were two membraniform pro-
ductions, the first appearance
of the optic tubercles or cor-
pora quadrigemina, taken to-
gether about a line in breadth
and one in length {cl). The
rudiments of the thalami (e),
in the shape of two rounded
protuberances, were next in
order, the space between
them being that which cor-
responds to the third ven-
tricle. In front of these eminences were two others, in
apposition to them, about a line in length, and apparently

Fig. 110. — Brain and spinal
row of the same foetus as repre-
presented in fig. 109, seen late-
rally. a. Spinal cord. b. Enlarge-
ment of ditto, c. Cerebellum, d.
Optic tubercles, or quadrigeminal
bodies, e. Optic thalami. /. Mem-
braniform hemispheres of the brain.
g. Protuberance analogous to the
corpora striatum.

Fig. 111. — Posterior view of the
same brain, split and open in all its
length, a a. Spinal marrow, b.
Orifice of the canal of the spinal
marrow, c. Swelling of the spinal
marrow, d d. The cerebellum split
in the median line, and laid like a
bridge over the fourth ventricle.
e e. The quadrigeminal bodies sepa-
rated from one another in the median
line.

DEVELOPMENT OE THE NERVOUS SYSTEM. «‘U 5

the rounded extremities of the anterior part of the crura
cerebri; these were the corpora striata (fig. 110, (j).

From the corpora striata arose two thin membraniform
productions of neurine curving backwards and inwards ;
these are the first commencement of the hemispheres of the
brain (fig. 112).

At this early period there are no traces of the com-
missure of the cerebellum or of the cerebrum, or of the
thalami, or of the longitudinal commissure, called the
fomix.

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 as-
sume a fibrous appearance until the commencement of the
fourth month. Tiedemann states that he could not per-
ceive any appearance of the cerebral nerves, which he ac-
counts 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 tissues, and then’ subsequent union with the brain
and spinal cord.

In the following details I have adhered generally to the
plan of describing 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 brain, not merely in man, but in all
the orders of vertebrated animals. 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 calf until the sixth, exists permanently of a certain width
m fishes, reptiles, and birds. In the foetal state of the human

316

HUMAN BRAIN.

embryo it is obliterated by the deposition of successive
layers of grey matter secreted by the pia mater. But what
is, perhaps, more extraordinary is, that the cord in the
human foetus extends to the extremity of the coccyx until
the third month, when it appears, according to the state-
ment of M. Serres, to rise suddenly to the point where it is
met with after birth, namely, opposite the second lumbar
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 ex-
tent in the young embryos of all classes ; it is without en-
largement either anteriorly or posteriorly, as in those rep-
tiles which do not possess extremities, as snakes, &c. This
appearance corresponds with the absence of extremities 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 beginning of the seventh, month. The interlace-
ment of the pyramidal fasciculi is visible in the human
embryo from the eighth week. In reptiles and in fishes
there is no interlacement at all.

In the second month of foetal existence the fasciculi of
the spinal cord, which are prolonged into the brain, are
curved downwards beneath the optic tubercles : this curve
remains distinct until the third month. The bundles may
be distinctly traced into the optic thalami, and having be-
come 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 de-
tached, which descends into the mammillary eminences.
These reflected on themselves, and thus directing their
course backwards, form the anterior pillars of the fornix, or,
more properly speaking, the inferior longitudinal commis-
sure.

All the other fibres of the crura, which are very nume-
rous, are directed forwards and outwards, passing under

DEVELOPMENT OP TIIK NERVOUS SYSTEM. 317

the corpora striata, forming the hemispheres ; and at the
posterior part they join, or more strictly speaking 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 foetus in the second month, nor even in
the early part of the third. Towards the end of the tim'd,
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 annual kingdom.

About the third month the cerebellic fasciculi, which we
formerly observed just touching each other, are now united
so as to form a concave mass internally, smooth and convex
externally, but without any appearance of grooves or leaf-
lets, thus accurately corresponding with the cerebellum 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 appearance as that of the skate ;
for grooves appear upon the surface, which gradually in-
crease in depth and number, till at the sixth month the
stems and branches of the arbor vitae become apparent, and
the part then puts on the exact appearance of that of birds.

la conclusion, let it be remembered that the cerebellum
proceeds, in the first instance, from the spinal marrow, — in

318

HUMAN BRAIN.

fact, from the two fasciculi which are earliest apparent, and
winch constitute the corpora restiformia.

The masses of neurine which correspond with the tu-
ei cula quadrigemina 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,
them 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 Math 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
hemispheres, so that they now resemble those of the Ro-
dentia.

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). To-
wards 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 ex-
tended over them. These protuberances, which are solid
throughout, are united by a transverse band representing
the posterior commissure, and their increase from this
period is in exact correspondence with the progressive
development of the hemispheres. The commissura mollis
was not observed by Tiedemann 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 superior 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.

DEVELOPMENT OF THE NERVOUS SYSTEM.

311)

In volume it is much larger in proportion to the size of
the brain in the ruminating animals than in man.

Fig. 112. Fig. 113. Fig. 1 14. Fig. 115. Fig. 110.

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 longi-
tudinal fissure, b b. Cerebellum, c. Parts which give rise to the quadri-
geminal bodies, d. Thalami optici. e. Membranous hemispheres, tinned
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.
6. Spinal marrow, c. Swelling of the spinal marrow, which is bent
inwards. d. Cerebellum. /. 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. li. Membranous
hemisphere of the cerebrum, broken down behind and before ; it does
not yet cover the eminences destined to form the quadrigeminal bodies.

Fig. 114. — Brain and spinal marrow of the same foetus seen posteriorly.
a a. Spinal marrow, with its posterior longitudinal fissure, b. Cerebel-
lum, and beneath it the fourth ventricle. c c. Hemispheres of the cere-
brum. 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 foetus, a a. Spinal
marrow, with the anterior longitudinal fissure, b b. Swelling of the spinal
marrow bent forward, cc. Peduncles of the cerebellum, which arise from
the cerebellum. d d. Cerebellum. e e. Peduncles of the cerebrum.
/Mammillary eminences. ^.Pituitary gland. kit. Anterior lobes of
the cerebrum. 1 1. The posterior and round appendices which represent
the middle and posterior lobes.

Fig. 116. View of the superior surface of the brain of the same
fcetus ; the membranous hemispheres are separated from one another
anil laid aside, a a. The two principal cords of the spinal marrow
b. rostenor longitudinal fissure, cc. Cerebellum, d d. Masses which
are to form the quadrigeminal bodies, e e. Thalami optici. f f, gang.
Membranous^ hemispheres separated from one another and iaid' on the
sides, hh The two corpora striata, which are a little wider anteriorly
anrl divided into two parts by a slight fissure, i. Commissure of the
two hemispheres and commencement of the corpus callosum, kk. La-
era 1 ventricles, with the radiated folds of the undcr-surface of the he-

320

HUMAN BRAIN.

llie thalami nervorum, opticorum, or posterior ganglions
of the cord, are just perceptible at the second month In
the commencement of the third they become more volumi-
nous, and are partly covered by the hemispheres, which
structures, being in the first instance mere layers of neu-
nne shooting out from the hinder part of the corpora
striata and thalami, give to the corpora striata an appear-
ance of gi eater 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 thalami, and which has
been so incorrectly designated a ventricle or bag.

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 desirable to give a more detailed
account of them. This is particularly important as calcu-
lated 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 surfaces of the brain. These ends,
indeed, can in no better way be accomplished than by fol-
lowing out the development of the hemispheres of the brain.
At any rate I think that if the reader will attentively com-
pare 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 state-
ment 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,

DEVELOPMENT OF THE NEKVOUS SYSTEM.

32 L

a thin delicate membrane, consisting of medullary neurine,
which is reflected backwards and inwards, 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).

U7. Fig. 118

liy. 117. — Superior surface of the brain of a foetus of fourteen or
fifteen weeks, a a. Spinal marrow, b. Peduncles of the cerebellum sepa-
rated from one another, from above downwards, which brings the fourth
ventricle into view. c. The cerebellum, which has not yet any fissures.
dd. The right hemisphere of the cerebrum, which does not yet cover the
quadrigeminal mass.

tig. 118. — Side view of the brain of a foetus of twenty-seven weeks.
B. Cerebrum, e. Cerebellum, h. Spinal marrow, s. Corpus olivare.
t. -orpus pyramidale. w. Corpus restiforme. x. Annular protuberance,
the ns aura Sylvu 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 encephalon, namely, to the
corpora stnata. The olfactory nerve descends from the fissura Sylvii.

During the fourth month (fig. 117) they have advanced as
tar 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. 1 1 8). At this period
we may perceive on the surface corresponding to the falx
major some grooves or furrows which are the first steps
towards the formation of the convolutions. The upper and

Y

322

HUMAN BRAIN.

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, depressions
appear here and there, the rudiments of the convolutions
and fossa, into which the pia mater dips. The fissuraj
Sylvii are distinct, lodging 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 ex-
amining 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
with convolutions and anfractuosities.

After these details, it must be evident that the hemi-
spheres are formed from before backwards, and from with-
out inwards • that at first they consist only of a thin mem-
branous 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 for-
mation of the hemispheres of the brain throughout the Ver-
tebrata, except that they are arrested at different stages of
the development in different species, which the human em-
bryo 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 :* —

* British and Foreign Quarterly Medical Review, vol. xxii. p. 503.

DEVELOPMENT OF TIIE NERVOUS SYSTEM.

323

“ 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 pos-
terior lobes. During the first period the descending horns of
the lateral ventricles, and the pedes hippocampi, are want-
ing ; 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 Ave examine a brain at
this period of development, Ave might, from its external
appearance, imagine that the posterior margin of the hemi-
spheres corresponds to their persistent posterior ends and
margins, i. e. to those which are their posterior margins
in their perfectly developed state. But it is not so. If Ave
open the brain we come at once to the descending horns of
the lateral ventricles, in which are the rudiments of the
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 poste-
rior lobes of the hemispheres. These, which are thus for a
long time only ru dimental, begin above the middle lobes,
gradually take in their posterior margin, folloAV it down, as
development advances, by the sides of the cerebral nucleus,
and terminate at that part of the middle lobes Avhich meet
the pedes hippocampi. Even in the brain of the mature
fr/'tn:s, as well as in the fully developed brains of older
persons, the posterior lobes are veiy clearly separated from
the middle lobes by a branching furroAV, which is especially
distinct on the vertical side of the hemisphere Avhich lies
next to the falx.”

Having entered generally into the composition of the
cerebral mass in fishes, reptiles, birds, and the mammalia
l consider it unnecessary to dwell more fully upon the

y 2

324

HUMAN BRAIN.

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 hemi-
sphere of the higher classes, in the two tubercular enlarge-
ments which are placed immediately in front of the optic
tubercles, and with which the peduncles of the olfactory
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 back-
wards and inwards, into which the fibres of the crura cerebri
expand as in the human embryo.

Tn the carp we have also observed rudimentary hemi-
spheres.

The rudimentary hemispheres of the reptiles are equally
interesting when viewed in relation to this subject. In the
crocodile, each hemisphere represents a membranous sack
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 reflec-
tion of neurine which constitutes the hemispheres, extend-
ing 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 ganglia : more than has been said
seems unnecessary.

The corpora mammillaria do not appear until the end of
the third month, and then not divided as they are after
birth, but simple and homogeneous.

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 commencement of this section
regarding the gradual development of the brain and spinal
cord on one simple and uniform type : and that the com-
plicated structure which we meet with in the human adult,

DEVELOPMENT OP THE NERVOUS SYSTEM. 325

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 development
Nature appears to have pursued the same plan which she
has adopted in the organization of each individual in her
vast family, gradually adding one part after another, and
at the same time concentrating the whole, each fresh addi-
tion changing the appearance of the several parts, so that
unless the chain be observed from its very commencement,
all the analogies which are so palpable when we proceed
step by step are obscured, and even made altogether in-
capable of demonstration.

Let me not, however, be misunderstood, when speaking
of the addition 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 Vertebrata in general, though the
amazing size of the hemispherical ganglia and the cerebel-
lum, with the addition of fresh commissures, give to the
human brain an appearance wholly unlike that of the reptile
and the fish.

HUMAN BRAIN.

PART X.

PHYSIOLOGY OP THE CEREBRO-SPINAL AXIS.

I his is a subject which every candid physiologist approaches
with great diffidence, tor 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 in-
terest to the anatomy than is usually attached to mere
details of structure, without reference to function, so
that in this section it will only be necessary to give a
summary of what has been more or less touched upon pre-
viously.

The sources of our information on the functions of the
nervous svstem are fourfold.

V

First. Observation of the parts composing it in the
lower animals, and the relation which they bear to those of
man, considered in connection 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 develop-
ment of the nervous centre keeps pace with the increase of
the animal powers ; and I need only advert to the impor-
tant 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 manifesta-
tions of intellect. Also observations on the relation be-
tween the external configuration of the cranium in indi-
viduals and their manifestations of particular degrees of in-
tellectual power, propensities, and sentiments.

Though the deductions which are made from experi-

PHYSIOLOGY.

327

xnents on living animals are so liable to error that reliance
must not be placed upon them as unerring sources of
knowledge, they have afforded very important and valu-
able information on this subject. I do not agree with the
objections which Mr. Combe has urged against the expe-
riments 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 comparative anatomy, pathology, and observation
during life, have afforded collateral evidence of the sepa-
rate offices of different portions of the brain and nervous
system. As regards our knowledge of the functions of
the 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 conclusions 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
a 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.

f rom pathology- we might naturally expect surer evi-
dence; but even here the physiologist who carefully ex-
amines its records is doomed to disappointment.

It. is clear that if, in uniform accordance with the derange-
ment, or obliteration of individual functions during life,
morbid alterations of individual portions of the nervous

328

HUMAN BRAIN.

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 physio-
logy from this source. 1 J

fhe last, or fourth, source mentioned as affording us
nowledge 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 favour of the belief
that the great hemispherical ganglion or cortical substance
ot the brain is the immediate agent in all mental operations,
is, m 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 men-
tal 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 “ Phreno-
evidence, rests on the same foundation as the
practice of medicine. The existence of disease cannot in
general be determined by weight or measure, and the cha-
racters of diseases can be judged of only by their appear-
ances, 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 then- lights to help the judgment
in its estimates, but they do not reveal the theory of
medicine a priori, nor do they render it a demonstrative
science.”

“ The same general laws of evidences must necessarily
apply to the study of phrenology. The mental manifesta-
tions 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 sus-
ceptibilities and capacities are possessed by different indivw
duals, 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 re-

PHYSIOLOGY.

329

flection, or remain for ever ignorant of mental science.”
(See Pliren. Journj vol. x. p. 55G. 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 following 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 strik-
ing results which followed their injury, show the important
part which they play as conductors of stimuli. And even
1 lerophilus, Erastatus, 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 pro-
duced the sensations. Further researches have only con-
finned the fact that they are mere conductors, not origi-
natmg the power of contraction in muscles, or perceiving
sensations m themselves, but in the first place conducting
a stimulus which calls the resident power of muscles, that,
of shortening themselvpa — i • n

330

HUMAN HRAIN.

conducting a something to a certain point, where it is con-
verted into a sensation and perceived • the course of these
influences, namely, the one, that of the stimulus to muscular
contractions, proceeding from the centre to the circum-
feience, the other, the producer of sensations, from the cir-
cumference 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 bram, but still in connection with the muscle,
might seem to prove that the stimulus to contraction actu-
ally resides in the nerve, and is merely called forth by the
bram ; yet the experiments of Muller* (see Muller, op. tit.,
p. 7 J 1 7) show that the divided nerves lose this power after
they have remained 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, Ma-
genclie, and Mayo, have proved that there are nerves sub-
servient to sensation — sensiferous or sensory nerves, and
nerves of voluntary motion. The physiological researches
of Whyte, 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 move-
ments of the body under the title of the excito-motory
system of nerves. All sound research and careful experi-
ment 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 therefore 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 indepen-
dent of volition from the ganglia of the spinal cord — the
efferent nerves of spinal power. The posterior roots are

1'UYSlOLOGr.

331

also binary in their functional power — nerves of sensa-
tion, 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 important to be left to the control of mind —
the incident nerves of spinal impressibility.

Tie spinal cord is a series of ganglionic centres, struc-
turally homologous and functionally analogous to the jointed
ganglionic cord of the articulata, and although we are unable
to point out any corresponding anatomical lines of demarca-
tion 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
unde via ting regularity in the Mammal, to the phrenic nerve,
endowing that nerve as a conductor with power that keeps
the cliaplwagm in unremitting and unwearied action during
the whole of life, must possess the power of acting inde-
pendently 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 deatli itself.

M herever there are distinct centres of power, there are
also connecting commissures. The transverse commissures
of the spinal cord, connecting corresponding ganglia on op-
posite sides (jf the mesial line, are easily demonstrated.
Longitudinal commissures connecting them together from
below upwards must also exist, though it is not so easy to
distinguish them from the longitudinal fibres of the volitional
and sensiferous nerves. ■ It is quite possible that the poste-
rior columns are the longitudinal commissures which con-
nect 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. 1 J

Hie spinal cord consists, then, of ganglia, nerves, trans-
verse and longitudinal commissures, perfectly similar to the

332

HUMAN BRAIN.

longitudinal commissures which connect the jointed cord
of the articulata.

The medulla oblongata consists of three ganglia on each side
of the mesial lme—six, therefore, in ah. The olivary bodies,
most probably the lingual ganglia, the restiform or pneumo-
gastnc 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 com-
missural communication is not so distinct, and there does
not appear to be the same physiological reason to expect it.

Ihe auditory ganglia are imbedded in the sensory tract ;
but undoubtedly some of these fibres which we have here-
tofore considered as belonging solely to this system of nerves,
must be regarded as belonging 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
^arolii. This, though evidently a great transverse com-
missure, must also be an instrument of power through the
medium of its vesicular neurine ; and though we are un-
prepared to define the nature of its power, it must hold
some relation to transmission of motor and sensory im-
pressions by the tracts which in the spinal cord conduct them.

Cerebellum. — The extensive surface of vesicular neurine
which constitutes 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 exten-
sive nervous and commissural connections also support this
opinion. 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 dynamic vesicles. By the in ter- cerebral commis-
sure the cerebellum is intimately associated with the optic, the
anterior and posterior cerebral, and the hemispherical ganglia

PHYSIOLOGY.

333

From what has been already said in the sections on com-
parative 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-ordinator of muscular action on the one part,
most probably by means of the central portion of the cere-
bellum, 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, are very striking, and almost as conclusive
as all other physiological evidence.*

The locus niger in the crus cerebri is the next ganglion
for our consideration ; it is the serial homologue and
analogue of the anterior peaks of grey matter of the spinal
cord. It is, I suppose, the seat of the excito-motor power of
the third pair of nerves, the importance of which in relation
to the instinctive and conservative movements of the eye-
ball need not be insisted on here.

The tubercula quadrigemina or optic tubercles, we may
fairlv conclude, aie the instruments by which the physical
impressions of light received by the retina are converted
into sensations of light, colour, form, &c.

The optic thalami and corpora striata, or anterior and
postenor cerebral 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 gan-
ghon 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 Ins review of Mr. Noble’s work in the

ssRrxi846e British and Forcign

J he 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

* On the Functions of the Cerebellum bv 71™ Gnli v:.

Broussais, translated from the French by George Comb^, 7 837. ^ “IU

HUMAN BRAIN.

centres of action, not mere appendages to the hemispheric
ganglia appears from the large quantity of vesicular neurine
which they contain ; and that the corpora striata are so,
tui ther appears from the absence of any correspondence in
size between them and the hemispheric ganglia. Thus in
slies we find that the corpora striata make up the prin-
cipal bulk of the second pair ot masses ; in reptiles, birds,
and the lower Mammalia, they still form a very large por-
tion of that which is commonly termed the cerebrum ; and
their suboidinate aspect in man and the higher Mammalia
is solely due to the large relative development of the hemi-
spheric 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 Mammalia ; but it is only in man that their dimen-
sions approach those of the corpora striata. The peculiar
connection ot the thalami optici with the posterior columns
ot the spinal cord, and their great development in man,
suggests the idea that they are the ganglia of tactual sensa-
tion; 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 grey matter in
the spinal cord — harmonizes well with the fact that the
greater number of muscular movements are directed by
common sensation ; whilst the special connection established
by the inter-cerebral commissure between the corpora striata
and the optic ganglia (tubercula quadrigemina) 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 cerebrum 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 corpora striata.

The whole chain of sensory ganglia is regarded by Dr. C.
as not only the instrument by which sensations are received,

PHYSIOLOGY.

335

but also as the centre of those automatic muscular move-
ments which differ from those of a simply reflex character,
in being dependent upon sensation. To this head, he re-
fers 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 move-
ments 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 auto-
matic by habit, as executed through the same channel ; each
movement being directly prompted by the sensation with
which it has become associated.

T\ e 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 ana-
tomy ; 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, — all afford a mass
of overwhelming evidence that this portion of the brain, and
this only, is the cerebral organ of intellectual power.

. ^fuller, whose authority on all physiological subjects is
interesting, after speaking of the general evidence in favour
of a belief that the intellectual faculties reside in the cere-
bral hemispheres, says, r; “ It has, however, been proved by
direct expenment that such is their seat. The experiments
of r lourens are here also especially instructive, and Hertwig
ia- in the essential points done no more than confirm them,
ihe hemispheres are insensible both to puncture and inci-
sions. I hat 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.

firm ‘uiernn’ hC >aySf << Th° exPeriments of Hertwig con-
nrm M. I lourens observations. Wounds of the hem i-

* I’. 834, np. n 7.

336

HUMAN BRAIN.

spheres (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 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 hemispheres 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 endured for a fort-
night, when the hearing and sensibility in a great measure
returned ; this pigeon lived three months. A hen, in which
Hertwig 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 sen-
sorial impressions are not merely perceived, but are con-
verted 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 phy-
siologist “regards man as he exists in this world, and
desires to investigate the laws which regulate the connec-
tion between the mind and its organs, but without attempt-
ing to discover the essence of either, or the manner in
which they arc united.”

And, in connection with this subject, let us ever bear in
mind that we are not conscious of the existence and func-
tions of the organs by which the mind operates in this life,

PHYSIOLOGY'.

337

and, in consequence, many, acts appear to us to be purely
mental, which experiment and observation prove incontest-
able 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 appa-
ratus by means of which our volition is carried into execu-
tion.”

“ Experiment and observation, however, demonstrate the
existence of bones of the arm, curiously articulated and
adapted to motion ; of muscles endowed with power of con-
traction ; 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 ap-
peal’s to him to be purely mental, and only the arm or thing
moved is conceived to be corporeal. Nevertheless, it is posi-
tively established by anatomical and physiological researches
that this conclusion is erroneous — that the act is not purely
mental, but accomplished by the instrumentality of the
various organs now enumerated. In like manner every act
of vision involves 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 whatever.”

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 imagination, every glow of affection,
and every effort of the understanding, in this life, is per-
formed 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 mate-
rial condition, without which no mental act is possible in
the present Yvorld.”

" 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 affection
of the principle of mind, the obvious inference follows,
tliat in like manner many changes in the condition of

/,

338

HUMAN BRAIN.

the brain destroy the power of feeling or of thinkine
and yet the mind itself or soul remain essentially the

The most decisive facts in proof that it is the surface of
e bi am or the hemispherical ganglion which directly
ministers to intellect, are derived from pathology, and
especially the consequence of inflammation of the mem-
branes, as we shall see when we consider the diseases of
the brain. The varying effects of apoplexy affords also
stiong evidence in favour of this opinion. 1 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
eftect of the general shock, remains perfect, though its con-
ducting instruments are paralysed.

The first philosopher ivho attempted to prove that the
irain does not minister to the intellect as a single organ,
but as a combination of organs, was Gall ; and I think lie
deserves the gratitude of mankind for his labours, though
all his views may not ultimately prove correct.

The science which Gall advocated is now well known
undei the title ol phrenology. Those who have not given
their serious attention to this subject have a sort of indefi-
nite idea that phrenology is some occult science, 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 industry 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
imagination. In the first place the term bump, in refer-
ence to the sm'face of the skull, has no place in the vocabu-
lary of the phrenologist. The practical phrenologist judges
of character by space rather than by mere elevation or
depression.

It must always be borne in mind that the physiological
principles upon which phrenology is founded may be per-

PHYSIOLOGY.

339

fectlv 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 practice of their art all sur-
geons have not the same dexterity. Every physician has
not equal facility in distinguishing diseases; the healing
art nevertheless exists.”

“I do not conceive that phrenology has reached perfec-
tion now [1S.26], 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
endeavour 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, Yol. 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 phrenologists, and especially the late worthy
Mr. Deville, such accurate characters of individuals known
to me, but unknown to them, that I cannot believe the ac-
counts I received could be the result of accident and con-
jecture, which must have been the case if phrenology is un-
true.

Secondly. Phrenology alone — as it appears to me — can
account for all the varieties of insanity, especially mono-
mania.

I hirdly. The facts which have been collected by the late
Mr. Deville, showing that the brain will alter its form at
any period of life.

f ourthly. I he existence of longitudinal commissures

z 2

340

HUMAN BRAIN.

In Mr. Deville s collection there are above twenty casts
which prove an alteration in form s as far as I am able to
jucge, they correspond with the mental and moral exercise
winch the brain experienced in the period during which
le changes were taking place. Few medical men are aware
°t the immense number, and the importance, of the facts
established 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 tor the purchase of antique marbles and specimens of
natural history for the British Museum— all important ob-
jects lor the improvement of the people ; and they would
comer a lasting benefit to science, and, through it, to the
nation at large, were they to add this to our national trea-

sures.

If phrenology is true, insanity on its first ingress is fre-
quently not a disease of the whole brain, but of only a part
ol it. The first effect of inflammation is to excite to an un-
natural degree the natural function of an organ. The func-
tion of the organ thus exalted obtains a mastery over the
lest. 1 or instance, a man, from defective education, com-
bined with hereditary tendency, allows his love of approba-
tion, his vanity, in other words, to grow with his growth, and
strengthen with his strength, gradually becoming the sole
luling principle of life : at last it, instead of reason, so com-
pletely guides and regulates all his actions, that they are
contrary to reason, and justly called the acts of a lunatic.
Fet 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.

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 con-
fidence of your patient ; and that once obtained, you may
do anythipg with him.

PHYSIOLOGY.

341

Now if this is true, (and no one who has treated the
insane on these principles doubts it,) so is it equally true
that thev may be awed by punishment and even acknow-
ledge its justice. Only the last time I had the pleasure
of visiting that noble asylum, Ilanwell, 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 exist-
ence, showing his mental aberration ; but he finished by
saying, as an argument for his being allowed his liberty,
that lie had always conducted himself with propriety while
there, which was perfectly tine. This sense of right and
wrong was as perfect as ever, and this sense enabled him
to conduct himself properly. But if he 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 pro-
perly? 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 imperfect 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,
l or instance, take two boys born of the same parents,
arid with the same or nearly the same original capacity;
suppose 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 stu-
dent. 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 intel-
lectual or muscular strength. But phrenology goes further
than merely to insist on the importance of educating the
child. It goes further also in tracing moral insanity to

342

HUMAN BRAIN.

or Ie« TtZ 11 IT1'68 US ,that the cllild “herits more
less of the mental or moral capacity of the parent iust

as much as he inherits the form of the face and physical

constitution. And as personal beauty may be more or

less spoiled and eflaced by evil education, (and I refer to

elanXt so , , educatio.r of oiicimstan c£ and

fan Hp«5 1 aTJ- 16 1bmn’ Wlth its mental and moral

acuities, be deteriorated and debased by the same causes

£ inculcates that, although it has pleased

the Almighty for some good and wise purpose, to ordain
t at not merely the bodily diseases of parents, but even
i mental and moral imperfections, shall more or less
descend to their children, such hereditary imperfections
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
o 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 bn-tli, 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 re-
straint.

Lastly, with regard to the office of the commissures, this
is implied in the name by which they are known. The
s tincture of these parts, their comparative anatomy, analogy,
and the few pathological facts that have been recorded, bear
us out m the Anew I have taken of their office as conduc-
tors of nervous power, as the media of establishing commu-
nication between one portion of the encephalic mass and
another, and, in this way, intimately connected with the
faculty, possessed by man especially, of comparing and
reasoning upon the various impressions received by the
different portions of the hemispheres.

( 343 )

PART XL

DISEASES OE THE BIIAIN.

In undertaking this division of my subject, I am afraid that
by some I shall be considered as stepping beyond the pro-
per boundaries of surgical practice. To such I must ob-
serve that every surgical disease requires 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 medi-
cine and sm'gery is artificial ; and that a distinction be-
tween diseases arising from external violence and from in-
ternal 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 endeavoured to observe the phenomena
which attend the disturbance of those functions. In de-
tailing the information I have obtained by observations 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 labours.

In this outline of the diseases of the brain, the following
arrangement will be adopted : —

1. Anaemic affections.

344

HUMAN BRAIN.

2. Hyperaemic.

3. Convulsive.

4. Organic.

• Jfhls arrangemcnt, like every othev that has been adopted
is of course liable to objections. Each of these affections

Sr?,™ 0116 int!° 'he 0thel’’ 80 the lines rf
distinction aie lost ; nevertheless, in a practical point of

r.thet whole be

oftl, J d °idlVlded*thf,h,StW- diasll0sis- and treatment
these diseases so strictly as some authors have done. My

i on tor which is that it is impossible to maintain these
divisions if the subject is much illustrated by cases; and I
believe that the interest of the reader is more contiguously
kept up by mingling them together. omousiy

it ^ln'6 '\° co!11sider these different affections separately
it v iff be advisable to determine, as far as possible, whether

whntT^i 7 ° ^ °°iC W!lthin the cWum ever varies, and
c th ci the cerebral substance can be compressed. The

student who has seen something of disease practically, 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 ad-
mitted, as an established doctrine of physiology, that the
quantity of blood in the cranium never varies, and that
tiie brain is incompressible. It will be necessary to show
lere the grounds upon which they are now abandoned.

.e theory has had a mischievous tendency in a practical
point of view; for instance, Dr. Clutterbuck, in his article
on cerebral apoplexy in the Encyclopaedia of Anatomy, says
that “ no additional quantity of blood can be admitted into
the vessels situated in the brain, the cavity of the skull
being already completely filled by its contents. A plethoric
state, or over fullness of the cerebral vessels altogether,
though often talked of, can have no real existence ; nor, on
the other hand, can the quantity of blood within the vessels
of the brain be diminished : no abstraction of blood, there-
fore, whether it be from the arm. or other part of the general
system, or from the jugular veins (and still less from the

PATHOLOGY.

345

temporal arteries), can have any effect on the blood-vessels
of the brain so as to lessen the absolute quantity of blood
contained within them.”

I cannot conceive a more dangerous doctrine in the prac-
tice of medicine, particularly coming from such an autho-
rity as Dr. Clutterbuck, and one who is generally so fond
of bleeding. The profession is indebted to Dr. George
Burrowes for dispelling these illusions.

Monro Secundus, of Edinburgh, is generally believed to
have been the first who propounded this doctrine. He ob-
serves,* “ As the substance of the brain, like that of the
other solids of our body, is nearly incompressible, the quan-
tity 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 quan-
tity 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, uninfluenced 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

Abercrombie, who supported this view, does not appear
to have instituted any positive experiments, but to have
founded his opinion on the experiments of Dr. Kellie, pub-
li-hed in Vol. i. of the Transactions of the Med. Cliir Society
ot Edinburgh. J

Dr. Burrowes first promulgated his valuable and conclu-
sive researches on this subject in his Lumlean Lectures
delivered at the College of Physicians, March 1843, pub-
hshed in the thirty-second volume of the Medical Gazette
p. 110, ami 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. Burrowes has since entered more fully into the subject
m his admirable work entitled “On Disorders of the Cere-
bral Circulation,” &c, 1846: The following experiments

* Ohsmatioirw on the Nervous System, Alex. Monro, M.D., 1793.

346

HUMAN BRAIN.

which he first made are so decisive of the question that I
cannot help quoting them in full :

th® llth of Januai7 1848, I killed two full-grown
rabbits. Ihe one (a) by opening the jugular vein and
carotid artery on one side of the throat ; the other (b) was
s a angled. Each animal died violently convulsed A liga-
ture was drawn tightly round the throat of the rabbit (a)
immediately it expired, to prevent any further escape of

ooc fiom 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 flowing from the rabbit
(a), the conjunctiva was observed to become pallid, and
the eye-balls to shrink within the sockets. Upon the ex-
amination of the head of the rabbit, the integuments and
muscles appeared blanched and exsanguine. Upon remov-
ing 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
longitudinal and lateral sinuses were nearly empty of blood,
and their course was not denoted by any colour of blood!
Upon making sections of the brain, the interior appeared
equally exsanguine.

“ Soon after the cord was drawn tight round the throat of
the rabbit (b), the conjunctiva became congested, the eye-
balls turgid, prominent, and even projecting beyond the
margin of their sockets. The integuments 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.

“ Ihe 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 vessel was turgid with
blood. It seems hardly necessary to bring forward further
evidence to prove that death by haemorrhage 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.

PATHOLOGY.

347

“ 1 have, however, repeated the experiments with similar
results. In fairness to Dr. Kellie 1 should state that 1 have
attended at the slaughtering of sheep by butchers, and find
the brains of those animals much less depleted than the
brains of rabbits winch 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 influ-
enced the appearances.

“ Hence it is not a fallacy, as some suppose, that bleeding
diminishes the actual quantity of blood in the cerebral ves-
sels. By abstraction of blood we not only diminish the
momentum of blood in the cerebral arteries and the quan-
tity supplied to the brain in a given tune, but we actually
diminish the quantity of blood in those vessels. Whether
the vacated place is replaced by serum or resiliency of the
cerebral substance under diminished pressure, is another
question, into which I do not now enter.”

Dr. Burrowes also made experiments to decide whether
position could effect 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. Burrowes says, “On the 28th of December 1S42,
tuo full-grown rabbits were killed by prussic acid, and,
while their hearts were still pulsating, the one (c) was sus-
pended 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 effec-
tually as was possible, any further flow of blood to or from

the head, after they were removed from their respective
positions. 1

In the rabbit (c) the whole of the external parts of the
head, the ears, the eye-balls, &e., 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 ; ameinic beyond
my expectation. J

348

HUMAN BRAIN.

“ In the rabbit (d) the external parts of the head, the ears,
eye-balls, &c., were turgid, livid, and congested. The
muscles and bones of the cranium were of a dark hue, and
goiged with blood, which at some parts appeared extrava-
sated Upon opening the cranium, the membranes 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
ol the tissues, if not extravasation of blood into the mem-
branes. The substance of the brain was uniformly dark,
and congested to a remarkable extent.”

l)r. Kellie asserts, but I think his experiments do not
suppoit linn, 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 anseraia
of the internal as well as external parts of the cranium ; in
the other a most intense hypersemia 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.”

“ ^ the cranium were the perfect sphere, as taught by
Monro, and as 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. Burrowes 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
that they are now admitted by nearly all men as established
principles in physiology.

Anaemic 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 certain indi-

AN.EMTC AFFECTIONS.

349

cation of inflammatory mischief ; but it is now well known
that both may arise from anaemia, either local or general.

The occurrence of scrions symptoms from a diminished
supply of blood to the brain is now 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 cerebral
capillary system.

Dr. Burrowes, in the lectures already referred to, says
that he is inclined to the opinion that some of the most re-
markable 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 sup-
plies. Take the salivary glands or the testicles, as an illus-
tration : 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.

Ihe effect upon the sensorium, of suddenly cutting off
the supply of blood to the brain, is strikingly exhibited in
tlie familiar instance of syncope, whether induced by loss
of blood or mental emotion. Now it appears to me con-
trary to all analogy that the function of an organ like the
bram (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.

1 he maintenance of such a doctrine appears to me to par-

! , of the ol(1 leavci>. which Dr. Burrowes has so admira-
bly upset.

Sir Astley Cooper, by his experiments with ligatures on
the carotid and vertebral arteries of dogs, showed the de-
pendence of the brain on its supply of blood for the Tier
ormanee of its functions. The first effect of pressure on

c carotid arteries was to produce a state of partial insen-

350

human brain.

sibihty : 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 op-
portunity of observing the effect upon the brain of cutting
oft 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 sen-
sonum, but more frequently there is an immediate, though
it may be a temporary, effect produced. In other cases, the
remote consequences are serious. I)r. Norman Chevers has
published in the Medical Gazette, Vol. xxxvi., p. 1140, Octo-
bei 31, 1840, 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 per-
formance. 1 lie wdiole paper is worthy of perusal, — but I
must confine myself to some of his deductions. lie says,
that though by far the larger proportion of those in whom
the primitive carotid artery on one side is obliterated, re-
cover, a considerable number become hemiplegic, and perish
from disease of that hemisphere of the brain. The conclu-
sion that obliteration 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 generally considered to depend upon
local anaemia, not upon congestion.

“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.

“ The parts of the cerebral substance which were princi-
pally involved in disease, were those supplied by the chief
branches of the obstructed vessel.

“ Obliteration of the internal jugular vein was not ob-
served.

“ (2.) — There were not remarked any morbid appear-

AN.EMIC AFFECTIONS.

351

ances to indicate that inflammation had been conveyed
backwards along the nerve to the brain. The part from
which the pax- vaguni arises is not shown to have been
involved in the disease. That cerebral disease may be
established in these cases quite independently of implica-
tion of either the vein or the nerve, is further proved by the
tacts that the paralysis has been known to occur almost
immediately after the artery has become obliterated, before
inflammation could be possibly established in the sur-
rounding 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 completely hemiplegic have
barely a chance of surviving.”

Dr. Chevers sums up with this excellent practical obser-
vation : — “ The facts adduced in this paper, it is submitted,
pio\e that the danger of cerebral disorganization should
ha\e 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 existence, and in

every case where other means of treatment can be em-
ployed.

Dr. Burrowcs, whose opinion on all practical subjects is
of the highest value, suggests the application of a ligature
to the carotid artery in some cerebral affections: he says *

rli?/ i r andvhTle8S CaSCS of ePiIcPsy and some kin-
dred maladies which are characterized by extreme cerebral

congestion it appears to me that, other remedies failing

us opera , on may be fairly resorted to. I am aware of the

respons. ahty of advocating a remedy attended with risk to

in i T 0ur ^remedies most violent poisons

m th° ,,amls of th« unskilful ? ” I quite concur with Dr

* F. 78, op. riJ.

352

HUMAN BRAIN.

Burro wes in this opinion, and more particularly as the
operation has been successfully performed for epilepsy, —
as related further on.

Surgical operations and accidents are not the only agents
which produce an anaemia of the brain, local or general.

Ihe balance of the circulation may be disturbed by
various causes, but there is none so frequently observed
as that arising from the intemperate use of stimulating
drinks.

Their primary effect is to excite the heart’s action to un-
natural exertion ; all the organs feel this, but the brain
more than the rest : after a storm comes a calm. The in-
tervals between the use of these stimuli are the calms ; but
unlike the calms of Nature’s hand, they are states of fear-
ful depression. When these intervals are long continued,
they are not merely states of depression, but states of deli-
rium ; and this leads us to the consideration of that fright-
ful, 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 horri-
ble malady, delirium tremens. Delirium ebriosorum I re-
gard as a distinct disease, an hyperaemic affection, as will be
explained a little further on.

Delirium tremens. — I believe that we are justified in
classing delirium tremens under the head of anaemic affec-
tions 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 ge-
nerally full ; and occasionally 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 Greenwich, first gave it its present title, and dis-
tinguished it from phrenitis. He says,* “Delirium tre-

* Tract on Delirium* Tremens, by Thos. Sutton, M.D., of the Royal
College of Physicians, late Physician to the Forces, and Consulting Phy-
sician to the Kent General Dispensary, 1813, p. 3.

DELIRIUM TREMENS.

353

mens, 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 Hos-
pital, and for many years lecturer on medicine at that hos-
pital, 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 distinguishing it from
phrenitis during forty years of his practice. So far as my
observations and inquiries have gone on this point, its treat-
ment is acknowledged by only a few, who have not collected
any very ample information on the subject.” The Doctor
does not add to our knowledge of the pathology of the disease.

Dr. Copland, whose article on this subject, like all con-
tained 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. Iilake ' 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 inflammation of the brain, as Dr.
Uutterbuck mentions m his lectures in the Lancet, vol. ii.
p- of >. i would ascribe it to serous effusion within the
cranium— -every post-mortem that I have since witnessed

IhTltK " trcmens' tcnded t0 confi™ ™ ”

fills author makes an excellent practical observation to
he correctness of which I can add my testimony, and which
bears out my view of the anmmic character of this disease
he stimulus of light, or indeed of any excitant, seems of ad-

nation^ of' Ti^ generally known under the denomi-

1310, p. 58 Cn9’ &C ’ 'V Andrew iilake, M.D., M.R.C.S., &<•..

354

HUMAN BRAIN.

vantage in delirium tremens • but not so in the commence-
ment of mania : its symptoms are invariably exasperated bv
such influence. J

Many authors have divided delirium tremens into two
kinds but, as I have long thought and taught, erroneously,
i hey have, m fact, confounded that delirium, delirium ebrio-
sorum which may be excited in any individual by the use of
stimulants, with the true delirium tremens, which is alone
pioduced 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 Avas much pleased to find it
thus treated by Dr. Blake. 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
condition 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 phlegmasise, the other to that of
neuroses. In illustration of the distinction of the delirium
which immediately follows indulgence to excess in spirituous
liquors and that which docs not come on until after a cessa-
tion of intemperate habits, he relates a case of a man who
was an habitual tippler, and whenever he exceeded his usual
alloAvance, which was tolerably often, he was attacked with
furious delirium, and which, if not cautiously treated, 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,

* P. 64, op. cif.

DELIRIUM TREMENS.

355

or more days, as the consequence of suddenly desisting from
the habitual abuse of any stimuli.

In the cases ot 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 ot one or more ot the extremities, injuries of
the head, &c., and whose habits are extremely intemperate.
Many of these miserable drunkards are in the habit of
swallowing more than a gallon of beer in the day, with a
certain amount of gin to cariy it off by the kidneys. On
then- admission into the hospital, of course; the enormous
supplies are cut oft, though we generally ascertain 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 quail-
tin , and in a few days we often observe a slight tremor of
the tongue when protruded. There is a wildness about the

eve.

an unnatural quickness of manner when answerin

mi • 1 n .

2- our

questions. The sister of the ward tells us that during our
absence he is very busy pulling the bed clothes, perhaps
rolling up lus upper sheet. The tongue is not unusually
c ry or furred, as m phrenitis ; the skin is bathed in sweat •
the pulse is quick and irregular, both in force and frequency’
iNow ft 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
ten- hours, and woe to the fracture.

Bi. AVatson, uhose description of all disease is so graphic
I i ™ and Wh0 haS seen H more frequently than

have had the opportunity of doing, unconnected with a
raflT™ iM, i"j"ries’ says- “ The delirium

delirium 8hi.t yvfnd I-®' not “ ficrc0 or mischievous
£l£T-’ , ,a Vusy, delirium ; he does whatever you
Kurt him to do, but he does it in a hurried manner with

;,f £°‘ Tfty If jH™ it properly. During the approach

forts Lweld ,Wl"IC V ,S ?Ct al,l° S° *o«t. lie

anre £ it ,'Ttlonc? ° J my 'f crfercnce, or advice, or assist-

and Id, t " ^ ' "tlCa' whlch hc sets "bout in a Imstlino

anil blundering manner. His Innnacity is extreme d
he refcra to matters that "

2 a 2

he is

356

HUMAN BRAIN.

not altogether inattentive 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 per-
haps for several nights, but been restless and rambling ; and
you will generally learn that he has been habitually intem-
perate, or subject to some great source of care, or anxiety, or
excitement : and in many cases he has been recently, some-
how or other, debarred from his customary stimulus. In
addition to these points 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 commonly 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
patient is affected, not with inflammation of the brain, but
with delirium tremens ; and that if you bleed him further
you will make him worse.” Sometimes the pathological
condition which excites delirium ebriosorum is an in-
flammatory action of a low character occurring in a con-
stitution much shattered by long-continued debauchery.
In these cases it is necessary to support the system with
the accustomed fermented liquors, and employ local counter-
irritants to the head, with diruretics, to prevent serous effu-
sion. The following history illustrates this class of cases : —

Case 1. — Coulson Johnson, set. 47, waterman on eab-staud, countenance
bloated, admitted into George’s 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 lie 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
be continued for some time.

DELIRIUM TREMENS.

357

Was put up in splints for the night. . .

Jan 13th Has passed a restless night, and complains ol much pain.
Pulse quick and full. Skin moist, but he says he is very cold. Tongue
and breath foul. Eestless. Put up in the straight splmts — great dith-
cultv 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.
Towards 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. Yespere. Mr.
Whitfield ordered him, Sol. Morph. Mur. npxx. Ammon. Garb. gr. v. ex.
Mist. Camph. 6^- Gin giv. Pulv. Ehei. c. Hydr. 9j. stat.

14th. Is no better. Passed evacuations and urine in bed this morning.
Dozes off occasionally, awakes, and is restless, and then dozes again for a
time. Answers questions when roused. He removed all the apparatus
from his thigh.

15 th. Much the same. Eemoves his apparatus, and the handcuffs were
put on him. I saw him for the first time to-day. The symptoms were
very obscure ; there was more coma and less tremour than we generally
meet with in delirium tremens. But the cold surface, sleeplessness, con-
tracted pupils, and weak pulse, determined me to give him porter ; at the
same time I thought it safe to add some tinctura Lyttse to his medicine,
in order to excite the action of the kidneys and avert serous cerebral effu-
sion, of which there was some threatening. Porter, 2 pints ; Tinct. Lyttse
npxv. e. Mist. Pupils contracted. Gets no continued rest.

16th. No better; 4 pints of porter.

17th. Is decidedly better for the extra porter ; but as he has diarrhoea,
and passes motions in bed, I feel obliged to omit the porter, and order
Tne. Opii rr|_x. Mist. Cretae Co. gj. 6tis- Brandy giv. daily.

18th. A little better. Has not passed evacuations since. Is restless
towards night. Pulse slower.

20th. His hands haring been unfastened, he undid all the apparatus
during the night.

22nd. Sol. Morph. Mur. npxl. e. Mist. 6tis- Continues in much the
same state.

26th. No better; but with rather more tendency to coma. Hyd. c.
Greta gr. ij. o.n. Tree. Opii. 6ds' horis — Empl. Lyttas pone aures.

27th. Apparatus put up once more.

28th. Is better for the blister. Has been quiet since yesterday, and
answers questions more rationally.

30th. Still better. Answers questions perfectly — remembers the cir-
cumstances of the accident — but not his pulling the splints off. Does not
pass evacuations in bed. Porter ilb fs.

Feb. 1st. As bad as ever. Eemoved all the splints again, but answers
questions, and declares he does not meddle with the apparatus, but that
the other patients do. In this state 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. Lytt* p. aur.

L6th. Rather better. One hand let loose, when lie immediately re-
moved the splints ; talks rationally except at night, when he calls out on

HUMAN BRAIN.

people whom he has seen in the day, and sometimes is very noisy
natural. .Evacuations not passed in bed.

20th. Put up in pasteboard splints to-day. The stimulants were
tinned, and he gradually recovered, but with weakened intellects.

Pulse

con-

. Judging from the cases of delirium ebriosorum, which
an, < ten now occasionally published in the medical periodi-
cals as cases of delirium tremens, I am afraid that this dis-
til 1 e t ion is not sufficiently attended to. The diagnosis is
often very difficult, but 1 have almost always found that
u lit n large doses of opium fail in producing sleep, we ought
to consider that the case is one of hyperaemia, and not
anaemia, and if wc change the treatment, relieving the con-
gestion 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 warm-bath for the Yvhole 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 ex-
plained further on in the section on chronic meningitis.
Iliese cases are often very obstinate, and require great pa-
tience on the part of both patient and surgeon. They
often ultimately terminate with more or less mental de-
bility. The last case of this kind which I had under my
care was a retired naval surgeon ; lie 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 diseases ; they must be seen frequently to be ap-
preciated. But the following 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, excited state of

DELIRIUM TREMENS.

359

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 ebrioso-
rum is usually dry, and sometimes brown, but this is no
certain guide. The pulse is most uncertain, for as all in-
flammatory affections of the brain are depressing in their ef-
fects on the heart’s action, so do we find that the pulse is not
hard and wirey in the hyperaemic 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 ebrio-
sorurn.

The danger attending an error in diagnosis in such cases
is evident, for if we omit to recognise 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 present that
we cannot mistake them, we have to bear in mind that
though delirium tremens is not an inflammatory disease,
that the excessive and constant use of stimulating liquors
does predispose the membranes of the brain to inflamma-
tion, and that the two diseases frequently run one into the
other.

The plan of treatment which I have found on the whole
most successful in true delirium tremens, is to give the sti-
mulus 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 revolt-
ing as it is to our feelings as moral beings 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 quan-
tity of porter from one pint up to four or even five ; and
gin up to twelve and sixteen ounces. 1 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

360

HUMAN BRAIN.

hours and a drachm of the tincture at night, to be repeated
it it does not produce sleep in two hours.

If theie is much irritability of stomach, I then give it in
a state of effervescence.

I have had no experience of anodyne enemata, as recom-
mended by Dupuytren, but I should not hesitate to employ
them, d the oral exhibition of opium failed.

As soon as the stomach will retain any food it must be
| atients will often take soups and broths before
solids ; but whatever is given should be highly nutritive.

Generally speaking, I find this plan successful, mere
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 complaint.

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 comparatively sure one in this complaint,
as when its frequency did not exceed 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 diffi-
cult to diagnose and prescribe for, are those which accom-
pany injuries of the skull occurring to persons of intem-
perate 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 de-
rived much valuable knowledge, used to recommend the
use of diffusible stimulus, such 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

* Op. cil.

ANEMIC COMA.

3GI

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 rendered him quite insensible, lie-action took place very
slowly ; Mr. T. first gave him ammonia, and afterwards a small quantity
of porter : he improved slightly. In the evening he was seen by another
surgeon, who took a different view of the case, and 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.

Ancemic coma. — We have seen that delirium may arise
from an antemic condition of the brain, and we shall next
observe that a state of insensibility 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 hydro-
cephalus, 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 two forms
of hydrocephalus, the one anaemic, the other inflammatory,

as well as twyo forms of ramollissement.

«

I)r. Marshall Hall wras 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 liydrencephaloid affection of in-
fants arising from exhaustion.”

Dr. Hall has observed this affection generally as a conse-
quence of continued diarrhoea, produced either by bad diet
or long-continued use of purgative medicines, or as a con-
sequence 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 power's appear to be
more prostrate.” He thus describes the signs of the com-
plaint : “ The infant becomes irritable, restless and feverish,
the face Hushed, 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 j
trie bowels are flatulent and loose, and the evacuations arc

362

HUMAN BRAIN.

an e™ notion
as to the nature of this affection, nourishment and cordials

he not given ; or if the diarrhoea continue either snout*,
neously or from the administration of medicine, the exhaus-
tion 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
f ™ pupils unmoved on the approach of light ; the breathing’
f om being quick, becomes irregular and affected by sighs •
he voice becomes husky ; and there is sometimes a husky’
teasing cough ; and eventually the strength of the little

% “ie vasciJar system cxhausted-

Dr. Ilall considers that this affection is to be distinguished
from true hydrocephalus principally “ by observing the con-
dition ol the countenance, and by tracing the history and
causes of the affection. ^

Dr. Abercrombie observes,* - In the last stages of diseases
of exhaustion, 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 diarrhoea,
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 termi-
nate favourably, or it may prove fatal. This affection seems
to correspond 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 sudden 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 distinctly, and is, in some cases,'

* r. 72, 76.

AN.EMIC COMA.

3G3

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 I)r.
Abercrombie, that gentleman observes, “ The state of in-
fants 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 ap-
pearance, but it is one which conveys the expression of
coma, rather than of sinking ; and I remember the first
time I met with the affection, the circumstance which ar-
rested 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 diar-
rhoea, and not with any symptom indicating an affection of
the head. The child recovered under the use of wine and
nourishment.”

“ The remedies for this affection,” says Dr. Hall, “ are
such as will check this diarrhoea, and afterwards regulate the
bowels and restore and sustain the strength of the little pa-
tient. ith the first object, it may be necessary to give the
tinctura opii and chalk, and afterwards the pilnla 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 and
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.”

l ive or ten drops of the sal volatile may be given every
three or four hours, and twice or thrice in the interval five
or ten drops of brandy may be given in arrowroot done in
water. As the diarrhoea and appearances 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 t lie nurse’s or asses’ milk. The brandy
has sometimes appeared to induce pain — sal volatile is then
to be substituted for it ; a dose of magnesia has also ap-
peared to do good. For the state of irritability, the warm-

364

HUMAN BRAIN.

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 elsewhere, by no means precludes the possi-
bility of real congestion of the brain. It rather implies it.
In extreme cases these are not only the symptoms of cere-
bral 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 efficacy.”
Dr. M. Hall follows up this account with some excellent
cases very illustrative of his views ; he also quotes the fol-
lowing 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 deli-
cate, 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 ex-
actly 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, natu-
rally anxious about their only surviving child, consulted another practi-
tioner. The case was immediately decided to be one of cerebral conges-
tion, 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 as-
pect 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 lan-
guid 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,

* I1. 29.

AN.EM1C COMA.

305

aud she was tossing about in that restless state which is so fatal a sign in
these territic cases. She could still speak, asked whether I was come (she
knew 1 had been sent for), and said, ‘ Am I in any danger ? how dark
the room is ! I can’t sec.’ The shutters were open, the blind up, and the
light from the window, facing the bed, fell strong on her face. I had the
curiositv to lift the lid and observe the state of the eye ; the pupil was
completely dilated, and perfectly motionless, though the light fell strong on
it. Who can doubt that here the insensibility of the retina depended on
the deficiency of its circulation ?— But to return to the little patient. The
next dav she had vomited her food several times ; it was, therefore, di-
rected that she should take no other nutriment than a dessert spoonful of
asses’ milk every hour, and this was strictly obeyed, and continued for
several davs. The child wasted, her features grew sharp, and every now
and then she looked fretful, and uttered a faint squeaking cry ; the eye-balls
became sunk in the socket, like those of a corpse that had been dead a
month ; the skin continued cool, aud often cold, and the pulse weak, tre-
mulous, and sometimes scarcely to be 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 lias perused the foregoing case attentively,
and has reflected on it, he will, of course, draw his own in-
ferences. I can draw no other than these : that the heavi-
ness of head and drowsiness which were attributed to con-
gestion in the brain, really depended on a deficiency of
nervous energy; that the bleeding and scanty diet aggra-
vated 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 importance.

“ I will now relate a case similar in the symptoms, but
very different in the treatment and result.

“ Cate l. — 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 his child, which he said had something the matter with its head and
that the medical gentleman of the family was in the house, just goin<r 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, langour, absence of heat, and all symp-

366

HUMAN BRAIN.

t°ms 0f fever. The child was not small of its age, and had not been weak

Tltlecl1 bCrreT? ab°Ut tW° m0nths> siuce w*»ich it had never thriven’
The leeches had not been put on. I took the medical gentleman into

Xch'hS^^nw 1° tbC f0reg0ing case> and several similar to it,
which had been treated m the same way. Then I related to him a similar

case, which I had seen m the neighbouring square, which had been treated

mth ammonia in decoction of bark, and good diet, which had recovered

nf if °" S° aS/° ma^e doubtful whether the treatment was the cause
of the recovery, but so speedily, that at the third visit 1 took my leave
Ie consented to postpone the leeches, and to pursue the plan which I re-
commended. We directed the gruel diet to be left off, and no other to be
fhnlfthai! afeS ?Uk’ of wl.uch the child was to take at least a pint and
M : af. ™ost a qnart’ m .the„ twenty-four hours. Its medicine was
1 ) mmims of the aiomatic spirit of ammonia m a small draught every four
hours. When wc 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, without aperient medicine

So inveteiate 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 nutri-
tion is reduced so that he has neither flesh on his body,
nor blood in his veins, well knows what it is to lay down
liis head and dose away half the day without any congestion
or inflammation of the brain. This error, although I have
specified it only in a particular complaint of children, may
be observed in our notions and treatment of other diseases,
and at other periods of life. If a woman has a profuse
haemorrhage after delivery, she will probably have a distress-
ing headache, with throbbing in the head, noises in the

ANAEMIC COMA.

307

ears, a colourless complexion, and a quick, weak, often
thrilling, pulse, all which symptoms arc greatly increased by
any exertion. 1 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, occurs
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 increased, merely obviating con-
stipation by aloetic aperients.”

My esteemed friend and colleague, Dr. Risdon Bennett,
in his admirable work on Hydrocephalus, advocates the
doctrine, that this disease assumes veiy distinct forms ;
and that though it undoubtedly does arise in some instances
from inflammation, in others it arises from an opposite
condition. He says,* “ There can be no difficulty in ad-
mitting 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 scr opinions
action, and may or may not be attended by the signs of
inflammation. D

Hie comatose condition which we see occasionally fol-
[°'vin2 a sevei’e attack of erysipelas of the head in a de-
bilitated constitution comes into this category of amende
affections of the brain. It is difficult to say whether this
condition of the brain is the result of that general de-
pression which is both cause and effect in the erysipelas
o London, or whether it can be attributed to a derivation
of blood to the surface. We all know that in hyperremia
of the brain we can relieve our patients by determining
he blood to the surface. It is therefore possible that
this morbid cutaneous determination of blood has the effect

T)iagn0Si8’ a,1<1 T™fraent of Acute Ilydrocc-

368

HUMAN BRAIN.

of diminishing the supply to the capillaries of the brain as
effectually as our artificial measures. In a practical point
ot view there is nothing more important to the surgeon
than a knowledge of the fact that a rambling, incoherent
manner m the day, with a restless delirium at night, is no

P1’00 '. the existence of inflammatory action in the brain.

le following case may be selected from many in illustra-
tion of this view of the subject : —

the month of January 1846, I removed a small tumour
fiom ovei the paiotid gland m a gentleman aged 25.

He imprudently exposed himself to cold after the operation, notwith-
standing my strong injunctions to keep his room, for fear of erysipelas
bemg excited. My fears were realised,' and a severe attack was thTS
My friend Dr Munk attended the case with me. The erysipelatous in-
flammation attacked the wound on the fifth day,— but I will <Ave the case
in lus words : — °

T ' Pa,tlent )vent °“ satisfactorily for some days; but on Saturday,
Jan 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
thiough the swollen parts. Port wine, decoction of bark, and small quan-
tities ot mtusion ol senna, were given at intervals.

“ 1 saw the case, in consultation with Mi-. Sollv, on Tuesday, Feb 3rd
Ihe inflammation had then extended over the whole of one* side of the
lace, and the right eye was completely closed. The affected parts were of
a dusky-red hue ; the pulse 120 ; the bowels purged ; and there was some
griping. I he 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
ot bark ; one drachm of the compound tincture of bark, and four grains of
the sesqui-carbonate of ammonia, every four hours.

“ The following day (Wednesday, Feb. 4th) he appeared much the
same ; the erysipelas, however, extending, now implicated the forehead
though not encroaching upon the hairy scalp.

9 j1 Thuisday, Feb. 5th, he was, in every respect, decidedly worse ; the
left side of the face and ear had now become affected, the disease, how-
ever, subsiding in the parts first attacked. The forehead was much swollen
tense, and of a dusky-red ; the pulse stiff 120, but decidedly weaker He
wandered considerably, but stiff replied to questions with tolerable accu-
racy, though rambling off again immediately. During the night he had
been violently delirious ; had got out of bed in spite of his attendants ;
and was with difficulty restrained. 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 mixture as before. This was at mid-day. About midnight we found
him slightly improved, quiet, rational, and his pulse, if anything, stronger

AN EMIC COMA.

36(J

anil 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. 6tli), at half-past four o’clock p.m.,
we found him again very decidedly changed, for the worse. The erysipe-
latous inflammation had not extended, 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 de-
cidedly cold. He laid in a heavy, semi-comatose condition, and was al-
together incapable of replying to our inquiries. His breathing was be-
coming 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 sugges-
tion of our patient’s friend, Mr. Bristowe, of Camberwell, who, throughout,
watched the ease with much anxiety, and favoured 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 neighbour, Mr. Hemy, of the Com-
mercial-road. He was then sinking rapidly. The pidse had risen to 150,
or upwards, and had become weak and thready : the respirations took
place at longer intervals, 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 ar-
rested. 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 112 or 118, and having, in great measure, re-
covered 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
laboured. 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 favourably. His pulse is now (ten o’clock p. m.)
under 100 ; skin warm and moist ; tongue clean and moist. He is now
perfectly rational, and has slept quietly and comfortably at intervals;
the inflammation has not extended, and desquamation has commenced •
the bowels have not been relieved since last evening ; but he feels an in-
clination 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 intermis-
I?® .to . ,t,me- , . , 11,13 intermission, however, is less marked al
h heart than in the radial artery ; tongue moist ; feet comfortably warm •
owing to the diminution of the swelling l.e can now open both eves- he

vrnniT96' .evacnation- four o’clock this niorning

h M and W ig nSa'n r(it,UnH'd ; lic Rallied with much effort, and
the feet and legs became cold, a state which shortly, however, disap.

2 j»

370

HUMAN BRAIN.

peared 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 decoc-
tion 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 steadilv pro-
gressive. Suppuration of both eyelids took place, and the pus was evacu-
ated by the lancet. He left town on the 26 th of February, and returned
about the end of March perfectly well.

Here is an instance of erysipelas treated by what some would perhaps
characterise as an undue and lavish administration of stimulants ; but I
feel fully convinced (and 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 favourable issue. I am
no advocate for large doses of medicines in ordinary cases. On the con-
trary, I am inclined to believe that the tendency of medical opinion and
practice is, at the present time, in favour of larger doses than the abso-
lute 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 sti-
mulants has been necessary : and I certainly have never met with one
in which their effects were so strikingly and unequivocally 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. Solly,
Mr. Bristowe, Mr. Henry and I saw him, he was sinkiug, and now two
ounces of nine were given every hour, and a drachm of Hoffman’s ano-
dyne every alternate horn’. 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
wine-glassfull was given every hour, and continued in the same quantity,
and at similar intervals, 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 administered,
neither the patient’s pidse nor his nervous system were at any time
unduly excited. 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 illus-
trated on Friday, Feb. 6th. At half-past four o’clock, the tongue was
dry, dark -brown, and fissured ; at six o’clock he appeared to be dying,

AN EMIC COMA.

871

and now commenced the administration of brandy. A wine-glassfidl
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, uncomplicated
condition, as it so frequently follows an inflammatory state,
though the inflammation may have been one of a low or
sub-acute character. ith the view of ascertaining the
condition of the brain, I have always anxiously sought for
ever}- opportunity of examining the brain of patients who
ha\e died in this state, and I have generally found it free
from all signs of inflammation. Nevertheless, though it
is true that in London, as a general rule, erysipelas is a
disease of debility, requiring wine, brandy, &c., we must
remember that acute inflammation of the scalp will some-
times travel by continuity of tissue to the membranes of
the brain, and then prove rapidly fatal, either by serous
effusion or by acute inflammation of the hemispherical gan-
g ion. \\ e should therefore endeavour, in our constitu-
tional treatment, to steer a middle course on the onset
keeping, as sailors say, your weather eye open for a storm
roin w ry opposite points of the compass. A scruple of

of'Vfn ' T \hat 1S’ five g^ns of calomel to fifteen

, i « L ’’ !°Uowed by,a scnna draught in the morning,
clears the prime via and fits the system for either course

as subsequent events may direct. In wounds of the seal,;

M A bn T 7'ark that ?ften "’hen a® pericranium
edLb f .if '’ft sePanded from the bone, and the
subs, -0110 th<! W°"nd ,ral 'l"'ckA tllere is always danger of
r to , tS''r’Prat'°n’ am' th° sl,r6con must, he on the
° rnake * free 0pcning, as matter cannot he nut up

o jj o *

372

HUMAN BRAIN.

between the tendon of the occipito frontalis and the bone
without the brain sympathising.

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 collection 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 corresponding
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 anaemic character
is often induced 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 6. — A watch and clock maker, who lived in the neighbourhood of
Shoreditch, consulted me in January 1840. He was a cripple, and
therefore unable to take much exercise, 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 wine-glass or large rummer struck close to the ear,
sometimes like water thrown on a hot iron, or running from a tap, some-
limes 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 bis mental miseries, he bad
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 them-
selves, with the following — a languid, weak, irritable pulse, cold skin, pale,
fiabby 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 morn-
ing, aud afterwards light bitters with rhubarb and soda, and strict atten-
tion to diet.

I have frequently been consulted by professional men,
and others engaged in business in London, who, suffering
from London cachexia, have supposed that they have some

CEREBRAL ANAEMIA.

373

disease of the brain. In one instance my patient stated
that he had lost his memory, that he frequently 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 sup-
pose, to their irregular habits, sudden alternations of tem-
perature, 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, at. 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 walking about his room ;
this returns two or three times in the same night. He says that it has
latch come on in the day. His general health is not very good, has had
gonorrhea 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
qmna ; he took it for some time, and though the improvement was not
rapid, he idtimately recovered.

AVhen these symptoms have lasted some time they are
subdued with difficulty, and require care. It is very ne-
cessary- that the practitioner should inform the sufferer of
their obstinacy, otherwise he will become impatient and
dissatisfied In the treatment of them, stimulants are pre-
judicial and the tonics must be very mild. Steel and qui-
nine seldom answer at first, and afterwards only in small
dmes. 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 mght, haustus senna in the morning'; and I examine the
evacuation before prescribing any other medicine. If the
liver is at fault, taraxacum with small doses of sulphate of
magnesia, and sulphuric acid, will be found more beneficial
gfmeraHy than mercury. This diseased condition cannot be

m i ? by a cov'P.de main> and it is not advisable to say
much o your patients regarding its nature, for if you con
vince them that it arises from debility, they think that they

374

HUMAN BRAIN.

have nothing to do hut eat, drink, and sleep, and thus get
strong, and then they will be well. On the other hand,
\ ou must relieve then1 minds of the impression, that it is
allied to apoplexy, and depends on fullness of the head
or inflammation of the brain, which is generally their feel-
ing, or, otherwise, they will be anxious to be cupped,
leeched, &c. If you have sensible persons 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 dringing 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, Avho perhaps orders a few leeches to
the head, which sometimes relieve for a day or two, from
the re-action 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 necessary to detail symptoms which
are familiar to all.

How instructive it is to watch the gradual disappearance
of the headaches, often most violent, under a judiciously
managed course of steel medicine. After the bowels having
been freely opened and the tongue clean, there is nothing
equal to the old steel mixture with the compound decoction
of aloes and aromatic confection, with a drachm of the
spiritus myristici ; but the practitioner must not expect the
headaches to be removed immediately.

1 believe that if cerebral anaemia continues for a long
while it will produce white softening, or one form of rarnol-
lissement, 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
sequence to hydrocephalus, and 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 difference of

RAMOLLISSEMENT.

375

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 disor-
ganization of the brain, implies the appearance which it
presents to the observer : it is, in fact, softening of the sub-
stance 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 doAvn into a
pulpy mass, he has more difficulty in deciding whether it
is truly a morbid appearance, or simply the effect of decom-
position. The portion thus broken down does not neces-
sarily lose its natural colour, though frequently it becomes
darker ; however, it never resembles pus either in colour
or in its disagreeable odour, so that it ought never to be
confounded with suppuration.

The earliest observations on this peculiar lesion of the
brain are to be met with in the fifth Letter of Morgagni,
De Sedibus, &c.,* “ 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 lelt,”
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 illus-
trate the lesion in question ; and these I shall give from Dr. Alexander’s
translation in the author’s own words :

But let us now go on to the head, for the sake of which, principally,
tin-! 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
pin mater were all distended with blood, as if they had been filled by in-
jection. This blood was such as that of the whole body, black, and not
very fluid. And under the same membrane, in the convolutions of the
brain was seen a transparent water, of the same kind with that which was
found m the lateral ventricles afterwards; yet the choroid plexuses were
not at all discoloured, 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, whicl. being taken off, the thalamus nervi op-

Translated by Dr. Alexander, 17(19,

p. 98, article <5 .

376

HUMAN BRAIN.

tic1 appeared not of the same colour as the right thalamus, 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 with a certain bloody fluid, of a colour
almost eflete ; 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
ia\e taken up ; and that colour of the bloody fluid was most manifest in
the middle thereof. It was more natural to take notice of this difference,
because the cerebrum in general, as 1 said, was of its natural colour, 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, m that place I have mentioned, a kind of bloody colour, and a
loose ill-compacted substance.

I believe that this was an apostema mi generis, which is agreeable to
the opinion even ol 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 extravasated, 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
Scats of Diseases” wrote; for until Rostan published his
“ Recherches sur le Ramollisseinent du Cerveau,” the
second edition of which appeared in 1823, softening of the
substance of the brain seems to have been entirely over-
looked by the pathologists of Europe.

In the present day, however, no one ought to have any
difficulty in distinguishing, after death, the morbid appear-
ances designated ramollissement by the French writers, and
softening by the English. But whether this lesion is the
result of inflammation or whether it is a disease sui generis
has not been so clearly decided. Lallemande believes that
ramollisseinent is invariably the result of an inflammatory
process, while Andral does not allow that this matter is yet
decided. But we will quote Andral’s own words : after
pointing out the different appearances he says :* — “ Do
these different appearances which may be presented by

* Op. cit., p. lfiO.

RAMOLLISSEMENT.

377

softening of the brain, refer to lesions of a different nature ?
Are they but degrees more or less advanced of one and the
same disease ? 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. Lnllemande. The softening 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 but 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
consistence is inflammation P A 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 sangui-
neous 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
softening enter into one or other of these states, and not
finding in this alteration the characters of an asthenic dis-
ease, must regard it as an inflammation.”

“ In thinking so, they but follow their theories ; but for
us, who think that in a crowd of morbid states there is no
more hvpersthenia 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
endeavour to determine these different conditions is the
task to be performed, — a task, difficult no doubt, but of
T'ite another importance from that on which medical men
have occupied themselves in latter times, when they have
wished to reduce every cerebral softening to one of (lie

378

HUMAN BRAIN.

forms or one of the degrees of inflammation 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 inflammation. 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 produc-
tion of a certain number of softenings. We might cite
other facts which would show us a remarkable 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 dis-
cover, no doubt, many other causes which, in the present
state of our knowledge, we cannot even suspect. All that
we affiim is, that it is necessary to seek elsewhere than in
inflammation 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 paralysed, it
suddenly became rigid, convulsed and contracted ; on open-
ing the body we often find, in such cases, one part of the
brain softened, and at the same time reddened with blood •.
leasoning may then lead us to admit that the sanguineous
congestion occurred but as a mere complication of soften-
ing, 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 red-
dened 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 hypersemia, and deprived them of their consist-
ence ? ”

“ Here no doubt arc very many questions raised which

ANEMIC RAMOLLISSE ME NT.

379

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 the opinion which
refers every softening to an inflammation. Because the
brain is softened after a blow on the cranium, is that a rea-
son for saying that every time it shall have lost its consist-
ence it must have been previously irritated ?”

“If science refuse to admit inflammation as the sole
cause of softening 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 encephalitis
cannot be used as synonymous with the word softening.
Neither do we think it correct to call this alteration capil-
lary 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 effu-
sions 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.”

Br. Abercrombie,* in speaking of ramollissement, says,
^Tien I formerly endeavoured to contribute something
to the pathology of this remarkable affection, I had no
hesitation in considering it as one of the results of inflam-
mation 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 mi generis , and M. Rostan, in particular,
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, 1 think we are
enabled to arrive at the conclusion that it occurs under

* Op. cil., p. 24.

380

HUMAN BRAIN.

two modifications which differ essentially from each other,
n the cases of M. Rostan the disorganization was observed
chiefly m the external parts of the brain : it occurred
a most 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 extravasa-
tion of blood, or surrounding 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 biain, the fornix, septum lucidum, and corpus cal-
losum, 01 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 distinctly combined with appearances of an inflam-
matory kind, such as deep redness of the cerebral matter
surrounding it, suppuration bordering upon it, and depo-
sition of false membrane in the membranous parts most
nearly connected with it. We may even observe, in dif-
ferent parts of the same diseased mass, one part in the
state of ramollissement, another 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
softening. Remarkable examples of this will be given in
the sequel, and another of a different nature, in which an
opening in the septimi lucidum produced by the ramollisse-
ment was entirely surrounded by a ring of inflammation.
This is the affection which I have endeavoured to investi-
gate, and which I consider as one of primary importance
in the pathology 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.”

“ 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

ANiEMIC RAMOLLISSEMliNT.

381

gangrene in other parts of the body ; and that like gan-
grene it may arise from two different causes, inflammation,
and failure of the circulation 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 ap-
pearances described by M. Rostan. If this doctrine be
admitted, 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. Ossifica-
tion of the arteries of the brain to a veiy 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 con-
dition of a part of the brain which terminates in the
ramollissement of M. Rostan, and indeed he distinctly
points at this explanation 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 occurrence. 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 appearance, and in which it is
sometimes of small extent. Of this some remarkable ex-
amples will be given in the sequel, in which the perfora-
tion 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 hydrocephalus.”

On reconsidering all these different opinions, and more
particularly the simple but clear-sighted views of Dr. Aber-
crombie, we are warranted in concluding that the morbid

382

HUMAN BRAIN.

appearance called ramollissement is usually the result of
acute inflammatory action, but that in old people it fre-
quently follows a total failure of the circulation, corre-
sponding, both m its consequence and in the cause pro-
ducmg it to asthenic senile gangrene in other parts, and
also that it may be the consequence of local and general
anaemia even m young subjects. The question regarding
its inflammatory character is peculiarly interesting to the
physiologist, from deductions he may draw from the effects
which its first stage produces on the functions of the brain
as distinguished from those exhibited after the disease
has pursued its course to the actual destruction of its
texture.

Chige,* * * § Henle f Valentin, + Wagner, § and Dr. Hughes
net 1 nett, of Edinburgh, have made some most important
and interesting observations on ramollissement of the brain,
lo the papers || of this last-mentioned excellent pathologist
lam indebted for the following information on this subject,
blugc was the first to point out, not only in softening of
tie brain, but that, in certain stages of inflammation gene-
ra v» corpuscles are produced, which he has denominated
compound inflammation globules. The blood in the
capillary vessels stands still. The blood corpuscles lose
tlieii coverings and colour, only their nuclei remaining.
Ihese become agglomerated by means of a white con-
necting mass, and form thick opaque round bodies, which
consist on an average of from twenty to thirty small
granules, which, when examined singly, are perfectly clear
and tianspai ent. Henle has shown that these granules
are contained in a true cell-wall with a neucleus. Valen-
tin, Vogel and Dr. H. Bennett concur in this view of their
structure.

Dr. H. Bennett thus describes the mode in which these
exudation corpuscles are developed : — “ The blood-plasma

* Anat. Mikroscopische Untersucliungen, pp. 12, 13.

t Miiller’s Archives, 1839, p. 24.

+ Vogel uber die Envachung des Gehirns.

§ Wagner, Handworterbueh der Physiologie.

| Ed. Med. & Surg. Journal, vol. lviii. pp. 58 & 60.
*j[ Ibid. vol. lix. p. 344.

AN/EMIC RAMOLLISSEMENT.

383

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 tilling up the spaces between them in masses more or
less dense. If a small quantity only be exuded, the gra-
mdes occur in small patches at irregular intervals. (Plate I.
fig. 5.) This appears to arise from a comparatively 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 congestion is more intense in certain places,
the exudation is more abundant, and the granules accumu-
late in a dense mass outside the vessels, or in the inter-
stices of the elementary structures of the organ. (Plate I.
fig. 4.) This exudation serves as a blastema for the pro-
duction and nourishment 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 corpuscles which
causes it to break up, and gradually become more and more
soft. T hus we have uniformly seen that when the soften-
ing is diffluent, perfect corpuscles are few, and that the
granules are numerous and loose. When it is pultaceous,
only the corpuscles are numerous, and the granules less so •
and when the diseased part retains to a considerable 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 disintegra-
tion, it frequently happens that portions of the solid exuda-
tion 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 micro-
scope.”

“ The exudation corpuscle is formed like all other primary
cells a nucleus is produced, from which a cell-wall arises.

384

HUMAN BRAIN.

Dining, 01 subsequent 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 exceedingly minute, and few in
number. As the development proceeds, the granules be-
come larger and more numerous, the corpuscle assumes a
brownish colour and becomes more or less opaque. Some-
times it entirely 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 were perfectly round and transparent.”

“ 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 oc-
curring in numerous corpuscles, causes the coagulated exu-
dation to become soft, pidtaccous, or even diffluent. When,
by the process of organization thus described, the exuded
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 produced, 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 capil-
lary 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, to know with cer-
tainty 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, absorption 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
softening of the brain is diffluent, not only is the exudation
mass reduced to granules, but the cylindrical and varicose

R AM0LI.1 SSEMKNT.

385

nervous tubes are broken up into fragments more or less
long”

“ L)r. 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 ob-
served them in inflamed lungs. He says, c They do not
always present in then- agglomerated form the figure de-
scribed 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
theu 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 development of the exudation corpuscle, as Dr. Hender-
son supposes, but are caused by the coagulated blood-plasma
breaking up into different-sized masses. I have frequently,
by means oi friction, caused such portions of coagulated
exudation to separate, to peel off, as it were, from the ex-
tend ot the vessels, and float loose amongst the granules
and corpuscles. 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, inappre-
cia ole to the naked eye, but clearly discernible with the
microscope. He also distinguished more decidedly than had
been done previously, the inflammatory and non-inflamma-
tory softening.

The following case illustrates very strikingly the value of
the microscope in the examination of the brain. It quite
confirms the opinion I have always expressed, that every de-
cided deviation from the normal action of the brain would
be always found to correspond to some alteration 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 ft tpmflrtnci

me^j'u^T* l,y(]roc«rp|iaIu3 ; death ten days after the commenee-

eonvolution, ‘k'^T h not,"n", abnormal in the brain. Vessels of the
a„e() o abundantly coated with exudation granules.— John Smith

X itTiiS " nt° thC It0'Vnl [nfinnar-v’^ under Dr. Traill, Feb-

386

HUMAN BRAIN.

According to the mother’s account, he awoke during the night of the
3rd instant with a loud scream, and, by pointing to his head, seemed to
indicate that he felt pain there. On the following day he vomited re-
peatedly, and he has since refused all food. On admission there was con-
stant rolling of the head ; pupils contracted on the approach of light ;
pulse quick and sharp ; bowels regular. Two leeches to the head ; pow-
ders of calomel and sugar.

Feb. 13th. \omited powder ; passed a restless night ; some tremor ob-
served 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 un-
usual vascularity. The ventricles contained no fluid, nor was the consist-
ence 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 presented 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 hydroce-
phalus in children, yet after death no morbid lesion of any consequence
was to be discovered. This is a circumstance 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 exudation
granules to a very great extent, and that these granules contained among
them numerous bodies similar to the corpuscular nuclei. That the exuda-
tion in this case should have presented this condition, notwithstanding the
violent symptoms, is very curious, and, in a histological point of view, ex-
ceedingly 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 :* —

1. That two kinds of cerebral and spinal softening exist,
an inflammatory and a non-inflammatory, which may always
be distinguished from each other by means of the micro-
scope.

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 formation and development of nucleated cells in exuded
blood-plasma : whilst the nature of non-inflammatory soften-

* Yol. lx. p. 398.

RAMOLLISSKMENT.

387

ing consists in the mechanical destruction or maceration
of the nervous tissue in serum, or is the result of putre-
faction.

4. That non-inflammatory softening, unaccompanied by
haemorrhage, is usually post-mortem, and causes no symp-
toms ; whilst uncomplicated inflammatory softening always
causes marked symptoms, which, however, vary according
to the seat of the lesion.

5. That the inflammatory and non-inflammatory soften-
ings have frequently been confounded together by morbid
anatomists, it being impossible 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 mi-
croscope, after it has escaped the search of good morbid
anatomists, and been indicated by most unequivocal symp-
toms.

7. That every different coloured 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-coloured softening is non-
inflammatorv.

8. That red softenings usually depend on congestion, or
the direct extravasation of blood ; yellow softenings on the
imbibition of the colouring-matter of the blood ; fawn and
grey-coloured softenings on the presence of grey exudation
corpuscles ; and white softenings, in the great majority of
cases, are post-mortem, and the result of maceration in

serum.

fl. 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 produce well-marked lesions of sensation and mo-
tion; whilst in inflammation of the peripheral portions,
lesions of intelligence arc commonly well pronounced.

11. That in idiopathic inflammatory softening of the

nain, contraction in one or more limbs is a common svmn-
tom. J 1

• 2. That the fawn-coloured spots, described by Dr. Sims
are no evidence of the cure of inflammatory softening

2 e 2

388

HUMAN BRAIN.

13. That inflammation accompanying haemorrhages is
usually consecutive.

14. The softening surrounding apoplectic clots, or san-
guineous infiltration, is no proof of inflammatory action.

l he following highly important communication on this
subject, I have received from my esteemed colleague, Dr.
Peacock. Knowing his accuracy, I have no hesitation in
publishing it in full.

“ 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, I think, be regarded as established : —

“ 1st. That in all cases where characteristic symptoms of softening of the
brain are present during life, evidences null be* found, on microscopic ex-
amination, ot the extravasation ot lymph into the cerebral substance under
one or other of the several forms of the so-called exudation granules, cor-
puscles, or masses :

“ 2ndly. That the appearance of portions of the brain softened after
death, either artificially, by manipulation, or from post-mortem change,
often, to the naked eye, so closely resembles the genuine results of disease
as to render it extremely difficult, if not impossible, for practised morbid
anatomists to decide between them : and

“ 3rdly. And consequently that portions of brain, presenting every ap-
pearance of softening 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 null 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 liftle apparent, as to be scarcely detectable to the unaided
sight, yet that, in this stage, their nature may be rendered conclusive on
microscopic examination ; 2ndly, 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 ap-
parent 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. Madelaine, at La Charity, under the care of M. Bouillaud, on
the 23rd 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 morn-
ing 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

RAM0LL1SSEMKNT.

389

suffering. The angle of the mouth was slightly drawn to the right side.
The tongue did not present any material deviation, and was freely move-
able ; 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 paralysed ; and
the forearm was flexed upon the arm, and rigid. She had experienced
some difficulty of making water, but the bowels had been naturally re-
lieved. The pulse was 8S, 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 im-
paired. She was directed to be bled to 3 palettes.

“On the 24th, the paralysis continued much as before, and was com-
bined with semiflexion of the joints, which ceased on extension. The
mouth was slightly drawn to the right side. The lips had then- natural
movement when she attempted to blow ; the motions of the eye-lids were
natural The pulse was 8S, and firm; the heat of skin moderate. The
blood drawn the night before was moderately contracted, and without any
buffy coat. M. Bouillaud gave as his diagnosis — Cerebral haemorrhage in
the optic lobes, or corpus striatum, of the right side, or in their immediate
neighbourhood, 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 af-
fected, was much improved after the bleeding, and the intelligence con-
tinued perfect. The contraction and rigidity of the left arm was very ir-
regular ; 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 bason of broth • por-
tions being drank at intervals. This did not produce vomiting, but’ acted
moderately on the bowels. J owards 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
lar<.'f size, the walls of the left ventricle being unusually thick and its
cavity small. The aorta and bicuspid valves were somewhat thickened
and opaque. The lungs and organs in the abdomen were healthy

‘ *n 1 , . ,ln tl»ere existed considerable sub-arachnoid effusion, and fluid
was found in large quantities at the base ; and the basilar and central ar-
teries, and then- divisions, were extensively ossified. The cerebral sub-
stance was of natural firmness ; the sections were abundantly sprinkled
with red dots. Divided into small sections, and examined with the °reatest
care, the brain displayed no trace of hemorrhage 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 ob-

Z7lT ° ’mnal!ir?1 in th,‘ ventriclcs. P""* Varolii, medulla oblongata,
or spinal marrow ; all these parts retained their natural firmness, and I he

390

HUMAN BRAIN.

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 bv M. Bouil-
laud to Ins 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
softening. Having taken portions of the thalamus and corpus striatum,

1 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, thougli
scarcely more tinged with blood than natural, as viewed by the naked eye,
were found, on microscopic examination, to contain numerous blood glo-
bules, and the tubes were much broken up ; along the sides of the capil-
lary vessels the small exudation granules were found extensively extrava-
sated, and occasionally there existed in the adjacent cerebral tissue the
large round clusters of granules, to which the terms exudation corpuscles,
and masses, has been applied. The exudation was, however, chiefly in the
granular form, and confined to the sides of the vessels, and thus corre-
sponded with the very slight amount of softening produced. 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 breathlessness, 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 abdo-
men turmicl and fluctuated on percussion. The tongue was covered with
a brown fur; the pulse was 88, and tolerably resistent ; the respirations
28, short, and laboured. The urine acid, very albuminous, and of a deep
brownish red colour ; 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 at-
tended 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 ac-
tion of the heart was regular, the sounds nearly inaudible, from the loud

RAMOLLISSEMENT.

391

pulmonary sounds ; but, on the breath being held, a rough and grating
murmur was heard, with the impulse of the heart, over the whole prse-
cordia. 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 au-
dible 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 22nd he complained of much
paiu in the region of the heart, and there was increased difficulty of
breathing ; deep brown-coloured expectoration, occasionally bloody ; great
lividity of face, and very scanty secretion of mine : 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.ji. the same day.

“ The right side of the chest and the cavity of the abdomen contained
much deep amber-coloured serum. Both lungs were very sparingly crepi-
tant, and exuded much serum ou compression, especially the right, which
was much compressed. The bronchi were dilated ; the tubes filled with
glary mucus, and the mucous membrane reddened. The heart was very
large, weighing one pound (avoirdupoise) ; it was much overlapped by the
left lung. The 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 tlieir attachments,
and a mass of atheroma projected between the angles of the right and
posterior crescents. The valves, though probably competent, had evi-
dently formed an obstruction to the passage of the blood from the ventri-
cle. 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 orifice of the coro-
nary arteries were surrounded by deposit, but not materially strictured.
The ehylopcetic organs were congested ; the kidneys were somewhat gra-
nular ; the proper coat adherent.

“ The brain weighed 39} ox. (avoirdupoise).

“ 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 lobcs^
The softened portions were of a deep amber colour, and occupied chiefly
the convexities of the convolutions. The softening seemed to have com-
menced on the free surface of the grey 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 oidy slightly abraded : in others the softening
involved the whole thickness of the cortical substance, but in none did the

392

HUMAN BRAIN.

_ fP,Pea1' to ™Phcate f}e subjacent medullary matter. The grey
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
icaddy miscible with water and a more solid material of a deep amber
colour, of the consistence of firm gelatine, and only admitting of being

cimSedTfV1? dlfCUlty' ,Th? former’ examined by the microscope,
exnrhHn f bro^en'do^1 cereldral substance, with capillary vessels having
grf8-their81tS’ and a few exudation corpuscles mixed
the ceiebial substance. The latter was composed of little else than

• rnaSr\f lggreg.fed Sranules of exudation. Both materials were

011 gl°b"leS’ “d cmlAed W-

„ the free surfaces of the corpora striata, in each ventricle, there

existed patches of softening. The cerebral substance was in these almost
ffluent, but retained its natural hue, and, when subjected to the micro-
scope, 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.

Hie various cerebral arteries were covered with atheromatous matter,
bin to a less extent than is frequently seen in elderly persons.

In this instance the brain presented two very different forms of
so temng— the one, involving very extensively the grey matter of the con-
volutions, was evidently inflammatory in its origin; the other, affecting the
surfaces of the corpora striata, was most probably the result of post-
mortem 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 web as afterwards, great mental hebitude,
Hith partial debrium, gradually lapsing into complete coma; the dis-
turbance of the intellectual functions which chronic disease of the grey
matter of the brain would be expected to induce. On the other hand, lie
had throughout his illness no convulsive attack or paralysis; which
would have existed had the central softening resulted in a morbid pro-
cess ; 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 grey matter of the brain was, in this
case, probably of considerable duration. The deep amber colour of the soft-
ened poi tions, 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,
ihe dark colour of the softened portions and the density and large size of
the exudation masses, are, I believe, characteristic of the slower forms oi
cerebral softening.

Ihe changes undergone by the surfaces of the corpora striata in this
case are also characteristic of the most frequent form of what is believed

HAMOLLISSEMENT.

393

to be post-mortem softening ; and the case affords an example of the cir-
cumstances under which this change most frequently occurs. The soften-
ing appears to be dependent on infiltration of the serum effused into the
ventricles and the adjacent cerebral substance ; and the appearances pre-
sented on microscopic examination are such as would thus result. 1
have many times observed this state, and have noticed its various stages,
from a degree of infiltration producing only a sudden appearance of por-
tions of the boimdaries of the ventricles, to the complete destruction of
extensive portions of the corpora striata, thalamis, 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 cer-
tainly not be the case. It is generally, however, if not always, found
in cases of very copious effusion from acute inflammation, and is espe-
cially 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 advanced 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 por-
tions of the surface of the brain. They were, therefore, both persons in
whom the form of softening, regarded 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 supported by several other cases I have had the opportunity of
observing, and I cannot but regard the views of these pathologists as
doubtful.

[lie importance of the colour of softened portions of the brain, as
affording the means of distinguishing the nature of the change lias I
believe, been overrated ; and while it is probable, that all cases of soft-
ening of some duration will be found to present decided changes of
colour referable, either to the engorgement of the part with blood
to slight sanguineous extravasation, or to the colour of the exuded mate-
rial, we have evidenced, in the first case, that inflammatory softening may
prove fatal without the tissue having undergone any alteration of colour
the difference between the processes of cerebral softening in persons at
ear v and advanced periods of life I regard as pcrfectlv analogous to
those which, under similar circumstances, affect other forms of diseased

394

HUMAN BRAIN.

Atrophy of the brain.— *1 here 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 de-
velopment in the foetal state. The anencephalous 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 par-
tially absorbed, and hence the paralysis. The hemispheri-
cal ganglion or cortical substance was neither atrophied nor
absorbed, but in normal quantity, as demonstrated 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 hemispherical 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 fatuity. The convolu-
tions are then narrow and pinched, almost sharp, instead
of being fiat 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 fossae between
the two convolutions are filled with that beautifid pro-
tector, the ccrebro-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

HYPER-EM I C AFFECTIONS OF THE BRAIN.

395

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 in-
stances of laceration of the brain from a blow on the skull
unaccompanied with fracture, an accident which is compa-
ratively 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 4 p.m., having received a large con-
tused wound which exposed the bone over the right eyebrow. 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 smTounding part preventing the state of the
right from being ascertained ; breathing laboured, with a stertorous noise ;
pulse 96, full and not easily compressed ; extremities moderately warm ;
fieces and urine involuntary passed ; great rigidity of the muscles, espe-
cially of the right aim and left leg ; frothy saliva issuing from the mouth ;
no spirituous odour could be detected in the breath.

History. — Shortly after 2 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 admis-
sion. Soon after she was brought in, she was cupped to §ix. 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. Breathing slightly
relieved bv cupping ; pulse continues full, and at 92. At 9 o’clock, I
saw her, with Mr. B. Travers, apparently exactly in the same state, ex-
cept 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 laboured. At 11 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 issuing 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 appearance 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, com-
missure which form the anterior part of the roof of the left ventricle. The
lacerated corpus striatum and thalamus were forced into the right ventricle

396

HUMAN BRAIN.

under the fornix, and, when first observed, looked almost like a medullary
tumour with an ulcerated surface.

In this case the brain appears to have been lacerated by the “ contre
coup, to which it was especially exposed from its diminished size, in re-
lation to its containing cavity, the result of senile atrophy.

Hyper omic affections of the brain.— From the anomic
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. In-
flammation of the brain consequent upon and continuous
with inflammation of its protective apparatus, viz., the peri-
cranium, 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 retrocession 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 sympathising. 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. 2ndly, That inflammation of the upper
portion of this ganglion may be distinguished from that
inflammation which is at the base of the brain. 3rdly, 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

H YPERJEMIC AFFECTIONS OF THE BRAIN.

397

relation to the external world, is the hemispherical ganglion
or cortical substance. From its exposed position this gan-
glion 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
terminations, and afterwards review the various circum-
stances which may give rise to them, such as disease and
injuries of the skull and membranes, &c. &c. Inflamma-
tion 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 appear-
ances of meningitis 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 vascidarity
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 laro-er
vessels rather than the capillaries. The morbid appearance
oi the arachnoid which indicate the existence of inflam-
mation, cannot be so easily affected. These are— First,
Opacity. It is true that this is a very common appearance!
mt still it is one which 1 believe all pathologists agree in
considering the result of chronic inflammation. Secondly
Dryness of the arachnoid. This is by no means common
mt 1 quite agree with Dr. Bright in saying, “In many
cases of high cerebral irritation, and where we have reason
o suspect actual inflammation, this appearance occurs- and

otiTJ3 n°, 7“?°" t0 doubt ttat in membrane, 'as in

Se° LfUTlr : lymph and

n irine are proofs of inflammatory action.

398

HUMAN BRAIN.

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 attack. These alterations may be
divided into alterations in consistency and alterations in
colour.

Thus there is softening and hardening. In regard to
colour, the changes are very striking. In health, the colour
varies a little, but the variation is slight. The natural
colour may be closely imitated in water colours, by mixing
light red and Indian red ; it is difficult to describe it in
words ; Dr. Bright has called it “ a light fawn-coloured
brown.”

In disease the colour 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
coloured drawing of the cortical substance, or hemispherical
ganglion, of all patients indiscriminately that 1 could ex-
amine after death ; at this time I went a great deal to Han-
well, and, through the kindness of that noble benefactor 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, Hartwell, April 23rd, 1842. Thomas Griffiths was

H YPER.EM1C A ERECTIONS OF THE BRAIN.

399

admitted on the 16th March 1S42; he was violent and refractory, but
not showing any disposition to injure anyone; very sleepless, opiates
having very little effect upon him ; never slept for more than two horns at
a time ; pulse always low, and 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 exhausted. These particulars I obtained from Dr. Begley.

Post-mortem. — Skull. — Sero sanguineous effusion into the sac of arach-
noid. 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 vascularity was so irre-
gular, that the patches gave the ganglion a mottled appearance of purple red
colour. Serum in the ventricles clear, but quantity increased.

A bright rose-coloured tint is sometimes met with, and
always indicates that there had been increased vascular ac-
tion during life. This colour 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 gan-
glion aic sometimes unusually distinct; but I have not
been able to associate this appearance with any peculiar
symptoms during life.

I)r. Bright says* that “ a rose tint is sometimes peculiarly
distinct on the inner layer, sometimes confined by a dis-
tinct 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
n ( ini rent shades of the habitual colour, or sometimes by
dark grey shades from venous congestion, or by the unusual
pm k ness 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
larked m elderly persons, and in those who have laboured
under symptoms of imbecility, as to be obviously a morbid
V‘ C' * l0Sf: cases, when the membranes have been

°V,a co1nvolutlon be gently pinched between the
hnger and thumb a considerable portion, of about the
nckness of a wafer or more, but uniform in its depth,
comes away, leaving an even surface. This state of the

* Reports of Medical Cases, Vol. ii. p. (577.

400

HUMAN BRAIN.

cineritious substance has appeared to me sometimes to be
the result of habitual excess in fermented liquors, and is
hkewise found where febrile diseases have been accompanied
with delirium and tremor. Although this condition of the
cmentious 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 grey colour
approaching in some cases to a deep violet colour. 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 oc-
casionally the result of fevers, particularly when they are
accompanied 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 grey appearance of the cineritious sub-
stance.”

The cineritious substance is sometimes of a yellow colour,
but I have never seen this except in connection with an altera-
tion in the colour 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 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

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 401

substance, which are often found in various parts at the
same time ; or by an abrasion of the surface, which is thus
reduced 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 fea-
tures and of the extremities of the opposite side is the fre-
quent 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 inf animation 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 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 inflam-
mation 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
die 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 become
perfectly paralytic; in this case the integrity of the neu-
Ine, through which volition traversed to call these muscles
nto action, is compromised, and its power, therefore, as
in instrument for the production of voluntary motion
lestroyed.

402

HUMAN BllAIN.

I he same phenomena are presented to us by observations
on the instruments ot 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 sensation originate, and in the brain
itself where they terminate.

The first effect of unusual arterial action of the hemisphe-
rical ganglion is to exalt the intellect ; this effect is often so
transient that it may be unobserved. We meet with a
good illustration of it in the effect produced by alcoholic
stimuli. Up to a certain point they render the individual
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 fur-
ther arguments in support of them : — 1st. That the hemi-
spherical ganglia are intimately connected with the intel-
lectual powers, and that it is in them peculiarly and not in
the whole cerebral mass that these powers reside. 2nd. 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. Toville and Pinel-Grandchamp, and such also is the
opinion of Bouillaud, who when investigating the localiza-
tion of the cerebral functions, says,* “ If we reflect that

* Op. cil.

inflammation of the hemispherical ganglion. 403

disturbance of the intellect can exist independently of
every other derangement of the cerebral functions, if we
reflect moreover 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 derangement 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 intelli-
gence : death the third day. Inflammation, with softening of the grey sub-
stance, arachnoiditis* — Maiiition, 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
monthsr Since two years he had shown signs of imbecility, and had
completely lost all memory. Whilst he was 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 mouths 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 putrefac-
tion in this cavity. Por a twelvemonth he has been weak in his legs. Lie
has always had a good appetite. After having taken cold-baths for a
month when he was in the hospital of St. Michel, he fell in a state of
great exhaustion, and experienced lypothymise.

The 17th of November he lost his mind, had repeated attacks of con-
vulsions, with loud and unequal respiraton.

The 18th, at ten in the morning, general convulsions; eyeswandering;
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 lie draws back when pinched, and makes gri-
maces ; 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 extremities, a purgative enema.)
The agitation continued the remainder of the day ; the convulsions are
universal ; the face i3 red and tumefied, the mouth is deformed, the lips
projecting anteriorly. With the ice, the head is exceedingly hot ; the
fore-arms are strongly flexed ; intellect is entirely lost. He was in the
same state during the night.

The 19th, in the morning, the right arm is almost without motion, the

* C )p . rit., Case XV. p. 85.

2 i) 2

404

HUMAN BRAIN.

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.
(V ensesect. ad Bxij. purgative enema, sinapisms, &c.) In the course of the
day the patient died in the greatest agony.

Autops. 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 medullary substance is
a little injected. The left lung is a little hard posteriorly, deprived of air,
and somewhat hepatised. 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 grey 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 attacks
characterized 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 con-
tused her left lumbar region. She merely applied pressure to the swelling.
After a time, a pldegmon, 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 colour ;
she felt 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, 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 cedematous : two grains

* Op. cit., Case XVI. p. 88.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 405

of tartar emetic produced abundant vomiting ; and after this the swelling
of the face abated. The secretion of the lumbar fistuhe also ceased.
Little attention is paid to this phenomenon : three ounces of manna are
ordered, which produce a few stools. The conjunctiva 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 liypogastrium. 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 discoloured, the lips
black, voice almost gone, respiration very difficult, frequent pulse, skin
cold. From the dyspnoea, we suspected a latent pneumonia, and then
we endeavoured to re-establish the running of the fistuhe. For this
purpose a large blister was applied, but without any effect, she having
died at five in the morning.

A ut ops. 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
grey 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 grey substance, in the space of three convolutions, cor-
responding to the spot where the membranes were altered, was of a red,
mixed with a yellow colour ; it had lost the shining appearance of the
other convolutions ; it was unequal, and, as it were, tubercular, and
several small red points were to be seen on its surface. Its consistence
was not everywhere the same : the superficial layer could easily be re-
moved 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 neighbouring parts. The grey 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 perfectly healthy. The heart was nearly
in a normal state.

The two cases just related are very remarkable, because both the pa-
tients showed no other signs of cerebral disorder than a slight defect in
the intellect. It is known that latterly MM. Foville and Pinel-Grand-
champ have maintained that the grey substance presides over the intel-
lectual phenomena, and the white over the movements. If tlieir asser-
tion is correct, it follows, that in both these patients there ought to have
been lesion of the grey substance only : this is also what we have seen.
It is true that the last patient had general convulsions ; but this pheno-
menon 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 intellect ; loss of the power of speech ; death 24 th dm/.
Ramollissement of the convexity of Hie cerebrum , particularly of the grey

406

HUMAN BRAIN.

subdance ; albuminous granulations, with an ash colour of the surromidind
pads, and injection of the meninges .*— Mary Morlet, 23 years of aee a
labomangMvonmn, strongly built, of a melancholic character, has feel
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
TT sllPc' i°i extremity is now in a state of torpor, and she is taken to the

Hospital Cochin, the 31st December 1821 6

nain^Volf 5TT 18*? ^ dePressed> and ^P^ns of

S ii ? f the body and of torpor of the right arm, symptoms which
gieatly disturb the patient; she appears 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 foetid ; skin hot and dry’
and there is pain in the epigastrium. {Twenty leeches 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. (/ enesect. at the arm ; blister to the nape of the neck ,- dimulcent
drink and bouillon .)

ffh(r P?tient answers none of our questions, and merely says
l'aul-il . which she constantly repeats in a sad tone of voice; the right
aim is paralysed, stiff, and (edematous ; 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
oscillations, 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 Faut-il ?

The 13th. Urinary and alvine excretions involuntary ; sinking; eye
fixed ; concentrated pulse, soft, slower.

I he 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. ( An-
other blister to the head, which does not take.)

The 22nd. In the evening, profound coma; little pulse, threadlike, ;
arid frequent ; respiration plaintive and suspirious ; eye widely open, .
fixed ; foolish look and trismus.

The 23rd. Eye fixed and dull ; pupils dilated, immoveable ; respira-
tion noisy, rattling; plaintive sighs; convulsive agitation of the left arm.

( Venesect . 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 con-

* Op. cit., Case XVII. p. 93.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 407

volutions of the right hemisphere; redness and injection, which appear to
be owing to the presence of the pia mater, the tissue of which is much
worked with blood. Having removed this vascular network, the surface ot
the'cerebral convolutions is covered by an infinite number of clots of blood ;
concrete albuminous granulations are spread here and there on 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 hemispheres 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 substance is softened ; its consistence is pulpy, ot a grey
red colour, much resembling the enceplialoid tissue, softened and combined
with a certain quantity of blood. This softening extends 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 exists at
the same time softening and hardening of the cerebral substance. There
is here tuberculous and encephaloid-looking matter, evidently produced by
phlegmasia. The grey substance surrounding these parts is of a well-
marked ash colour. The lateral ventricles only contain a few drops of san-
guineous serum ; the cerebellum and spinal marrow are healthy ; the pia
mater which envelopes them is red and injected.

Thoracic organs. — The lungs are healthy ; the pericardium distended,
fluctuating ; it extends as far as the right side of the chest, and contains
from six to eight ounces of lemon-coloured 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 pro-
ceeded in a very rapid manner, and the inflammation in general had been
of an acute kind : we find the same thing in the following case related by
M. Avoyne :

Case 15. — Cephalalgia ; furious delirium; convidsions alternating with
a stale of collapse : death. — Arachnitis, with softening of the cortical sub-
stance of the cerebral hemispheres * — A. Mahon, 30 years of age, of a
sanguineous biliary temperament, having got drunk, fell from a first story
the 1st of January 1816. No serious mischief arose immediately after
the accident ; he lost a little blood from the left car, and cephalalgia super-
vened, which continued ; but on the fourth day it greatly augmented : on

* Op. cit., Case XVIII. p. 08.

408

HUMAN BRAIN.

thaUay, 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 coidd
rouse him ; the face, a little pale, had a gloomy appearance ; the eyelids
were shut; m 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 mil ; the patient nowand then agitated his arms, and sighed fre-
quently. Neither the cranium nor the other parts of the body showed
any trace of contusion. (. Infusion of Roman camomile with tamarind* ;
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 Ins 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 discoloured. ( Three leeches on each side of the
neck, and cupping-glasses on the tcounds.) The patient was sensible of the
application of the cupping-glasses, and had no delirium in the night. The
seventh day, in the morning, very nearly the same state; sometimes 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. Ihe cerebrum was disorganised in many places on its
supei ioi surface, and there were collections of blood between the pia mater
and the arachnoid. This disorganization, which was only superficial, was
rather deep in the posterior part of the posterior lobe of the left side ; all
the encephalic mass was reel, 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 arachnoid ; but you see that the phlegmasia is not
confined to the meninges, since the cortical substance of the superior con-
volutions of the brain was disorganized in many places, with very con-
siderable injection. The intellectual disorder must be attributed to the
irritation of the grey 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 corresponded 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 grey substance of the convolutions.

Case 16. — Contusion of the cranium; no remarkable cerebral symptoms
the first days , then furious delirium ; coma : death the 2 0th day. — Abscess in
the grey substance of the convexity of the cerebrum ; inflammation and' disor-
ganization 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

, V. u , 111 VllU JUV/lllIU^^ 11111 1 IJ 1/11/ M VI 1/11 —

head with a hammer; but not succeeding in killing himself, he takes a bad
* Op. cit., Case XXII. p. 116.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 409

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 him-
self On his arrival the surgeon who was present observed about the line
of union of the parietal bones with the frontal, a considerable tumour,
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 woimd, 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 tied.) The 8 th, no accident has occurred.
The following days the patient was getting better, 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 nos-
trils. To this, furious delirium supervenes ; the patient jumps out of bed,
threatens his neighbours, wishes to fight them, when he is seized by two
nurses, who replace him in bed and tie him to it. ITe expiles in a quaitei
of an hour.

si u tops, cadav. — The dura mater, which is thickened, is covered by a
yellow false membrane, and on its internal siu'face are a few black tuber-
cles ; the pia mater is equally thickened ; the arachnoid is nearly altogether
disorganized, especially between the convolutions of the cerebium, 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*

This case confirms what we have already said, viz. that a circumscribed
lesion of the grey substance has no direct influence on the movements of
the extremities. Effectively, the patient rises in a furious state the day of
his death, threatens to maltreat his neighbours, and cannot be kept quiet
until he is tied. On opening the cranium, an abscess was found, termi
nating in the grey substance of the brain. As to the delirium, the agita-
tion, and the fiver, they are accounted for by the phlegmasia of the arach-

noid.

Case 17. — Slow answers ; alteration of the intellectual faculties ; a species
of idiotim, without paralysis or convulsions of the extremities ; death the
Tilth day. — Two larye abscesses, occupying the middle of the cerebral hemi-
spheres .f — A soldier, 26 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 invasion. He was tranquil, scarcely answered, the e^cs
wide open, with a stupid look, and he complained of nothing. He could
get up to ease himself. His face was much coloured, 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

* This case wa3 reported by Hr. Hcnnelle, then house student at the
hospital of La GharitA

Op. cit., Case. XXVI. p. 128.

410

HUMAN BRAIN.

looked stupiSy^® that\vfhSf on “ J^'T*

^dofh^

diarrhffia then came on, and the febrile E? suLweth^ ThrS51^2^ J
ci eased, the wants were no longer known and lip fi,r. i (i 'l)0r 11 J"
sions, the 22nd day of his arrival and the’ S7tH ^ Wltll0ut C0Ilvul-

to his account 5 37th ot the evasion, according

a considerable injection of all the encqlaC ^ UP' Wlth thlS

SS^^tSSF^ss

bv MM Parent ■n.rl TUT *• * i b US * ldt> as ^ias I36611 truly observed
y tmvi laient and Martinet, delirium is connected with inflammation of

win P°!ftl°n1 °i t lC arac^n°ld which covers the convexity of the brain von

PnviHp1 ai" c vcry “uch disposed to agree with the opinion of MM
Foville and Pmel-Grandchamp, which places the seat of intellilence i the
coitieal substance of the superior part of the brain.” °

I quite agree with Dr. Abercrombie that it is impossi-
ble to separate inflammation of the arachnoid and pia
mater either in diagnosis or in treatment ; but I mav again
acid also that it is impossible to separate inflammation of
these membranes from that of the hemispherical ganglion
oi coi tical 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
pm mater. In almost all the cases, for instance, where the
convexity ot 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
membrane, the morbid product is displaced, but not re-
moved. However, whilst we admit that in the diseases
designated by the name of arachnitis, or more properly

* Clinique Medicalc Trans., by SpiUan, p. 42.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 411

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 re-
mains unaffected.

l)r. Abercrombie considered the phrenitis of systematic
writers inflammation of the membranes of the brain. “ It is
characterized,” says this admirable observer, “ by fever,
watchfulness, acute headache, impatience 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 mania; and a condition
nearly allied to it sometimes occurs after injuries of the
head. Circumstances will be afterwards mentioned, which
render it probable that in this form of the disease the in-
flammation is primarily seated in the membranes of the
brain. When fatal, it is generally by a rapid sinking of
the vital powers supervening upon the high excitement,
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 may be referred to
this head. It is characterized by a peculiar aberration of
mind without any complaint of pain. There is a remark-
able restlessness, quickness, and impatience of manner,
obstinate watchfulness, and incessant rapid talking, the
patient rambling from one subject to another with little
connection, but often without any actual hallucination ; he
knows 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 chieflv of

V J

412

HUMAN BRAIN.

resSLXmlta.^ 'he * With°Ut actual

We cannot, I think, ascribe the mental disturbance, ex-
ci ement, excessive pam, 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 membrane • we are com-
pelled to refer them all to the injury which that portion of
the brain that is m contact with these membranes has
received from inflammatory action.

Bayle,* in his admirable work on diseases of the brain
strongly supports 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 mem-
branes of the brain.” He also draws an important dis-
tinction between inflammation of the arachnoidea reflexa, or
that lining the dura, mater, and the arachnoidea investiens,
01 that m 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 arachnoid and
pia mater.

Bayle considers that a certain number of monomaniacs
and melancholic 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 delirium.
But he says, “ I am far from saying that matter has no in-
fluence 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 derangements 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

* Traite des Maladies du Cerveau et de ses Membranes, par A. L. Bavle,
1826.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 413

as inflammation of the hemispherical ganglion from within,
as distinguished from meningitis.

Bavle considered that some very rare alienations depend
on a specific or sympathetic irritation of the brain. If
Bayle means that any mental alienation exists 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.

Parent Duchatelet 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 duration 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 re-action, accom-
panied with disturbance of the muscular system, corre-
sponding to that of the brain, convulsions, delirium, agita-
tion, contractions, oscillation, and the commencement 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 scat. 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,

* Rechf-rches sur l’inflammation <lc l’arachd' cerebral et spinal, ouvrnge
fait conjointement. Paris, 1821.

414

HUMAN BRAIN.

while that on the convexity or the upper part of the hemi-
spherical 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
ol the senses, a loss of movement, local and general para-
) sis coma At this period it is difficult to distinguish
positively the existence of simple arachnitis. My own ob-
servation corresponds with the above authors in the general
characters of these symptoms, especially in the distinction
I n;t ween 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 1 do
not think they have laid sufficient stress on the mental
excitement.

Di. Neisser* remarks very justly that the symptoms of
effusion are sometimes marked by the excitement of the
brain resisting the oppressive effect of the extravasated fluid,
so tlitit there is a sort of balance between the symptoms.

Andralf bears his testimony to the constancy of lesions
of intelligence accompanying meningitis ; such lesion pre-
senting itself either under the form of delirium or coma.
The delirium may present the greatest varieties noth 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 much prostrated in strength.
Sometimes one single idea engages the mind of the patient ;
sometimes ideas of the most heterogeneous description
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 deli-
rium presented, we might arrive at this important conclu-
sion ; — that no single one of these various forms charac-
terizes meningitis, that there is not one of them which may

* Die Acute Entziindung der Serosen Haute des Geliirns und Riieken-
marks naoh eigenen Beobachtungen am Krankenbett Geschriebcn. Von
Dr. Joseph Neisser, Prakt. Arzt. zu Berlin, 1845.
f P. 56, op. cit.

INFLAMMATION 01' THE HEMISPHERICAL GANGLION . 415

not be found in the different cerebral irritations which are
purely sympathetic, and unaccompanied with any structural
alteration of the membranes appreciable on the dead body.

When once the delirium has developed itself, it may not
cease, presenting merely alternations of exacerbation and
remission ; it may also be only transitory. There are some
patients in whom this disturbance of the intellectual facul-
ties is but of very short duration ; then at the end of a
period more or less long, it returns ; the intermissions be-
come more and more short, and at last the disturbance
becomes continued. In some the delirium commences only
at night, and the clearness of the intellect during the day
seems, at first, to exclude the idea of meningitis altogether.
In some, a delirium of several days’ duration suddenly dis-
appears 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 sympathetic irritation of the brain,
it is wrong to lay it down that the latter only can be inter-
mittent, as 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
dependent 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 intel-
ligence in meningitis can only be accounted for by referring
to the differing susceptibility of the brain to impressions.

My reason for dwelling so fully on these symptoms of
mental excitement 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 diagnose
affections of the brain.

41 G

HUMAN 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 j
and the symptoms and circumstances which are peculiar "to
these varieties.

Concussion of the brain.— In both a practical and a phy-
siological point of view all injuries of the skull, as product-
ions o meningitis, aie especially interesting ; almost every
case presents some new and peculiar feature worthy of at-
tention. For beautifully as nature has protected the brain
the bony case which has been contrived for this purpose
cannot be seriously injured without some disturbance of the
oigans contained within it. And we find in practice that
all injuries to the skull occasion more or less derangement
of the intellectual faculties.

After what has been stated regarding the connection
between the intellectual 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 consequences of a severe blow on the
head is concussion of the brain. Inasmuch as this injury
frequently leads to inflammation 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 vio-
lence, the mental phenomena 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 vio-
lent blow on the head, and in an instant loses his conscious-
ness and lies dead to the world around him. This result we
suppose 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

CONCUSSION OF THE BRAIN.

417

light, and lie 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 import, nor able sufficiently to collect
his thoughts to give a particular answer. If the case proves
favourable, these symptoms disappear by degrees, the patient
recovers, and no traces of the accident remain. If, how-
ever, inflammation supervene, another train of symptoms
makes its appearance, and then the consequences are gene-
rally fatal.

>o one who has once observed a case of concussion can
doubt that the intellectual facidties 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 com-
mencement of meningitis. Of all effects of inflammation
on the human frame this is most to be dreaded. We can-
not be too much on our guard to prevent its intrusion, or
too careful in our endeavours to distinguish the symptoms
which indicate its approach. When once set up it is dif-
ficult 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 more fre-
quently observes the effect of injury to the brain as a whole,
than merely to the membranes primarily and the hemisphe-
rical ganglion secondarily, that he is more in danger of
overlooking such symptoms than the physician, whose at-
tention has been directed to this disease in its idiopathic
form. 1

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'

2 K

418

HUMAN BRAIN.

and the whole train of symptoms are decided and unequivo-
cal, fiom the first ; but sometimes the effect of the concus-
sion 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 de-
served.

The following case is peculiarly interesting and instruc-
tive 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 con-
cussion. About five o’clock in the afternoon, while working as a bricklayer’s
labourer on some scaffolding at Woolwich, he slipped, and fell from a height
of seventy feet. He fell across a piece of timber, first striking 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 acci-
dent, states, that he was insensible, pale, cold, and almost pulseless.
Warmth was applied to the body, a slight stimulus given, and when re-
action 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 some-
what 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, cry-
ing 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, re-
fusing 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 to 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.

Plis extreme irritability and restlessness, and his semiconscious state,
led Mr. Solly to think that some imflammatory action was commencing in
the hemispherical ganglia. Ordered, calomel gr. i. qufique horfi donee
alvus soluta sit. postea duabus horis. Hirud. xx. capiti applicand.

CONCUSSION OF T1IE BRAIN.

410

A [ay 11th, 8j 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.

1 J- p.m. — His bowels have been freely opened, and a large cpiantity of
solid feculent matter voided.

8 p.m. — Is a little better, more conscious, and quieter, bowels purged ,
merciu-ial stools, pulse jerking 144, right pupil rather more dilated than
the left. Kept. Hirud. xxx.

Hyd. c. Greta gr. ij. Ext. Aconiti gr. i. Pulv. Doveri gr. ij. 4ta quaque
hora.

May 12 th. — Has passed a better night; quieter, and not so violent, irri-
table, 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. Lyttse abdomini Ung. Hydrarg. Fort, for
dressing.

1 p.m. — Sleeping; head rather hot; hands cool; cries out occasionally
without any apparent 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
118, 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 recognised 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 powTder and increase the Hyd. c. Greta to gr. iij.

Yesp. Much the same, pulse 120.

15 th. — Pale; has been excessively irritable during the night, but not in-
coherent; much purged ; stools bright yellow ; pulse 116, irregular, not
much power. Pulv. Ipec. Co. gr. iij. 4ta hora.

7 p.m. — Quieter than usual ; during the day less purged. Pulse 124.

16th. — Much the same; pulse 120.

17th. — 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. Lyttrn.

20th. — Free from pain; countenance much the same ; pulse 130. '

21st- — Better in every respect; wishes for more food, and to get un ;
pulse 110.

30th. — 13 up to-day ; complains only of weakness.

June loth.— He was presented to-day, quite well. It was quite striking
the difference in his language and manner. His language, instead of being
nide, foul, and abusive, was 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 au absence of the
usual symptoms of serious injury to the head, the boy would soon have

'2 E 2

420

HUMAN BRAIN.

been decidedly insane, and then the same measures would have been com-
paratively 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

O *

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 exist-
ence of the patient was in danger : —

Case 19. — Wm. Johnson, aet. 30, gardener’s labourer, stout, hearty-
looking man, was driving his master’s cart in Bisliopsgate-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 every thing. On examination of
the head, 1 found a spot about the size of a crown, over the superior pos-
terior angle of the left parietal bone, puffed and swollen, but no irregula-
rity 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 horn- after the occurrence of the accident ; he now shows
some signs of returning intellect by endeavouring 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 insen-
sible state again. Ordered, Pulv. Jalap c. Hyd. Chi. gr. xv. stat. M. S. C.
6ta hord postea. Hirud. xx. capiti, if his pulse got up in the evening,
and the dresser thought he required them.

Dec. 1 9th. — Quite rational ; vomited about two horn’s after I left. Sis-
ter considers he rejected 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 brew-
house, a height of at least 80 feet. His hand being stretched out, first sus-
tained the shock, by which the carpal bones were separated, and driven up-
wards, 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 hospi-
tal, 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,

CONCUSSION OF T11E BRAIN.

421

and it was observed that there was not much dilatation of the pupils, and
but little stertor in respiration. 1 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.
AYhen I spoke to him softly, he did not answer. I pinched his hand
slio-htlv, but he did not move ; but when I repeated this a little harder, lie
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 medi-
cine, which emptied his bowels ; and four leeches were applied to his
temples, but they extracted very little blood, and I thought his pulse coun-
termanded 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 sensibility, 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 disposition 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 with-
out any apparent benefit, the powers and actions of life gradually dimi-
nished, 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 turged 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 coloured, and, in some places, bloody, coagulated lymph filled all the
recesses 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 aggravate 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

422

human brain.

depleted locally and mercurialized, as soon as “ his minils
became more contracted,” he might have recovered. ? P

regard this condition of the pupils taken conjoin tlv
with a hot skm as a very clear indication of the commence-
ment of inflammatory mischief.

ns j5eg,m n ^.administration of opium in such a condition
as decidedly injurious.

°f thC Sk!-n m(Jre freflucnt]y than mere concus-
n lead to meningitis ; the inflammatory action passing
continuously from the bone and its periosteum the dura
mater, to the arachnoid and pia mater.

The fullon'ing case marks well the train of symptoms
which I behove indicate inflammation of the hemispherical
ganglion, consequent on fracture of the skull.

1 I21'-Betsey Gankin. 18, was admitted into St. Thomas’s
Hospital, under my care as Mr. Travers’s 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 b Z thrown
out Of a swing at Greenwich fair a month previously to her admission •
that she was stunned at the time, and has suffered severely from pain in
■lie head since; but she was not considered severely injured. At the time

?! S'!86 W 1 ’ ShC ?Xhibitcd aU unn"y excited appearance of

t c cye’ but ll(1 answers to questions were perfectly rational, though her
manner was rude and abrupt. ° 1101

f f \ eolleagues happening to see the case immediately after she
was n bed, before I came into the ward, and believing it to be his own

T UP°“ ar !fegUlarity’ which he ^nnd upon the surface of the
skull ; the pain of the incision made her very violent and disgustingly
abusive ni her language. The incision permitted the escape of some
coagulated blood; the division of the temporal artery gave rise to a free
lueinorrhage of about eight, ounces. It exposed a fracture extending hori-
zontally through the parietal to the frontal bone, and another running per-
pendicularly from the above. & 1

11 P. m. Same day. Still very violent and abusive in her language
vdien spoken to, otherwise quiet and dozing ; tongue foul; pulse quick.

explained to the sister of the ward that her violent language was to be
considered as a symptom of disease, and that every thing was to be
effected by a soothing system and by kindness. This was scarcely at first
understood ; but my directions were most fully carried out, and their
value afterwards thorougldy appreciated. When I saw her I ordered
M^t. Sennae Comp. stat. Hyd. Chlorid. gr. ij. quaquetertia horfi.

^ist.— Bowds 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 in 6ta
quaque hora. o v

INFLAMMATION OF THE DURA MATER.

423

22ml. As the bowels are now quiet, ordered the calomel to be renewed;

she is rather more rational. . , . . ,

23rd— Bowels relieved, but not purged; complains of pain m her
head which is unnaturally hot. Ordered twelve leeches to be applied, it
the sister could persuade her to have them on ; but not to use any

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’s 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 veiy little pain m the head, and
no heat ; ordered a little fish. Her conduct and manner to-day was 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 oi her
previous excited manner, and fearing return of the inflammation, I oideied,
as I did not think her constitution would bear any more calomel, aconite

er. ij. t. d. Hirud. xij.

8th. Pil. Hvdr. gr. v. ter in die. Quite rational ; says her head is

quite well, the wound healthy and discharging freely.

11th. — 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 every-
thing 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,
hut generally either the consequence of syphilis or of local
injury.

Dr. Watson* considers that the dura mater may he in-
flamed while the pia mater remains unaffected ; and that
the arachnoid may suffer inflammation and leave the sub-
jacent pia mater untouched. Whether the arachnoid ever
escapes participating in the inflammation of the dura
mater on the one side, or the pia mater on the other, is
to he doubted. “ But it seems to me scarcely possible

* Lectures, Med. Gaz., vol. xxvii. p. 170.

424

HUMAN BRAIN.

that inflammation of the pia mater should take place with-
°ut implicating also the surface of the convolutions ”

I agree with Dr Watson in his opinion regarding in-
flammation of the dura mater ; but I doubt if the invest-
ing portion of the arachnoid is ever inflamed without the
pia mater being more or less implicated, and with it the

thTFshr Tf°n- 1 hr k* feI‘ convinced that
theie is no such thing as inflammation of the pia mater

independent of the brain, and that much mischief has
acciued from our systematic writers treating of inflamma-
tion of the membranes of the brain as distinct from inflam-
mation of the brain itself, instead of distinguishing be-
tween inflammation of the hemispherical ganglion, the tu-
bercular portion beneath, and other cerebral ganglia
Dr. Watson, in his lectures,* relates the Mowing case
which unequivocally illustrates his opinion that inflamma-
tion 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.

of u!r,!!ir77Avnr fam™° the hosPital t0 have a small incised wound
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

Kilned^ ?“ralytlC °“. °.D,e ^ °f the bocb' 1 saw the man’s skull tre-
panned ; he was perfectly calm and collected : that part of the dura mater

effnsed01TeSP°uded to. the, wound 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 manifested; there had

been no convulsions, nor was there any other morbid appearance within
the cranium. 11

. Infl^mation of the dura mater sometimes occurs con-
tmuously from the petrous portion of the temporal bone
and the lining membrane of the internal ear; and some-
times without any disease of the bone, it extends along the
sheath of the auditory nerve. This affection is not uncom-
mon among the poorer classes and those whose diathesis
is strumous. It occurs more frequently in childhood than
m either adult, or old age. Its progress is very gradual
and insidious. The knowledge that such a consequence

* Med. Gaz., vol. xxvii. p. 771.

INFLAMMATION OF Til E 1)UKA MATEIl. 425

may result from otitis or inflammation of the internal ear,
should make us very careful in our treatment of this affec-
tion, and very guarded in our prognosis. I have found
that the best treatment in such cases, is to use very mild
and unstimulating 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-fiver 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 Whit-
tington, aged 5 years, had had an occasional discharge from the ear ever
since her birth ; but the mother says, that she was always a very lively,
healthy-looking child, and never appeared ill until seven days previous to
my seeing her, at wliich time the discharge stopped, and she then com-
plained of ear-ache.

I first saw her on Wednesday, the 17tli; she then looked pale and in
pain, but not diseased. I discovered a small fluctuating tumour behind
the right ear, over the temporal bone, about the same size as the external
circumference of the ear. The skin was not discoloured. 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 grey
powder with a sb'ght sedative ; but she remained in great pain, screaming
violently till about twenty hours before her death, when she became coma-
tose, and died just ten days after the invasion of these fatal symptoms.

Post-mortem . — Cerebru m presented no morbid appearance ; layer of pus
under the tentorium ; abscess in the cerebellum ; thickening of the neuri-
lemma 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 de-
nuded.

The abscess formed a thick layer on the centre of the right lobe of the
cerebellum, occupying, in a horizontal plane, nearly the whole of the outer
circumference of that lobe, and extending across the mesial line a little way
into the left lobe. The neurine round the abscess was not altered in
colour for more than a line or two at the most.

Labyrinth of the ear filled with pus, and the whole disorganized,
considered that this case was originally one of inflammation of the

426

HUMAN BRAIN.

lining membrane of the car, 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 syphi-
lis m two ways ; first, and most commonly, as a continuous
inflammation from a diseased cranium ; secondly, from the
diiect action of the poison, as in other fibrous tissues and
periosteal membranes in other situations ; in the latter in-
stance 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 liyperaemic affections, and the effects
of hyperaemia of the dura mater, we must not omit
osseous deposits. The dura mater, it must never be for-
gotten, is the nutritive membrane of bone. Its vessels
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 ten-
torium. It always acts more or less as an irritating 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 men-
tioning 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 bonv deposits on the
falx major.

Since then I have frequently remarked the same connec-
tion 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 bis
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.

lie sank more apparently from the elfect of the intestinal than the ce-
rebral disease.

Post-mortem, 24 hours after death. — Weather cool — March 1839.

INFLAMMATION OF THE DURA MATER.

427

Skull. — External appearances. — Supra-orbitar region fully developed,
frontal region rather small, occipital and posterior parietal full and large.

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 longitu-
dinal sinus on the right side ; the most anterior of which was situated op-
posite 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 posterior 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 neighbourhood of the osseous deposits.

Three layers of cineritious neurine were distinctly visible in this gan-
glion. The external, the darkest ; the middle, the lightest in colour ; 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-csecal valve.

The extreme thickness of the skull, which is not unfre-
quently met with in insane patients, must be regarded as
the result of long-continued and general hypersemia of the
dura mater.

The spiculae of bone which are found sometimes shooting
from the internal surface of the skull, though scarcely comiim
into this category, deserve mention here. There are genes
rally an abnormal development of normal projections ; we
meet with them not unfrequently springing from the tem-
poral and parietal bones in the temporo-sphenoidal fossae.
I have seen them in cases where they have evidently lace-
rated 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 spi-
culum is jerked out of the fossa in the brain in which it
lies quietly at rest, and lacerates the brain on the side
Hie following case illustrates this, and also organic disease
in connection with which subject I shall again have occa-
sion to refer to it.

428

HUMAN BRAIN.

llic anterior and posterior clinoid processes are not
untrequently 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
complaint. I had the opportunity of making a post-mortem
examination m the following case, through the kindness of
my friend, Mr. Ebenezer Smith, of Billiter Square.

Case 26 — E. W aged 32, suffered from epilepsy since she was 12 years
of age. The first attack followed a blow on the back part of the head, oc-
casioned by a fall ; latterly the fits occurred very frequently, four or five
times m the night, with an occasional interval of four or five days Her
temper was excessively irritable, and her mind had gradually become im-
becUe. bhe died during the fit, apparently in a state of asphixia.

Post-mortem. — Sub-fascial cellular tissue of the cranium abnormally
vascular and firm. Bones of the skull vascular, compact, and thick, par-
ticulaily at the centres of ossification in the frontal and parietal bones.

lie fi on tell bone in the mesial line thin. Vessels of the dura mater
enormously distended ; bled very freely on separating it from calvarium
Arachnoid slightly opaque. Vessels of pia mater very full of blood.
Fossae digitatae between the convolutions in the parietal and frontal
regions large ; cerebro-spinal fluid abundant. Cortical substance of the
cei ebellum 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 of demarcation 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 tem-
poral sphenoidal fissure we found an abnormally-developed mammillary pro-
cess, 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 membranes, and thence to the hemispheri-
cal ganglion. Sometimes it stops short of the brain, but
causes fatal effusion from the arachnoidal surface.

The following shows the disease advancing from syphi-
litic 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 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

INFLAMMATION OF THE DURA MATER.

429

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,
and 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 ques-
tion 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 mer-
curial ointment ; he got rapidly worse, and soon became quite insensible ;
but in twentv-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 ques-
tions, and ultimately quite recovered. It was also interesting to observe
an immense improvement in all his syphilitic symptoms. His nodes be-
came healthy, and some large rupial sores which he had on his thighs
and legs began to heal, and progressed most favourably. 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.

Caze 28. — On the 19th of January 1843, a seaman, of the name of John
Kichardson, 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 ex-
tensive sore on the forehead, at the bottom of which there was a large
piece of blackened dead bone. The appearance presented was so charac-
teristic, 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 scold-
ing somebody. From the commencement of these symptoms he was never
sufficiently conscious to answer any questions.

No pont-mortem examination.

I have seen in the venereal wards of our hospital rheu-
mato-syphilitic inflammation of the dura mater pass on to the

430

HUMAN BRAIN.

brain and produce insanity. The following case is a «wl
illustration of it, and the value of active treatment — °

complexion~Md^ aspect, pale

Mr. Green’s assistant, into Job’s Ward i niy Te’ as

in his us',,,! good health till WeSyfSThe siato otaerved some!
g iaiP 1,1 lus manner, and a wild expression of countenance The

t t]S Wa“ltlliS hat and «* and^rnained out
tne wnole ot the day, the weather being very cold and wet • lie returned

in the evening, and complained of pain in all his limbs; it was found that
lus knees and ankles were swollen and red ; he passed a sleepless nieht
fiequently changing his position in bed, and occasionally crying out with

SmmanTo M°Wing day the j°ints ** from aLwel^g;

the 7 qUe+Stl0ned ™ to pain, complained of headache ;

S : f lus countenance was vacant, wild, and suspicious; he

to be in lwl ? ^ °Te’ andthat he ought, therefore, not

to ho m bed, and it was with difficulty that he could be prevailed upon to

lo so , he refused to take any nourishment or medicine, but he answered
questions that were put to him quite correctly, though during the day lie
was sometimes so obstinately silent that no answers could be elicited from
11m. 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 in-
flammation of the membranes of the brain, caused by metastasis from the
sudden recession of rheumatic inflammation.

It appears that the habits of the patient have always been regular and
temperate; none of Ins family have suffered from insanity. He was or-
derderd Pulv. Jalap® c. Cal. 9j. M. S. C. Liq. Amin. Acet. Xfs. Vin. Col-
cliid rnxl. Mag. Curb. 3j. Aq. Menth. Pip. 6«" horis. Venesectio ad Win.
Cal. gr. v. 4lls- horis. 0 J

28th.— On the following day he was quiet and composed; he no
longei 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 nuchae. Ung. Hydrarg.

9=- Aconite gr. j. Hyd. c. Creta gr. v. 6tls> horis.

Morphia? Hydrochlor. gr. j. o. n.

Ext. Colchici. gr. iij. 6tis’ horis.

Maich 1st. Appears to day quite comfortable; the countenance is
neailv natuial, and lie passed a goodnight; he makes no complaint.

4‘th - lie has continued improving daily since the last report ; he now
appears to be perfectly rational, and he sleeps well.

Ordered Hyd. c. Creta gr. ij. 6";- horis. Beef tea, Vin. Colchici m xx.

, 0 cbange occurred in this patient’s progress; he perfectly recovered,
and went out quite well.

I have no doubt that chronic inflammation of the dura

INFLAMMATION OF THE DURA MATER.

431

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 Han well. 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 1 give these, as I recorded
them at the time.

Case 30. — Thickness of the os frontis producing melancholia. — Han-
well, March 2nd, 1841. — Death from fever supervening on melancholia,
during which the patient was almost constantly crying and moaning;
she could only make incoherent replies. During the febrile excitement
she occasionally gave distinct answers, and protruded her tongue when
requested.

History of Case unknown.

Post-mortem, — 28 horns. Body much emaciated.

Cranium exceedingly thick in the frontal region, especially over the
organs of mirthfulness, 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 thicker than
natural, especially the anterior portions of the parietal bone, as shown by
the great depth of the arterial fossre.

Brain. — Fibrous neurine more vascular than natural. Cineritious sub-
stance of the anterior convolutions decidedly darker than natural, and
much more so than the posterior.

Weight of brain and cerebellum, 2 lbs. 13 oz.

Lung. — One tubercle, in the lower portion of upper lobe of right lun°\

Liver. — Peritoneal covering slightly thickened by white deposit. Pan-
creas firmer than usual.

Remarks.— I consider that in the preceding case, the disease commenced
with chronic inflammation of the dura mater, covering the anterior part
of the brain, producing, as in ordinary cases of periostitis, gradual thick-
ening 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 inflammation of the arachnoid and pia
mater. It i3 very much to be regretted that there was no early his-
tory 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 : —

432

HUMAN BRAIN.

Case 3 1 • Plan well, April 1st, 1841.— John Buckingham, a*. 48. In-
sane ten years. Mental imbecility supervening on anxiety
Post-mortem, — 37 hours. J

Head— -Skull generally thick at the anterior part } arterial fossae nu-
merous and rather deep In the centre of the frontal bone it was £ths

Dura mater strongly

c -n r : : — : . u- . ui me in

ot an English mch in thickness (4 French lines),
adherent to the skull.

Brain. Cortical substance pale, softening of that portion of the longi-
tudinal commissure called the septum lucidum.

Weight of cerebrum and pons, 3 lbs. 6 oz. Cerebellum and me-
(lulla 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
ot the hospital, whose sufferings were excessive. When I first prescribed
for him I did so undel the belief that he had this form of inflammation,
but finding that all the remedies which I have ordinarily found success-
ful in the treatment of these cases, such as mercury, leeches, and the
iodine of potassium, entirely fail, I thought I must have mistaken the
case ; and as there were no cerebral symptoms, I ventured to prescribe
for him such medicines as are beneficial in neuralgia, but without any im-
provement. Having failed in all my endeavours to alleviate 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
paralysed on one side of his face, and totally deaf. The disease, how-
ever, stopped here. He did not lose his intellect, 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 eruption appears ; and sometimes, the eruption
not appearing at all, the nature 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 exhibited
the true eruption of scarlatina. In these cases depletion
must not be attempted, but every thing to determine the
poison to the skin.

The sequelae of scarlatina are, however, every now and
then most formidable in relation to the brain. Every prac-
titioner has seen these cases. The patient is apparently
recovering from a mild attack of scarlatina, when suddenly
he is seized with headache and blindness, with or without

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 433

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 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 slioidd, indeed, be borne in
mind that all the sequelae 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. Abercrombie
and Andra! 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 ac-
count of the metaphysical state.

When inflammation of the hemispherical ganglion is ex-
cited by moral impressions, the existing cause of the attack
travels through the nerves of sense from without inwards,
centripetally. It ought to be distinguished from those
attacks which are induced by external causes, such as those
we have just been considering.

The following cases will illustrate what I mean by in-
flammation 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 in-
flammation was of a very low and feeble character, not
confined to this ganglion, but extending to the tubular
substance and lining membrane of the ventricles, and
accompanied by some serous effusion.

CW 33. — Inflammation of hemispherical ganglion produced by fright.

On the 2nd of June 1842, I was called by Mr. Wildbore, of Shoreditch,
to visit Miss Yj. It., who was suffering from cerebral symptoms. I found

* T>r. Pritchard (op. nil., p. 371) makes some interesting observations
on this subject.

434

HUMAN BRAIN.

her lying in bed; countenance pale and anxious; pupils dilated and slug-
gish 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
s le complained of violent pain ; pidse 84, and small ; head hot ; tongue
turred but not dry ; understands what is said to her, but answers slowly.

Mistory.— She was a nervous person when in health, and naturally
rather irritable and excitable. 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 ran down the hill. She
e l, was not hurt, but much frightened, and made excessively angry. She
was menstruating at the time. She continued to cry and sob hysterically '
or 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 I
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 lyin°- 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.

2nd day, |-past 9 a.m. — Has not slept much during the night ; com-
plained 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 fright-
ened ; 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. Lyttm to be dressed
with mercurial ointment, and as there was difficulty in getting her to take
pills, we substituted Hyd. bichlorid. gr. 4tis‘ hor. in mint water.
Hirud. xx. to the head.

10 p.m.— Has been ranch quieter, and apparently more easy, after the :
application of the leeches.

The same principle of treatment was earned 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 labour , after many days'
congestion of the brain supervening , with probable effusion. — C. J. B. ;et. 36, j
the wife of a medical man in the country, was delivered of her fourth
child, January 2nd, 184 — , after an easy and natural labour 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 inter-
vals, 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 congenital 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 favourite, had been ailing for
some weeks, and it had been doubtful whether she would be able to wait

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 435

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 hvoscyamus and morphia, during the two first days. They did not,
however, succeed in procuring much, or good, sleep, and induced a numb-
ness in the hands and face, which rather alarmed so timid a patient,
i 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, every thing 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 aperient medicine had, to all appearance, its
proper effect upon the bowels. The child was very healthy, and afforded
no cause for extra attention.

e 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 aud suffering, to give up her situation. This, in the pa-
tient’s owu 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 con-
sequence was, however, yet observable ; for during the three or four sub-
sequent 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 sire 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 incapability on the
part of the woman.

On the 15th of January, this state of nervous irritability had much in-
creased, every cry of the child seeming to aggravate it, so that the nurse
and child were removed to another room, but without ultimately producin'--
any improvement in the matter. All matters connected with the uterus
were quite satisfactory. There was no abdominal or hypogastric tender-
ness. 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 expected
was not satisfied. 1 ’

2 f 2

43 G

HUMAN BRAIN.

. Gns peiiod, 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 im-
piession was strong upon her mind that the bilious matters required more
calomel. The pulse had varied from 110 even to 140, evidently kept up
by mental, or more properly nervous, excitement. The perspirations hail
subsided, but an undue temperature of the skin was complained of, which
was also sensible to the touch ; the tongue exhibited posteriorly a 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 Hyclr. c Cret&, gr. viij. with gr. v. of Pulv.
lthaei. One dose of these she took on the morning of the 16th, but fad-
ing 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 me-
mory, great anxiety, and timidity regarding her own state of health, though
not expressed at the time, yet plainly indicated by countenance, manner,
and watchfubiess, but not what could be called restlessness, nor was there
any complaint of want of sleep ; she expressed herself rationally.

January 18 th. — The nervous irritation was unrelieved, as likewise the
concomitant febrile excitement. The bowels had been freely acted upon by
saline aperient medicines, but during the day she made complaint of pain
and sense of obstruction at the lowest part of the sacrum, accompanied by
endeavours at expulsion, as if there was some lodgment in the rectum.
An enema of plain warm water was used in the evening, anil 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 ou 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. 3h Liquor Amra. Acct. 3'ij- Sp. /Fthcris. Nit. 3>-

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 437

Mist. Camph. 3vj. 6tls- lioris. Also a night draught, containing, in ad-
dition to the above, five grains ot Dover s powder. _ . ......

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 34, was
soft and compressible, and continued so throughout the day. She com-
plained 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 se-
cretions too dark and offensive ; nourishment was obviously required, and
towards the latter part of the day more was taken than for several pre-
1 ceding days, in the shape of arrow-root and gruel, in the last of which
she had, at two different times, altogether nearly §fs. of brandy. Not-
withstanding this, there existed much confused sensation in the head, the
■ sequel of the morning 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
i urgent ; considerable heat of skin ; general expression of countenance
anxious, especially indicated by the eye. Supposing the present pain to
be still referrible to the opiate, and the bowels not being so fully opened
during the last twelve hours, the saline draughts were repeated more fre-
quently, and front part of the head covered with rags wetted in cold vine-
gar 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 natural 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 interrogated, 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 conjunc-
tival 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 minute, somewhat nasal, with the alae
nasi contracted and visibly in motion ; tongue, heretofore moist, had a
tendency to dryness, and to assume a brown colour. Bowels had been
twice acted upon during the day, the stools the same 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 .lamcs’s powder, were administered. The
latter was directed to be repeated every three hours, along with the saline

438

HUMAN BRAIN.

di mights and JPs. of Mist. Sennas two liours after tlie ralom^l t •
there were noticed slight catching of the ! , e °mel ; at nine

refused SeTfil Xrs "h”6 al°Ue she but

andULt0paSePreri°d ***** had been ™dcr tlie care of ** husband

Witklnin' of Whliei 22/U1, th<i CX|llibit,ion of mercury was advised by Mr.
two horns- the Z T ’ Td Ca,lmue w,as 8iven in two-grain doses ‘every
: shaved, and slightly enveloped in cloths wrung

out or iced water. The condition of the eye was then unchanged but all
the former symptoms were continuing, and, if possible, aggravated ’ except-

bvnin 16 SUbSU ti9’ UC 1 was vlslbl.V abated ; congestion of blood in the
b am was considered to exist by Mr. Wickham and the other surgeons
iliey agreed as to the danger to be apprehended from effusion, on the one
and and, on the other, from depression of the vital powers (never other
than feeble m this patient, as before stated) by mercury and the other re-
medies necessary Had she not been in this doubtful state, Mr. W. thought
lie puhse wouhl have justified further abstraction of blood, even from the

to resortL tohwTei’ ^ COul( .n°t recommend, but he would not hesitate
to lesoit to leeches again, if the power of the pulse continued much

onger 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 supported by beef-tea, and arrow-root, and other fari-
naceous substances, in quantities to be regulated by the pulse, heat of
skin, and degree of cerebral symptoms. Dry warmth was applied to the
bi easts, which had been drawn twice in the previous six hours, and yielded
each time upwards of half an ounce of milk. A 8 o’clock a.m., the flush-
ing 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 respiration the
same m 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 apparent depression she continued for the
next twelve hours, with the alteration of a flush, lasting about two hours ; I
between two and four o’clock equally conscious, though incapable of re-
turning 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 tilings and persons around her, with the eyes constantly closed as if in
the softest sleep, whilst this state of heavy drowsiness recurred directly
after she had swallowed either food or medicine. These she still took

INFLAMMATION OF THE HEMISPHERICAL GANGLION.

439

most readily from her husband, and in quite sufficient abundance Several
had passed involuntarily from the b»wc of tto
former appearance; and urine also more freely m the same way.
evaporating lotion, composed of spirit and muriate of ^‘^^pped
stinted for the iced water, and compound spirit of aether was cti 11
upon the scalp at short intervals, the heat of head being undimmished , •
also the excessive carotid impulsion. A second large hbster was appb
over the upper site of the former, at the nape of the neck, at six o

and the former remedies had been regularly exhibited.

23rd S am.— About ten o’clock last night her husband had great
difficulty in rousing her to take sustenance, on two separate occasions and
at intervals of only a few minutes ; and when she temporarily awoke out o
this stupor, or extreme somnolence, the stare was more strongly visible
though die pupils were naturally susceptible of contraction, and the ey •
indicated no other morbid or unnatural expression. 1 ujse between UJ
and 130, less powerful, but not soft; respiration 3G ; Happing of bo h
cheeks during each expiration, attended by an audible purling soum ,
this peculiar state of breathing lasted not above a quarter ol an hour
Considerable flushing of the face succeeded to this, with increase of geneial
heat, and force of pulse, as well as rapidity. Two grains of ammonia had
been given twice, 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 scrum. 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, ot the two
female attendants beside her. Her husband at once stilled her, and o
him she took slight notice, and began to make inquiries m 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 re-
duced to 34, and quite regular, also freer ; had been now and then slight
sighin'', and stertor ; three dark motions, the product ot calomel, have
been voided involuutarily, with a good deal of flatus ; urine passes also un-
restrained. Nourishment to be taken less liquid, though thirst is urgent ;
this is to be relieved by effervescing draughts, ad libitum.

s p \[ — Through the kindness of Mr. Solly, who accompanied him, Di.
(tape visited the patient about six o’clock. In addition to the plan we
were pursuing, he prescribed Camphor two grains, reduced to powdei,
with spirit of wine, and carefully rubbed down with mucilage, so as to be
suspended in the fluid form, with eighteen minims of tinct. ITyoscyami,
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 puJ-e had fallen to 110, but had lost little of its power, and the re-
spiration 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
not exceed 103. There was exhibited on the tongue, st ill moist , a trifling
eopper-coloured fur, attributed to the local as well as a general action ot
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, was evidently

440

HUMAN BRAIN.

there was no longer the same feCp Wa.s ^ stro«g> and as

nearly natural, it" was evidently refresht^^ 1?bet.ude ln lts character, now
such herself. Of course the strictest m a^’ wbe1n askcd> pronounced it
out, and was now more reqS ^ oWed th™gb-

complained of shortness of9 breath* but there ^ “ornmS she ha(I
able, and the feeling passed oft- after u ,1 ,as 110 d3'sPnoea observa-
The nutriment wa^as Z and athSi t ““f dos? of ammon- ^rbon.
tea thickened with isbmlass £1^*“ sh,e ,couldtake, namely, beef-
She now requested frennentfv tn 1 1 an^ biscuit boiled into jelly,

vesoing mcdidne, ’ % 40 have bcr stinted by the iffe'r-

its general P™ «™jr to* horns, as

-io„ „„ the gnmf wasTo^cr1' Pdt ab»i S"' “'ll *1 ^
this number softer ami . e a jout or rather below

and — 24; more free,

nished; taJS ’fl' m i.b“bs ™™,the heat having dimf

and occiput, and also that from the bl tteredZrfal^ SI0”1 f°"'l‘'ad

in *««» “> to mat-

and lava it to the e£ c ng (7^") faUth®"?1"?-0 *T*>

to take more. She being u™ble *>

s t rf :

former remX’ t LXjT^Z'Z “S
'SMS: ”nd the b<rfta- '&C-. bare

breathing natural ; bowels moved freely in the hist 24 hours and evacu-

imt H e* 1 r,!, t0 be CXpCpe,l> the same- No urine has been discharged
but the bladder is not distended, nor uncomfortable ; some tenderness’
however, on pressure over it. Pulse 98, during sleeping open and soft
when she 1S roused, about 108 ; tongue moist, and ilining to whitens s’
tie Hus lings have recurred occasionally, but more slightly heat of head

" S r,t 1 t n'1- al"! ™' -l-t. lotion Tre equally

P • thc thll8t has bee" ,ess urgent, and the saline draughts there-
loic, unnecessary; otherwise, the diet and medicines have been the same.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 441

8 P.M. — She has had no calomel since nine this morning, as its effects
have become more apparent in the mouth, and the odour 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 cam-
phor and hyoscyamus have been taken, but no other medicines ; rather
more than a pint of mine was drawn off again at two p.m., previously to
which she had expressed considerable uneasiness.

26th, 8 a.m. — It was necessary to draw off the urine again this morn-
ing, 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 iii
character ; soreness of the mouth complained of ; tongue white, and
more furred, and the gums more affected ; sleepiness undiminished, but
sensibility and sensation obviously increasing. There has been no further
occasion for calomel ; the camphor, &c., has been regularly exhibited, and
the saline draught once or twice.

s p- M. — There has been less disposition to sleep, and a very percepti-
ble acquisition of sensibility and memory. The bowels have not been so
much acted upon, and she has voided mine by her own endeavours. Pulse
during present sleep, 90. By her own desire, she has partaken of more
nourishment during the day, and has shown improved strength • one lar°-e
watery stool was discharged this afternoon involuntarily.

2Bh. “Was permitted to sleep for five horns together last ni°ht, as
she rested so tranquilly and naturally ; there has been considerable less
flushing. Pulse 90, not weak ; but soft, and with nearly a natural stroke
1 he feces and secretions of urine have been passed consciously and the
former, more sparingly and fewer, changing gradually to a lighter meen
are now yellow. Has eaten a little sopped bread at her own request, and
could have taken more but from the increasing soreness of h,.,- .

natural, they are omitted. Pulse 80, during sleep, {
natura! ; bowels still relaxed, but the faeces "natural •

Orilf nn/l • — _1 i .. <1 • • .

vertigo, together with occasional nn-
ihe may be now pronounced perfectly
•rralion of mind, though the power of
lays some anxiety concerning the fu-

442

HUMAN BRAIN.

ture 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 yesterday. 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. Creta gr. iij. Pulv. Ehsei. gr. v. f‘. Pulv. hac nocte sumend.

30th. — Some nausea and pain were produced by the powder, but sub-
sided as soon as the bowels, which have not acted for 30 hours, were
moved by it. Has had four stools, relaxed, and cpiite healthy. Pulse
as yesterday ; there has been scarcely any sleep in the night, from the dis-
turbance 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 1 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
he of little service if I did not obtain the confidence of my
patient, I immediately 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 him that I came to pre-
scribe for him, as I understood that he was not well. He
then asked me if I was a physician or a surgeon. On my
informing him that 1 was the latter, he said, “ Very well,
that will do, they are not humbugs generally.” He then
said, “ But I want no medical advice, 1 never was better in
my life,” and began talking incessantly, 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 my 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 fore-
head, fomentations to promote bleeding, and aftervvards
cold lotions ; five grains of calomel with rhubarb and jalap,

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 443

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 neighbourhood 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 grey powder, with a
grain of aconite, three times a day. He took a great deal
of exercise, and recovered 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 ren-
dered a confirmed lunatic. If, for instance, the straight
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
establishments 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 waggon without springs would to a com-
pound fracture of the leg.

1 have had three very similar cases, all of which recovered
under the same general plan of treatment.

1 he 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 centripetal! y.

>/*? Id —Apoplexy, with Hemiplegia, in consequence of friqht —A
robust, and rather plethoric woman, thirty-eight years old, was iii perfect
health, and speaking to a neighbour, when her servant girl frightened her
by brandishing a bright spiral wire over her head, so as to make it look as
i a snake were falling on her. In her fright, the woman suddenly fell
bow n as in an apoplectic tit, and remained for some time nearly unconscious
' , examined, she complained of a noise and beating in the left side of

her head, deafness of the left car, and of blindness and loss of taste on
the same side. She could not move any part of the left side of the body

444

HUMAN BRAIN.

and in every respect resembled a patient suffering from hemiplegia, in con-
sequence of sanguineous apoplexy. By active antiphlogistic treatment,
and various other measures, she was gradually restored from this state in
about three months.

Worry in business, mental anxiety, and vexation of spirit,
will sometimes bring on spasmodic action of the muscles,
and paralysis. In some cases the anxiety and mental irri-
tation induces disease in the hemispherical ganglion, seri-
ously 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 ganglion as the motor
tract, conducts the will to the muscles; and the conse-
quence of this excitement is an irregular supply of stimulus
to the muscular system exhibited by the twichings 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 innervation, only that in epilepsy
the nervous or electric fluid accumulates in undue quantity,
and passes off in a large quantity at once, like the dis-
charge 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 twitch-
ings 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 complete 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, nervo-sanguincous temperament,
wlio bad been engaged in practice for some years in the North of England,
consulted me in the spring of 1842 witli the following symptoms: — Some
numbness down the right leg and arm, dragging of botli lower extremities,
but especially the right. This partial paralysis was so severe, that it

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 445

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 catch-
ing 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 come 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 for a year or
two. Up to this time his complaint had been considered spinal , and the
counsel he received was often contradictory ; one very eminent surgeon
recommended tonics, and to live well ; another considered it spinal irrita-
tion 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, I felt
convinced that the affection was cerebral, and not spinal.

In a consultation which I had with two of those medical friends under
whom he had been before seeing me, I urged my reasons for so flunking,
and they acquiesced in my view of it. Previously they had recommended
a voyage to India as surgeon to the vessel ; this 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, —
“ f 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 Ids letters written during his absence from home. Italics
rny own.

June 3rd, 1812. — “During the month I have been from home I have
experienced little, if any, mitigation of the convulsive catchings which
come on as I arn passing into sleep. The uneasiness of the head remains

440

HUMAN BRAIN.

the same, and the sense of heaviness or confusion nmW r r

excitement. The leg is much better, and were it Zt

muscular exertion I think I could walk as well as ever. My sSs -ire

generally good, and my general health may be called excellent

the gr ij of blue pill every night, whii yoTwmTiw iTZ'

menced at your suggestion near three months ago. I keep' the Si

shaved, and commonly sit without my wig.” b P liead

July 4th, 1842.—“ I certainly am not worse than when I wrote a month

T '£££%?% £ W 1 T “

tender; I have felt very feeble, and since your last fevoiff hive^ostrar^
fully 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 yollr
heaits content; and much smarting every other nieht nml •> l i
exfoliation of cuticle does it keep up* I detZ “lie p h,
leg gets numb now and then, and would, I daresay, if I tried to walk
much, soon tire. A nting gives me some uneasiness of head, &c The
catch mgs and jerkings of the body come on every night on my going off to
sleep This condition abiding, I must deem myself about iLtatuaw
though the quietude f cultivate and the discipline I undergo, through your

ror&d^”mU8t b6"e structure torecZ

August 1st, 1842.-“ 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 disea e
would be discovered; lie 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. b 1

“ 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

Gidves says you know it is a tome which does not determine to the head
What say you ?

1 T10hft(? hrmi SUYUlg t]plt 1 had 110 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 agiee so well with him as the mercury.

About the 18th of August I wrote to him, recommending the appli-
cation of four leeches every night for a week, the bleeding encouraged by
exhausted glasses. D •>

One or two moderate doses of salts in the morning.

“ Under this plan,” says this gentleman in a letter! lately received from
lum, the head was much relieved in so marked a degree that 1 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 doses of mercury did a vast deal of -mod
but the ‘ catclimgs 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 oil; resumed again in January in small doses, and
continued ten or twelve weeks.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 447

“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 1S46, 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 aioay.”

Mr. Dunn, of Norfolk Street, has related a most in-
teresting case in the twenty-fifth volume of the Med.-Chir.
Transactions, which corroborates my view of the pathology
of the above case. Mr. Dunn’s case is well worthy of
perusal in full, but I shall only refer to those points which
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 placid child, he had
become irritable, peevish, and petulant, impatient of con-
trol. 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. Tie had awoke as usual, be-
tween 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 talk-
ing, 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
sidf and lower extremity, with twitchings of the eye and
angle of the mouth. These fits increased in violence.
Towards their termination, (and they lasted about two
hours,) he cried and screamed violently, but throughout
their continuance he was sensible, and could at times be
soothed by kind attentions from his parents. The fits
w.re followed by profound sleep for several hours, and the
side was left partially paralysed. The paralysis was not
persistent. A few days previous to Ids death, the right

448

HUMAN BRAIN.

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, eves
squinting, and turned inwards, insensible to light, eyelids constantly open
and only at times recognising the persons about him. On the subsidence
ol one ol 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. Bowman, of King’s College, and I am indebted to the kindness of
the former distinguished physiologist 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 \\ as most abundant on the surface of the convolutions ; it never-
theless descended into the sulci between them, a circumstance which proved
its connection with the deep surface of the pia mater. The cortical sub-
stance 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 eidargement 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 in surface. The ventricles con-
tained more water than natural — about double — aud did not collapse when
laid open. The cerebral substance throughout, excepting at the diseased
part, was firmer than usual at the patient’s age. This firmness was no
doubt owing to the compression 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 substance of the brain is attended with convulsions, without
decided or persistent paralysis, aud that it requires the medullary matter
to be involved to render the paralysis permanent. My 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 per-
sistent until after the violent attacks of cramp, and from this time may
probably be dated the implication of the medullary substance in the in-
flammatory process. Admitting the justness of the view, that red soften-
ing 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.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 449

“ 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 expected from the history of the case.”

Thus I think it may be considered established that me-
ningitis, though always accompanied with derangement of
the mind and temper to a greater or less extent, is in many
cases accompanied with derangement ot the motor powers.
The character of these lesions of motion depend upon the
extent of the disease. In the early stage, before it has
advanced 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 sometimes, though very rarely,
.general. AYhen 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 consideration ; thus per-
manent flexion of the fore arm 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 neck, trunk or extremities,
trismus, &c.

“ finder the second class, in which motion is diminished
or altogether destroyed, may be reckoned those numerous
varieties of paralysis observed in meningitis. This para-
lysis may affect the muscles of the eye, of the eyelids, face,
lips, or limbs ; either one or several of these may be de-
prived of motion. In these different parts the paralysis
may be established either slowly or as instantaneously
as the loss of motion succeeding cerebral haemorrhage.
The paralysis may supervene from the commencement, 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

* P. 51.

450

HUMAN BRAIN.

the upper extremities completely deprived of motion, whilst
the other was more or less violently convulsed. There are
also some cases in which the paralysis appears and disap-
pear s 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
nyperaemia ol 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. Abercrombie* makes the following acute observations
on a form of meningitis which I have more than once had
the opportunity of observing : —

“A dangerous modification of the disease, which shows
only increased vascularity.

“ Another important modification of the disease occurs in
an insidious and highly dangerous affection, which, I think,
has been little attended to by Avriters 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 dan-
gerous nature of it lias sometimes been overlooked, until it
proved rapidly and unexpectedly fatal. It sometimes com-
mences with depression 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 mania-
cal 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 Avhich 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 poAvers, supervening upon the high excitement,
Avitliout coma. The principal morbid appearance is a

* P. Gl, § viii.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 451

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 purgatives, 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, super-
vening upon the high excitement, without any of the actual
results of inflammation.”

The following cases are related by Dr. Abercrombie to
illustrate tliis class of symptoms, and the first is one
of those cases which illustrate inflammation from within,
excited by mental causes. The colour of the hemispherical
.ganglion unfortunately was not noted, but the inflamma-
tion of the pia mater without that of the arachnoid is par-
' ticularly described.

Cane 37. — A lady, aged 23, had suffered much distress from the
Jeath of a sister, and had been affected in consequence with impaired ap-
retite and want of sleep. This had gone on for about two months, when,
in the 4th of August 1825, she sent for Dr. Kellie, and said she wished
I o consult him about her stomach. He found her rambling from one sub-
eet to another with extreme rapidity and considerable incoherence ; and
1 m the 5th she was in a state of the highest excitement, with incessant
alking, alternating with screaming aud singing: pulse from 80 to 90.
n the evening she became suddenly calm and quiet after an opiate; con-
mued so for an hour or more, then fell asleep, and after sleeping two
| ,our3 awoke in the same state of excitement as before. The same symp-
oms continued on the 6th; the pulse in the morning was little affected,

: iut after this time it became small and very rapid. On the 7th, after a
i nght of great anti constant excitement, she had another lucid interval, but
e.-r pulse was now 150. The excitement soon returned, and continued
lii four in the afternoon, when she fell asleep. She awoke about eight,
*nlrn and collected, but with an evident tendency to coma; pulse 150, and
mail. She now took food and wine, and passed the night partly in a
tate of similar excitement, and partly comatose; and died about mid-day
>1 the 8th, having continued to talk incoherently, but knowing those about
ier, and in general understanding what was said to her.

Inspection, fhe only morbid appearance that could he discovered

2 G 2

452

HUMAN BRAIN.

was a highly vascular state of the pia mater, with numerous red points in
the substance of the brain. 1

Case 38. A gentleman, aged 44, of a stout make, and very temperate
habits, became suddenly affected, without any known cause, with extreme de-
pletion oi spii its, 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 sunk
into a state of collapse, and died.

Inspection.— The only morbid appearance was a higlily 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. lhe patient in the first instance was labouring under a false
impression, which, producing excessive fear, was followed by tremors, con-
vulsions, 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 menin-
gitis, 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 com-
plained of by the patient.

In the sixteen cases in which the pain did exist, the alte-
rations discovered after death were as follows : — In two
ot these cases the patients presented tumours developed
primarily in the dura mater, which had compressed 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 ven-
tricles. Three other subjects presented nothing but redness
of the meninges. Another case presented pseudo-membra-

* P. 47.

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 453

nous concretions deposited within the great arachnoid

^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 cel-
lular adhesions intimately connecting together the two
reflexions of the arachnoid covering the convexity oi the
brain This individual had been all his life tormented with

headache. ^ ^ were the ventricles found filled with

purulent fluid. “ From these facts,” says Andral, “ we
are warranted in concluding that the pam accompanying
diseases of the meningis may exist with diseases ot these
membranes, widely differing from each other both in then

nature and their seat. , .

“ Let us now inquire what lesions were found m the

membranes in the twelve patients who complained not of
headache. In two of them the pia mater was infiltrated
was 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 m one

“ From these facts it follows that the diseases of the mem-
branes, during which no headache was obseived, difleied
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
decrees of the intensity of the headache depended either
on^he 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 head-
ache 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 surrounding the nervous centres ;

454

HUMAN BRAIN.

Ss’ again’ t0 effUSi°nS °f PUS or semm int0 the ven-

“ 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, pheno-
mena of the most different kind.

1 lie nature, also, of the pain felt by patients attacked
with meningitis is not the same in all. Some think that
there is an enormous weight on then’ skull ; some complain
ot violent lancinating pain either continued or returning at
intervals ; several fancy that a tight band compresses their
forehead ; some say that their head is squeezed, as it were
in a vice. All motion applied to the head, or even to the
other parts of the body, is oftentimes intolerable. We
lave seen some patients whose headache was increased by
slight pressure made on the integuments of the cranium.

c ncvci saw, on the contrary, this pressure diminish the
headache, as so often happens in the cases of headache
called nervous. Ihe period when the headache appears is
not the same in all cases. Most frequently, however, it
shows itself from the commencement, sometimes 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
commencement of the disease seem divisible into two series,
according as the headache developes itself singly, without
any other morbid phenomenon accompanying it, or accord-
ing as its appearance coincides with that of other symptoms, j
The first series includes the most numerous cases. The time
during which the headache continues, the only appreciable
morbid phenomenon may vary from some hours to several
days. When this headache thus precedes the other symp-
toms, there are some cases in which it seems to have
nothing serious in it. It sometimes resembles mere rheu-

INFLAMMATION OF THE HEMISPHERICAL GANGLION. 455

matic 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 alter the
appearance of the headache, vomiting supervened, ihe
second series includes those cases in which the headache
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. disturb-
ances of innervation. There are some rare cases in which
the pam of head continues with great intensity during the
entire disease ; but most frequently there are developed on
the part of the nervous system more severe symptoms,
wliich 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 veiy uncommon to see it come on alter
this period. Headache is almost the only modification ot
sensibility observed in the ordinary cases of meningitis.
In some few of the cases reported by us, the cutaneous sen-
sibility was rendered rather obtuse ; but it may be re-
marked, that in one of them the brain itself was the seat of
considerable pressure, made by a tumour developed in the
dura mater. There was one case also where the sensibility
was very7 much exalted. From several cases published by
M. Parent and also by M. Dance, we feel warranted in
laving it down, that in the meningitis of adults, modifica-
tions observed in the cutaneous sensibility may be consi-
dered 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 information derivable from the existence of pain in
the head, its peculiar character, scat, 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 becomes important.

For instance, if the patient has violent pain in the head, but

456

human brain.

the temper and mmd ai.e not unusually disturbed and ex-

tabm’tv of t lele 1S "°i mdlcatlon of incipient paralysis or ini-
iflnld^or8™ a5\ em’ 1,0 insomnolence except such
bo *i ne occasioned by severe pain in any part of the

BuUf with T ?’e ”° “,dioation of cerebral disease.

But i with such symptoms as above described the patient

important s PT.“the head- is ,ts existence fmosE

less local depletion and derivation of the blood" to other
oi gans , the intestinal canal with its extended surface always
attordmg an open field for rapid evacuation of the nutritive

subject of headache is one of great interest,
legal ding its pathology we have still much to learn
•Dr. Bright* observes—- That this symptom depends on
various causes, and that it is connected with different con-
ditions of the circulation in the brain, is not improbable ;
but m 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 Exhaustion from fatigue, exhaustion
nom the loss of blood, exhaustion from over excitement
by mental exertion or bodily excesses, all tend to produce
a state of debility m the vessels of the brain which favours
congestion ; 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 occasion-
ally from dyspeptic headache; and indiscretion in diet will
bring it on, especially if he has been at all worried in busi-
ness 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

* Op, cit., p. 222.

INFLAMMATION OF THE HEMISPHERES.

457

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 aggra-
vates 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 1 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 ns next turn to the consideration of inflam-
mation of the -substance of the hemispheres — 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 afterwards, without the intellect being affected,
when the inflammation is confined to that portion of the
cerebral substance which is within the grey matter of the
convolutions, that matter remaining itself unaffected. The
important conclusions, which may be drawn from these facts,
regarding 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 por-
tion, is characterized by the appearance of convulsions pre-
vious to any sign of mental excitement. This inflammation
frequently terminates very rapidly in ramollissement.

This form is extremely insidious ; the absence of any
disturbance of the intellectual faculties prevents the atten-
tion 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 lie
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 ne-
glected— it is vomiting.

The convulsions are occasionally followed by coma, and

458

HUMAN BRAIN.

then all doubt regarding the danger of the attack is at
lest : though it is true, as stated by Dr. Abercrombie that
sometimes after the coma has lasted for a ceTa^ t^nf
perhaps for twelve hours, there is a complete recovery from
it, and for several days the patient appears to be in a
favourable state; when, without any warning, the convul-
sion returns, and terminates in fatal coma. If there is one

lmg mme inexplicable than any other in cerebral diseases,
it their cessation and remission, sometimes amounting to
an almost regular periodical intermittent. But still the

ddeteriou^mmne ^ CaSeS is’ like other stimulants,

Bnhe 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
ot the head have been already cited as among the
causes which produce inflammation of the hemisphe-
rical ganglion, and thus affect the intellect; we must
again refer to them m relation to the tubular substance
beneath, and the effect on the conducting instruments of
tlie brain, as shown by involuntary convulsive actions of
the muscles. When an injury to the head is immediately
followed by convulsions, it is generally a sign of very seri-
ous and severe injury to the substance of the brain, usually
a laceration. J

YY lien convulsions, after a few days, supervene on a blow
of the head, they must be promptly attended to, as indica-
tive of inflammatory mischief in the tubular structure or
undei surface of the ganglion. The following case illus-
trates this subject well : —

Case 4 0.— 1 Thomas Smith, aged 14, was admitted from Woolwich into
George s Ward, St. Thomas’s Hospital, under Mi-. Solly, as Mr. Green’s
assistant. May 11th, 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 seen by Mr. Solly at
hall-past 9 a.m. He had been insensible up to the time of admission, and

INFLAMMATION OF THE HEMISPHERES.

45(J

continued so at that time. His head was shaved, and cold lotion applied :
at half-past 1 p. Mt he had recovered his senses ; his pulse was somewhat
slow and labouring ; 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. sumend.

2 p.m. — Hvdr. Chlor. gr. ij. quaque 2da' hora sumenda. Hirud. xx.
ad caput applicand.

9 p.m. — Yenesectio ad 3xij.

May 12th, Si a.m. — Complains still of pain in the head; continues
drowsy ; pulse 7 2 ; bowels not opened, although he has taken eight doses
of calomel.

S{ a.m. — Ilirud. xxx. Hydr-. Chlor. gr. v. quacpie hora donee alvus
saluta sit.

I p.m. — Pergat.

II p.m. — Enema — statim, repr> donee alvus soluta sit. — Sleeping; sensi-
ble 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 cpiite 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. — Bather more drowsy; becoming forgetful. Hirudines xxx.
applicantur.

7 p.m. — The sister observed that he had slight grating of the teeth,
and almost immediately afterwards thrust bis tongue from his mouth,
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 more conscious, and
said, in answer to a question, that he was easier. 1;L Hydr. c. Creta
gr. ij. 4'1*- horis.

May 14th. — Say3 he is very bad, but seems more conscious ; has had
no more convulsions ; says that his head aches. Pulse 7 2, soft ; mouth a
little tender.

9 p.m. — Countenance better ; more cheerful ; head cooler: pulse 80,
pergat ; says he is a little better.

About 11 p.m. he had a convidsive fit, very short, mouth drawn to the

460

HUMAN BRAIN.

right side, foamed at the mouth, did not scream ; 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-g- 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, but not readily ; bowels not open ; pergat.

H 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. Lyttse, pectori. Ungt. Hydr. to the blistered
surface.

May 16th. — Pulse 80 : not so conscious, or well in other respects.

May 17th. — Very drowsy, little conscious; has frequent fits; counte-
nance bad ; pulse 140 ; cannot get him to take any food.

May 18tli. — Much worse ; countenance anxious; can scarcely answer
any questions ; says he wants his breakfast ; always expressing a feeling
of hunger. Pulse 150, small. Has convulsions every ten minutes.

May 19th. — 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 21st. — 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 22nd. — The convulsions continue very violent, but occur less fre-
quently than yesterday ; still pain in the head ; pupils contract to light ;
pulse 120 ; bowels open ; says he feels better.

May 23rd. — Little alteration as regards the frequency and violence of
the convulsions ; has the power of moving his right arm, which was para-
lyzed on Wednesday, and can close his hand ; countenance much improved ;
pulse 120 ; bowels open. — Continue treatment.

May 24th. — 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.
Pi lulie node maueque. Omitt. UnglL 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 ; coun-
tenance good ; tongue cleaner ; pulse 112; bowels eonfined. Ordered by
Mr. Solly to take Compd- Colocynth pill ten grains, to be repeated, it
necessary ; he had a relief shortly afterwards, consequently the aperient
was not administered.

INFLAMMATION OP THE HEMISPHERES.

401

May 28th. — Is progressing favourably. ,

June 3rd. — IIi» gums being still tender, and he generally much im-
proved, to take the mercury less frequently. U- Hydr. c. Creti Igr. ij.j alt.

noct. ..iti i

June 7th. — Is much better; says he has no pain in the head or else-
where; 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 tlmt the pathological course of this case was
thus : first, concussion of the brain, with either slight frac-
ture 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 absence of much intellectual disturbance ;
effusion of blood into the tubular structure not in sufficient
quantity to produce immediate paralysis, but sufficient to
irritate and excite inflammation, indicated by the spasmodic
action and convulsions; effusion of lymph consequent on
the inflammation indicated by the paralysis ; arrest of in-
flammation by blood-letting and mercury ; absorption of
lymph by continued action of mercury, restoration of the
injured brain — recovery.

1 never examined after death a case in which inflamma-
tion 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
Ik; more or less excited and perturbed; if downwards to
the ventricles, then, effusion taking place, coma is the con-
sequence.

'fhe following case (and I think it supports my view of
its pathology) is in point after the last; 1 shall designate it
acute stimulation of the motor tract, as well as the hemi-
spherical ganglion. It is from Andral.*

Case H — /. Icu.te rneningiti s limited to the convexity of the left hemisphere
of the. brain ; delirium ; convulsive movement* of the face and extremities of

* Case 6, p. 6, op. cit.

462

HUMAN BRAIN.

mited some drink he had taken Tn it 5 §t appetlte> and v°-

Ser. f°U0Wed fr°m ^ t0 time

n aust* sTi 1 / 7 t;llrtlie headachei continued, but the vomiting ceased; some

~ S %tz is

missure of the linT v1^ °f the muscles wllich move the com-

“S and n?tpPVl 18 TT? aCClU'ate ; Sives a Perfect account of his
state, and of everything which happened to him since the commencement

of Ir, jUness; the pulse moderately frequent and regular; ever^Sg else

ft was difficult to assign a precise seat to this group of symptoms •
the first complaints, however, regarded the head ; the vomiting milht be
considered as connected with a commencing cerebral affection and the
seveie headache seemed to point out the head as the seat of disease The

repelled t With respect t0 the “^entaiy canal,

irnt 'ild’cnl1 W^hetic of gastrointestinal

of if )?, abse?Ce °f, aU febnJe disturbance precluded the possibility

of its being mere continued fever. The state of the patient, however ap-

?bsenlVo7f aTUlg 5 itllC appearance of his countenance, and, amidst the
absence of local symptoms, the great alteration already of his features

pectfno- n\t°t 01f 1 a ra?r Unfavourable prognosis. M. Lerminier sus-
?* * “gT a state of encephalic congestion, applied, notwithstanding the ex-
mc paleness of his face, twenty leeches across each jugular vein De-
mulcent drmks and sinapisms to the lower extremities. No change in the
patient on the following morning.

withndiffi!f if °th I1'® 78! VGry “Ufh CaSt down’ md answered questions
with difficulty and reluctance; bght was painful to him, he kept his 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 the
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
c night, and occasionally uttered several piercing cries.

On the 21st he was kept in bed by force. The face' had now become
led ; the head was agitated by a continual movement, which carried it from
light to left, and left to right ; the muscles moving the lips, the aim nasi,
and the eyebrows, were in the highest degree of convulsive 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

INFLAMMATION OF THE HEMISPHERES.

403

frequency did not seem very great, (Bleeding from the arm, twenty
leeches to the neck, cold applications to the head.) No change on the 21 st.

On the 22nd, violent delirium ; convulsive motions of the muscles of
the face ; risus sardonicus ; 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 23rd, head turned back, and to the right ; strong contraction
of the right arm ; respiration 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 understand them ; original paleness of face returned ; pulse sixty a
minute, and regular ; bowels not free ; tongue cannot be seen : teeth not
drv. He remained quite torpid during the day, but at night violent de-
lirium re-appeared ; uttered very loud cries.

On the 24th this excitement was succeeded by profound coma ; ex-
tremities cold ; a clammy sweat covered the face ; respiration ralaiit.
Died in the course of the day.

Sectio cadav. — On the upper surface a considerable difference in the colour
of the two cerebral hemispheres, the right being pale, while the left pre-
sented a well-marked red tint, which resided entirely in the sub-arachnoid
cellular tissue, which was traversed by numerous vessels ; neither serum
nor pus in the tissue ; the grey substance, constituting the most superficial
portion of the convolutions of the left hemisphere, participates in the in-
jection 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 colouring 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 paralysed, still continuing
painful * — A woman, 7 1 years old, had felt, for about a year before enter-
ing 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.

IV hen they were intense, they gave rise occasionally to slight convul-
sive 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 original severity, and ultimately the patient only felt in the
extremities of the left side, and particularly 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

* Andral, Op. cit., Case X V. p. 145.

464

HUMAN BRAIN.

time also the left upper extremity became weaker ; she coukl 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
pams which had marked the commencement of the disease returned with
t ieii oi lginal 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 sub-
mitted 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 extremities 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 com-
missure 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 diffi-
culty of breathing. These symptoms, however, completely disappeared.
After remaining about a month in hospital, a large eschar formed on the
sacrum : she gradually wasted away; her feet became cedematous, and she
sank exhausted, 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. Ante-
riorly it was limited by a line, the internal extremity of which might ter-
minate at the junction of the anterior four-fifths with the posterior fifth of the
corpus striatum. Posteriorly it extended nearly to the posterior extremity
of the hemisphere. No injection in the softened portion. The softened
cerebral substance is of a greyish white in certain points, and yellowish in
others. The fornix and septum lucidum diffluent. The two lateral ven-
tricles 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 in-
flamed without the arachnoid on the surface being affected.
Andral remarked that diseases of the former are not neces-
sarily connected with diseases of the pia mater 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 is most fre-
quently attacked in the first instance, and that of the ven-
tricles subsequently. The diagnosis might perhaps be con-
sidered more interesting in a physiological than useful in a

INFLAMMATION OF THE HEMISPHERES.

4G5

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
illustrates 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 ill consultation a
young lady, a?t. 15, suffering in the following maimer : — I found her lying
on a sofa, her countenance much flushed, her head hot, pidse 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 answer
any questions, but sufficiently conscious to open her mouth slightly, and
partially protrude 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 bed clothes, 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 occasion-
ally 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 without any show.

For the present illness ill-. F. visited her six days ago ; he found her
with an exceedingly quick, small pulse, without anything apparently to
» iccount for it ; there was a general dullness of expression ; eyes looking

■ ueavy ; pupils dilated ; intellect rather blunted, giving perfectly correct
answers, only very slowly. She complained of pain in the left side of the
ibdornen, and slight pain in the head. He ordered her saline aperients

- md hyoscyamus in veiy small doses.

Mr. F. informs me that no very decided change took place in her symp-
i om- til! the fourth day, when she was much worse; she complained of
•old chills, and soon after the parents observed that the limbs on the left
•ide lay like withered limbs, and those on the right side were seized with
•onvulsive movements. She was still sufficiently sensible to complain of
he 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
ining membrane of the ventricles, with effusion, and I was afraid that there
(ras some softening about the thalamus, more especially on the left side.

• die died about eight hours after I saw her.

Pnut-mortem, 84 hours.— Body plump, slightly green over the abdomen
Hit otherwise fresh. ' ’

If no d. Convolutions of the upper part of the brain flattened, no in-
animation of the arachnoid in this situation, or sub-arachnoidal effusion •

2 H

466

HUMAN BRAIN.

slight softening of the great transverse commissure ; ventricles filled, and
distended with bloody serum mixed with some pus. The lining mem-
brane of the right ventricle slightly inflamed, studded all over with eccliy-
mosed spots ; sero-sanguineous effusion into the left ventricle ; suppura-
tion, with softening of the right thalamus, some softening of the left, some
effusion at the base round the medulla oblongata.

Abdomen. — Hydatid attached to each broad ligament of the uterus.

It is sometimes difficult to decide whether the quantity
of fluid, contained in the ventricles, is above the normal
quantity, whether it is in morbid excess. If the arachnoid
and pia mater is 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 fossae
digitatae at the vertex of the brain indicate 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 ven-
tricles.

Andral considers that the presence of serum in the ven-
tricles should only be considered the result of a morbid
process when its quantity exceeds an ounce in each lateral
ventricle. Excess of serum is more frequently met with in
the ventricles than in the external arachnoidal sack.

Andral remarks, that when the quantity is very consider-
able, the septum lucidum and fornix are always found soft-
ened. . .

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 imbibi-
tion, 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 some-
times, 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, wffo

INFLAMMATION OF THE HEMISPHERES.

467

are much harrassed 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 bar dell * has well pointed out the
change which takes place in these cases. He calls it a sieve-
like condition of the brain, etat crible da cerveau. “ These
little holes are usually surrounded by perfectly healthy cere-
bral substance. They are circular, with well-defined edges,
scattered irregularly through the brain, varying in diameter,
and unchanged in form by a stream of water. If water is
allowed 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
unassociated with any other lesion ; at other times, how-
ever, 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. Calmed has de-
scribed 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 acci-
dental ; thus, in one instance, in which idiotcy, attended
with occasioned attacks of mania, followed a 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 softening of the brain to meet with
this sieve-like appearance for some distance around the
softened part, betokening the previous existence of ddatation
of the vessels. In the same brain, too, M. Fardel has met
with recent ramollissement and injection of the vessels, and
old ramollissement with the etat crible."

from his observations, many of which are detailed at
length, the writer concludes that “ the 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

* fiazctte Mcdicalc, Jan. 15th, 1812, quoted in the British and Fo-
reign Quarterly Medical Review, Vol. xiv., p. 225.

2 ii 2

468

HUMAN B11AIN.

vessel, to the dilatation of which their formation is doubt-
less 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 ad-
vanced life.

“ The usual seat is in the cerebral hemispheres, especially
beneath the convolutions, but they are likewise met with
in the cerebral protuberance, 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 san-
guineous congestion, or to frequent recurrence of congestion
of the organ.

“ This opinion seems sufficiently warranted by the pheno-
mena observed 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 ramollissenient of
the convolutions in insane persons affected with general
paralysis, with general or partial induration of the brain,
and in the centre of, or around, portions 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 ol
anaemia and hyperamiia, 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 altera-
tion in texture is now acknowledged by all pathologists, anc
I believe it is generally admitted to be the result ol hypene-
mia of the part. It may seem strange that inflammatory

INDURATION OF THE BRAIN.

4 GO

action should produce both softening and hardening, 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* mentions several instances. “ Indura-
tion,” says this author, “of the centre of the medullary
substance of the cerebral hemispheres was observed 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-cartilaginoiis. M. Payen
once found in a child, six years old, a depression in the
posterior third of the left cerebral hemisphere, which was
owing to the induration and shrinking of one of the convo-
lutions. 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 re-
markably 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 con-
sidered of a slower and less acute character. 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 lu-
natics is interesting and important, as throwing further
light on the pathology of that disease, and pointing to the
proper mode of treating it medically. “ General indura-
tion of the brain,” says Dr. Copland, fi “ generally occasions
loss of memory, confusion of thought, and derangement of
the mental manifestations, causing insanity without lucid
intervals. \\ hen 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 de-
rangement, 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 conse-
quence of the most advanced degrees of this lesion. The
* Pnthologiral Anatomy, p. 75. f P. 221, op. cit.

470

HUMAN BRAIN.

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 in-
ability to pursue a long train of ideas, indifference to mo-
mentary impressions, and to present or future occurrences,
difficulty of articulation, derangement 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 hyperamiic disease of the brain, the
practitioner must remember that the scalp is liable to va-
rious eruptive diseases ; but he must not set to work and
heal them by local remedies, like diseases 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 grey powder every other night, with a little mag-
nesia 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 Quarterly
Medical Review for July 1844, there is an account, ex-
tracted from the Memoires de l’Acad. Roy. de Med., Paris,
1843, of this form of disease.

It appears to have ravaged the garrisons of Versailles,
Lyons, Bayonne, Groet, Metz, Strasburg, &c., and its not
being confined to the military gives it a title to be con-
sidered epidemic. The predisposing causes were, extreme

TREATMENT OF INFLAMMATION OF THE BRAIN. 471

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 have
acted most frequently as immediate causes. Post-mortem
examinations detected injection of the membranes, with
effusion of red-coloured serosity, pus in the pia mater, soft-
ening 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, purgatives, cold applications to the head, &c. :
when the cases were treated on the onset of the attack,
this plan answered ; but when the inflammation had ex-
tended 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. Roflett, finding that the ordinary modes of
exciting such action by blisters, sinapisms, and ammonieal
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 cauteri-
zation gave no pain, but re-action 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 inf animation of the brain , whatever
the form may be, no time must be lost ; minutes are even
of importance. Bleeding, both topical and general, are im-
portant remedies, but they require great judgment in their
application ; as a general rule, vensesectio brachii is not so
useful as bleeding by leeches from the head. But in cases
where there is evidence of there having been good constitu-
tional power previous 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 discouraged in the employment of this
remedy, if we have deliberately decided that it is right lo

472

HUMAN BRAIN.

employ it, though it does not immediately produce a be-
neficial effect.

Case 44. A girl, aged 11, had violent headache and vomiting, with
great, obstinacy ot the bowels, and these symptoms were followed by dilated
pupil, and a degree of stupor bordering upon perfect coma; pulse 130.
She had been ill five or six days ; purgatives, blisters, and mercury to sali-
vation, 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 formerly resisted, and in a few days she was
cpiite well.

Case 45.— A slender and delicate girl, aged 11, had scarlatina in a fa-
vourable form, in the beginning of April 1820. About the 16tli 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 medi-
cine, with partial benefit. About the 26th, however, the anasarca had again
increased considerably, especially in the face, which was very much swelled.
In the following 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 recurred 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 bleed-
ing, purgatives, antimonial solution, &c. Towards midnight the convul-
sions ceased, and some time afterward she gradually 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 favourably. 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
haemorrhoidal vessels might be much more frequently em-
ployed than it is in affections of the brain, as tvell as in

* P. 55, op. cit.

TREATMENT OE INFLAMMATION OF THE DRAIN. 473

those of the spinal cord. 1 know no mode in which a given
quantity of blood can be removed with equal effect in the
cases where it is required. It, maybe 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 illustration of it. Nor can
1 doubt that something here is due to that peculiar relation
between the blood in the portal circulation and the func-
tions and diseases of the brain, of which experience affords
so many remarkable proofs. For the practice itself, we have
especial argument in the frequent alternation of bleeding,
haemorrhoids, with headaches, and other graver affections of
the head ; and also in the serious effects which sometimes
ensue upon the suspension of such discharge, after it has
long been habitual to the system.”

Dr. Pritchard* 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 over-
distended state of the vessels.”

Dr. Pritchardf relates some interesting cases of maniacal
disease cured by the supervention of contagious fever. He
had, he says, “ an opportunity of frequently witnessing the
effects of fever communicated to maniacs, as male lunatics
are placed in the same ward with persons labouring under
contagious fever.” I will select the following, as I think it
illustrative of the pathology of insanity. The observations
which follow I entirely concur with.

Cate 47. — Anne Jaunery, admitted June 17, 1817.

Deacription. — A married woman, aged 28 years, the mother of three
children. She is of a tall and slender make ; has brown hair, dark grey
eye3, low forehead, sharp features ; her natural disposition is irascible.

Huton/. — She ha.s never been before affected with maniacal symptoms ;
this attack is supposed to have been produced by intemperance. Her hus-
band is insane, and is. confined in this house; his disorder is attributed to
vexation in consequence of the loss of property.

* A Treatise on Diseases of the Nervous System, 1822, p. 236.
t Op. cit., p. 72.

474

HUMAN BRAIN.

Present state. — She is extremely irritable; talks incessantly on different
subjects ; frowns, and closes her eyes as if intolerant of light.

Treatment. — Shave her head ; Haust. Catli. 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; pidse 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. 5xvj. Syncope followed blood of loose
consistence ; the bleeding relieved her. From this time she continued oc-
casionally with pain in the head, attended with increased pulsation of the
carotid and temporal arteries, and a renewal of her restlessness and ma-
niacal symptoms, winch were generally relieved for the time by the applica-
tion 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 2nd of January 1818, she had a slight attack of contagious
fever, which subsided in about a week. From that time she gradually re-
covered, 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 deple-
tion ; but not cured, until a new disease took place, which altered the de-
termination of the vascular system, and overcame the tendency to conges-
tion in the head.

Purgatives and mercury are our most valuable allies in
combating inflammatory disease of the brain. Dr. Aber-
crombie says, “ In all the forms of the disease, active purg-
ing 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
experience is, that more recoveries from head affections of
the most alarming 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 : —

Case 48.*— A gentleman, aged 17, 1st February 1S10, 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, followed by purging and raercu-

* Op. cit., u. 160, Duodecimo.

TREATMENT OP INFLAMMATION OF THE BRAIN. 475

rial frictions, and after a few clays 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 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 22nd 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 evacuations
in the day, with complete relief of all his symptoms. On the 28th there
was some delirium, which subsided in another clay. For a week he con-
tinued to complain of some headache and a feeling of weight in his head,
but by the 10th of March he was tree 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 con-
stantly 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 operation of it, a strong man thrown
in a very fewr minutes into a state approaching to asphixia,
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

* P. 47, op. r It.

476

HUMAN BRAIN.

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 suddenly
applied after embrocation, it by no means follows that this
application, 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 sometimes 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 dispa-
rity doubtless exists as to the more serious affections of
this organ requiring discrimination wherever we can exer-
cise it. Unfortunately these are cases in which generally
patients can render least aid. Sometimes they are mani-
festly uneasy under the application of cold. Their feeling,
whenever it can be ascertained, is better than any other
test.”

I have found aconite, antimony, and digitalis, each and
all most useful 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 depress-
ing in its operation. Digitalis is more useful in chronic
cases than in the acute.

1 have long felt convinced that much of the obscurity
which envelopes these diseases and those of other parts of
the brain, might be removed by comparing them with dis-
eases 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

TREATMENT OE INFLAMMATION OF THE BRAIN. 477

prognosis of inflammation, both chronic and acute in other
organs, is the facility with which we can observe the action
of remedies, medicines, topical applications, general stimu-
lants, and diet, upon an organ so open to observation. 1
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 am convinced that the reason why physicians, to whom
the treatment of the insane has been entrusted, believe in the
existence of mental disease unattended until 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 know-
ledge 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 woidd
bleed from the arm, purge violently, and then possibly put
his patient under the influence of mercury. What would
be the consequence ? Why, most assuredly the loss of the
eye, total blindness. And the same sad results followed the
treatment of insanity when it was considered to be an in-
flammation of the brain, except in very acute cases occur-
ring in subjects with much constitutional power ; injudi-
cious treatment being attended in the one case with the
loss of sight, in the other with the loss of intellect. But
suppose a judicious surgeon, one bred in the school of
Farre, Travers, Lawrence, and my late respected col-
league, Frederic Tyrrell, called upon to treat this stru-
mous inflammation of the eye. He would support his
patient’s general health with a tonic plan of treatment; lie
would improve the condition of the circulating fluid and
the instruments which circulate it. He would endeavour
to arrest local inflammation by small local blood-lettings,
counter-irritants, and astringent lotions, by removing liim
from all those atmospheric influences and moral eireum-

478

HUMAN BRAIN.

stances which would stimulate the organ. And thus he
might ultimately succeed ; but what care, what patience,
and what confidence in the remedial agents employed, does
it require on the part of the surgeon who treats these cases,
to effect a cure !

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 injurious agents
which have produced this inflammation, and exclude the
natural stimulus of the organ, and see, in the whole course
of our remedial measures, the progress or the failure of each
particular plan of treatment, is it astonishing that men
should have failed so much in the treatment of chronic and
strumous inflammation of the arachnoid, pia mater, and
hemispherical ganglion, when they have all these difficul-
ties to contend with, and want many of the adjuncts ?

Mr. Tyrrell, in his lectures, used to relate, in illustration
of the importance 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 intel-
ligent 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 prescribe for your boy, go and give him a good
dinner, and a pint of porter.” The father was thunder-
struck, 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 pre-
scriptions, 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 treatment,
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

TREATMENT OR INFLAMMATION OF THE BRAIN. 479

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 stimu-
lus of light and atmospheric influences.

The moral treatment of the insane is no more. It essen-
tially consists in the removal of injurious stimuli, soothing
and tranquillising the organ.

Strumous ophthalmia has been alone adverted to in illus-
tration 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 demon-
strating 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 be-
lieve, 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 its vascular and serous membrane,
the choroid and membrana Jacobi, thickened by morbid de-
posit.

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 perseve-
rance in the treatment of chronic choroiditis and amaurosis
ought to encourage us to similar patience and perseverance
in the treatment of chronic meningitis.

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 grey 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
entirely prevented, by rapid salivation, in consequence of

480

HUMAN BRAIN.

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 Avithout
any improvement in vision, but this has not discouraged
him, and that, by proceeding with the plan, he has ultimately
restored many a poor felloAv to sight, whose case had been
abandoned as hopeless. Mercury is in disrepute in the
treatment of insanity, because, 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 consistency ; neither abnormally
hard, or soft and shrunken : for when the disease is of very
long continuance, then the retina and vitreous humour be-
come sometimes implicated in the morbid action, and par-
tial atrophy ensues.

If we could apply the same test in our diagnosis and
prognosis of cerebral affections, avc should administer our
remedies Avith more confidence, as it is almost impossible to
say when the ganglion has become atrophied, and when it
is still unchanged in structure. In these amaurotic 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 constitution must be sustained by a good nutri-
tious diet and a moderate quantity of stimulus. Mr. Tyr-
rell’s words are,* “ I consider that the safety of the treat-
ment, 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 in-
jurious 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

* Cyclopedia of Surgery, i. p. 91.

TREATMENT OF INFLAMMATION OF TTIE BRAIN. 481

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 of adhesion between the
pupillary margin of the iris, and the anterior capsule of the lens ; the
iricles were discoloured and dull, and he had the vacant aspect of a blind
person. I admitted him into the infirmary, then iu Charter Idouse-square,
and put him under mercurial treatment, with a nutritious diet ; as soon as
the mouth became tender, a considerable degree of sclerotitis 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 then- natural figures ; by degrees the vision improved, all appear-
ance 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 discharged about 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 convinced 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 insane 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 inflam-
matory action, demands serious attention and careful ma-
nagement; the 'patient ttciny otherwise constantly liable to a
sudden burst of inf animation and its consequences.

“ The existence, then, of a network or gauze, or the ap-

* 1’. an.

2 i

482

HUMAN BRAIN.

pearance 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 conjunctiva or sclerotic, should
meet with prompt attention and careful treatment, by which
the integrity of the organ may be in most instances restored,
and, at all events, useful vision preserved.

“ The organ should he perfectly rested , and kept from expo-
sure to bright light. Counter irritation, by means of blister
or tartar emetic ointment, should be created upon the lore-
head 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 neces-
sary), and such matter as is not easy of digestion, or is
incompatible with the medicine employed.

“ 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 neces-
sary to produce mercurial action in the system.”

He directs that blood should always he taken away in
moderation , and only in sufficient quantity to relieve conges-
tion, hut not to affect the general circulation ; that in many
cases, when the disease is apparently acute, hut the power
feeble, the loss of blood aggravates rather than benefits the
affection ; this I have observed most frequently in young and
delicate females. I have known the continuance of depletory
treatment prove most injurious in augmenting the moibid
action and hastening disorganizing process .” ■

« Unfortunately, as relief frequently follows the local ab-
straction 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, readilv adopts it ; the relief is, however, of short
duration, and this burst of acute symptoms m 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 disorgani-
zation. Under continuance of this treatment the patient

TREATMKNT OF INFLAMMATION OF THE BRAIN.

483

suffers from repeated attacks of the acute kind, each of
which produces an increase in the amaurosis, and eventually
vision is completely destroyed, while at the same time the
general health is materially deranged, if not permanently
injured. I have seen several very distressing cases of per-
manent amaurosis resulting from such treatment; and I
have also known many instances in which the disease has
been arrested and vision preserved, by raising and main-
taining the general power, and pursuing the medical treat-
ment 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 treat-
ment in chronic 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 eye-
balls. W hen 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 flut-
tering underneath the skin ; sometimes the right eyeball flutters so vio-
lently that it feels to her as if it would jump out of her head. The right
arm and leg sometimes is numb, but the left never feels so.

She passes, per anum, from piles, nearly a pint of blood during the
week, which she considers gives great relief in the head.

I found, on inquiry, that she had been much harrassed latterly, and suf-
fered 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 pre-
vented 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 Hydr. c. Creth gr. ij. node maneque. Emp. Lyttae fronti.

After using the mercury in doses varying according to its effect, and
never so as to salivate, with various counter-irritants, issues, &c., at flic

484

HUMAN BRAIN.

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 1 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 vio-
lent, 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. 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 uncom-
fortable. 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 22nd of June that 1 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 lifer reason.

I continued the mercury for four months, at the end of which time she
was quite well. Her sight was quite restored ; no pain in her head ; feels
strong and hearty ; spirits good ; mind equable and placid. Her counte-
nance is entirely changed ; instead of a staring, wild, unnatural expres-
sion, she looks composed and comfortable. She expresses herself grateful
for her recovery.

I have been gratified in finding the following observa-
tions on the use of mercury in such cases from the pen of
that admirable surgeon, the late Mr. Colics,* 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 ex-
perience, 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 mer-
cury, when actively, and at the same time judiciously, ad-
ministered, 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.”

* On the Use of Mercury in Affections of the Nervous System. By
Abraham Colics, 1S37, p. 328.

TREATMENT OF INFLAMMATION OF THE BRAIN. 485

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 be-
lieve ultimately terminates in mental imbecility.

Case 51. — Oct. 3rd, 1S36. — 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 confusion 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 observed 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 anything out of her hand, she can-
not, 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. A lien 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 yester-
day, with some soreness 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 sick-
ness 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 accouut, which she could not previously attempt to do ; but still she
feels she would become confused if she attended to them beyond a very
short time. Habeat Haust. c. Quin®. 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 re-
collect 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 Ungt. 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 un-
pleasant sensations; her memory and spirits are improving; she can now
attend to her household affairs, and can recollect what she has to do.

Nov. 3rd. — She now reads with interest, and recollects what she has

486

HUMAN DRAIN.

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 prin-
cipal nervous uneasiness she now experiences. She feels her temper much
improved since the scalp has healed.

Nov. 16tli. — 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 ag-
gravated 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 symptoms,
such as pain, impatience of light and sound, sickness and
vomiting, adds, “ great aggravation of the uneasy feelings
in assuming the erect posture.” As a general rule, I find
the contrary : that the recumbent posture is the most
comfortable in anaemia, the erect in hyperaemia. It is pos-
sible that all he means is, that every kind of motion is pain-
ful ; and there I agree with him, but not that it is limited
to the inflammatory affections. lie agrees with most pa-
thologists in objecting to the use of opium in these affec-
tions. He is strongly in favour 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 inflam-
mation lasts very long, or returns very frequently, and ulti-
mately abates completely, 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

* Outlines of Pathology, &c., 1844.

f P. 344, op. cit.

TREATMENT OF INFLAMMATION OF THE DRAIN. 487

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 :* “ Perseverance in
the use of bichloride of mercury is of singular avail in cer-
tain cerebral or spinal disorders — to obtain the full bene-
fit, we must be patient as well as decided in its use.” He
refers to one very interesting case.

Treatment. — Recapitulation. — In the treatment of all
inflammatory affections of the brain, the following bioad
principles must always be attended to : —

1st. There is no time to be lost — even minutes are of

value. .

2ndly. That inflammation of the brain is a depressing
disease, and that, as a general rule, general blood-letting is
not often admissible.

3rdly. 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 lias failed to
produce sleep, leeches and cold applications frequently will ;
and if they do, it is strong evidence that the excitement
arises from hypersemia, and not from anaemia, as in that of
delirium tremens.

Gthly. That aconite and digitalis are the best sedatives,
especially when combined with mercury.

7thly T 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.

8thly. Always commence the treatment with a brisk
mercurial purgative.

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.

* ]\ 250, op. cit.

488

HUMAN BRAIN.

llthly. Never lose your patience in the treatment of a
chronic case, or try to hasten the cure by increasing the
doses.

1 2tlily. When it is considered necessary to continue the
use of mercury for a lengthened period, combine tonics
with it.

Apoplexy. — The term is derived from the Greek word
«7ro7rX»)£w, to strike-, hence the common appellation, an
apoplectic stroke, or a stroke of the palsy.

Apoplexy, long 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 designate the pathological
condition which gives rise to those symptoms.

I think that it is applied too generally to the effects of
disease, instead of the cause. The classification of dis-
eases 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 scrum, 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 synony-
mous with cerebral pressure, and I believe that all its varie-
ties 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 dis-
ease to suffer from, to witness, or administer to.

A man, in apparently good health, suddenly falls down
deprived of all his senses, wholly unconscious of surround-
ing objects. The countenance livid, the vessels of the face
and head turgid with blood, the breathing stertorous, slow,
and labouring ; 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. TIis brain, when examined after death, is found
to have been more or less torn and destroyed by extrava-
sated blood.

APOPLEXY.

489

This may he considered as a typical case of apoplexy,
but this description of it will no more include all the varie-
ties of this disease, all the aberrant forms of the complaint,
if we may so speak, than the description of the character-
istics 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 within 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 apo-
plectic attack, and very admirable are his descriptions. The
first are those which are immediately and primarily apo-
plectic, using the term as synonymous with coma; the
second are those which begin with a sudden attack of head-
ache, and pass gradually into apoplexy ; and the third are
those which are characterised 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 hemi-
spheres, that the powers of the hemispherical ganglion 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

490

HUMAN BRAIN.

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 becomes op-
pressed, forgetful and incoherent, and then sinks into coma,
from which he never recovers. In some cases, paralysis of
one side occurs ; but in others, and I think the greater
proportion of this class, no paralysis is observed.”*

This form will be pathologically described as meningeal
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 annihilated, the
patient is cognizant of pain ; the effusion continuing, till
at last all the cerebral ganglia are compressed, and the
patient dies comatose. 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 following
illustrates this in a striking way : —

Case 52. — Laceration of brain, from a blow on the head, without frac-
ture of the skull. — May 7th, 1845. — I was this day, at nine o’clock, a. m.,
called in by Mr. Maybury, of Little Tower Street, to see Mi-. J. 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 temperate 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 pave-
ment ; 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 advised him to remain at the Hospital ; he
however refused, saying that his wife would be rendered anxious by his
absence. From Mi-. Maybury I learnt the following particulars, viz. : —
that he was sent for on the same evening, and on arriving at the house

* Op. cit., p. 204.

APOPLEXY.

491

found C. sitting 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 haemorrhage 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
srmill arteries were poiu-ing out blood profusely. This bleeding 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 labouring under difficult and ster-
torous breathing, and presenting all the worst symptoms of compres-
sion ; the pupils remaining fixed before 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 intermittent.
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 ster-
torous breathing was altered so as almost to amount to a groan. I tried
if he could swallow a little water ; but be was nearly suffocated by the
attempt.

I ordered a turpentine enema 3] to the lbj. 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. Maybury 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 found 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 blood on the same side,
amounting in quantity to about three or four ounces, between 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 ensued from pressure, as in apoplexy, though the
active external hminorrhage delayed the fatal event.

The pallor and faintness which attend the class of apo-
plectic 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 important organ. It is well

492

HUMAN BRAIN.

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 maybe removed
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 extravasation 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 generally 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 irreme-
diable ; 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 pos-
terior 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.

APOPLEXY.

493

This class includes many eases 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 symptoms result — namely, ex-
travasated blood, sanyuinous apoplexy ; extravasated serum,
serous apoplexy, abnormally distended blood-vessels, simple
apoplexy. In these latter cases there are no post-mortem
appearances.

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 treat-
ment. I cannot pretend to say- exactly what the patholo-
gical condition is — but not ansemia ; 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 tlie 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 endea-
voured 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 sisus 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 quickness, but not positively intermittent,
nor labouring 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 symptom he had, took place about an hour
previous ; he wanted to put down 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
],;i off so quickly that he soon sent another messenger to say lie 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 1 found him.

Previous history. — A man of highly nervous temperament, exceedingly
active in business, in which lie has "been a good deal luuiasscd lately, leav-
ing 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, lie would have some
serious illness ; this they said from seeing him every now and then in

494

HUMAN BRAIN.

toST ofgl'eatexhaustion: he had also been suffering lately from hooping-

It was very clear tliat stimulants were the only things indicated here in
the first instance. 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 ior a cab, but when he got up to go down stairs, he said, “ I
am afraid 1 am going to be ill again,” and I asked him why he thought so :
lie answeied, because I am losing the power over my hand and le0-; and
liis speech began to falter : lie then told me where he wished to betaken
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 return 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 Mi-. 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. Ad-
vanced age is also a predisposing cause of apoplexy. In-
dividuals seem to inherit from their ancestors a predispo-
sition to this disease, occasioned, most probably, by a simi-
lar 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 dependent on disease of other organs, as organic
disease of the heart and arteries, diseases of the lungs, sud-
den 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 conco-
mitance of diseases of the heart and diseases of the brain.
When it was my duty to conduct the post-mortem exami-
nations 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,

APOPLEXY.

495

with atheromatous 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 uncon-
nected, 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’ re-
searches 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 pro-
ducing cerebral diseases. Dr. Burrowes says,* “ In oppo-
sition" 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, my own observations,
supported by facts already detailed, convince me that in
many, perhaps the majority of cases of apoplexy and hemi-
plegia, the primary disease is not situated within the
craniiuu.

“ I would go further, and affirm, that in many cerebral
affections apparently depending on effusions of serum or
blood, there is no further primary disease of the brain than
there is of the cellular tissue in anasarca, or of the perito-
neum in ascites, or of the skin in purpura, or of the
stomach in hsematemesis. There is, indeed, a palpable
morbid condition of these several tissues and organs where
the effusion or ecchymosis 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 cranium, similar to those observed in the stomach
and peritoneum when there is obstruction to the circula-
tion through the portal veins in the liver.

“ If the pathology of the brain in apoplexy and hemi-
plegia be analogous to that of other organs which suffer
from effusions of serum and blood, how much must this

Op. cil., p. 124.

49G

HUMAN BRATN.

knowledge improve the routine treatment of apoplexy, which
has so extensively prevailed.

“ Does not the view of the pathology of apoplexy render
more intelligible those different varieties of the disease which
are described by ancient writers, although they could not
account for the differences ?”

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 cerebral lesions, and
their vital effects.

As a general observation, attacks of apoplexy are appa-
rently 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, there-
fore, important to consider the premonitory symptoms,
which, if not attended to, would usher in an apoplectic fit.
The patient will sometimes exhibit an unusual tendency to
sleep, Avill 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 tinitus aurium, partial deaf-
ness 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 par-
tially so. The most common terms and occurrences are
forgotten, while the memory of more uncommon words and
circumstances is perfect ; sometimes one word, of a totally
different meaning, is substituted for another. The patient
appears 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

APOrLEXV.

497

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 occa-
sionally observed. Frequent cramps and numbness of the
limbs, toes, or lingers, all exhibit a tendency to paralysis, and
are consequently deserving of serious consideration.

Now although the above is a tolerably correct outline of the
premonitory symptoms of apoplexy, it must not be supposed
that such phenomena 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 speak-
ing, if we ask a patient whose brain evidently sympathises
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 little
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 doubtful cases an active
aperient is the best medicine, and a little careful watching
will soon decide as to 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 remembered as a possible forerunner of apo-
plexy. Dr. Conolly* says that he knew a very corpulent
woman subject to hysteria, with some threatenings of para-
lysis of the left side, who described herself as feeling so
well and lively before her worst attacks that she “ could not

V

always refrain from singing,” showing that the capillary
system of the hemispherical ganglion was at that time in a
state of hypercemia. In the consideration of such excite-
ment, for the guidance of our diagnosis we must of course
attend particularly to the general character of the constitu-

* An Inquiry concerning tlic Indications of Insanity. By John Conolly,
M.D., 1830. London. Pp. 2't8.

2 K

498

HUMAN BIIAIX.

tion, and the moral circumstances which have been lately
influencing the patient. Case 35 is a good illustration of
apoplexy induced by moral causes.

Sanguineous apoplexy presents many interesting points
for our consideration, both in a practical, pathological, and
physiological point of view. To some of these our atten-
tion 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 gene-
rally 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 demon-
strate the exact seat of the effusion, but I have very little
doubt that it was in the right crus cerebri, and that the quan-
tity was effused so slowly that the conducting fibres were not
ruptured, only pressed on by the blood effused between
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; lcuco-phlegmatic temperament; no apparent hereditary
predisposition to apoplexy.

July 5th, 1 84 6 . — Applied to me at the Dispensary for partial loss ot power
of the left leg and foot. On this occasion he merely complained ol 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.
gl'.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 extravasation into some portion of the cerebral mass, and
most probably in the region of the right crus cerebri. I made further in-
quiries, 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
sin. After that he had his dinner, about one ; and then went to sleep
on his bed, as was his usual custom in the middle of the day. On waking,
he found that he had lost the use of his foot, and it felt numb and prick-
ing but still he went on with his work as usual. Since the loss of power

APOPLEXY.

499

iu his leg, but not before, he has had occasional sharp pains across his
iorehead, but they did not continue ; he felt occasionally stupid in his
head, but this went off again, lie never lost his senses. As there was no
great power in the pulse, or evidence of general plethora, I ordered him
to continue the calomel.

15th. — His mouth is tender from the mercury; decidedly better.
Ordered, Mist. Ioclin. et dee. Sarsaparilla: b. d.

1 9th. — Complains of his head. Ordered, the Tinct. lodinii. Comp, to the
neck and back of the head, as a counter-irritant.

22nd. — He now complains of some feeling of giddiness, and great pain
in his head ; bowels 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 liis head there is less
pain, and this is confined to a spot about the size of half-a-crown. Or-
dered, C. Cruentae Occipiti ad 5 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.

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 dis-
appeared in the face and arm, both as regards the numbness and the ex-
pression of the countenance. After this, I lost sight of him until the
20th of November 1S46. About four years since the loss of power in
the leg, but not before, he has had occasional sharp pains across the fore-
head, but they did not continue. He felt occasionally 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 or-
dered an active aperient. Pulv. Jalap, gr. xv. Calomel gr. v. statim
sumendus M. S. C. mane. C. C. lumbis ad 3vi. Cal. gr. ij. Opii. 4 n. et m.

/

The effects of sanguineous apoplexy are very varied, de-
pending 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 mis-
taken for death from disease of the heart. It very seldom
occurs, for this part is not very vascular ; the vessels arc
not large, and they arc well supported. Effusion more fre-
quently takes place on 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 respiratory
centre proving so rapidly destructive to life, must be ob-
vious to every physiologist. It is from this centre that the
nerves of respiration and the muscles which they command
receive their power of action. When blood is effused into

2 k 2

500

HUMAN BRAIN.

the third ventricle from rupture of the vessels 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 cerebellum {pons Varolii), and secondarily into the
medulla oblongata, the effects are often most interesting
and instructive to the physiologist ; and, vice versd, the
symptoms are so characteristic that the lesion may be easily
recognised by the practitioner. Effusion into the pons
V arolii produces 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 respiration are unnaturally and irregularly stimu-
lated, and the sensibility of the respiratory passages abnor-
mally 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
Abercrombie, is equally so, showing the absence of all symp-
toms of injury to the respiratory system, and the confine-
ment of the extravasation to a small portion of the pons.

Case 55. — Spontaneous haemorrhage and rupture of the cephalic bulb of
the spinal marrow and of the ann ular protuberance. — Convulsive con tractions
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 ringing in the ears ; some minutes after he screamed from
acute pain ; he arose, commenced to run, as if to escape the danger winch
threatened him. After having run for a short distance he fell, and pre-
sented the following symptoms -.—Complete loss of consciousness ; lace
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 ap-
proximated (the upper lid of the right side fell a little subsequently to the
left) ; immobility of the globe of the eye; mouth half open ; tongue co-
vered with arterial blood, and occasionally protruded, but without peima-
nent deviation of its point ; lips covered with frothy saliva ; no perceptible

tension of the mouth. . • «

Respiratory movements frequent, irregular, accompanied occasiona y
with stertor , and almost continually with a sound similar to that which is
frequent in attacks of epilepsy. The alae nasi contract convulsively with

* Ollivier, tom. ii. p. 511.

APOPLEXY.

501

the muscles of respiration ; twice there was violent 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 en-
tirely permanent ; 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 con-
tractions 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 obe-
dience to the laws of gravity, from inclining to the right or to the left, for-
wards or backwards, according to the position given to the patient. With
respect to the sensibility, it was hard to determine whether it was abolished
or 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
svmptom 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 ot nervous sub-
stance, softened and coloured 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, because the general paralysis which must have preceded it
might have been ascertained. It cannot be doubted but that the spon-
taneous haemorrhage produced the cessation of motion and sensibility when
it occasioned the laceration of the entire substance of the spiual 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 system. These symptoms are truly charac-
teristic, and present no analogy to those which are peculiar to other cere-
bral haemorrhages. 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
change. These spasmodic convulsions, observed at the commencement of
the attacks of apoplexy in general, seem to me to depend on the irritation
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 pout -mortem, there
has been found an apoplectic cavity in the substance of the protuberance
and peduncles. M. Serrcs saw several instances of this haemorrhage, and
always, he says, complete immobility of the trunk and upper and lower

502

HUMAN BRAIN.

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 pre-
ceding case.

In the first moments we saw that the respiratory movements were exe-
cuted 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 expuls'fbn which is impossible
when the action of the respiratory nerves is abolished. It is probable
that the haemorrhage, confined to the protuberance, and to some fibres of
the corresponding portion of the peduncles, did but lacerate them progres-
sively, whilst it extended itself towards the cephalic bulb, a point where
the rupture was soon followed by death. The manifest movements made
by the patient when pinched, and when his skin was cut in venesection,
show that at the commencement the sensibility was not extinguished ; and
this circumstance is precisely conformable to the seat of the haemorrhage,
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 haemorrhage is more
abundant, and the more it involves the cephalic bulb of the spinal mar-
row. The respiration becomes more difficult, and stertorous also ; it be-
comes progressively retarded, and the patient dies of real asphyxia ; some-
times, too, the lungs are found emphysematous. M. Serres cpiotes two
facts which prove that life may still continue a long time, notwithstanding
the paralysis of the upper and lower extremities, consecutive on haemor-
rhage of the protuberance. lie met in two subjects, even in the midst of
the pons Varolii, a cavity containing a yellowish fluid ; there was an indu-
ration 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 dyspeptic complaints, with occasional
vomiting, and yellow tinge of the skin, and considerable uneasiness in the
region of the liver. Tor these complaints he had been advised by his me-
dical attendants in the north to go to Cheltenham, and arrived in Edin-
burgh with that intention on the 22nd 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 com-
plained 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 oedema of the legs. By topical bleeding,
purging, &c., he was considerably relieved ; and on the 21th, he ex-
pressed himself as feeling much better, but his pulse continued frequent.
On the morning of the 25th he was suddenly seized with giddiness, noise
and confusion in his head, and numbness of the whole right side. — He
was oppressed, but not comatose ; answered questions distinctly, but in a

APOPLEXY.

503

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. The 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 gradu-
ally assumed a more favourable aspect, and, after four or five days, he was
considered as being out of any immediate 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 appearance
of the eve natural, except a slight degree of paralysis ol the upper eyelid
of the right side. His breathing was easy, and he made no complaint,
except of the tight and cramped feeling, with numbness ol the right aim
and \es. His look, however, continued vacant and peculiar. IIis appetite
and digestion were good, and his bowels easily regulated. He was mi-
provin°* in strength, and was able to be out of bed pait ot the c ay. us
favourable state continued till the 14th of April, on which day he was
found with a veiy frequent pulse, without any other change in the symp-
toms. This febrile state continued on the two following days with rapid
failure of strength, and he died on the evening of the 1 6th. He continued
sensible to the last, and during this febrile attack he seemed to have ac-
quired an increased command over the limbs of the aftected side.

About the commencement of his illness, on 25th March, lie complained
of considerable uneasiness in passing his urine ; for a day or two it was
bloody, and there was a good deal of tenderness m the region ot the
bladder. After a few days this subsided, and he began to pass consider-
able 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 so t cyst, and
full of dark grumous blood of a firm consistence. This remarkable 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 rif'ht, and the surrounding 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 lb.ij. The right lung was con-
tracted, and extensively hepatized ; the left was much loaded with sero-
purulent fluid. The liver was very considerably enlarged, and ot a pale
ash colour and granular texture. The left kidney was pale indiira ed,
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

501.

HUMAN BRAIN.

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 sensorium. The follow-
ing case, though happily we have no post-mortem examina-
tion to produce in confirmation of the opinion, is most pro-
bably of this kind. It shows also the value of temperate
and judicious treatment.

Case 57. May 12th, 1847. — Mr. W., act. 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 complained of slight
numbness.

History. — I learnt from him, that for some time past he has all day
been occupied in a government office, after which he was engaged till ten
at night in further mental labour. 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 oc-
casionally 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 that 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 ir-
regular 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. iij. 4tis- horse. Hirudines xx. dextri. lat. cup.
Emp. Lyttse nuchse.

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 increased 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, — IjL Inf. Buchu. Ji. Liq. Iiyd. Bichlor. Ji. Tinct. Lyttae n^x.
sextis. hor. sum. Hirud. rept. Blister dressed with strong mercurial
ointment, cold lotion to the head. Calomel omitted.

14th. — Has passed a quiet, comfortable night ; says he is much better ;
says he is five from pain in his head, but that he still suffers from a sense
of weight and difficulty of moving it off’ the pillow.

Bowels not open to day ; urine high coloured.

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

LESIONS OE THE CORPUS STRIATUM.

505

of the blister. He can move his arm and leg perfectly. The numbness
has quite passed away; pulse 18-20, soft and regular; mouth tender.

Til. aloes co. gr. x. adde. potas. acet. Jfs. singidae dosi misturse.

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 dis-
appeared, 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. lbfs. Ext. ejus. 5j- 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 re-
quired 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 had either delirium tremens or sunk exhausted.
The appearance of the carbuncle shows that he would not have borne de-
pletion. I believe that mercury here, as in all apoplectic cases, was in-
valuable ; it arrested inflammation, and it promoted the absorption of the
clot. With regard to the cause of the disease, I believe that may be
sought alone in the over-mental exertiou 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 ple-
thora, or physical conformation, tending to the disease, such as short, thick
neck.

Lesions of the corpus striatum. — I believe it is an inva-
riable fact that extravasation into the corpus striatum is
followed by paralysis; and consequently 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 con-
nection with volition and the production of voluntary motion
is considered. Morgagni, with his usual acumen, was among
the first to observe that disease or injury from extravasa-
tion into the substance of this body was followed by para-
lysis. In the eleventh letter of this writer, we find the fol-
lowing passage : “ But whatever was the cause of this sepa-
ration of the corpus striatum, 1 have already shown you, in
the third letter which 1 sent you, how often a hemiplegia is

50G

11UM AM URAIN.

wont to happen from an injury in one or other of these
bodies or their neighbourhood. Add to this what the sepul-
chretum teaches, that Willis also having sometimes 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 discoloured
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 : “ 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 pre-
side over the motions of the upper and lower extremities.
Very probably these particular parts do exist, since each
limb may be separately convulsed, paralysed, &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 in-
clined to establish in latter times.”

In opposition to what has been said of the special func-
tion 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 question was accompanied with
paralysis not of the lower but of the upper extremity.*

Case 58. — Effusion of Mood into the corpus striatum of the right side ;
sudden loss of consciousness ; 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 tune after, she was
bled ; at the end of two hours she came to herself ; she entered the hos-
pital of La Chari te the same evening. On the next morning we found the
two extremities of the left side completely deprived of motion and sensa-
tion. The right commissure of the lips was drawn upwards ; intellect
perfect : pulse hard, vibrating, a little frequent. (She had blisters to the

* Andral, op. cit., p. 102.

LESIONS OF THE CORPUS STRIATUM.

507

legs, and purgatives.) On the following day a visible amendment ; sensi-
bility restored in the paralysed side ; the left lower extremity begins to
perform some movements ; the left upper extremity as much paralysed 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 shoulders.)
From this period to the 1st of April, symptoms of gastro-intestinal irrita-
tion manifested themselves ; tongue red and dry ; great thirst ; tension of
the abdomen; diarrhcea; 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 ordy 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 ventrielc 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 appear-
ance of the inner surface of the ileum through a great portion of its ex-
tent.

Remarks. — It is rare to find haemorrhage so exactly limited to the cor-
pus 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 inconsiderable, 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 paralysed, which already invalidates the opinion ac-
cording to which isolated lesions of the corpus striatum should modify
motion only in the inferior extremity. But this is not all ; one of the para-
lysed limbs soon recovers the power of moving, and that is the lower ex-
tremity ; 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 inflammation that the
patient sank. She had also hypertrophy of the heart.

The following case appears to prove that the tract of
neurine which conveys the dictates of the will to the lower
extremities as well as that which leads it to the upper ex-
tremities, partly passes through the corpus striatum ; it also
teaches us that partial recovery occasionally takes place
after apoplexy.

Caw .19. — Traces of an old. effusion of blood into the riff lit corpus stria-

508

HUMAN BRAIN.

turn ; hemiplegia, preceded by loss of consciousness : death thirteen months
after the attack of apoplexy * — A hair-dresser, 46 years of age, entered La
Ckaritd 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 para-
lysed in the two extremities 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 external 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 tilled with a substance similar in colour
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 yel-
lowish pidp. Caverns and tubercles in the lungs ; heart normal ; ulcera-
tion 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 pos-
terior part of the corpus striatum that the haemorrhage took place. The
paralysis, though considerably diminished, existed however, in a slight de-
gree, 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 organised membrane on the parietes of the cavity, and around
it the cerebral substance had neither the natural consistence nor colour.

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 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 sensa-
tion, as its communication with the posterior columns would
induce us to believe, it is not entirely devoted to this pur-
pose, for there are many cases on record, in which its lesions
have been accompanied with paralysis, while the sensibility
of the parts paralysed has remained intact. In truth, I
believe with Andral,f that though sensation is perhaps more
frequently affected by cerebral haemorrhage than motion,

* Andral, p. 103. t Ibid. p. 113.

THAI, AM I NERVI OPTICI.

509

“ 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 aboli-
tion.’’

In the following case* the lesion was so entirely confined
to the thalami that it cannot but prove interesting.

Cane 60. — A man, 60 years of age, was admitted, towards the com-
mencement of November, into the Maison de Sant6, with a disease of the
heart of long standing. The two extremities of the left side weie also
paralysed; the intelligence was perfect. About three weeks before his ad-
mission, 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 extre-
mity of the left side also deprived of motion ; the sensibility of the para-
lysed limbs remained. His dyspnoea increased, as also his dropsy, and he
died on the 25th of November, the hemiplegia continuing to the last mo-

ment. .

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 pericardium. 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 huge, dense, and black ; liver gorged with

Remarks. — This case differs from all the preceding, in this, that no loss
of consciousness occurred when the haemorrhage came on. . The two ex-
tremities 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 substance 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 ease from Andral
in illustration. It also demonstrates the way in which a
false membrane is sometimes thrown round a clot of blood. b

Case 6 1 . — Effusion of blood into the middle part of the right hemisphere.
Some softening of the cerebral substance around this effusion. Death the

* Andral, p. 103. + Ibid- op- cit., p. 100.

510

HUMAN BRAIN.

seventh month. — A periwig-maker, seventy-one years of age, of a good con-
stitution, fell suddenly, deprived of consciousness, on the 15th of May
1S20. This loss of consciousness lasted but for some hours. When he
came to himself, he fouud that he was paralysed in all the left side of the
body. He entered the La Gharite 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 immoveable, 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; pulse full, a little frequent; intel-
lect perfect. On the 4<th of July it was observed that the left side of the
thoracic parietes was covered with an enormous anthrax. A crucial in-
cision was made into it a considerable depth ; whitish eschars were de-
tached from it by degrees ; towards the end of August it was scarcely
cicatrized. During the month of September another 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 paralysed limb became atrophied,
and permanently contracted, the fore-arm 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 October he
became very feeble ; scarcely ever spoke ; large eschars formed on the
sacrum ; the contraction of the left upper extremity ceased, whilst its im-
mobility remained. He died the 21st of November, without his respira-
tion having become stertorous.

Post-mortem. — Complete marasmus ; extremities rigid ; broad ulcers on
sacrum and trochanters.

Cranium. — Its walls very brittle ; dura mater strongly adherent to the
vault of the cranium ; 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, external,
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 removed along with it.
The cavity is filled with a softish substance having the colour 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 some-
times been described as meningeal apoplexy. This is di-
visible into two kinds, one into the cavity of the arach-
noid, 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

TFIALAMI NERVI OPTICI.

511

are blood-discs extravasated, there are also openings in the
sides of the vessels. The blood coagulates in this situation,
and is frequently invested with a false membrane, which
adheres to the arachnoid. This subject has been well
investigated by the French writers, Rost an, Bayle, Cruveil-
liier, Durant Fardel, and Dr. Truss. There is a good ab-
stract of the paper * of this last-mentioned author in the
British and Foreign Quarterly Medical Review.

The disease has been described by Carswell and Dr. Bur-
rowes in the Croonian Lectures, and more lately by Mr. Pres-
cott Hewett, in the tenth volume of the Medico-Chirurgical
Transactions. This careful pathologist 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, Calmed, Ernest Boudet, and others, have all
shown that the fine, delicate membrane which covers these
extravasations of blood, and which presents to the naked
eve 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 na-
ture which I have examined have afforded me an opportu-
nity of verifying the accuracy of this opinion ; and in
speaking of the formation of this membrane, I shall bring
forward several examples, which will, I trust, prove that it
is much more frequently and much more rapidly formed
than is usually supposed.”

Mr. Hewett considers that this membrane is wholly
formed bv the coagulated fibrine of the 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 im-
portant occasional characteristics of this disease is the inter-
mission 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 l think the
existence of the mental excitement ought to have warned
* Memoiredc l’Academie Boyale do Mcdecinc, Tome xi. Paris ; 1845.

512

HUMAN BRAIN.

the practitioner as to the possible nature of the case, and
forbad the use of quinine.

Case 62.— Ill the early part of 1841, Mrs. , jet. 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 continued for seve-
ral days to recur twice in the twenty-four hours, presenting all the charac-
ters 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, wander-
ing and impairment of the intellectual faculties, terminating in coma. There
never was any paralysis, neither were any contractions of the limbs ob-
served. 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 corre-
sponded both to the upper and to the inferior surfaces of the right hemi-
sphere, and a small quantity of it had even made its way into the correspond-
ing cerebellic fossa, where it was lying on the margin of the foramen mag-
num ; the whole of this extravasated blood was of a dark fawn colour.
At the base of the skull, the extravasation 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 sub-
stance 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. Pruss 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 apo-
plectic 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 mem-
brane of a brown yellowish colour, 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 abundant beneath.

MENINUEAL APOPLEXY.

513

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 s:ive rise to effusion of blood, I oftentimes re-
marked 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 commenced at the base,
was the discovery of the ruptured vessel, generally the
middle meningeal artery. 1 have not had the opportunity of
observing 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. Pruss sets down the cephalalgia, redness, and heat of
the integuments 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 hfemorrhage 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 what-
ever can be found, and sometimes 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 sen-
sibility 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 hist for some
days, but generally coma comes on rapidly and relieves 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

514

HUMAN BRAIN.

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 ap-
pearance 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 instruc-
tive, 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 lias
had five children, the last of whom is five months old. She was nursing
at the time of seizure, on the evening of the 15 th 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 consciousness.

I saw her about twenty minutes after the commencement of vomiting,
and found her sitting 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 consciousness much
restored. She knew every body and every thing, but had some hesitation
in replying to questions ; but the answers were all perfectly correct ;
muscular power appeared very weak, but under control ; she com-
plained of headache, and said she felt very ill ; retching continued very
troublesome. The contents of the stomach having been previously ex-
pelled, small quantities of mucus were ejected. Bowels constipated. — Or-
dered to be put to bed, her head raised, and cold lotion applied ; hot
bottles to the feet and legs, Hyd. Clilorid. gr. viij. stat. Magn. Sulph.
3fs. ex. aquae Cinnamomi jifs. post horam dimidiam.

Saw her again in forty minutes ; had thrown up the powder and draught ;
pulse quite small and feeble ; sensibility rather more obtuse ; she still an-
swered 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 coidis and
calves of the legs. Calomel gr. v. 4ta- horfi. 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 paralysed.
Contin. gruel only, for sustenance.

MENINGEAL APOPLEXY.

515

16th. — 1’ulsc 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 sensible, 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. Calo-
mel gr. ij. 3’Ji- bora. Hs. Aper. 6,ishoris. 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. Lyttae capiti.

Vesper e. — Consciousness and sensibility much more blunted and im-
paired ; 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 sensi-
tive. When I saw the patient, she was still asleep. Her manner was
rational, and not peculiar ; but when asked who Mr. W., her medical at-
tendant, 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
slowv ; 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. Lyttm
jifs. aq. Month. §viij. 6lam' part1”- omni hora. fy. Olei Terob. 5b Tinct.
Assafetid. 3b aq. gviij. 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. Before removing the brain from the skull, we observed
a slight sanguineous effusion extending over the upper surface of the ante-
rior lobes, below and before, backwards, forming a very thin layer — a mere
smearing of the brain. On removing the brain from the skull, 1 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 evidently 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.

510

HUMAN BRAIN.

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 hazel-
nut— the brain softened and discoloured 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 ffoor, also the pos-
terior cornu ; all the rest of the brain was healthy.

Ched. — 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 none of the ordinary signs of sanguineous apo-
plexy— 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 pro-
gressive effects of extravasation of blood in exciting inflam-
matory action of the tubular substance, and with it convul-
sive movements ; these being followed by paralysis, as the
brain becomes softened, and the conducting instruments de-
stroyed.

Case 64 — Mr. A., about 60 years of age, bad a fracture with a depres-
sion 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 put-
ting the tongue out. The pulse was feeble; oppression. (A liquid
emetic.) The third day deglutition difficult, thirst, skin hot, pulse fre-
quent. The fourth day, drowsiness, answers always correct. (A large
Mister to the nape of the neck.) Fifth day, drowsiness increases, loss of
speech : lie understands what is said to him, but can only answer by

APOPLEXY OP THE CEREBELLUM.

517

cries ; the feces and urine pass involuntarily. Sixth day, drowsiness still
more increased, 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 paralysed. 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 illusions, convulsive jerkings during the night. The
following day same state. The eleventh day, loss of sense, aphonia, im-
mobility and general insensibility, coma, respiration loud and difficult,
See. ; death at eleven in the evening.

Jut op. 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 ns far as
the corpus callosum, and on the other to the base of the brain. This in-
flammation 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 ot apoplectic eff usion on or into
the Cerebellum. These lesions are always more or less fol-
lowed 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 dis-
turbance, generally 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 cerebel-
lum, and its effect — convulsive movements ; fifthly, the su-
pervention of inflammation of the hemispherical ganglion,
and its effect— delirium ; sixthly, effusion into the ventricles,
and its effect — coma.

CW 65 ,~~-Cmwhrahle '.of toning of the right lobe of the cerobe'lnin ;

518

HUMAN BRAIN.

with hemiplegia* — A seamstress, thirty-one years old, who had hitherto
enjoyed good health, about six weeks before entering the hospital of La
Charity, 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 ot the fingers ot the left hand ; she could use this hand but awk-
wardly, and was astonished at seeing what she handled with it fall con-
tinually 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
ol 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 ol motion of one of the sides of the body, her sight,
till then extremely good, became very weak, and five weeks after the in-
vasion 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 paralysed limbs were flaccid, and could be moved in all direc-
tions ; 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 hos-
pital ; 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 immoveable, 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 accompanied these convulsions ; the intelligence soon became dis-
turbed ; complete delirium set in ; for twenty-four hours the patient
spoke, aud was agitated incessantly ; she then fell into a profound coma,
in which state she died.

Post-viortem exavdnation. — The pia mater extending over the con-
vexity of the cerebral hemispheres was very much injected, as was also
that covering the cerebellum. The substance of the brain, properly so
called, was marked with a considerable number of red points, and pre-
sented no other lesion ; lateral ventricles distended with a great quantity
of limpid serum ; the fomixand 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 down-

* Andrei's Clinique Medicale, sect. ii. Case I. p. 202.

APOPLEXY OF THE CEREBELLUM.

519

wards, when we found an immense cavity, where this substance, deprived
of its normal consistence, was changed into a greyish bouillie; this soiten-
ing 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.

Cane 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 vears 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 deprived of consciousness and mo-
tion. Alter 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 morn-
ing her state was as follows : face injected equally on both sides,

contraction of the pupils, vision unimpaired, air of stupor ; she answeis
questions wTith correctness, no embarrassment of speech. 1 he two ex-
tremities 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,
80 to 34 every minute.

This girl seemed to us to have been struck with cerebral hsemoirliage ;
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, except considerable sandiness of
their tissue. In the central part of the right hemisphere of the cere-
bellum was found an effusion of blood, which formed in the nervous
substance a cavity large enough to hold a pullet’s egg. Around this ca-
vity the tissue of the cerebellum was red and softened for the space of
three or four lines.

A man mentioned by Senes, f after a blow on the back and
lateral part of the head, which stunned him at the time, had
a certain unsteadiness in walking, which made him always
anxious to take the arm of a friend ; and he had a weak-
ness 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 irrita-
ble, and was affected with trembling of the limbs. Soon
after, the left leg became paralytic, and the arm of the same
side felt benumbed and weakened. After the insertion oi
a seton in the neck, the arm recovered, llirce months

* Andr.il, op. nil., p. 195. t Journal de Physiologic, 1822-23.

HUMAN BRAIN.

520

after this the patient died, with fever, delirium, and an af-
fection of the bowels.

There was found disease in the right lobe of the cerebel-
1 uni, with an abscess and extensive softening.

In another man, mentioned by the same writer, who died
m forty days there was palsy of the light 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 cere-
bellum, occupying chiefly the centre of the left peduncle.

The cases above referred to prove that lesions of the ce-
rebellum, like those of the cerebrum, generally produce
paralysis of the side of the body opposite to the seat of in-
jury. In some cases the sensibility was decidedly impaired,
but in others this function scarcely presented any sioms of
implication.

One of the most interesting and extraordinary circum-
stances connected with injuries of the cerebellum with
which I am acquainted, I give on the authority of Andral *
When the haemorrhage of the cerebellum occurs simul-
taneously with that of the cerebrum, or a little time after it,
but so that the blood is effused on the right into the cere-
bellum, and on the left into the cerebrum, or vice vevsd,
there is paralysis only on the side of the body opposite to
the hemisphere of the brain where the haemorrhage has taken
place ; that is, on the same side as the haemorrhage of the
cerebellum. IIow then does it come to pass, that whereas
the movements of the extremities 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 paralysing the extremi-
ties 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 cir-
cumstance in the present state of our knowledge would be
premature. We would only beseech pathologists to pay
particular attention to the fact, and in the first instance en-
deavour to ascertain whether matters invariably fall out as
* Op. ci(., Part I. p. 201.

S A X UU1N E0 r S A P0PLEX Y .

52 1

they are reported to have done in the cases related by the
learned and very candid author above cpioted.

Abercrombie* quotes a curious case from Morgagni, in
which scirrhus of the left lobe of the cerebellum was fol-
lowed by paralysis of the lower extremities, the upper being
left perfectly sound.

Portal, when treating of paralysis produced by lesions of
the cerebellum, says : “In some cases of injuries of the ce-
rebellum, the paralysis and the convulsions have happened
on the wounded, and not on the opposite side, as is usually
the case in patients whose cerebrum lias been wounded ;
but still this is not sufficiently proved to be received as a
demonstrated point of doctrine.”

A mono; the anomalous instances of disease of the cere-
bellum producing no symptoms of paralysis, I may relate
one mentioned by Douglas, f The patient had been for
three months affected with pain in the forehead, which gene-
rally obliged him to sit with his head leaning forward ; he
had little appetite, and his sleep was disturbed ; but no
other symptom of disease. He died suddenly from an at-
tack resembling syncope, having been for a day much better,
with a good appetite, and enjoying quiet sleep. An en-
cysted abscess was found in the middle of the cerebellum,
and a rupture of the left lateral sinus, which probably was
the immediate cause of death.

I will conclude these observations on sanguineous apo-
plexy with a quotation from Dr. Bright’s admirable work.

Dr. Bright J 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 mo-
tion ; for a few minutes, or a few hours, the retarded pulse
bespeaks the difficulty with which the heart and arteries
maintain, by their voluntary actions, the labour of circula-
tion, 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
* I’. 170. f Quoted l>y Miereiombic, 125). % Op. cit., p. 327.

HUMAN BRAIN.

5:22

air in the process of respiration, and these soon prove in-
sufficient to maintain life. At other times, the apoplectic
condition, though well marked, gradually subsides, or fre-
quently 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 consciousness should have returned, yet, if effu-
sion of blood have taken place, paralysis will generally re-
main. The extent of this paralysis will vary almost indefi-
nitely ; it frequently affects both the motion and the sensa-
tion of the same part : sometimes, however, the motion,
and sometimes 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 from effusion of blood within the cranium.
I have, indeed, never met with a decided instance of para-
plegia 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 ex-
tremities has appeared to depend on other disease or injury
in the brain ; but of these we should always be somewhat
sceptical, from the obvious sources of error to which they
are liable, amongst which the unobserved or the unsought
diseases of the spinal cord and its membranes are the most
to be suspected. Defective articulation 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 irritability, and some-
times 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

SANGUINEOUS APOPLEXY. 523

which the affection oi“ the mind is so slight, that it is only
bv close examination it can be detected.”

“ The successive changes,” says l)r. 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 circumstances 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 commi-
nuted 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 admixture
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 yellow-
ish-white substance interposes, forming a permanent cica-
trix 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 become enlarged. In another case, on the tenth day
the clot had undergone considerable change in its colour,
and with the broken cerebral matter was separating from
the more sound brain. But in Case 13S, though twelve

* Op. ciL, p. 332.

524

HUMAN BRAIN.

days had elapsed, no such favourable change had taken
place ; the broken surface was still soft, and the surround-
ing 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 process by which the injured brain is de-
tached 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
colour, and so solid as to allow of being detached from the
surrounding brain. In this case it was peculiar that this
fine membrane should have formed, though the brain im-
mediately exterior to it was decidedly unhealthy and dis-
coloured ; but it is possible that this might in part have de-
pended 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 begin-
ning to form vascular adhesions ; and very similar cavities
Avere 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 Saunders. In Case 145, after about a year, a cicatrix
w as formed, a little soft in the centre, but apparently con-
tracted, round its whole circumference, and 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 favourable 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 apoplexy from con-
gestion and certain epileptic attacks. There is in truth
scarcely any precise distinction to be recognised ; the same
state of vessels apparently inducing both, ^ and the one
passing imperceptibly into the other. I lie convulsive
nature of the symptoms marks the chief difference, and
this probably depends rather on some original irritability
* Reports of Medical Cases, vol. ii. p. 198.

SEROUS APOPLEXY.

of the brain, or on the part which chiefly suffers from con-
gestion, 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 de-
bilitv, with local vascular excitement and congestion of an
asthenic character. For instance, a man of intemperate habits
may get a blow on liis head, producing concussion : if this is
judiciously treated, he recovers in the course of a few days.
But suppose 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. The exact treatment in such a case must, of
course, depend on the state of the pulse, skin, head, intel-
lect, bowels, &c., but most probably a purgative 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 suppression 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, ret. 29, boot-blocker by trade, was admitted
into St. Thomas’s Hospital, January 25, 1842, under my care. On admis-
sion, he was suffering from suppurative erysipelas, of a low, slow, sluggish
character. His countenance indicated organic disease. 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
containing 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. Parcirae bravae 5ifs. Acid. Muriat. dil.
rr^x. Gin. Jiv. Daily — beef-tea, fish. Two incisions and poultices to
the limb ; in a fortnight the erysipelatous inflammation was entirely sub-
dued, and the wounds on the limb nearly healed. After a few more days,
suppuration commenced suddenly in the opposite thigh ; the following 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 discharge 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 ta’lking to his mother, quite rationally, and, ns he seemed in-

520

HUMAN BRAIN.

dined to go to sleep, she left liim to go to the fire, when he suddenly
screamed out— Oh, mother, mother ! what have you done to my head? and
he continued screaming violently for four hours, that was until foiu- 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.

Sedio cadaver is. — 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 colour,
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 scrum 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 depo-
sit 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 longitudinal fibres of the septum luci-
dum. 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.

Abdomen. — Liver, nutmeg colour, no tubercles, colon very low down,
nearly in the pelvis ; mesenteric glands large. Chyle vessels very dis-
tinct.

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 cavities, lined by a distinct membrane, and
containing more or less tuberculous matter, ltenal 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 ; lining membrane, dark greyish colour, but not rough
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

SEROUS APOPLEXY. 527

disorganized, converted into a series of cells, communicating freely, about
the size of peas ; the left natural.

L 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 col-
league, 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 positive patho-
logical condition in this case, I think no one will dispute
the existence of serous effusion. My chief reasons for con-
sidering the attack inflammatory, though accompanied with
great want of power, were, 1st, The exciting cause, excessive
use of the organ, and therefore necessarily excessive san-
guineous stimulation ; 2nd, The heat of the head. Never-
theless, if this patient had been bled to any extent in the
first instance, he would have sunk immediately. The dif-
fusible stimulus which Avas given was the best thing, and
it kept the flame in until the mercury arrested the asthe-
nic inflammatory action, and caused the absorption of the
fluid.

Case 68. — J. B., rnt. 20, of an excitable disposition, spare babit, ordi-
nary good health, though suffering occasionally from severe headache, was
seized on the 11th 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 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 11th, he was persuaded
to go out for a little time instead of reading. He left home for this pur-
pose, and was brought back in about ten minutes by a gentleman, who
saw him stagger and fall. He was then sufficiently sensible to state,
somewhat unconnectedly, that lie 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 per-
fectly insensible to light. The breathing regular, without noise ; no
vomiting. I ordered him a mixture of sether and ammonia, with hot ap-
plications to the extremities.

HUMAN BRAIN.

523

Three hours afterwards, a slight re-action had taken place, there being
fuller and quicker pulse ; the extremities had recovered their natural term
perature, but the symptoms of pressure on the brain still continued undi-
minished, 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 extremi-
ties 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
Mi1. 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 lie swallowed a little beef-tea. The same
treatment was continued, and, towards evening, he was more restless and
uneasy, and became 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 me, 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 13tli, first cogni-
zant of desire to pass water.

Nov. 15. — Mr. Solly saw him for the last time ; nearly all the symptoms
of pressure having been removed. As most probably, however, some effu-
sion might remain, he was ordered 5 minims of Tinct. Canth. in a mixture,
with some Liq. potassm. This was continued, with such modification as
circumstances required, until he was perfectly convalescent ; and he was
able to resume his studies after the Christmas vacation.

Simple apoplexy. — Dr. Abercrombie classifies under a dis-
tinct head, that of simple apoplexy, those cases which occur
and terminate fatally without leaving any morbid appear-
ance 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 ves-
sels, brought on by determination of blood to the part, or by
detention of blood there. “ But if this be the correct ex-
planation of the production of these cases,” says the same
author, “why does the coma persist, and death so speedily
ensue, although the vascular distension, the supposed cause
of pressure, is removed by abstraction ot blood, or other re-

SIMPLE APOPLEXY.

52!)

medies, and, as we ascertain after death, the brain 1ms
sustained no structural lesion?”

lie ascribes the fatal event to another cause. He con-
siders that from the partial arrest of the respiratory func-
tion, the substance ot the brain is gradually saturated with
undecarbonized blood. The apoplectic person 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 eii'ects of imperfect re-
spiration, 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, I)r. Burrowes
attributes the coma to the state of congestion which precedes
the effusion, and not to the effusion itself. “ I am of opi-
nion, that apoplectic coma is rarely dependent upon the
extravasation of blood, although the concomitant paralysis
undoubtedly 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
extravasations 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 ex-
travasation 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 pressure exerted on the brain by an increased
propulsion of blood upon it, or transmission of blood
through it.”

The following case, for which 1 am indebted to Mr.
Adams, Curator of the Museum at St. Thomas’s Hospital,

* P. 02, op. til. f l’. 602.

2 M

030

HUMAN liltAIN.

illustrates well the form of simple apoplexy, and it confirms
the opinion that the symptoms arise from pressure, occa-
sioned by turgid vessels.

Caso, 69. — James Bibby, set. 38, a man of intemperate habits, though
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 and 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 as-
sistance was rendered ; when picked up, he was perfectly insensible, with
extremely laboured and slightly stertorous breathing ; he remained in this
condition for about twenty minutes, when consciousness began to return,
and he afterwards 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 wan-
dering, and was allowed a small quantity of gin.

On the 9th December, the restlessness and wandering were increased,
and he became extremely violent; his symptoms resembling those of deli-
rium tremens : gin, morphia, and ammonia, with sulphuric ether, were
given. He continued in the same state till 6 p.m., when he suddenly be-
came perfectly quiet, the pupils fixed, breathing stertorous, pulse slow ,
full, and laboured, and had the ordinary appearance of a man in an apo-
plectic fit ; in this condition he remained till 11 p.m., when lie died; five
hours from the appearance of the apoplectic symptoms.

At the post-mortem inspection, on the 10 th 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 thoracic and abdo-
minal viscera were generally healthy.

Andral believes in the existence of this congestive apo-
plexy, and relates 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 constitution, 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 consciousness, fell, and le-
tained, when she came to herself, some difficulty in her speech, with some
falling of the commissure of the lips and tongue on the right side; con-
siderable diminution of motion and sensation of this side, nausea and
bilious vomiting. Under proper treatment tins state disappeared at tlm
end of four weeks. After this the patient returned to a perfect state o

* Andral, op. cit ., p. 24.

SIMPLE APOPLEXY.

”)31

health, when towards the middle of March 1811) she again began to feel
a little weakness in the right arm ; slight pains of head in the frontal re-
gion soon supervened, 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 disappeared, 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 numbness and weak-
ness ou 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 ap-
peared in the night, upon which sinapisms were applied to the feet ; after
this the feces passed involuntary. On the 30th, hemiplegia more deve-
loped ; 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, countenance cpiite 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 immoveable, blindness, trismus, frothing at the
mouth at each expiration, contractility 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.

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 sanguineous congestions in the brain. It would appear that
here the hemiplegia was the result of a sanguineous congestion, greater in
one hemisphere than in the other, whereby this hemisphere lost its in-
fluence over the muscular contractility, even when the congestion ceased to
exist. The first time, the hemiplegia was preceded by a total loss of con-
sciousness ; 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 result of serous effusion into the ventricles ;
of which the habitual sanguineous congestion had been probably a predis-
posing cause. We should not forget to notice here the influence of the
vomiting on increasing the hemiplegia.

The following graphic account, derived from the Madras

5:3:2

HUMAN B11A1N.

Journal, edited by iny old fellow apprentice, Samuel
Rogers, is interesting in many points of view ; and while
it strikingly illustrates the value of cold effusion as a thera-
peutical agent in cerebral affections, it presents many
facts highly instructive both physiologically and prac-
tically. After describing 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 hos-
pital. Om’ loss on this occasion, with one exception, was
entirely confined to the recruits, and the chief part of the
sickness 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 oppression 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 tendi-
nura, and involuntary stools. Along with these symptoms,
the patients also had a strong, full and frequent pulse, tre-
mendous 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

* Madras Journal, vol. ii, p. 326.

SIMPLE APOPLEXY.

533

immersed in hot water. Blisters were applied to the head,
neck, and lower extremities ; brisk purgatives were admi-
nistered, and their operation assisted by purgative injec-
tions. 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 vomit-
ing took place, without producing any marked effect. No
case of paralysis supervened.

“ 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, sud-
denness, and urgency of the symptoms, venae sectio seemed
at once indicated, and it was carried ad deliquium, or to
the relieving the patient. It was found that it sometimes
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 pre-
vious 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 inordinate
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 effectual remedy! Just as one
man had expired, I might almost say under the lancet,
another was brought into hospital, lie 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 3i. 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 ol blood were
taken from his arm. He was by these means perfectly
relieved, and fell asleep ; and as often as the pain and heat

534

HUMAN BRAIN.

returned was the cold effusion had recourse to. This, with
purgatives, leeches to the temples, and cold cloths to the
head, cured him, as well as all the subsequent 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 recollection the advantages I formerly de-
rived 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 pro-
cured sleep.”

Treatment of the premonitory symptoms. — Though it is
not possible to say a great deal on this subject, inasmuch as
each individual case will vary 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 impossible 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 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 ol
apoplexy in a form predisposed by disease to its occunence.
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 ot
the digestive organs must lie attended to, especially the

TREATMENT OF APOPLEXY.

535

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 respiration 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, it
they have been freely used habitually. The entire aban-
donment 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 contented 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 dangerous, 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 ot his
died from an apoplectic fit induced by straining in pulling
on a wet boot. Loud talking, playing on wind instru-
ments, singing, intepiperance, venereal excess, the depend-
ing posture, and severe cold, are all referred to by this
physician as occasionally exciting causes of apoplexy. It
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 ot a
sthenic or asthenic character, whether our patient will bear
depletion, or whether he is depressed, and whether the
disease itself is the result of exhaustion. With regard to
our diagnosis of the seat and nature ot the eftusion, this is

5!3G HUMAN BRAIN.

more important in relation to onr prognosis of this disease
than our treatment. 1 do not mean to undervalue careful
diagnosis in these cases ; on the contrary, 1 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 favourable or otherwise, must
depend on the conclusions we arrive at regarding the
cause, the seat, and the nature of the effusion. If the
cause ot the effusion be extreme plethora, and some acci-
dental circumstance, such as posture, or straining at stool,
without any disease of heart and vessels, then our prognosis
might be favourable. If the seat of the effusion appears to
be at the base of the brain, but not near the medulla
oblongata, 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 pro-
duced, 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 treatment 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, lie says,* “ In the extent of our
evacuations, indeed, a due regard is certainly 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 say-
ing, that there are no symptoms which characterize a dis-
tinct class of apoplectic 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

* P. 288.

TREATMENT OE APOPLEXY.

537

and paleness of the countenance \ve have seen to he fre-
quent symptoms of the worst forms of sanguineous apo-
plexy, 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 cir-
cumstance that could lead us to consider the disease as serous
apoplexy, but which was fatal without any effusion ; and an-
other 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
uncertain 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.

“ It would be quite superfluous to detail common apoplec-
tic 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 termi-
nating favourably.

(jane 71. — “A woman, aged 70, of a spare habit, and thin, withered
aspect, having walked out in her usual health, fell down in the stieet,
speechless and paralytic on the right side. I saw her tour or five hours
after the attack. She was then much oppressed, but not entirely coma-
tose. She was completely speechless and paralytic : her pulse about 96,
and of tolerable strength. She was bled to 15 ounces ; purgative medi-
cine was ordered, with cold applications to her head. On the following
dav she was considerably improved, both in speech and in the motion ot
the right side ; but having become rather worse towards night, she was
airain largely bled, and purgative medicine was continued. Prom this
time she improved rapidly. At the end ol 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

538

human brain.

theiefoie 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 favour of blood-
letting as the general 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 labouring. He is opposed to small bleedings, as
they only relieve the heart of its load, and enable it to do
more mischief, increasing the force of the circulation in-
stead of diminishing it. If, after bleeding, the pulse in-
creases 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.

l)r. W atson, who considers blood-letting our sheet-anchor
in certain forms of apoplexy, carefully distinguishing ‘be-
tween those which require it and those in which it would
be injurious, also advises, after one full and sufficient bleed-
ing 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 ir-
regular 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 inflammatory 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 extra-
vasation, 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

TREATMENT OE APOPLEXY.

539

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 indi-
cate the necessity of immediate and decided blood-letting,
and I think it illustrates the value of prompt treatment
on the very onset of the apoplectic attack. 1 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 it she had not
been bled freely at first, extravasation must have inevitably
occurred.

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 lit oi
apoplexv.

The patient, Mrs. T., 40 years of age, stout, and rather full habit, tem-
perate, and in comfortable circumstances ; she has had seven cbildien, the
youngest 13 months old. She has been under Mr. Wildbore’s care occa-
sionally for the last five years, with symptoms of cerebral disease, but ol so
doubtful a character that a physician oi high character who saw her about
two years ago pronounced them merely functional. The symptoms weie
varied : sometimes she expressed a feeling oi numbness in hei limbs ;
sometimes shooting pains in her head, and a feeling ot swelling oi the lips,
lowness of spirits, and feeling of weakness.

The present attack came on when she was stooping to show her ser-
vant 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, “ O Caroline,
I am dying, take me up stab's.” When she was laid down on the bed,
she vomited, and almost immediately afterwards lost her consciousness . she
rlid 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 lici head.

Present slate. — 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 oi the head. She had previously
answered quite rationally some questions from one oi 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 Jfi oz. : this

HUMAN BRAIN.

540

1 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 bo dressed with mercurial ointment. Turpentine enema imme-
diately. Liq. hyd.bichlorid. §j. tinct. lyttae, 5^'s- acl- cinnamon. Jjvfs. sumat.
cochl. duo magna. 6tia- 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 ; coun-
tenance 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. 4.
om. bora. Hirudines xxx. capiti. Leave off the hyd. bichlorid.

1 7 th, 10 A. m. — Has passed a quiet night, slightly better, stomach
still very irritable, cannot keep any thing 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. 6lis- 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. armo-
racse. 5J. Acid hydrocyanic dil. iqiv.

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 eye-
balls are painful ; her countenance is flushed. The Ini', armoracse seems to
have been too stimulating ; ordered to be cupped to §vj. and to take a
saline draught.

20tli, 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.

23rd. — Going on well, head much more comfortable.

She recovered perfectly in about a week.

1 have since seen this patient repeatedly, and she has no return of the apo-
plectic 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 comfortable ever since she adopted
this regime.

On being called to an alleged case of apoplexy it is well
to accompany your messenger. I11 cases of emergency this
is frequently one of the family, and much valuable informa-
tion touching the history of the patient and the advent ot
the attack may often be gained before seeing him. Inquiry
should be made as to his age, and whether there is any
hereditary predisposition to the disease ; whether lie is

T UK ATM ENT Ol' A PC) PLKXY.

5-1 1

subject to fits, what arc his habits of lite, what his circum-
stances, whether he has had cause for anxiety lately, whether
lie has been harrassed in business. The period oi 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 de-
cided 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 ot 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 discrimination ot the practitioner at the time.
The countenance may be either pale or flushed, if the pulse
be strong, slow, lull, or wiry. "Whatever the state ol the
pulse is,°lf the face is flushed and the head hot, feet cold,
patient under 60, and robust, and active ; and the attack
induced by* excitement, whether of a psychical or physical
nature, whether the result of mental disturbance oi stimu-
lating 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 suddenly changed from a
stimulating to an abstemious one, or his having been ex-
hausted 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 l")r. Burrowes,

“ in apoplexv and other cerebral affections must, indeed, be
noticed, but they arc often very perplexing, especially when
we arc looking to the state ot the circulation as an indie iv-

* Burrowes np. e/7., p. I 10-3.

542

HUMAN BRAIN.

tion for treatment. But suppose a careful examination of
the apoplectic or hemiplegic patient’s heart discloses the
existence 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 abstrac-
tion 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 obstruct-
ing 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 hyper-
trophy 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 pulse ;
and one which, if it be regarded without reference to the
structural 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 hemi-
plegia, where, from an examination of the heart by auscul-
tation, we feel assured there is serious valvular disease;
and, from the character of the cardiac murmurs, and other
physical signs, we arrive at a well-grounded suspicion that
there is osseous deposit about the valves of the left ventri-
cle, in the coats of the ascending aorta, and, in all proba-
bility, in the tunics of the arteries within the cranium. In
such a condition of the arterial system an accidental cere-
bral congestion may have been followed by extravasation of
blood, and thus have arisen the most common symptoms
of apoplexy. The knowledge obtained through ausculta-
tion in such cases would properly dissuade from large losses

TREATMENT OR APOPLEXY.

513

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 discover dilatation of the cavities of the heart and ex-
tensive emphysema of the lungs ; the latter lesion is, indeed,
a more common cause of cerebral congestions and hemi-
plegia among the labouring classes than is commonly sup-
posed. In such cases the appearance of extreme congestion
and dyspnoea might tempt to practise 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
scapulae, with the internal administration of stimulating
diuretics, diffusible stimulants, and the application of rube-
facients to the sternum. Many mistakes arising from the
causes I have now adverted to may certainly 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 profession falling into the opposite extreme of allow-
ing 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-let-
ting.

In the treatment of apoplexy, especially after the first
serious symptoms are subdued, it is often much more im-
portant 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 neces-
sary to prescribe medicines which are inert, in order to pre-
vent mischief being done by others. In such cases we
can do no barm, 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 “ Bleeding in Affections of the Brain, which lie
thus begins: “ Is not depletion by bleeding, a practice still

544

HUMAN BRAIN.

too general and indiscriminate in affections of the brain,
and especially in the different forms of paralysis ? 1 believe
that the soundest medical experience will warrant this
opinion.” lie then points out a variety of cases where
there is diminished nervous power, but which, from then-
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 affec-
tions.

The following observations bear so directly on the ques-
tion 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 other-
wise. The paralysis, when depending on apoplexy, with
extravasation of blood or serum, or on other cause of con-
tinued 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 mo-
mentary 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 substance itself is often primarily affected. We
have certainly no proof of mere pressure from fullness of
vessels being concerned, to warrant large bleeding, espe-
cially after the stroke of palsy has actually occurred. The
degree of coma attending and following these seizures is not
alone sufficient cause for the practice, and will usually sub-
side 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 treatment can be desirable im-
mediately before and after a stroke of palsy. I do not

* Op. cit ., p. 45.

TREATMENT OE APOPLEXY.

545

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 gene-
rally be less from waiting a certain time, to observe the
effect of what has occurred upon the circulation, the breath-
ing, 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 consequences. 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 disturb-
ance any large depletion makes in the system, and par-
ticularly in the organs upon which these functions depend.
The importance of this consideration may be readily under-
stood. It is a point constantly before us in practice.

“ Even where evidence is obtained of the fitness of bleed-
ing 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 bleed-
ings, repeated as observation may suggest. And this ques-
tion the practitioner, while prepared for boldness in all fit
and urgent cases, is bound always to keep before him ;
seeing especially, that any great excess in the remedy may
hurry on the very mischief it is sought to prevent. I be-
lieve that in most cases the latter method is to be preferred.
It accords better with the state of our knowledge 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 depletion would
probably hurry on. The proof here can seldom be explicit,
but the presumption is one I have often been led to enter-
tain. These remarks, and the cautions they suggest, arc
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

2 N

5fG

HUMAN DRAIN.

gives a show of activity in the practitioner at moments when
there appears peculiar need of this promptitude. Current
opinions and prejudices 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 under-
stood as recognising, in the fullest sense, the value and
need of this remedy, promptly and vigorously used, in
various cerebral diseases, or in prevention of such, where
well-marked symptoms lead to their anticipation. And I
dwell upon this the more earnestly, lest, whde merely in-
culcating 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 congestion 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 othei in-
stances, often with difficulty to be distinguished fiom
the former. And in the right direction of diagnosis and
treatment here, we have the best proof that the mind of a
practitioner is equal to the most difficult exigencies o 11s

profession.” . . f

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 apoplectic seizure by blood-letting, carried as far as
the circumstances of the case admit, he has still much to do.
Mercury must be Ins sheet-anchor in every case though the
mode of administration may vary according to the constitu-
tional powers of the patient, the amount of plethora, and

TREATMENT 01f APOPLEXY.

547

the state of the bowels. The best plan is to raise the
cuticle immediately, either by means of the liq. amnion,
tort, or boiling water, and dress the raw surface with the
stiong mercurial ointment. Calomel should be given in-
tt 1 nallv in doses ot two grains every hour, or five grains
ev 01 y 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. J

The value 0f purgatives in the treatment of apoplexy,
especially the croton oil, is acknowledged by every expe-
rienced practitioner. With respect to mercury, Dr. Bright
gives the following practical hint : “ We should be careful
not to administer calomel before the powers of deglutition
are sufficient to ensure 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
th, it there is still remaining in or on the brain extravasated
blood, which has a tendency like an extraneous body to ex-
eat,; inflammation. After a day or two, when consciousness
a.s. JCea Inore or less restored, the patient may be observed
raising his hand to his head, and showing by his move-
ments that he is suffering in that direction. The head will
>c found unnaturally hot, and more so on the side opposite
the paralyzed limbs, in a case of hemiplegia.

It is in this stage that leeches to the scalp and cold appli-
cations will be found especially useful, followed by blisters
to the nape of the neck.

Diuretics may be employed with benefit, and the inf.
Jigitahs with the bichlorid. of mercury is one of the best •

2 n 2

548

HUMAN BRAIN.

the inf. armoracse with spirit, seth. 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 induced 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 -g-th,
itli, and I a grain to a blistered surface, with the effect of
producing spasmodic action through the paralyzed muscle,
and I have sometimes administered it internally with ad-
vantage. But cases of hemiplegia from rupture 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 advanced stages of convalescence, with safety, at
least, and sometimes with benefit.”

Dr. Burrowes does not recommend strychnia in these
cases. He says : “ My opinion as to the effects of strych-
nia as a direct stimulus to the nerves in hemiplegia is even
less favourable than that which 1 have expressed lcspectmg
electricity. In some cases strychnia does much harm by
ao-gravating 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 para-
lysis remains, the bichlorid. of mercury will be found usefu .
thus, Liq. hyd. bichlorid. 3i., Tinct. lyttae, n\x., Decoct.

sarsaparill. ^iv. ter. in die. .

I have also seen decided benefit from the tmctiue o
iodine, as a local application to the head. Ihis was ycry

* P. 338.

TREATMENT OF APOPLEXY.

549

evident in the following case, which is interesting in many
other respects.

Case 73. — On the 9th of March 1842, 1 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 paralysed, 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 her head so much that she is obliged to walk as well as she can.

I learnt 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 liydr. 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
1S40 ; 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 symp-
tom she had lost all power of speech.

Eor the following details I am indebted to Mr. Eisher, 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. quarum st. j. statim
et rep. in hor. duobus.

19th. — Symptoms unaltered, bowels not acted on, a powerful purga-
tive enema administered, 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 extreme 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. Calumbsc, with Tinct. Aurantii 5j- every
four hours.

June 7th. — Health has continued to improve under the above treat-
ment, but only very slight improvement in the nervous symptoms; some

550

HUMAN BRAIN.

motion in the leg ; able to say yes and no ; but although she evidently
vises them as negative and affirmative, she uses them indiscriminately
very expressively nodding her assent, and saying at the same time, “ No’
no,” and vice versd, 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 the least resemblance to a
letter, although she could before write. She has never, from the fust,
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 pa-
ralysis is not so complete in the face as in the limbs.

17th. Able, with difficulty, to sit up; motion of lower limb some-
what 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 recol-
lected the purport of every word addressed to her vivd 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 sti-
mulating liniment was now prescribed.

20th. — Seen to-day by Dr. Farre, who ordered her to take every four
hours Tinct. Aurantii. Jfs. Spt. Amm. Arom. nyv. in Inf. Valerianae 5j.
and to continue the liniment.

July 1st. — Removed to Camberwell, and was advised to continue the
medicines with an occasional Aloetie 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.

23rd. — Can raise her arm to touch her forehead ; feeling has partially
returned ; bowels confined. Pil. Rliei. 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 grey powder, in the dose of one grain, and take Inf. Aurant. co. 5j.
Tinct. Calumb. 5j- Sodae 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 im-
proved.

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 illness 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 grey powder at night, and use
the chlorate of soda gargle.

18th. — 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 lias not been able to do
before. Can read the newspaper to herself, and understand it, which she
has not been able to do since her fust, attack.

TREATMENT OF APOPLEXY .

5ol

25(1,. — Mouth and throat exceedingly sore; to discontinue all medi-
cine, and use the gargle, and take Olii llicini Jj.

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 lias not before
been able to do ; taking the Iodine and Gent. t. d.

22nd. — When sitting up in bed reading, she felt a curious sensation
down the affected side, and almost immediately afterwards lost all con-
sciousness. She was found by her sister on the floor perfectly insensible,
very pale and cold. A Mr. Cooke, the nearest medical man, was sent ioi,
who sent her a draught, and said that nothing else could be done t'oi lici.
She recovered her senses gradually.

23rd. — 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 hail 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. Id.
Rhei. co. gr. ij. t. d.

July 22nd. — 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
found 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
dav she suffered so much from her head, and felt as it 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.

2fith. — Has continued to apply the tincture of Iodine to the head, and
is improving ; has more feeling in her side, and her speech is impioving,
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 docs
not perceive any more 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 ; 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 sistei
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 hri
chair, however great the noise. 1 his symptom has only existed toi the

552

HUMAN BRAIN.

last two or three days. Bowels opened with the Conf. Sen. • appetite
very good. 1 1

i-843, January 2nd. — Has been stopping at Hampstead, and is much
better in every respect.

Jidy 14th.— I lost sight of this patient since the last date, but I now
leai ii that she is much better, can walk three or four miles, and her speech
is better ; she does not take any medicine, but continues the Tinct. Iod.
to the head, and she finds if she leaves it off her speech becomes worse.

Convulsive affections. — Convulsion, from convellere , “ to
tear or pluck up.’ The term is now confined pathologically
to sudden, spasmodic, involuntary action of muscles. Con-
vulsions are most frequently the effect of disease, either
functional or organic, of the cerebro-spinal axis, sometimes
the effect of injury. 1 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 phy-
siological inferences with those pathological deductions
which are to direct the diagnosis and guide the treatment.

In considering the pathology of convulsions, I think it
will be found that the same law holds good as in inflamma-
tory affections. In inflammatory affections, we have already
observed that mental excitement is an indication of inflam-
mation or irritation of the hemispherical ganglion, and I
believe it will be found that convulsions are indications of
irritation or inflammation of the tubular neurine, either
where it is in contact 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 in-
vestigated, 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 Ollivier,* of “spontaneous
haemorrhage 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,

* P. 500.

CON V l LSI V 15 AFFECTIONS.

553

“ 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 movements of rotation inwards. The
opening of the mouth underwent no change. The spas-
modic convulsions observed at the commencement of the
attacks of apoplexy in general, seem to me to depend on
the irritation which the blood produces on the extremities
of the torn medullary fibres, with which it remains in con-
tact, 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, aetat. 42, brought into the Middlesex Hospital,
and supposed to be intoxicated. He was drowsy, heavy, stupid, not in-
sensible ; 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 be-
came convulsed : v. s. jxviij. : the convulsions ceased for a time, then re-
turned 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 breath-
ing 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, oc-
cupied the centre of the right hemisphere of the brain : it did not commu-
nicate with the lateral ventricle, but opened between the sulci of the
convolutions, 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 hemi-
sphere. 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 cone] tiding
observations, when cases like the following, related by
Abercrombie, are to be met with so frequently, f

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 1810; 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, lie was walking about

* Part I. p. 208. Abercrombie, c. x. p. 243.

HUMAN BRAIN.

551

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 insen-
sibility, with laborious breathing ; saliva was flowing from his mouth ;
his eyes were much diffused and greatly distorted, the cornea of both being
completely 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 ; tlxey 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 horn- ; and he expired
in another attack of the same kind about ten minutes after. Blood-letting
and every other remedy that the time admitted of were employed in the
most judicious manner.

Inspection. — On removing the scull-cap an appearance was observed on
the surface of the dura mater of coagulated blood in small detached por-
tions. 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 rais-
ing the dura mater there came into view a eoagulum of blood, covering and
completely concealing the right hemisphere of the brain ; it was about two
lines in thickness over the middle lobe, and became gradually thinner as it
spread over the anterior and posterior lobes, and dipped down below the
base of the brain. The eoagulum being removed weighed about 5V. O11

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
luemorrhage could not be discovered. There was no fluid in the ventri-
cles, and no other disease was discovered. The stomach being carefully
examined, was found to contain nothing but air and healthy mucus.

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 apposite that I can-
not resist quoting them.*

“ You have just heard many different opinions founded
on observations 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 oc-
casioned convulsions and sometimes paralysis ; so that the
convulsions (always of the opposite side) were produced by
inflammation, and paralysis by suppuration ; that is to say,

* Op. cit., p. 500.

CON V U LS I V E A FFECTIONS.

555

by compression of the brain. Another series of observa-
tions brings forth other opinions.

“ Salmuthius* found in a patient who had had paralysis
on one side and convulsions on the other, an abscess in the
hemisphere opposite to the paralysed 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 considerable destruction of the brain,
had paralysis on the right and convulsive motions on the
left side. These facts, after all, are very common ; there
are few practitioners who have not observed them.

“ Berenger f says that he has most frequently seen con-
vidsions 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 convulsions attack the side corresponding
to the injured brain ; but when convulsions alone are pre-
sent, and on one side only, it is generally opposite to the
injury.’

“ 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

‘ Baralysis is not the only disorder produced by com-
pression ot the brain and alteration of its substance. Con-
vulsions 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 oppo-
site to that paralysed, that is to say, the injured side, whilst
the convulsive motions afiected 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
endeavouring to explain them ; others have thought that
the same affection could at the same time produce convul-

* Obs. Medicor. Ccnturim tres, t to, Bruns. 1 (H8.

t tract. dc Fractiirn Cranii, Mo, Veuct. 1535.

+ Traitc ties Mai. f 'li irurg., Jo-., tom. v. p. 109.

556

HUMAN BRAIN.

sions on the injured side, and paralysis on the opposite.
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 compression of the brain, have
thought that in this case the hemisphere corresponding to
the injury was at the same time inflamed, and compressed
by blood, serum, or pus. But thus to explain these two
orders of symptoms, required that the opinions of the an-
cients, generally received, should be rejected ; and this is
what is done. It is pretended that the symptoms of con-
vulsions are quite different from those of paralysis ; 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 suf-
fices to show its absurdity, the notion has had a great many
supporters.

“ It appears that in Morgagni’s time it was much ac-
credited, 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 agnoscemus.’

“ 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 an hypothesis more or less probable. 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 in-
juries of the head, have admitted that convulsions could
occur on the side of the inflamed hemisphere, or on the op-

* See Epist. Anat., xiii., Nos. 14, 17, 18, & 22. Pc Sed. et Caus.
Morb. Epist., Nos. 46, 47, & 48.

CON V ULS 1 VE A F F ECTI ON S .

557

posite side, whether this last was free or paralysed, — a cir-
cumstance much more difficult to be conceived.

“ It has, indeed, been imagined that convulsions only
occurred on one side, because the antagonist muscles were
paralysed, 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 con-
vulsions 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 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 ex-
plained the paralysis of the opposite side : but they some-
times 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 ex-
isted the great difficulty : they did not find in the hemi-
sphere of the side opposite to that convulsed, evident traces
of inflammation of the brain, and the state of the arachnoid
was thought of no importance, for two reasons : the first, as
you have seen, is, that it is much more inflamed on the in-
jured side than on the other ; so that by comparison they
thought it healthy when red, injected and opaque, &c. ; the

558

HUMAN BRAIN.

second is that they did not think that inflammation of the
arachnoid was more likely to produce convulsions than de-
lirium.

Some facts, certainly rather rare, threw into confusion
the opinions ol authors concerning convulsions and para-
lysis after injuries of the head. Paralysis was observed to
take place on the side injured, and convulsions 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
tune very much embarrassed 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 slioit time perceived that the lesion of the brain was op-
posite to that of the skull, and consequently opposite to the
paralysis.*

“ These two sei’ies of symptoms, then, explain themselves
in the same manner as in the preceding case. I have seen
no other means of exhibiting to you in the most simple
and clear manner possible, this rapid sketch of all these
opinions, and ol 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
labour 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 1 even ought,
after endeavouring to build upon bases more extended and

* Amongst others, see the case of Paillot, continued by M. Ant.lPetit,
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 paralysed,
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.

CONVULSIVE A F FECTION S .

551)

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 observa-
tions; that great importance has always been 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 sponta-
neous 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 important, both in a surgical and physiological point
of view. The appearance of convulsions after injury of
the head is a most serious symptom. 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 not always
irremediable.

I have no doubt that the convulsive twitchings in this
case were occasioned 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, ret. about 40, a pot-boy
at a public-house, was admitted into George’s Ward under my care, May
16th, 1^42, with a small lacerated wound on the left side of the head ; he

5G0

HUMAN BRAIN.

was intoxicated at the time of admission. The accident 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 characteristic of disordered stomach than brain.
There was no drowsiness, and his manner was natural ; he referred the
pain to his forehead, and not to the seat of injury ; his pupils acted naturally.

I ordered— Tulv. Jalaprn c. Cal. 5j. stat. M. S. C. Gta. 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. liora.

18. — 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 character. Tongue drawn to the left side. Constantly spitting
a large quantity of frothy saliva. Both pupils are alike, and slightly con-
tracted, but act freely to the light. Pulse 116, weak. He is quite con-
scious, 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, oppo-
site the wound.

Ordered — Hirudines xx. to the right side of the head ; to be followed
by a blister.

Opii Tinctura, ttfxxx. ; Spirit. Ammon. Arom. Jfs. ; Mist. Camphor.
5j . hac nocte.

20th. — Says he found relief from the leeches, and his head is much bet-
ter, though still very bad. Pulse soft.

22nd. — 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 3vj. in arrow-
root.

23rd. — 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.

24th. — Much better ; free from headache ; no twitching since yesterday ;
appetite returning. Pulse weak, 80.

Quinine and a pint of porter daily, in addition to the wine.

This man perfectly recovered, and left the hospital quite well soon after
the last report.

Ill 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

CON V U LSI Yli A FFECT1 0 N S .

50 1

brain, it is interesting, in as much 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 substance 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 bear-
ing on the use of the trephine (and to this subject our atten-
tion must also be directed) ; pathologically and physiologi-
cally, in as much as it shows that convulsions result in some
cases from lesion of the cerebrum, and that they are not
solely pathognomic of spinal irritation and disease, as stated
by Dr. Marshall Hall.

Case 77. — John Wingrove, set. 33, a stone sawyer, of healthy appear-
ance, 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
accident 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 ham-
mer which flew off 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 arrived there.

I ordered Cat. Lini. to the wound. Calomel, gr. v. 3tia horh.

\ past 12 p.m. — No change.

4 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 live doses of the calomel, and the bowels have been co-
piously relieved ; a3 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.

1 5th. — Has had a good deal of pain in the forehead, which he attributes to

Z o

562

HUMAN BRAIN.

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 neigh-
bourhood ; bowels not open to-day.

Ordered — Calomel, gr. v. 4t& hora ; Hirud. xxx. lateri capitis dextro.
Head shaved. Pil. Ipecac, c. Conio, gr. v. 6ttL horh. Emplast. Lytt. pec-
tori.

16th. — Much better ; Ins cough very much relieved; free from pain in
Iris 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.

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.

20tli. — Free from pain in his head, and the cough nearly gone.

21st and 22nd. — I did not see him.

23rd. — 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
neighbourhood of the wound ; his mouth is tender from the mercury. As
the pain has so much of a neuralgic 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. rvhen I saw him again, he had been re-
lieved 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 intothe face.

Pulv. Jalap co. 3j. h&c nocte. M. S. C. eras mane.

27th, 12 a.m. — Pulse SO, soft, and rather weak ; complains of his fore-
head and the side of the head, but no pain in the neighbourhood 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 complained of his head
throbbing violently.

COX V U I.S 1 V li A F FECTION S .

503

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 unfavourable prognosis.

At S 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
thev were all of a true epileptic character. As soon as lie began to re-
cover his senses he went off again, and just previous to this he became very
violent, and was with difticidty 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 incipient 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 opera-
tion, but very little afterwards. I performed it just after the commence-
ment 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 me 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 some-
times 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, and then he complained of being faint. I gave him
a very little weak brandy and water, and ordered some sal volatile occa-
sionally. 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 consciousness. I learned from the sister that she had observed twitch-
ing 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 during 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 I in the

2 o 2

HUMAN BRAIN.

5G4

afternoon, when twelve leeches were applied to his lie-ad, and lie had no
more till 11 o’clock at night, when he had a very slight one ; hut at 12 he
had a very severe one, which continued one hour : he was perfectly con-
scious, 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
hall. After this he totally lost the use of his inferior extremities ; all con-
sciousness 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 endeavouring 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 in-
ward from the upper edge of the fracture. A portion of this table which
was thus split 1 had removed with the dressing forceps after using the
trephine. The portions which remained could not have been removed
without some force, as they were only partially separated from the sur-
rounding bone.

At the time of the operation I did not detect this further depression,
from a fear of separating the dura mater more than was absolutely neces-
sary. 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
opening made by the trephine), in searching carefully for any further por-
tions 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-coloured brain was exuding. On turning
back the dura mater, we found on the same side the whole surface of the
arachnoidea investieus covered with healthy yellow pus. The arachnoidea
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 discoloured.
The centre of this discoloration was of a dark, dirty brownish hue, of a
semi-liquid consistency, gradually becoming firmer, and shaded off to a
dingy pinkish colour towards the circumference, which was spotted with
deep bloody points : an horizontal section of the brain about half an inch
from the surface showed this very distinctly. The disorganization ex-
tended downwards into the lateral ventricle at the commencement of the
descending and posterior cornua, involving a portion of the transverse com-
missure, 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 hemisphere.

The hemispherical ganglion was scarcely, if at all, altered in its condi-

CONVULSIVE A 1'1'ECT IONS.

5 Go

tkm ; its colour was healthy, neither paler nor deeper than usual ; the
edge, in some situations, was converted into a greyish-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 pertcctly
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 examination, could have been ascer-
tained 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 elevating the depressed portion. This operation,
however, in the present day, is not as a general rule consi-
dered justifiable in the absence of symptoms of compression,
or three t 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 endeavour, 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 sensi-
ble, 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 indicative
of the state of the nervous apparatus it is destined to pro-
tect, 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

566

HUMAN BRAIN.

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 con-
nected, though it may happen, as in the case of very severe
concussion, that the injury is remediable. The contracted
pupil, on the contrary, indicates an irritability 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 con-
traction 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 subsequent
inflammation and softening.

The next point to which my 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, Avas not the case It soon ceased, which gave me
reason to hope that the inner table Avas not fractured.
That the outer table may be fractured Avithout the inner,
has long been knoAvn. We have a very good preparation
in the Museum at St. Thomas’s, Avhere there is considerable
depression of the outer without 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 portions were partially depressed, notwiths: an cling
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 facul-
ties are smothered, and they cannot be roused. Many of
the functions of Aregetative life are also interfered Avith, *

CONVULSIVE AFFECTIONS.

567

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,
whv were they entirely absent in this case, where the inner
table was depressed and driven in upon the brain P I am
inclined to believe that the acknowledged symptoms of
compression depend upon the extent of the hemispherical
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 cjuoted : nevertheless, you must
not consider it more than an hypothesis of my own, and
not as an established principle, but 1 conceive this is the
only truly physiological explanation of this apparent ano-
maly.

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 hemispherical ganglion originally in-
jured. The medullary or fibrous substance beneath was so
shaken that blood was effused in small points, as may some-
times be observed in cases of simple concussion without
fracture. On referring to treatises on injuries of the head,
I have been surprised to find so many cases recorded in
which very serious injuries to the brain have been unat-
tended by serious symptoms of disturbed intellect ; 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 hemispherical 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 ot the mind
not distinguishing between the ganglion which is connected
with the mind, and those which are not. I he following

568

HUMAN BRAIN.

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
pam which occurred occasionally 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 with-
out any result. The paralysis continuing on the opposite
side to that on which the wound had been received, it was
thought right to open the dura mater, and 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 sensible, and entirely, though gradually,
recovered.

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 returned, and the paralysis ceased.

Whether this explanation of the fact that we meet with
cases of depression of the table of the skull without the
ordinary signs of compression 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 al-
most 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
favourable result of the anticipatory treatment which I had
adopted. It may be fairly considered that these anti-
phlogistic 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

CON V l LS 1 V E A I'FECTl ON S .

569

under the influence of mercury 'within 24 hours of the oc-
currence of the injury, and though he was not bled from
the arm, for he never had a pulse exhibiting sufficient vas-
cular 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 mate-
rially 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 pro-
ceeded. 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 tre-
phine, 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 occasion-
ally stopped for a short period by local blood-letting, they
return at intervals, until the patient becomes quite insensi-
ble, remaining so for twelve hours previous to his death.
This loss of consciousness I attribute to the pus we found
effused on the surface of the brain, for until the pus was
effused there was nothing to interfere with the hemispheri-
cal ganglion, and therefore nothing to affect the intellect ;
and neither the quantity or 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 ac-
tion which caused it was occasioned by the epileptic fits,
and not the cause of them. The cause of the fits 1 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 conclusion that if this patient had been trephined
when he was first admitted, he would have had a better

570

HUMAN BRAIN.

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 can-
didly 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 examination 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 re-
covered 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 difficulty in the
present case ivas 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 consequence of the differ-
ence of opinion regarding the line of practice that ought to
be folloAved in particular cases. He relates seven cases of
fracture, until depression, which occurred within one twelve-
month 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 sur-
geons 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 ivith those surgeons ivlio
are against trephining in slight depressions of the skull, or
small extravasations of the dura mater.”

CONVULSIVE AFFECTIONS.

571

Benjamin Bell, whose System of Surgery was published
in 1S01, says, “ Hitherto it has been a general rule to con-
sider the application of the trepan as necessary in every
fissure, whether any symptoms of a compressed brain have
occurred or not ; but due attention to the real nature of the
fissure, and to the effects most likely to result from per-
forating the skull, will show, that although fissures may be
frequently combined with such symptoms as require the
trepan, yet that they are not always, or necessarily so ; and
unless when such symptoms actually exist, that this opera-
tion, instead of affording relief, must frequently do harm ;
for it is by no means calculated for, or in any respect ade-
quate to, the prevention of these symptoms, and I have
already endeavoured to show that laying the brain bare is
never to be considered as harmless, and therefore that it
should never be advised but where it is probable that some
advantage may be derived from it.” In the present day
these observations of Mr. Bell seem almost superfluous, but
when we find such precepts as the following inculcated by
John Hunter in his Surgical Lectures, we need not be sur-
prised 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, “ whether the symptoms arise from con-
cussion, compression, 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, published 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 principles 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

572

HUMAN BRAIN.

were, the favourable state of the patient generally, and in
particular the absence of all symptoms indicating compres-
sion of the brain ; the specimens in pathological 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 ex-
tensive incision of the integuments, and exposure of the
bone, dura mater, and brain, which an operation would
have involved ; and the almost invariable fatal termination
of such proceedings within my own experience in hospital
practice.”

Dr. Hennen, in his admirable work on Military Surgery,
relates many cases to show that, in the absence of symp-
toms, 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 tre-
panning 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 until the present ease. “ A soldier was shot in the
head in the Canadian campaign. A fracture was the conse-
quence, with a depression of not less than an inch and a
half ; but as no untoward symptom occurred, no operation
was had recourse to. This man recovered, and went to the
rear, where, at a distance of several weeks afterwards, he
got an attack ofphrenitis from excessive drinking, and died.
As the existence of the ball in the brain was strongly sus-
pected, an inquiry was made after death, and on dissection
it was found lodged in the corpus callosum.”

Mr. Guthrie, in his interesting and valuable work on
Injuries of the Head, lately published, makes some excel-
lent 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 1 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 axe, sword,” &c.,

CONVULSIVE AFFECTIONS.

573

just iii fact as a piece of wood might be, while the inner
table, like a piece of glass or brittle steel, is broken and
splintered inwards. “ 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 inves-
tigation 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 irritating 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 symptoms, that he is not much hurt, and is satis-
fied 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 perpendicular cut into his
left parietal bone and knocked him down. As he soon re-
covered from the blow, and suffered nothing but the ordinary
symptoms of a common wound of the head with fracture,
it was considered to be a favourable 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
Hght 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, yel-
low, and in a state of suppuration.” After relating several
other instructive cases bearing on this point, he savs, “the

574

HUMAN BRAIN.

principle being laid down that it is right and proper to ex-
amine 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
is ascertained to have taken place P There can be no hesi-
tation in answering that in all such cases the trephine
should be applied, although no symptoms should exist, with
the view of anticipating them.”

“ 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 practice re-
commended, 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 support than in-
validate 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 1 have
particularly referred to having been asceitamed, I maintain
that the practice should be promp and decisive in every in-
stance in which 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 duia

nicitcr

I have thought it incumbent on me to du ell veiy fully
on the justifiableness of the use of the trephine in such
fractures of the skull where there is an absence of cerebral
symptoms. Nevertheless, I cannot recommend the use of
the trephine in any case, unless there is very decided cm-

CON YU I,S 1 V E AFFECTION S.

575

dence of a wounded dura mater from splintered portions of
the inner table. “ If there be any doubt,” says the same
authority, “ on the mind of the surgeon whether there are,
or are not, any portions depressed 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 considerable 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 pecu-
liar 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 com-
pression are absent. Such cases, it is true, are rare, and
then- 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 vegetative life are not so
seriously interfered with as to make a fatal result inevit-
able ; for the records of surgery teem with cases showing
from what serious injury of the braiu 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 por-
tion of the skull, will be seen to rise and fall with the pul-
sations of the brain, if it is not separated from the dura
mater by anything else than the other investing membranes,
ft is true that in a tranquil state, and with a small opening,

576

HUMAN BRAIN.

the motion is very slight. The absence of this motion is
stated by Mr. Guthrie as diagnostic of fluid beneath. “ I
have seen,” says this author, “ on the removal of a portion
of bone, the dura mater rapidly rise 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 ; arid an opening into it
under these circumstances has allowed a quantity of puru-
lent 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.
1 consider 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 punc-
tured it, though I cannot believe, from the post-mortem
examination, that the operation would have altered the
result, as nothing could have changed the1' gangrenous con-
dition of the brain. There are many other points of interest
connected with injuries of the skull, and the use of the
trephine, not bearing upon the present subject, which 1
shall notice in another place.

I cannot conclude these remarks without again adverting
to the importance 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 blame-

CON VI LSI Y E AFFECTIONS.

377

fully mischievous if the condition 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 frequency 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 obstinate the symptoms were until the system was
influenced by the mercury. I have no doubt but that the
blood-letting arrested the inflammatory 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 up-
wards, in height, pitching upon his head ; when picked up, was cpiite in-
sensible, and there was bleeding from the right ear.

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 evi-
dently 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 immediately.

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 labouring, the pupils dilated, particularly
the left, but contracted upon the admission of light. He was ordered to
take two gTains of calomel every two hours, and to have twenty leeches
applied to the head.

At 9 p.m. wa3 much the same as in the middle of the day. Was bled
from the arm to Jviff-

May 12th, half-past 8 a.m. — He complained still of pain in the head,
continued drowsy; putae 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, particularlv on the left side of the head Bowels still confined ;

2 P

578

HUMAN BRAIN.

had taken nine 5-gr. doses of Calomel. Ordered an enema to be adminis-
tered immediately, and repeated, if necessary. The Calomel to be omitted
until the morning.

13th. — Sleeps a good deal, and he is not easily roused, but quite sen-
sible, when awakened. Said, “ I have got the headache, Sir,” and then
dozed off again ; pulse 64 ; bowels opened twice by the enema, stool
lumpy, and dark brown. Ordered, Calomel gr. v.

1 P.M. — Itather 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 immediately 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 conscious, but he could not speak.
She then sent for Mr. S., which was at

g 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 accompanied with a slight moan. The artery was then com-
pletely divided, which stopped the bleeding, and he was again laid on the
pillow ; he almost immediately recovered his consciousness ; his counte-
nance 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. CretS, gr. ij. 4ta hor.

14th, mane pr'mo. — Said he was very bad ; quite conscious ; has had
no more convulsions ; complained of his head. Pulse 72, soft ; mouth
rather tender.

9 p.ji. — Countenance more cheerful; head cooler; pulse 80. Said he
was better. Continue treatment.

11 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.

Half-past 7 p.m.— Has had several fits, but not of great length, nor se-
vere • countenance much the same ; answers slowly, but rationally. Bowels
relieved ; motions loose and green ; pulse 80. Continue the Hydr. c.
Cret&. Empl. Lyttie to chest. Acet. Lyttse. et Ungt. Hvdrarg. ad

°U 16th. Not so conscious, or so well in other respects ; pulse 80. Con-
tinue treatment. ,

1 7 th — 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.

KPILKPSY.

570

ISth. — Much worse; countenance continues anxious; can scarcely an-
swer any question ; pulse 156, small. Says lie wants his breakfast; al-
ways 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.

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 for a
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.

22nd. — The convulsions continue very violent, but occur less frequently
even than yesterday ; his countenance has much improved ; pupils act ;
pulse 120 ; bowels open. Says he is better, but complains of his head.

23rd. — There is little alteration as regards the frequency and violence
of the convulsions. He has the power of moving his arm, which was
paralysed on Wednesday; countenance continues good; pulse 120;
bowels open ; mouth beginning to get a little tender. Continue treat-
ment.

24th. — Has had no fit since last night ; appears much relieved ; the
pain in the head diminished ; countenance good ; bowels opeD ; 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, Compd- 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 favourably.

June 3rd. — 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. — from E7nXequ/3avw, “ to invade, at-
tack, 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 mortals who suf-
fered from its influence were supposed to be possessed of a

2 p 2

5»0

HUMAN I1RAIN.

devil. For there is no doubt that the Demoniacs of Scrip-
ture 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
(Eginita, (Mr. Adams,) that Galen, Oribasius, Hi tins,
Aretaeus, Pseudo-Dioscorides, Alexander Leo, and a host of
others, including Phases, have devoted their attention to the
complaint. Dr. Copland, whose learned article on this sub-
ject ought to be perused by every member of the profession,
says, that by none has it been noticed so fully and accu-
rately as by Aretaeus.

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 prac-
tical 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 symp-
toms, when the disease is only in embryo.

The following is the usual order of phaenomena 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 sitting, 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 slioit,
slight warning, which enables him to lay himself on the
ground, and save the violent concussion of the face.

Bv the convulsive paroxysm, the jaws are fixed, and in

EPILEPSY.

OS 1,

the suddenness of their closure, the tongue is usually severely
bitten. The expression of suffering is agonising. Bloody,
frothy saliva issues from the mouth. The head is drawn
down upon the chest, the body curved forwards, 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 violently. The seminal
fluid is generally ejected during the paroxysms by the
violent convulsive action of the ejaculator muscles. Gra-
dually 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 suf-
ferer 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 circum-
stance 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 gene-
rally much worse. On one occasion l 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 fort-
night ; but on this occasion he had twenty-four in forty-eight
hours, occurring regularly every two hours, almost to a mi-
nute. The unusual number appeared to have been produced

HUMAN BRAIN.

56 2

by mental excitement, for after the first fit he wanted to get
np, and leave the house, which was new to him, and the ser-
vants 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 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 com-
plete epileptic paroxysm, or fit. The disease does not always
exhibit itself in precisely this form ; there are many modi-
fications 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
exposing 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 unconsciousness : 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
Mai , 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 mol was attended with
more disturbance of the intellect than the complete attacks.

Warnings. — These vary considerably, both as regards the
disease generally, and individuals in particular. Some pa-
tients that I know have a warning at night, and not in the
day. Others say that they used to have a warning when

EPILEPSY.

583

the disease first came on, but that they do not now ; some
have headaches, and feel tidiness of the head; others ex-
perience a most disagreeable odour for a day or two ; others,
again, are particularly well, cheerful, and clear-headed.
One boy is always excessively mischievous and high-spirited
just previous to an attack, and his thumbs are drawn into
the palm of his hand, as in children affected with crowing
convulsions. This turning in of the thumbs is a very com-
mon sign of the approach of the attack. Some patients
are always found lying on their face 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
wdl 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. Another who says she always knows when an at-
tack is coming on by everything looking different ; she
cannot define the appearance, though she says she has often
attempted. One gentleman 1 knew had sufficient 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
my 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, my 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 conscious-
ness. 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 common ; out of between forty and
fifty cases of epilepsy that I have seen, I have only met
with it once.

5S4

HUMAN BRAIN.

Sii' 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 radial nerve, lie said, “ A man was
sent to me, by a surgeon of \\ afford, having this disease ;
he would occasionally be seized by a severe pain in the
thumb, which gradually extended up the arm, in the course
ot the radial and brachial nerves, through the axilla to the
neck ; his head would then become twisted, and in a mo-
ment he would drop on the floor in a fit ; shortly after-
wards he would get up, and appear as well as ever. 1 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 re-
turned 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 perfect
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 desig-
nated 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 in-
termission. It is more decidedly inflammatory, and the
antiphlogistic measures which will permanently remove 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.

* Piet, rle Medicine, 31 vols., tome viii ., 1833, p. 207.

Ll’ll.KPSt .

585

Many of the higher animals are subject to epilepsy ; for
instance, the 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 epilepsy, says he has never seen such a case ;
he avows franklv that lie knows nothing of the nature of

v O

epilepsy.

Post-mortem examinations have failed to show that epi-
lepsy is dependent 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 divided 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 mem-
branes, &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 conclusion. Let iis 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 spicnlum 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 I)r. 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 form's,
where there is interruption to the mental operations, but

* P. 21 t. f Pcs Miilndirs rin Oervcnii, tonic i., p. 313', L R 3 S .

58G

HUMAN BRAIN.

without any convulsion, affords a strong argument in favour
of this opinion. All that Dr. Ilall 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 convulsions, or epilepsy,” and “ Centripetal epi-
lepsy.” 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 unintentionally do in-
justice to this able physiologist.

“ Any disease within the cranium or spine, whether
effusion, tumour, exostosis, &c., may induce convulsions or
epilepsy.

“ Fright, or other sudden mental emotion, has induced
convulsion, and this convulsion has been repeated, afford-
ing one of the most deplorable 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).

“ The cerebrum is obviously the seat of the mind ; it is
neither sentient itself, nor the originator of motions in
itself. The true spinal marrow, on the contrary, is the
term of certain excitements and the combiner 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 move-
ments 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 epi-
lepsy still more immediately. This form of epilepsy is also,
for the most part, incurable. These cases are, for obvious
reasons, frequently met with in hospitals, asylums, and work-
houses. Hence the idea that epilepsy is not to be subdued
by medicine, prevalent amongst those who draw their conclu-
sions from observations made in these establishments. +

* rage 319, op. cit. f Page 319.

EPILEPSY. 5S7

Epilepsy induced by external causes, not internal disease,
he denominates Centripetal epilepsy.

“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 denomi-
nated this form of epilepsy centripetal. This form of
epilepsy 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. Every thing depends upon rigid rules
proposed by the physician, and most strictly and perse-
veringly observed 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 distinctly but ex-
clusively involved in the circumstances of the disease ; if
the encephalon suffers, it is only as an effect of the convul-
sive 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 act through the medium of the pneumogas-
tric, 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 par-
ticularly intelligent woman for her station 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 articulation was perfectly
distinct, and she had abundant power of expressing herself.
Her excitability was so great, that any over-amusement or
emotion produced sleeplessness. This, after the first diffi-

* I’. 322, op. ril.

588

HUMAN BRAIN.

culties 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 be-
came fixed, with a quick vibration of the head, and a ten-
dency 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, in-
creased 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
consciousness was so complete that, though she always re-
covered 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 wrere con-
siderably 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
conversation, with a hesitating, tremulous voice, accom-
panied with many ocular delusions. This state, which
came on every few 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 re-
move 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, suddenly fell back in a strong epileptic fit, which it was
impossible to conceal from the child, who appeared deeply
affected by it, and on the following morning (which was the

EPILEPSY.

589

day tor 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 tits 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 \ alerian, 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 effi-
cacy gradually wore away. The symptoms which indicate
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 emetic under these threatening signs, and with suc-
cess. Four or five weeks may perhaps be considered as a
fair average duration for the interval 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 langour of body
for one or two days, after which all nervous susceptibility
seems quite gone. For a week, at least, all vibration of the
eyelids is quite suspended, and the mind appears to be per-
fectly calm and free from excitation. On eight different
occasions she has lain in convulsions 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 apparent insensibility, when
the saliva has bubbled from the mouth, and the hearing
has seemed quite gone. During the whole time that these

590

HUMAN BRAIN.

convulsions have lasted, the heart has beat violently, the
face has been suffused 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-con-
scious state through two successive days ; sometimes the fit
has closed it, and sometimes 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 de-
pends. In many diseases it is extremely difficult to come
to any satisfactory conclusion, but still it is our duty to at-
tempt 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 de-
serve 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 discharge from an electric battery, and, from its quantity
and excess, produces excessive action of the musles. It is
another illustration of a law that we had occasion to decide
upon already, namely, that the first effect of arterial excite-
ment 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

tPlLlil'SV.

59 1

to other 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 sud-
den determination of blood to a particular part. And the
lachrymal glands, salivary glands, testicles, prostate gland,
gastric glands, and even the kidneys, often pom- forth their
secretions so abundantly and so suddenly that the formative
fluid, the blood, must have circulated through their capil-
laries in greater quantity and with greater rapidity than
when the glands were at rest, and their secretions sus-
pended. 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.*

“ There are hardly any chronic local diseases in which
local determinations 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 re-
garded 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 in-
jurious results. Thus, very various derangements of the
functions of the nervous system, headaches, giddiness, tran-
sient 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 affec-
tions, 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.”

The vessels which are especially the seat of this morbid
action 1 suspect are those of the choroid plexus and one of
the layers of the cortical substance. The choroid plexus is

*

Alison’s Pathol., p. 554, op. cif.

59:2

HUMAN BRAIN.

frequently found hypertrophied 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 tumours, 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 suf-
ficiently to give a solidity to the wall of the pipe, so that
the force of the contraction is not lost on a yielding sur-
face. 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
physically and temporarily to the leaden tube. Arteries with
permanently rigid walls, like leaden tubes, would have in-
terfered 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 con-
gestion.

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 corroborative evidence in favour 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 syn-
chronous with the heart, which it is. It is the same yield-
ing of the coat of the capillaries in an inflamed limb which

EPILEPSY.

593

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 far, I can see much probability
in the opinion of the Wenzels, that the pituitary gland
is in fault in epilepsy, — believing, as I do, with I)r.
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 remarking 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 capillaries
lose their vital tone, have their circulating functions im-
paired, become more or less dilated, and are disposed to
rupture.”

The invaluable researches of Dr. Burrowes have shown
that the vessels 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 affected.

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 unlimited,
augmenting with every increase of luxury and civilization.”
“ It is impossible for us not to feel admiration at the won-
derful power of resistance by which the brain is daily pre-
served from disorganization, when we consider the intensity
of mental application to which it is exposed, the violence of
* Diet., vol. i. p. 97. f Op. cit., p. 653.

594

HUMAN BRAIN.

internal strife by which it is agitated, the heedless stimula-
tion to which its vessels are subjected, and the rapid vicis-
situdes of temperature, and the severe and neglected exter-
nal 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 any thing that would tend to accelerate the circulation.
In the following quotation from Dr. Abercrombie, 1 have
put in italics those phoenomena which appear to me to sup-
port 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 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.
This latter supposition is also countenanced by the stomach
being frequently much disordered, and by the more violent
attacks being often accompanied by vomiting. The dia-
gnosis, 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
conversation, without becoming distressed and his headache
increased ; and the same effects are produced by wine am
bodily exertion, lie seeks quietness, coolness, and darkness ;

* Abercrombie, op. cit., p. 317.

EPILEPSY.

595

and in these respects the disease differs remarkably from
dyspeptic headache, which is commonly dissipated by exercise
and cheerful company. Sometimes the paroxysms are ac-
companied 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

Esquirol says,* “ Sanguineous plethora has been ad-
mitted by all authors as a cause of essential epilepsy.”
koville states that the brain of patients who have died in
the fit is always found congested ; but he attributes it to
the mode ot 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.” 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 congestion and plethora, by
which signs we measure the amount of the interned or most
marked, just when the symptoms of the paroxysm begin to
subside and disappear, so that we cannot look on the con-
gestion 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, 1
think that the congested state of the venous system, after
the convulsive explosion has taken place, can only be caused

* Op. nil., tome i. p. 307, 1 S 3 8 .

t Lectures, 2nd Edit., 1845, vol. i. p. 017.

2 a 2

596

HUMAN BllAIN.

by the flow of blood from the arterial or secerning system.
l)r. Holland considers this condition of the arteries, which
I believe to be the immediate cause of determinations of
blood, dependent on nervous influence. lie 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 in-
fluence.”* “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 Laennec, 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. ”f

With regard to the cause of epilepsy, Dr. Copland thus
expresses himself —

“ That in the simple and early disease it is not depen-
dent 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 sufficiently ex-
amined 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 he
referred rather to the repeated derangements 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 epileptic attacks. That general
congestion of the encephalic vessels evidently exists in the
second or convulsive stage of the fit ; but it is not so mani-
fest that this state is present from the commencement of

* Med. Notes and Refiec., 533.

+ Med. Diet., p. 797.

-f- Op. cit., p. 540.

EPlI.ErSY.

597

the seizure, as cases have presented, at this period, symp-
toms of a very opposite condition. This congestion is only
a passing phenomenon, evidently caused by interruption to
the respiratory actions, impeded circulation through the
heart, and to the spasmodic action of the muscular system,
and is not the cause of the seizure ; the principal pheno-
mena 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
sensibility depends, and which actuate the respiratory and
muscular organs.”

“ Congestions of blood do not occur ; and we are not suf-
ficiently informed of the cases in which such irregularity in
the distribution of the blood may be regarded as the pri-
mary 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, tits 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.”

My own observations do not accord with Dr. Copland, in
so far as 1 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 1 have seen derived from the
use of Digitalis, as described under the head of “ Treat-
ment,” is strongly corroborative of this theory. This power-

598 ‘

HUMAN BRAIN.

ful 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 pre-
viously he had had two or three during 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., jet. 19. Eresli complexion, healthy looking, steady
habits, neither addicted to masturbation nor venery. Consulted me
February 3rd, 1845, for epilepsy. About June 1843 he had a severe
mental impression from reading “ Diary of a Physician” — depressed. In
Oct. 1843 he lost consciousness when playing at Loto, but without any
fit : this half attack occurred nearly every day until he had his 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 11th
November, one on the 9th December, and on the 20th January he had
two, between one and five in the afternoon. Ilis 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 colourless state of the brain, with softening, anti a few ounces of fluid in
the ventricles : bis symptoms during life were attributed by his medical at-
tendants to ramollissement.

February 3rd. — The attacks have lately come on more frequently, gene-
rally 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; sometimes one, some-
times 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 3rd of March
to take it three times a-day with gr. ij. of Ext. Col. co. ; also Liq.
Potass, gifs. Tinct. Iodinei co. 5j- Sp. iEther. Nit. gifs. Capt. coch. min.
ex aquA b. d.

March 1st. — Had a decided fit while walking with his mother, — was in a
state of unconsciousness for several minutes previous to the fit. There was
no flushing of the countenance, no cry, countenance blue during the fit, but
soon recovered its colour, the struggle was not severe, and did not last long.
He remembered every thing 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. 13. in the country. 1°
take Argent . Oxyd. gr. j. Ext. Col. co. Ext. Gentian, co. gr. iifs. It. Pil. ij * ^

EPILEPSY.

599

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 conges-
tion of the head and face, not followed by any coma, lias always three
partial attacks in a day.

23rd. — 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 duration 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. Iodinei. c. Liq. Potass®.

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 con-
scious of their existence.

September 5th. — Eive attacks yesterday, with symptoms of indigestion.

15th. — Better : attacks slighter and less frequent.

29th. — Heavy and low spirited : a leech has been applied to the nostnl
occasionally, and with benefit.

November 2nd. — Still has four attacks daily, though not so severe.

6th. — A complete attack with convulsion, but short. Two hall attacks
in the evening.

11th.—1 Three half attacks daily. Zinci Sulph. gr. ij. Conf. Ros®. q. s.

29th. — He continues much the same, general health pretty good, some-
times three, sometimes even five, half attacks per day ; three every Sun-
day. To-day he was ordered to omit the pills and commence taking Inf.
Digitalis 5j. every night.

Jan. 4th, 1846. — Four half attacks daily, two complete to-day. These
two are the last he has had.

6th. — Dose increased to 5'fs-

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.

27 th.— Has had no attacks at all since last report, but has had four half
attacks to day.

28th. — Five; 5x. ......

February 1st. — None; pulse 58. Has had some sickness, which has

gone off.

6 th. — None.

7th. — None : very sick: omit medicine two days.

10th. — Three half attacks.

18th. — None ; has had one daily for the last few days.

27th. — None ; pulse 84. Irregular. Dose ^iis.

March 1st. — No attack, general health excellent.

GOO

HUMAN BRAIN.

6th. — Has had one yesterday and to-day.

24th. — Has had some days one attack, on others none during the day.
Had a hall attack to-day. Pulse averaged from this date 54 in the minute
until he left off the Digitalis.

June 13th. — lias lett the country ; has not had any attack since the last
report ; takes §ij. o. n.

June 1 847 . — Continues perfectly well ; has not had any more attacks nor
taken any of the medicine since the 15th of August ; 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 came singly, and only two in num-
ber— 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 enormously 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 the post-mortem examination of four convicts,
who died at Woolwich from eating it. The progressive
amount of sanguineous effusion on the brain was in propor-
tion 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 the 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

EPILEPSY. 601

the proximate cause of the convulsions is a rush of blood to
the brain, if it may be so expressed.

Case SO. —Ligature of the common carotid in epilepsy. — Michael Cox,
pensioner, ret. 25, sanguineous temperament and muscular. — This man has
for the last live years been subject to very severe epileptic fits, recurring
generally about once a fortnight, lie 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 and undergone great fatigue. He had lived gene-
rally temperately. Since the first seizure, the epileptic fits have generally
recurred without any assignable exciting cause, but have been also occa-
sionally 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 particu-
larly 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 con-
ceive 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 nature, 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 re-
turn of the epileptic attacks, nor any tendency to them. He has experienced
also, since that time, a great improvement in his general health and feel-
ings. His spirits have been good — before almost 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 shoemaker — and was obliged to abandon it. Since the opera-
tion, 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 whicli I have already adverted to, which many
epileptics have, viz., a singing noise in the ears, I believe
arises from the dilated carotid artery vibrating in the carotid

602

HUMAN BRAIN.

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 favour of this
theory.

Dr. Conolly* observes that epileptic patients are occa-
sionally warned of the approach of a paroxysm by mental
excitement, their high spirits becoming to their friends the
well-known precursors of then' sufferings. This must arise
from arterial action. It is analogous to the mental excite-
ment 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 connection.
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 lacerate or injure it. Still, how-
ever, there is no doubt that it is sometimes out of propor-
tion, small and compressed ; at other times larger than we
should suppose healthy ; sometimes the seat of small ex-
cavations, and even of suppuration ; and in one case men-
tioned in the present volume it was supposed to be altoge-
ther wanting. It is by no means impossible that it may
want some peculiar influence in epilepsy ; but I have un-
doubtedly seen epilepsy where no obvious disease existed
in the pituitary 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 epi-
lepsy— the thickening and morbid growth of the processes
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, san-
guineous congestion takes place within the brain.”

* An Inquiry concerning the Indications oi Insanity, by John Conolly,
M.D. London, 1830. p. 241.

f Op. cit., vol. ii. p. 696.

EPILEPSY.

603

Continued cold weather sometimes induces epilepsy in
old and feeble constitutions. I suppose it is by disturbing
the circulation that it produces 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 a vacant look, and apparently
lost to all surrounding objects ; his eyes were open, and pupils 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
seventy. I then heard the following 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 de-
pletion. 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 ac-
companied 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 horn-, and then very slowly recovered his consciousness ; but before
this took place he was lifted into a cab, and I proceeded to his home, in
the neighbourhood of Loudon ; by the time lie had arrived there, he had
so far recovered liiraself, that he soon recognised 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 mus-
tard poidtices 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 treatment 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 mer-
cury in sarsaparilla. The latter medicine was given in consequence of the
partial paralysis of the lower limbs. 1 le 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 (lie dura
mater. We have already had occasion to consider this.
Syphillitic inflammation in the fibrous tissue not unfre-

G04

HUMAN BRAIN.

quently produces deposits and thickening ; and more than
once have I seen epileptic fits apparently result from the irri-
tation 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 perios-
teal mischief, though its syphillitic 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, «consultcd 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. lie has no decided pain in his head, but he
feels very uncomfortable, has occasional retching, but does not bring any
thing off his stomach.

Complexion yellow ; pulse 100, weak and irregular ; tongue rather pale,
but not furred ; fauces slightly injected ; he has occasionally twitekings
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 practitioner with the oxymuriate of mercury and
sarsaparilla : he got quite well, and is quite certain that he has not had
any symptom, of any kind, of this disease since. About three years ago he
was thrown out of iiis 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. Ilydr. c. Greta,
gr. ij. Pulv. Phei gr. j. o. n.

13th. — Head shaved, Tinct. Iodine to the head.

18tli. — Decidedly better, and went out of town.

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 cooling 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.

Iiis place of business is hot, and he feels the writing so much that he is

EPILEPSY. G05

obliged to give it up again : he remained a week sleeping out of town, but
he found it was of no use.

July 3rd. — When lie returned to me, he complained much of pain in his
head, and twitchings at uiglit.. I ordered him an active purge, three leeches
to the head over a spot where lie has a fixed pain. Afterwards Hydr. c.
Creta. gr. iv. o. u. 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 1 7 th. — lias been down in Kent, living very quietly, continuing
his medicine, Dec. Sarsa. c. Iod. and Hydr. c. Creta. 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.

22nd. — 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 Tincture of Iodine till within a few
days ago, when he thought there was a little heat in his head ; he con-
tinues the Hydr. c. Creta. gr. ij. alt. n. Mist. Iodin. and Sarsa. once a-day.
Ord. Hirud. ij. vertici appl. alt. die. Hydr. c. Creta. 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, occasionally at the vertex, when he attempted to
read. This feeling he says seems to come on from any sh’ght 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 every thing like pain or uncomfortable feeling in his
head, but he had a sensation of giddiness on the 22nd, 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. and Hyd. c. Creta., and take Zinci
Sulph. gr. ij. t. d.

29th. — Still uncomfortable in his head from a feeling of weakness and
giddiness. Ordered, Pil. Ithei. Cal. gr. x. II. S.

December 1st. — Has acted very powerfully, his head is more comfort-
able, 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. Iodin. ex.
Sarsa. bis in die, and to go fora fortnight to the sea.

28th. — Says he is now quite well ; that after being two days at the sea,
he felt all his uncomfortable feelings leave him. He has been stopping a
week at Blackheath, and has continued well.

006

HUMAN BltAIN.

1845, June 15th. — I was sent for during the night to see Mr.

When I arrived at 3 a.m., 1 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, aud 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 drunk 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 Ehei and
Jalap, and a draught in the morning : he had had a mustard emetic.

16th. — Going on well. I ordered Liq. Am. acetatis and Tinct. Lyttas,
&c. No beer or other stimulus.

18tli. — Going on well : to take the Argent. Oxyd. gr. j. t. d.

23rd. — Free from all pain, and is quite comfortable : he came to see
me.

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 unfavourable. But sometimes they occur
singly, or limited to two or three, and never re-appear ;
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 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 suggested 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, and 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. Amin. Ar. 5^s- Tinct- Ehei. 5j- Inf. Aur. 3j. and two pills
at night; Pil. Bliei. co. gr. v. Pil. Hyoscy. gr. v., and to keep in bed till
I see him next day.

EPILEl’SY.

G07

ISth. — Motion full of bilt>, and healthy; says lie feels comfortable;
pulse SO, regular, ot fair power; examined the spine — could not detect
any symptoms whatever of disease. Ordered, — Inf. Aurant. co. 5 vis.
Sp. Amm. Ar. 36. Sodse Carbon 3j. Tr. Ithei. gij. Mf. Mist, cujus cap.
sextain partem bis in die.

1 attended him for about a mouth, 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 following was one of this class.

Case S4. — Eliza Tittensor, aet. 20, lives at home — domestic occupation ;
healthy appearance.

First tit 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 23rd. — Third fit to-day ; no particular cause; complains of
her head never having been comfortable since the first fit. Made an issue
with Potassa Eusa in the neck. Pil. Ehei. c. Cal. gr. x. H. P. mane.

October 16th. — Argent. Oxyd. gr. ij.

23rd. — She complained of her head so much, and as I felt it arose from
the stomach, ordered Inf. Cinchon. §vj. Tinct. Ithei. gj. Pot. Carb. 5ij.
Acid Hydrocyan. dil. 3j. Sp. Menth. Pip. 3j. Coch. Magn. ij. bis die.

November 29th. — Much better, free from fits, head easy.

Hecember 18th. — Has continued the mixture regularly, free from head-
ache, 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 relieve her head ; had not had any fit since the 23rd.

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 con-
tinued till March 15th ; left off all medicine, and dried up the issue : con-
tinues quite well.

I received a letter from the medical man of the family, stating that
these fits were epileptic, complicated with hysteria.

The various forms of epilepsy liiivc thus been classified

G 03

HUMAN BRAIN.

by Esquirol, who has seen as much of this disease as most
men : essential, sympathetic, and symptomatic.

Essential idiopathic epilepsy has its seat in the brain
and its appendages. It may be divided into three va-
rieties : — -

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 organiza-
tion of the cranium, on lesion of the meninges or of the
brain, or serous or sanguineous 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 depends on the presence of indigestible matter in the
alimentary canal — intestinal worms. 1 have certainly known
an attack of epilepsy brought on in a patient who had been
free from fits for twelve months, by indigestion 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 designates 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 scat 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, cause this species.

The fourth has its seat in the organs of reproduction —
epilepsia genitalis , epilepsia uterina, the abuse of venereal
pleasures, onanism, continence, pregnancy, accouchement,
are the ultimate or proximate causes.

The fifth has its seat in the external organs — epilepsia

EPILEPSY.

009

sympathicn 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 difference may be one of words merely,
and that what he would call sympathetic I should call
functional.

Esquirol’s prognosis of epilepsy is as unfavourable 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
humours on the head.

“ 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 some-
times 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

2 a

610

HUMAN BRAIN.

violent convulsions, not during the fit. Epilepsy, compli-
cated with mania, is incurable.”

Dr. Pritchard* supports the doctrine of particular deter-
minations of blood to distinct parts. He says we often
find a patient labouring 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 vessels on the surface generally constricted.
If the feet are plunged in hot water, and rubbed, blood
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. Pritchard believes in a power of active dilatation in
the artery : he says, “ This property of the arteries is pre-
cisely that which Dr. Parry has described under the term
Tonicity.” He states distinctly-)- that he considers “ the
immediate cause of an attack of epilepsy, or that physical
change which, in a constitution prepared by natural predis-
position, or by the action of morbid circumstances, is the
immediate precursor and occasion of the fit, appears to me
to be a preternatural influx of blood into the vessels of the
encephalon, or an unusual fullness in some part of the vas-
cular system of that organ.” Dr. Pritchard then goes very
fully and ably into his reasons for this opinion.

The following case illustrates one of the forms sometimes
assumed by this Protean disease. It is only by a know-
ledge 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., jet. 12, on account of the following ailment. She sud-
denly loses her consciousness ; her hands fall, and she (bops 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 halt ago, and tne

* Op. tit., p. 82. t P- 10L

EPILEPSY.

611

attacks have gradually increased in frequency since : they now sometimes
occur three aud four times in the day. She seldom passes a day without
one or two ; not more liable at one period of the day than another. She suf-
fers very much from headache, which is especially over the forehead. 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 bead aches she is always very pale.
IPulse 18, 17, 19, in the quarter, very small, and a little irregular. Tongue
a little dry ; forehead hot ; bowels regular.

Ordered, — No Study. PH. Rhei. co. gr. vij. Hydr. Chlorid. gr. j.
!M. ft. pH. ij. hac nocte sumend. Haust. Senn. co. mane. The first
dose did not operate much, but the evacuation was very dark and offensive.
IRcpeated 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 Sulpli. 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.

11th. — No fits since the last date; her head feels much better. Or-
dered, gr. x.

22nd. — 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 2nd of January —
eight fits in all. They were not unusually severe ; headache, but not
more than usual: the last fit was the worst. Inf. Digitatis 5'j-, 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 de-
scribes 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 wTas very much controlled by the digitalis.

It also show's the importance of giving medicines to
tranquillize 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, 1
give the hydrocyanic acid.

In marking the state of the pulse in epilepsy, I always
note the number of pulsations in each quarter separately,

2 r 2

HUMAN BRAIN.

61:2

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 note the numbers when it has settled down.
The reader must therefore understand that the figures refer
to the quarter, not to the Avhole of the minute.

Case 86. — Oct. 14, 1846. — M. T., act. 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 pre-
ceded by the pain in the stomach ; 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 any thing. Her me-
mory is now afFected.

The father died from fungoid tumour 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 sup-
pose 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 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 tlie care of a great many different
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. 1) ;

after him by Dr. A , and was mesmerised 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 in the night fits and the day except, in the warn-
ing ; she has more warning in the night.

Once she had a fit in my waiting room. I heard the cry, which was

EPILEPSY.

G13

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 IS, 20. Inf. Digitalis (Dublin) 5(j. n. et m,

16th. — Pulse IS, IS, 17. Two bad fits, 1 p.m. and 7 P.M. $iv.

17th.— Pulse 23, 22, 23. Bj- h. s.

ISth. — Two tits yesterday. Pulse 18, 20. 5X-

19th. — Three yesterday ; one in the night ; four in all ; but not so strong.
Pulse 24, 25, 23. 5(3. n. etm. Passed a large quantity of urine.

20th. — Only one yesterday; none in the night. Pulse 23, 24. Bj-
n. et m.

21st. — None; but she has had more headache. Pulse very variable,
30, 20, 15. Bj- u. et m.

22ud. — One in the night, very slight. Pulse 25, 23. Not so much head-
ache. 3]. n. et m.

23rd. — None in the night ; two in the morning; sleepy ; Pulse,
ten minutes after the attack, full, 16, 16. 5X- 11 • et m. ; has been
sick.

24th. — Has been sick again. Pulse 23, 24. 3X- n. et m.

25th. — A little sickness; two fits since yesterday. Pulse 25, 30, 27.
5x. n. et m.

26th. — Little sickness: very sleepy ; speaks thick ; looks silly. Pulse 24.
Pulv. Jalap gr. v. Cal. gr. iv. Olii carui. iqj. M. ft. Pil. ij. h. n.
sum. Inf. Senn. Bj- Magues. Sulph. 5j. Acid. Sulph. iqiv. Syrup.
Zingiber. 5j- niane.

27th. — Was very ill all yesterday ; but no fits.

28th. — Acid. Hydrocyani. dil. nqiij. ex aqua Bj- t. d.

29th. — No fit.

30th. — Acid. Hydr. dil. rqiv. aq. Bj- t. d. Pulse 15, 16.

Dec. 1st. — Very queer all yesterday ;. a very bad fit this morning.
Pulse 25, 26. Inf. Digitalis Bj- Quin. Sulph. gr.j.t. d.

2nd. — Better. Pulse 20, 21, sharp. Inf. Digitalis B'fs. Quin. gr. fs.
t. d. Pil. Cal. co. gr. v. om. 11.

3rd. — Pulse 22, 20, small. Inf. Senna B'j - Magn. Sulph. Bl’s- Tiuct. Card,
co. Jij. statim. Inf. Digitalis Bj- Quin. Sulph. gr. fs. n. etm.

4th. — Creosote iqj. t. d. Pulse 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 iqj. t. d. Pulse regular, 20, 21. Ext. Colocynth. co.
gr. iv. om.

8th. — Pulse irregular, 16, 18.

9th. — Pelt, yesterday, for some time, as if she would have a fit ; but
had none. Went off with crying ; cried for an hour. Creosote iqj. t. d.

10th. — Ditto. Pulse 20, 20.

11th. — Creosote rqj. t. d. Pulse 21.

12th. — Ditto. Pulse 20, 18, 18.

13th. — Very poorly all yesterday; headache; bowels purged; no sick-
ness; bad fits at half-past nine; interval nine days. Pulse 25.

15th. — Conf. Arornat. 3fs. (purged). Mist. Cretce Bj- Spirit. Menth.
Pip. 3j. bis in die. Pulse 22.

614

HUMAN BRAIN.

1 6ili. — Bowels quieter.

17 th. — Hep. Mist.

18tli. — Inf. Digitalis 5j. n. ct m.; fit about 5 r. 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. Digi-
talis 5ifs.

22nd. — Fit yesterday ; not ill to-day ; no sickness or headache ; pulse
full, IS, 18 ; Creosote iiy. b. d.

23rd. — Quite comfortable; ditto.

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 be-
coming 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.

15th. — Continue Argent. Oxyd.

22nd. — Has not had any fits since the last report. Rep.

23rd. — One fit.

25th. — Three fits, not so severe.

26tli. — Three in the day, slighter, very numerous in the night. —
Continue. Did not lose the use of leg, only of the hand.

Feb. 3rd. — Three, violent.

4th. — One rather slight.

15 th. — 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 intermission ; at least two in the hour.

March 1st. — 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.

20tli. — Rep.

April 18th. — Had several fits this day; but much slighter than they
have ever been before ; very different.

May 5th. — None since; has been in the country — Blaekheath; has
continued the pills.

21st. — One bad fit.

23rd. — Two fits, much lighter ones.

June 7<h. — One fit.

EPILEPSY.

G15

21st.— One fit.

2Sth. — 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 ex-
amined,* “ 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 unfavour-
able, and little can be expected from treatment ; but not so
if the disease, as is generally the case, results from func-
tional 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 ap-
pears 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 attended to. Indeed, no course of tonic
medicines ought to be commenced without first giving a full
dose of calomel combined with colocynth, rhubarb, or
some other purgative, and the character of the faecal eva-
cuations 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
repetition of the attacks. Even the application ol leeches
either before the attack, at the time, or afterwards, only

* Reports of Medical Gases, by R- Fright, 1831, vol. ii. p. 553.

G'lG

HUMAN BRAIN.

does harm. Foville* is in favour 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 ac-
cording to the extent of the disease may therapeutic agents
be pushed ; but in almost all cases hydrocyanic 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 not be carried to any extent. Three or
four leeches every now and then will do good, whereas
twelve or twenty woidd excite the heart. I have also
found a belladonna plaister 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
Pharmacopoeia 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 exhi-
bition was followed by the cure of the disease. I have,
however, frequently given it since, but with only temporary
benefit, and some of the cases have recovered with other
means ; and 1 have treated successfully with other medi-
cines 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, lias 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 witli Ins
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 follows : —

* Diet, dc Med. et de Chir. Prat., vol. vii., 1831.

EPILEPSY.

617

“ 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, my memory failed me for some minutes before the fit, so that I
could not explain what 1 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 1 recovered iny senses, and I was rpiite
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 ’.n the street at the time. I had another
attack the next night, while in bed : it was not so violent as the first, but
it was some time before I recovered my senses.” I ordered him an ape-
rient, and having got his secretions generally in a healthy state I gave him
the sulphate of zinc — ordering a total abstinence from stimidating 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
before ; and he had notice of their coining. 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. Eor the last day or two he has found him-
self sighing very deeply, and quite unconsciously. Has felt a little dim-
ness of vision when about his work. Ordered, — Calomel gr. v. Jalap

gr. viij. 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 ; lie has left oil the Sulphate of Zinc
for the last six weeks — only aperients since. Ordered to renew the
Zinc.

March 2nd. — 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 of January 1843 till August 1844, when lie 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 off 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 head-
ache, and cold shivering-, which he could not attribute to indigestion, as lie
has strictly observed my rules of diet, lie had recourse lo the Cal. and
Jalap, with the aperient draught, which operated well, but did not avert
the attack, lie is free from headache, and feels well, only sore from the

618

HUMAN BRAIN.

cramp. Pulse 76 ; tongue dry but clean. Ordered, — Zinci Sulph gr. ij.

t. d. Pil. Bbei 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 tit for nearly
two years and a half.

The following case illustrates an important point in re-
gard to the advent of epilepsy, namely, that it is often pre-
ceded 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 approaching
epilepsy.

Case 88. — I was consulted on the 11th of November 1837, 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 particulai-s : —

“ Memorandum of ray 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 ; conti-
nued in this state from March to November, when he quite recovered ; the
succeeding 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 pro-
fusely, he fainted at the time, and again the next morning ; he conti-
nued daily to faint, sometimes from six to eight times in an hour ; never
struggled or changed colour 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
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
anyone by the feel of them 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.”

EPILEPSY. G19

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 a while I gave him the sulphate of zinc in
doses ot two grains, 'this he continued for about three months, and ulti-
mately 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 con-
firmed and the fits do not occur so frequently. For a know-
ledge 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 prepared and of the
latest gathering. The mode of the administration is to begin
with 3j. of the infusion every night at bed time, increasing
it after a week to gifs., and after another week to gij.,
beyond which it is rarely necessary to go, and continuing
it till sickness of the stomach and dilated pupils arc
observed, when the dose is to be diminished by gfs. or gj.,
till the maximum dose that can be borne without inconve-

* VoJ. 36, p. 1473.

G20

HUMAN BRAIN.

nience be ascertained, which quantity is to be taken for
two or three months. Given in this way its administra-
tion is attended with no inconvenience beyond an occa-
sional 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
avocations.

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. Mi ink* has made some excel-
lent observations 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 constitution
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 symp-
toms, 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 pub-
lished an essay on this subject, states that he prescribed it
with great benefit in haemorrhage generally, but especially
in menorrhagia.

In relating a few more of the cases m which 1 have
found the digitalis beneficial, I shall again advert to its use
when there is any disturbance of the uterine functions, and

* Dr. Munk on the Action of Digitalis, p. 295, Guy’s Hospital Reports,
for October 1844.

EPILEPSY.

021

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, number-
ing the pulsations in the quarter, as related in the next case ;
after 1 have employed it for some months, I am then satis-
fied with a report every other day.

Case S9. — November 7th, 1S4G. — A. B. C., set. 16, a tall, delicate-
looking girl, with a pleasing countenance, lias 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 disease. Father and mo-
ther 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 grandmother 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 iu 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 beginning 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 quar-
ters. Ordered, Inf. Digitalis (Dublin Pharmacopoeia) Jij- hac 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. Jij. h. n.

9th. — Pulse 29, quarter of minute ; Jfs.

10th. — Pulse 20 ; 5yj.

11th. — Pulse 20 ; 3j.

12th.— Pulse 20, 13, 18; 5x.

13th. — Pulse 19.

14th. — Has had several threatenings, but no complete attack; pulse
22, 19, 19, 19 ; 5x.

15th. — Pulse 19; Jj.

16th. — Pulse 18 ; Jx.

17th. — Pulse 21, 21, 21. 3 i fs . 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 thi.s week ; it is now always very profuse.

18th. — Pulse 19 ; Jifs.

19th. — Pulse 20 ; 5>v*

20th. — Pulse 16; Jij.

21st. — Pulse 16, 10; no complete attack, but several tremblings;

C22

HUMAN BRAIN.

hiccup and sickness. Continue Pil. Rhei. co. gr. viij. Me nocte. Cal. gr. ij.
Inf. Senna £j. Syrup. Zingib. 5j. Magn. Sulpli. 5ij. Acid Sulph. dil.
Il^iv. mane.

22nd.— Pulse 16, 17, 18, 17.

23rd. — The aperient has acted very freely ; the pulse is sharp and full —
20, 18; 5x.

24th. — Pulse 20 ; 5xij-
25th. — Pulse 18 ;

26th. — Pulse 18, 17, 18 ; vomited this morning ; 5vj. Pil. Rhei co.
gr. vj. Cal. gr. j. Inf. Senn. 3j. Magn. Sidph. 5j- Acid Sulph. dil. iqy.
Syrup. Zingib. 5,1 • mane ; to be taken to-night, if the sickness continues.
27th. — Pulse 17 ; Pil. et H. ut supra liac nocte.

28th. — Pulse 20 ; two fits.

29th. — Pulse 20; one fit ; Rep. Haust. Digit. £vj.

30th. — Pulse 19, 16, 18 ; Inf. Digit. 3j. Pil. Rhei co. gr. v. p. r. n.

December 1st. — Pulse 20; no attack; §j. 5ij-

2nd. — Pulse 18, 17, 18, 18 ; one nervous attack ; 5X*

3rd. — Pulse 16, 18, 18, 18; none ; 3X>

4th.' — Pulse 20 ; three slight ; 5x’j-
5tli. — Pulse 18, 20; several; 5xy •

6th. — Pulse 18, 20; four slight; 5xb •

7th. — Pulse 20, 18, 20, 20; three slight attacks; 5x'j-
8th. — Pulse 18, 20, 18; 3!]'.

9th. — Pulse 18 ; Pil. Rhei gr. v. h. n.

10th. — Pulse 18 ; one or two slight attacks; Rep. II. Digit. Li-
lith.— Pulse 19, 19, 19 ; sij.

12th. — Pulse 20 ;

13th. — Pulse 20 ; 5^-

14th to 17th. — Repeated nervous attacks, but slight; 5xiy-
18th. — The same ; Ilyd. Chlor. gr. iij. h. n. Haust. Aper. mane.

20tli. — Pulse 19, 20; omit the Digitalis.

2lst. — Pulse 20, 19 ; Rep. IIs. Digit. 3xiv. The nervous affections
frequent, and excessively low in the animal spirits.

22nd. — Pulse 18, 19; two more complete fits; Creosote ny. Panis.
q. s. ut fiat Pil. j. ter in die.

23rd. — 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 men-
strual discharge was not so profuse as usual. The nights have been better
since taking the Creosote.

26th.— Pulse 18, 18, 19, 19 ; Creosote iqj. t. d.

28th. — Pulse 18 ; Rep. Pil.

30th. — Pulse 18, 17 ; two nervous ; Rep. Pil. Creosote.

31st. — Pulse 18, 19 ; Rep. Pil.

January 2nd, 1847. — Pulse 18, 17; Rep. Pil.

4th. — Pulse 18, 18 ; Rep. Pil. Creosote.

5th. — Pulse 20 ; Rep.

6tli. — Pulse 20, 20.

EPILEPSY. 623

9th. — Pulse 20, 20 ; Pil. Creosote ; b. d. ; Inf. Digitalis ; gfs. nocte.
11th. — Pulse 20, 20; Rep. H. ; gj.

13th. — Pulse 20 ; Rep. FI. ; gifs, nocte.

14th. — Pulse IS, 16; half attacks less frequent and less severe than
they were ; gifs.

16th. — Pulse IS ; Rep. Digit.

ISth. — One slight.

19th. — Pulse 20, 20 ; slight attacks, not as it used to be: Rep. Digit.
3'j*

20th. — Pulse IS, IS, IS ; gij.

22nd. — Pulse IS ; gij.

24th. — Pulse IS, 18 ; gij.

26th. — Pulse 18, 16, 17 ; gij. Pil. Rhei co. gr. v. h. n. Nervous
attacks less frequent, some days none ; less severe.

2Sth. — Pulse 19, 18.

30th. — Pulse ,17, 16 ; Rep. Digit.

February 1st. — Pulse 17, 16.

2nd. — Pulse 17, 16 ; Rep. gij.

4th. — Pulse 17, 16 ; Rep. gij.

6th. — Pulse 16, 16, 17 ; Rep. gij.

8th.— Pulse 13, 20.

10th. — Pulse 18, 20 ; gij.

12th. — Pidse 19, 20 ; nervous attacks frequent in the last day or two ;
this is the case after aperient medicine.

13th. — Pulse 18, 19, 18 ; gij. ; Creosote ny. 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, gifs, nocte ; ditto, gfs. mane ; omit Creosote ; Hirud. ij. ; singuhe
mamms.

16th. — Menses returned ; slept well.

17th. — Pulse 18, 18, 18; one fit.

18 th. — Another fit, stronger.

19th. — Pulse 36, 18; Iirf. Digitalis gij. Spirit Menth. Pip. 5j- o. n.
Creosote Try. Ext. Rhei gr. iij. Misce fiat pil. j. bis in die sumenda.
22nd.— Pulse 18, 18.

23rd. — Pulse 18, 18 ; gj. o. n. Rep. Creosote b. d.

25th. — Pulse 18, 18.

26th.— Pulse 16, 17, 18 ; gfs. o. n.

28th. — Pulse, 17, 18.

March 1st. — Pulse, 17, 17, 16.

2nd. — Pulse 18, 18; gij.

4th.— Pulse 16, 16.

6th.— Pulse 17, 16, 18; gij.

7 th. — gifs. alt. nocte.

8th.— Pulse 16, 17, 17 ; gij.

9th. — Pulse 16, 17, 16; gifs. o. n.

10th.— Pulse 17, 17, 17.

1 2th. — Pulse 17, 17 ; Rep. If. Digit, gifs.

13th.— Pulse 16, 16, 17 ; gij. o. u.

624

HUMAN BRAIN.

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 ; 5^s- °- n-
18th. — Pulse 20, 20 ; gifs.

19th.— Pulse, 17, 17, 17; Bifs.

20th.— Pulse 17, 17, 17; Sifs-
22nd.— Pulse 17, 16, 17 ; gife.

23rd. — Pulse 16, 16; Bits.

25th. — Pulse 15, 16, 16.

26th.— Pulse 17, 17, 17, 17 ; one fit; Bifs.

27th. — Pulse 22, 23, 23, 23; two fits this night; ^ifs.

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 Pil. Rhei co.
gr. v. every other night ; the last fit very slight.

29tli. — Pulse 17, 17, 17, 18 ; no Digitalis last night; Inf. Digitalis, Bifs.
o. n. Creosote iitj. b. d. Pil. Rhei co. gr. v. p. r. n.

31st. — Pulse 15, 16, 16, 15 ; Rep. II. Digit.

April 1st. — Pulse 16, 16 ; Rep. Digit.

3rd. — Pulse 16, 17, 16, 16.

4th. — Some threatening of an attack.

5th.— Pulse 16, 17, 17 ; Rep. Creosote. Rep. Digital. B'j-

6th. — Pulse 16, 16 ; Rep. Digit. B'j-

8th. —Pulse 17, 16, 18, 18; Rep. Creosote. Rep. Digit. B'j-

10th.— Pulse 18, 20, 20, 18.

lltli.— Pulse 15, 16, 16 ; Rep. Digit. B'j-

12th. — Pulse 16, 17.

14th. — Pulse 17, 16, 17.

15th.— Pulse 16, 17 ; Rep. Dig. B'j-
16th.— Pulse 20, 19; Rep. Dig. B'j-
18tli.— Pulse 16; Rep. Dig. B'j-
19 tli. — Pulse 20, 20; after dinner and exercise.

20th. — Pulse 16, 15; B'j-

22nd. — Pulse 20, 20 ; after trundling her hoop; B'J-
23rd. — Pulse 18, 18 ; B'j-
24tli. — Pulse 19, 20.

25th.— Pulse 18, 19.

27th— Pulse 16, 16, 18 ; Ferri Sulph. gr. j. Creos. li\j. Aloes co.
gr v o. n. She menstruated 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 iry. b. d. Int. Dig. B'j- °- n-

Pil. Aloes co. gr. v. o. n.

28th.— Pulse 16, 16, 18; B'J- 0. n. Creosote inj- FemSulph.gr.
Quinin. Sulph. gr. j. bis in the. Pil. Aloes co. gr. v. o. n.

29th.— Pulse 17, 17 ; B'j- °- "•

30th. — Pulse 17, 18.

May 2nd.— Pulse 17, 16, 16 ; Rep. H. Digit.

3rd. — Pulse 17, 16; Rep. Dig.

j-

El’ILEPSY.

025

4th.— Pulse 16, 16.

5th. Pulse 15, 16, 15; Ilep. 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.

1 2th. — Pulse IS, 18, 17.

14th. — Pulse 16, 17; Rep. Inf. Dig. Ferri Sulphatis gr. i. 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.

17 th.— Pulse 16, 17.

ISth. — Slight fit this morning; sickness and vomiting afterwards;
bowels freely opened. Ord. — Pil. Col. h. n. Inf. Dig. -j. h. n. Omit
Pil. Ferri.

19th. — Pulse 20, 20. Rep. Inf. Dig. jj.

20th. — Pulse 18, 18. Rep. Ferri. Inf. Dig. lifs.

22nd.— Pulse 17, 18.

24th. — Pulse 16, 16. Rep. Omnia.

25th.— Pulse 19, 20, 19. 3ij.

26th. — Pulse 17, 18, 17, at noon.

27th. — Pulse 17, 17, 11a.m. 3>j. Omit Ferri.

28th. — Pulse 17, 16, 17, at noon; in the evening, 17, 18, 17.

29th. — Pulse 17, 17, 18, 18, vespere. Inf. gij.

30th.— Pulse 17, 17, 17, ditto. Rep. Dig. tij.

31st. — Pulse 16, 18. Rep. Dig. ^ij.

June 1st. — Pulse 17, 18, 17, late in the evening, after a long walk.

3rd. — Pulse 15, 15, 11 a.m. Rep. Ferri. Inf. 3 i j .

6th. — Pulse 16, 16, in the evening.

7th. — Pulse 16, 16, 16, 16, vespere.

— Pulse 14, 15, 15. Rep. Ferri. Inf. Digitalis 5ii.

9th.— Pulse 17,16, 0.11.

10th.— Pulse 17, 16, 17. Rep. Digit, gij.

11th. — Aery slight fit, six weeks interval. Pulse 18, 17, 18. gij.

1 Continue Ferri quotidie.

12th.— Pulse 17, 17, 17, 17.

14th.— Pulse 16, 16, 16. Rep. Inf. Digit.

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. — Puke 17, 17, 17, in the morning, after a walk of three miles.
22nd. — Pulse 15, 16, 16. Rep. Omnia.

24th.— Pulse 16, 17, 17.

25th. — Puke 14, 15, 14. Ferri Sulph. gr. ij. b. d.

27th.— Puke 19, 20, 19. 3ifs. h. n.

28th. — Puke 15, 15, 15. Ferri in die Inf. ^ifs. o. n.

30th.— Pulse 16, 15, 16. Rep. Digit.

July 2nd. — Puke 16, 17. Ferri Sulph. gr. ij. in die. Inf. Digit.
’31*8' °- n. Feck quite well ; very few nervous feelings now.

2 H

G2G

HUMAN BRAIN.

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 sometimes attended with injurious effects. The case
receives an additional interest from the clear way in which
it is detailed by Mr. Greenhow, of Tynemouth, 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 cessa-
tion of the eruption he became enormously fat for his period of life, and
acquired a pale, pasty kind of complexion. He has at no time manifested
anv symptom of aberration of mind 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 ol the counte-
nance before described. - ,, , „ i

Mr. S. T. P. has always been prone to derangements of the stomach,

accompanied by great tendency to sickness, which he has been accus-
tomed to encourage by copious draughts of warm water; and by occasional
headache and feverishness. His tongue, always more or less funed has
a swollen, sodden kind of appearance, and is also deeply indented by the
teeth The pulse is regular, rather small, and averages 7 .

His father took a prominent part in the electiou of 1841, and he bem
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,) lie was awakened out of his sleep by a sensation of cramp in the I t
le- which was immediately followed by an epileptic fit. I did not see
him during the attack, which lasted a very short too l
nrich much deranged on the following day. At fiist the attacks .
ceeded one another at regular intervals ; generally between the hours of
4 and 5 a m and were always preceded by the aura epdephea, which
awoke him and gave time to alarm his father and mother, who slept n
?he adSincr room. If at any time lie had a slighter paroxysm, it was
most frequently succeeded by a second on 2

wmmrnrn.

“Vu"tast two years I have been only ve„ occasionally called «

EPILEPSY.

(5.27

see him ; but the epileptic attacks still occur, though less regularly and
with longer intervals. "\ arious modes of treatment having been dili-
gently tried without any very decided benefit, medicine has of late only
been had recourse to when the attack has been succeeded by feverish-
ness or unusual 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 attri-
buted 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 attention to removing the evident derangement of stomach,
which complicated if it wTas not the indirect cause of the epilepsy. All
excitement was strictly forbidden, and a very restricted diet, with ab-
stineuce 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 laxatives. 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 then- suggestion, the Pil. Hydrarg. was
continued until the gums became tender. Afterwards, at Dr. White’s
suggestion, he took the following : — 5k Pulv. Ead. Dictamni. Exotic Jifs.
Pul''; Ead. Zedoar Elav. 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 fr ee eruption was kept up on the arms for several
weeks by the use of the following liniment : — pL 01. Croton 5j. Sp. Te-
rebinthime 3vj. T. La vend. co. 5j. 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. Pie has also tried the Nit. Argenti twice
for about four months, with a few weeks interval between the two courses ;
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 have been frequently and strin-
gently enforced.

On the receipt of this report I wrote to Mr. 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 oc-
casioned by positive disease of the nervous system. I have no doubt
that Mr. S. 1. P.’s attacks are referrible 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 (o
hold out any certain prospect of such n desirable result after so much has

2 s 2

628

HUMAN BRAIN.

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 valueless 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 table
spoonful 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 potatoe. Farinaceous puddings, but no pastry, no
fruit, no preserves, no dessert of any kind ; 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 tiling 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 fatigue ; no horse exercise;
no mental excitement ; no sexual excitement ; to sleep on a mattress, 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.
3ifs. Tinct. Iodin. co. 5j. Spirit iEth. Nit. gifs, sumat cochl. min. ex cyatho
vinoso aqua bis in die sumat.”

“ Tynemouth, 21st November 1845.

“ My Dear Sir, — I have intended writing to you for some time past,
having in the first instance 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 with-
out, 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 fol-
lowed your plan: in other respects he pursues it strictly.”

Tynemouth, 15th February 1846.

in

our

“ My Dear Sir, — I almost fear you must have thought me inattentive
allowin''- so long a period to elapse without again giving you a report ot
° - ’ ■ ’ ^ it necessary to

thought

um patient’s progress. I have not, however,
trouble you sooner, as no material change has taken place since my a »
and vou had led me to expect the improvement would be very slow, no

EPILEPSY.

029

Las 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 thiuk 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 state-
ment of his case on these points during the same period in each year since
he was first seized. I ought also to mention 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. 27 th,
Nov. 80th, and Dec. 2nd; 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
treating epilepsy with Digitalis ? I remember to have seen a short ac-
count of it in one of the J oumals, but too brief to enable me to judge of
its merits.

“ Believe me, my deal- Sir, yours very sincerely,

“ E. Head lam Greenhow.”

In answer to this I wrote to advise the omission of the oxyde, as I was
afraid of discoloration of the skin, as he had taken it four months, and I
recommended the use of the Digitalis as prescribed by Dr. Corrigan,
having now had a good deal of experience of its efficacy.

“Tynemouth 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
i 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;
i 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
I he did not become entirely insensible, although he had the aura , convul-
sions, and I033 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. Loud.). On April 1st, lie
was very sick ; pulse 60, weak and irregular ; headache, pains in the
limbs, and along the course of the spine. The Digitalis was now omitted
Tor three nights, when his pulse having resumed its natural character, he
recommenced with the original £ 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 Digitabs
ceased to affect the regularity of the pulse, which, contrary to its former

630

HUMAN BRAIN.

and more usual effect, was henceforward uniformly increased in frequency
as the patient came under its influence. The draught was omitted on the
13tli of April, but resumed on the 14th. On the 16th the pain had in-
creased ; 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 resem-
bling measles, which extended over the back, shoulders, chest, abdo-
men, 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 20tli, the tongue had
the tremulous character observed in delirium tremens ; and on the 22nd
his hands were also tremulous. On the 25th of April he had a threaten-
ing, 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 lj- oz.
(equal to 3 oz. P. Lond.), but varied according to circumstances. The
eruption continued with but slight alteration for many weeks, only acquir-
ing a blueish 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 had uot, however, entirely discontinued
it, when, on the 2Sth, 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 eye-ball. 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
commencing 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 disorder 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
intervals. I am satisfied that Digitalis occasionally exercises a very
decided influence over the complaint, and I think that it may prove suc-
cessful in a few instances ; but my experience leads me to think its admi-
nistration requires great caution, and 1 should scarcely again peisist so

EPILEPSY.

G31

loug in its use as 1 have clone in Mr. S. T. P.’s case. Begging you to
excuse all defects, as I write in haste,

“ Believe me, my dear Sir, very sincerely yours,

“ E. IIeadlam Greeniiow.”

List of Mr. S. T. P.’s attacks of epilepsy, between the 16th of No-
vember and 12th of February in each year, since 1841 : —

1S41, November 16th. — Two slight attacks; first at 21 A.M., and se-
cond at 7 a.m.; was each time awoke out of his sleep by the aura.

23rd. — Oue attack at 7 a.m.; was awoke by the aura.

29th. — Was awoke at 7 a.m., by the aura, followed by slight convul-
sion, without becoming insensible.

Dec. 13th.— An attack at 61 a.m.; was again awoke.

1842, Jan. 1st. — An attack at 5 a.m.; ditto.

Deb. 26th. — Two attacks whilst asleep, each time being awoke, as
usual, by the aura ; 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, aud during the remainder of the period comprised in the
table, of half-grain doses 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. Dicetamni 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.

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. 11th. — An attack at 6 a.m.

23rd. — 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
farinacem, from April until the commencement of 1843. All stimulants
had been prohibited from the first.

Nov. 11th. — An attack at, 3 a.m.

Dec. 2nd. — Ditto, ditto, 7 a.m.

22nd. — 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 1 always heard ol his attacks.
Three or four times during the year 1844 1 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.

G32

HUMAN BRAIN.

Hyd. Pil. Rhei. co. Ext. Hyoscyami— and occasionally Infus. Gentian or
Calumbae, with Carb. Socbc, 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. 2nd. — Ditto, at 4 a. m.

9th. — Ditto, at 4 a.m.

1846, Jan. 3rd. — Ditto, at 3 a.m.

Feb. 2nd. — 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 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 resultedin the destruction of the right eye ; since
which his general health has been very much improved, and although still
subject 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 circum-
stances which have since come to ray knowledge, I am disposed to be-
lieve, 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 superintended 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 consulted, is now
trying it, but I have not as yet heard the result.

“ Believe me, my dear Sir, yours very sincerely,

“ E. IIeadlam Greenhow.”

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

EPILEPSY.

038

first attack occurred 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 inflammation 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 inspiration. I asked him how he knew
he was going to have a fit; he said by uneasy sensa-
tions 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 respiratory 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. Hyoscyani. 3j. Ant. Pot. Tart. gr. fs. Magn. Sulph. 3ij. Mist.
Camph. 3j.

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 homoeopathy for two years ; he tried mcsme-

634

HUMAN BRAIN.

rism ; 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 fari-
naceous diet, meat diet invariably making him too ple-
thoric ; 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, con-
tinued for two months, and then omitted for a fortnight,
the conjunctiva being carefully watched, to observe any
change of colour. 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, ^ifs. Tinct. Iodin. co. 3j. Spirit iEtli. Nit. 3ifs. 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 fourteen days, for twelve months. lie
has now been well nearly four years, and has quite reco-
vered his mental activity. He has been closely occupied
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 otvn

words : —

Qase gq, « 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.

« ia the beginning of June 1838 I had an attack. I was put on vciy
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, lor
two years ; during which time I abstained from beer, wme, and spmts,
but did not rigidly adhere to the diet recommended by Brodie.

tTILEPSY.

035

“ 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 *1 certainly often felt symptoms of an attack. 1 discontinued the tin,
on a return of my old complaint, 21st Jan. 18-41. On the 27th April of
the same year I had an attack; again, July 24th; and on the 5 th October.
I observed no particular diet, but took beer and wine in small quantities.

“ On 23rd October 1841 I left England, and had no attack until May
1S42 ; again in October 1842 ; and during my stay in the colony, I had
them about ouce every three months. Had an attack 5th of July (the day
1 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
1 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. Tthei 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 13tli.

January 12th, 1845. — Has had no symptoms whatever of an attack;
returned to the use of the silver in this form. 9>. Argent. Oxyd. gr. xxiv.
Ext. Col. co. 3j. Cal. gr. ij. Conf. Q. s. fiat Pil. xx.

April 9th. — To leave off Argent. Oxyd., and take a purgative ; feels
quite free from all symptoms.

18th. — Weak; loss of appetite; to take Quinine and Eerri Sulphas,
gr. j. t. d.

June 24th. — Peeling 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 , set. 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 regu-
larly, but suffers a good deal of pain during that period ; she has no leucor-
rhoea or headache either before or after ; her memory is not at all affected,
and she has no waraing 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 Jt. Argent. Oxyd. gr. j. Conf. 28, ut fiat Pilula, b. d.

Oct. 28th. — Her medicine was altered to Pil. cap. ter in die.

6 36

HUMAN BRAIN.

Dec. 19th. Has continued the medicine regularly up to this time but
had an attack between 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. Potassae Jifs. Tinct. Iodine co. 3j.
Sp. iEtlier Nit. §j. mist, cujus sumat. coch. min. et cyatho vinoso aquae
bis m die. 1

Jan. 2nd, 1845.— She was not better, and the Oxyd. of silver was re-
commended.

Feb. 20th. — 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.

i3th. — Has had a half attack.

27th. — lo continue the medicine as before, three times a-day ; has had
no further attack.

2Sth. — 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. Potassae, &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.

Sept. 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.

22nd. — She has had a very slight attack this morning, which lasted a
few miuutes, and she has since slept for two hours ; a very short time
after she was enabled to resume her employment 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 23rd, 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.

Case 93. — April 13th, 1846. — Jane Brown, set. 24, single, healthy
looking, — her countenance not at all indicating any cerebral disease, —
states she has been subject to fits of an epileptic 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

EPILEPSY.

(337

then came on much more frequently, sometimes only a fortnight, and at
other times there has been two 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 ;
and when, after the weakness and general debility occasioned by the fits
have passed off and her health and strength is returning, she is again at-
tacked. The fits are of a strong convulsive 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 shordd soon get strong and well ; has not been able
to go to service on account of them. Ordered, — Argent. Oxyd. Pulv.
Acacias gr. j. ft. Pil. xviij. t. d. Nit. Cal. co. gr. v. h. s. Si alocis con-
stipe t. d.

Slav 6th. — Has continued well ; to continue the medicine.

26 th. — 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.

2Sth. — 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 tole-
rably 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.

23rd. — 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 can-
not 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 re-
sume 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 sto-
mach. Ordered Bismuth Tris. Nit. gr. iv. t. d.

Sept. 22nd. — 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.

22nd. — Says that for the first three days after leaving off’ the medicine

G 38

HUMAN BRAIN.

her stomach was uncomfortable; but that after taking an aperient pill it
became all right. Ordered to renew the medicine.

Kov. 19th.- -Feels well; no pain in the head ; stomach comfortable;
sometimes a little pain, but not much. Continue the medicine.

Dec. 2nd. No fit, but was very uncomfortable two days ao-o as if
she was going to have one, but it passed off, and she now feels pretty
well. Ordered to continue the Argent. Oxyd.

1S47, Jan. 4tli. 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
gums of the lower jaw ; had a slight fit on March 9th, during the men-
struation period; interval nearly six months; the last on the 22nd of Sept.
Ordered Zinci Sulpli. gr. ij. t. d.

31st. Bismuth Tris 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 iqj 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. — Has 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 occur-
red 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 favour. He states that he
has found more good from the vinum ferri than other
tonics. lie 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 favourite or
usual mode of treatment ; and if I were called upon to
name any single chug 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,

* Medical Gazette, vol. xxviii. p. 376.

EPILEPSY.

G39

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 some-
times produces strangury, and therefore the patient must
be forewarned of this or carefully watched. Occasionally
turpentine has done good in virtue of its anthclmentic pro-
perties. 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 laboured
for some time under epilepsy, with the oleum terebinthinae.
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 messenger said he
was supposed to be dying. He was only intoxicated, how-
ever, by the free dose of turpentine he had taken. The
next morning 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 inter-
esting ; they show that irritation of the stomach or intes-
tines may be sufficient to cause the fit ; they illustrate
excellently 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 complaint by such simple means, the cause of his malady,
and the certainty of his having got rid of that cause, being
both 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 unfre-

640

HUMAN BRAIN.

quently consulted by patients to whom it has been unsuc-
cessfully administered. In the following instance it had
been given very freely by a very intelligent 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 ; 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 sensation
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-lialf ago ; but not more than a wine-glass of blood came
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 ; bad several miscarriages ; complains of great heat
on the top of the head and over the eyes ; youngest child twelve last
J uly ; two miscarriages since ; the last is about ten years ; it is five
mouths since she had any show.

March 6th, 1847. — Pulse 16; dose5ij. h.

7th. — Pulse 14, 18. 5>tj-

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 off 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. lthei §fs. Tinct. Aloes co. 5>j- Tinct. Card. co. 5j. o.n.

20th. — One fit. Loss of limbs for above an horn-.

23rd. — Continue the medicine.

April 14tli. — Argent. Oxyd. gr. j. Hydr. c. Creta gr. fs. 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.

EPILEPSY.

041

31st. — Has continued the warm baths three times a- week ; is won-
derfully improved in appearance ; looks cheerfid, and countenance not so
pale; has continued the Argent. Oxyd. gr. j. bis in die. No fit of any
kind. Savs 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, and that they now
pass off with a slight perspiration about the eyelids. Still troubled with
a feeling of wind in the stomach. Ordered, 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.

Jidy 3rd. — Peels altogether much better ; does not suffer so much
from the faintness ; has left off the warm baths, but lias 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 head-
ache. Argent. Oxyd. gr. j. Opii. gr. 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 structures. These may
be divided into malignant or non-malignant, according 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 tumours is extremely unsatis-
factory both in a therapeutical and physical point of view.
In other regions all tumours are highly interesting to the
surgeon, both medically and chirurgically ; 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 tumours, there is not
much to be said, though l agree with Dr. Abercrombie that
we should not consider them all as hopeless. The system

2 T

642

HUMAN BRAIN.

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, fiom the want of accuracy in their
detail and the impossibility of ascertaining the limits to
which the influence of any tumour 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 diseases of the brain are included those of the
membranes also. The first of these that we have to con-
sider are sometimes peculiarly interesting to the surgeon ;
I allude to those tumours of the dura mater which, perfo-
rating the skull, make their way outwards. Such is not
often the progress of cerebral tumours, but there are several
on record. Dr. Abercrombie refers to them in the follow-
ing words :* — “ Tumours 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 originally excited by
injuries : and in others an injury appears to have accele-
rated the process by which the tumour was making its
way through the bone. When these tumours have been
rashly meddled with by incision, death has generally been
the consequence.” The surgeon is often required to decide
on the nature of tumours 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 Academy of Surgeons, Paris, was
one of the first who pointed out the nature of the pene-
trating tumours of the dura mater. His paper is published
* Abercrombie, p. 313, op. cit.

ORGANIC DISEASES OF THE BRAIN. 643

in the thirteenth volume of the Memoirs de l’Academie
Roy. de Chirurg. 17S4. He states that the profession
mistook the nature of these tumours, because they could
not believe that a soft substance, such as these tumours,
could penetrate a hard substance like the bones of the skull.
“ Cut,” says he, “ does not nature show us similar pheno-
mena 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, without striking his head, but still
he felt it was disturbed by the accident, and he had great
difficulty in rising. The accident was not accompanied
with any pain ; but the disturbance of the dura mater
appeared to last for four months, and then insensibly dis-
appeared. After a perfectly 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 or elevation. On the following day a small
tumour appeared about the size of lialf-a-crown, a little
raised, and with a pulsatory movement. The tumour in-
creased 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 pres-
sure, which easily made it disappear, but gave rise to such
giddiness that it frightened him. He was seen by a great
number of surgeons ; 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,
“ 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

2 t 2

G44

HUMAN BRAIN.

Louis accounts for by supposing that the pain was occa-
sioned by the pricking of the sharp points of bone from
the edge of the opening in the skull. But as loss of con-
sciousness 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 tumour was not even adherent to the skin ; he sim-
ply says that the tumour was covered by a distinct mem-
brane, and of the same consistence as the ordinary sarco-
matous tumours, without, elasticity or fluctuation 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 endeavoured, 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, en-
titled, ‘ Novum Orgauum Scientiarum in which he says
that an exact observation of facts, and a correct and careful
induction, is the true method of understanding and inter-
preting 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 as-
sured that they do not contradict one another, we may be
secure of deducing some useful truth, which will lead to
new discoveries. 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 recognises as theory that which is based upon tacts ;
examples must follow all rules, and must apply or rather
must form them.”

The brothers Wenzel were the next who published facts
in confirmation ot those of Louis ; and it is noAV universally
admitted that fungoid disease of the dura mater will some-
times cause aborption of the bones of the skull, and appear
externally.

ORGANIC DISEASES OF TIIE BRAIN.

645

Cruveilhier* divides cancerous tumours of the dura mater
into two classes : the one formed at the expense of the ex-
ternal layer, the other of the internal. The latter are the
most frequent. There are also tumours which originate in
the sub-araclmoidal cellular tissue, and then, causing adhe-
sion of the two layers, it becomes difficult to say from whence
the disease first sprung.

But more numerous still are those enceplialoid tumours
which spring from the tissue of the boue 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 pro-
nounced as springing from the dura mater alone.

Dr. Walshe has shown that these perforating tumours 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 tumours 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
tumours are occasionally thus imbedded. Within the last
year I have had two cases under my care in St. Thomas’s
Hospital, of simple sebaceous tumours 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
* Anat. Pathol., liv. viii. p. 2.

646

HUMAN BRAIN.

depth. I lie tumour was sott hut 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 tumours ? The following are tolerably certain, but
they are not so unerring 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 sen-
sorium 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 sharp
pains which generally attend the growth of cancerous disease.
When ulceration takes place, the real character of the disease
is unmasked, and no one can mistake it ; but death gene-
rally ensues before this stage is arrived at.

There is no portion of the dura mater in which these
tumours are not occasionally found, varying of course in
their effects according fo their situation. They have been
found attached to the falx and the tentorium. Andral
relates a very interesting case of osteo-fibrons tumour at-
tached 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 tumour was apparently
owing to a blow received four years previous to death.
“ Immediately after the fall he experienced no uneasiness ;
subsequently, 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 followed 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

* Andral, p. 2, op. cit.

ORGANIC DISEASES OE TI1E BRAIN.

647

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
between 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 permanent 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, says* —
“ Cancerous productions occur in the brain in both the
tuberiform and infiltrated lorms. The size of tumours 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. Tumours 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 in-
stances. Cancerous tumours appear in some cases actually
continuous with the surrounding brain ; in others they are
said to be separated from this by cellular membrane, assum-
ing 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 disease 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 in eight, in both hemispheres in two. In nine-
teen 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

* The Nature ami Treatment of Cancer, by Walter Hoyle Walshe, M.P.,
1846, p. 888.

648

HUMAN BRAIN.

nineteen cases the optic thalamus, in two the corpus stria-
tum, and in one botli 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 secondary one. I\ot 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 gene-
rally so. Its presence is generally indicated by the inflam-
mation 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 character. It also is an instance of the cause
of death, being the inflammation and serous effusion occa-
sioned by the tumour, and not the tumour 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 mouths. This

child, after having been inactive and sleepy for several months, was seized,
on the 9th of August 1831, with an epileptic tit, 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 coloured, and notwithstanding the daily use of the mercurial
ointment and calomel, with scammony, until the 24th (amounting to
6,0 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
colour, and the child was apparently well. Medicine soon after discon-
tinued ; but, however, before long, he again gradually became sleepy and
forgetful ; and he would frecpiently 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 exteut. 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. Bleed-
ing, purgatives and blistering were directed ; but the parents feeling con-
vinced of the inutility of these measures, declined adopting them. lie died
on the 24th, having laid two days in a state of coma.

Post-mortem appearances. — On cutting through the dura mater, the

* Med. Gaz., x. p. 191.

ORGANIC DISEASES OF THE BRAIN.

G 19

braiu 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 dis-
tended by fluid; the septum lucidum bulged in from the pressure of the
fluid in the opposite ventricle ; the arachnoid lining the ventricles was much
thickened : the quantity of fluid contained in both ventricles was about six
ounces.

On proceeding with the section of the left hemisphere, a tumour was
discovered in the posterior lobe ; it was about the size of a hen’s e°-o-; but
not perfectly homogeneous in its texture ; the most external portionTioked
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 tumour, 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 grey white colour, slightly granular on
section, with claws, as it were, shooting out from the centre ; it was sepa-
rated from the posterior cornua by a very thin layer of medullary matter,
and the thickened arachnoid which fined the ventricle. The rest of the
brain perfectly healthy.

The non-malignant tumours and membranes of the brain
are the fibrous, osseous, tubercular, hydatid, steatomatous,
fleshy or kidney-like tumours : 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 pre-
sents the same physical and microscopic characters in the
brain as elsewhere. The situation of it in the brain varies
much, but it is not se 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. Dennis Green, in an admirable paper on this sub-
ject/ 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 1 17 cases of phthisis
* Med.-Cliir. Trans., vol. xxi. p. 192, rend Jan. and Junu 1812.

650

HUMAN BRAIN.

among adults. And Lugol assures us that in his extensive
practice at the Hospital de St. Louis, he has seen only
eight cases of the disease ; in four, the tuberculous matter
occupied the cerebrum ; in three the cerebellum ; and in
one the pons Varolii. In six of these eight cases no symp-
toms existed during life ; and M. Lugol affirms “ that the
diagnosis of cerebral tubercle is involved in the greatest
obscurity.” I)r. Abercrombie only relates one case from
his own practice, which occurred in a man 34 years of age.
“ In children, on the contrary,” says Dr. Hennis Green,
“ tubercle of the brain is, comparatively 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 affec-
tion confined to the brain. Tubercles or tubercular deposit
were invariably found at the same time, either in the tho-
racic 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, by 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 ex-
ternal strumous sores internal disease is excited. In this
case the internal appeared to be dormant, while the ex-
ternal was going on, and as soon as the external was cured
the internal disease appeared.

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 5j- 1. d., and

ORGANIC DISEASES OF THE BRAIN.

G51

the Tiuct. of Iodine to the chest, ns 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 ap-
pearance, 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 hos-
pital 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 19tli 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 becoming 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 he 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. Mem-
branes healthy ; convolutions 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 hypertrophy of its tissue. It is
doubtful whether this fleshy appearance is the effect of re-
peated dilatation of its vessels, or a true morbid growth.
I am not aware that it has been connected with any peculiar
symptoms during life.

Still more frequently do we find this portion of the pin
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 occasionally the predisposing
causes of apoplexy.

Among the morbid adventitious structures which are
met with in the brain, we must not omit to mention hsema-

652

HUMAN BRAIN.

toma, as it has been designated by Dr. Hooper in his
illustrations of diseases of the brain. It is doubtful whether
this disease is anything but a form of fungus haematoides.

Dr. Hooper has given a very beautiful drawing of this
disease, which he thus describes : “ This tumour 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 con-
volutions 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 colour, with portions here and there of
a coagulated blood-like substance.”

“ The circumstances,” says Dr. Walshe,* “ most dis-
tinctly permitting the physician to affirm that a tumour
exists within the cranium, are, the existence for a consider-
able period of intense cephalalgia, especially if 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 paraly-
sis 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 combi-
nation of circumstances will not very commonly exhibit
itself.”

Dr. Abercrombie does not attempt to connect any par-
ticular symptoms with the various forms of organic' dis-
eases, but he gives a very interesting outline of the prin-
cipal modifications of these symptoms in the aggregate, of
which the following may be considered as an abstract : —

Eirst — Long-continued and severe headache, the pain
varying both in scat and severity, sometimes occurring in

* Op. cit., 495.

ORGANIC DISEASES Ol'' THE BRAIN.

G53

regular paroxysms, leaving intervals of comparative or com-
plete 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 ag-
gravating 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 pe-
riodical 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 attention especially
to the brain. In vomiting from dyspepsia, the headache 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 the smell ; ptosis or paralysis of
the upper eyelids ensues ; and lastly, the intellect gradually
becomes dull and the memory imperfect. All such symp-
toms must of course depend on the exact seat of the tumour ;
the loss of power in the different nerves depending on
pressure either of the nerve or of its ganglion. When the
tumour 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 tumours 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 ot
the muscular system, and the result of t his excitation — con-
vulsions. Sometimes these convulsions appear under the
regular form of epilepsy, but generally more irregular ;
sometimes violent paroxysms of headache precede the con-

654

HUMAN BRAIN.

vulsions, which are not usual in functional epilepsy.
Tubercles in the cerebellum, in the tubular neurine of the
hemispheres, pons Varolii, and crura, will give rise to these
convulsions ; also spiculse 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 para-
lysis 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 stomach, 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, passions
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 in-
tervals, and very suddenly, without any previous sickness.
There are in general uneasy sensations referred to various
organs, by which the nature of the disease may be disguised
in its earlier periods ; but after a certain time symptoms
referrible 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
* Abercrombie, p. 321, op. cit.

ORGANIC DISEASES OF T11E BRAIN.

655

must beware of being misled in regard to the nature of the
complaint, by observing that the symptoms in the stomaeh
are alleviated by a strict regimen, or by treatment directed
to the stomach itself. If digestion be impeded, from what-
ever 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 apoplexy of a slight transient character, until
the repetition of the symptoms rather frequently and with-
out any great increase in severity shows that they cannot
be dependent on effusion of blood ; for when the effusion 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 affec-
tions 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
tumours of the brain may be formed and grow to a consi-
derable 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

656

HUMAN BRAIN.

liad known for many years, and was in the habit of seeing
him frequently. 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 con-
stitution 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 pa-
ralysis. 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, set. 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 lie 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 «i little more on the right side than the opposite. The face is
decidedly, though slightly, drawn to the right side ; the tongue is pro-
truded 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. 3j. ad lb. Ilirud. xij. lotio frigida. Pulse
slow and feeble.

1 0 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. 6tl8- horis. Emp. Lyttm 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

ORGANIC DISEASES OF T1IF, DRAIN.

057

the night. Bowels not opened ; they are not generally obstinate ; pulse
50, sot't and regular; perfectly rational, answers immediately and dis-
tinctly ; pupils quite natural ; tongue furred in the centre, flabby and
indented on the side; no inclination for food or drink.

Ord. — Cal. to be continued, and hair to be cut very short. Hep. Enema
Terebinth.

5 p. M. — Enema has returned immediately ; bowels have not acted ;
head very uncomfortable, but the intellect intact ; pulse 5 6 ; head hot.

Ord. — Olei Tiglii i)\j. Before this was given, the bowels acted. C.
Crueutm temporibus ad jjviij.

10 p.m. — Better; head more comfortable. Ord. — Cal. gr. iv. bis 4ta
hora postea 6 til hora.

22nd. — Has had a better night ; pulse 56, soft. Bowels open, urine
abundant. Tongue cleaning ; decidedly better ; continue the calomel.

23rd, 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. — Iufus. Senna
gij. Magnes. Sulph. 5 fs. Syrup Zinzib. Jij.

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. — Gargarisma so dm chloratis Jj.
ad 5 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. 31. — 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. Peeling it was a ques-
tion 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. Jbj- Ammon.
Carbon, gr. v. Aq. distill. 5J. 6tis- 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 3aid that he had been very restless, not sleeping at all. When 1

658

HUMAN BRAIN.

saw him, he answered quite rationally ; hut 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. rqxx. Liq. Hyd. Bichlorid. 5j. Aq. Menth. |j. h. n.

27th, 9 a.m. — Has passed a quiet night ; dozing this morning. Nurse
says he woke 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 ford ; very feeble,
when moving from one room to another ; passes all his urine in bed, in-
voluntarily ; dozes and rambles.

9 p.m. — Has had a good deal of twitching in the arms and legs ; coun-
tenance not more drawn than before. Dr. Cobb saw him with me, and
thought him rather better. We ordered Potass. Oxymur. 9j. 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 rest-
less, talking a great deal about -whiskey 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 ; sat up during
the day ; ate 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 excite-
ment 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 woke, and was restless. -

June 2nd. — Cheerful and collected; has eat an egg for his breakfast;
says he is much better. He woke 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).

3rd. — 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 confidently that he had been at Dalston the night before,
and showing delusions on other points. Pulse soft, 50. This incohe-
rency passed off after he had his dinner ; and when I saw him at 3, he

ORGANIC DISEASES OE THE BRAIN.

659

was quite rational. I ordered him a meat supper, with another glass of
bitter beer, and Liq. Opii sedative trxxx. hora sound.

11 p.m. — Has been quite sensible all the evening ; enjoyed his supper
at 7 ; took his draught at 9 ; went off to sleep quietly. Slept well till 4 ;
got out of bed to evacuate ; returned 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.

9- Iufus. Calumbse. §v. Ammon. Sesquicarb. 5fs. Spirit Myrist. 5 ij .
Tinct. Card. co. 5vi. M. ft. Mist. 6la- bis die 11 a.m. & 4 p.m. This
mixture was continued till June 17tli.

1,1. Liq. Opii sedat. Jfs. Mist. Camph. 3j. M. ft. Haust. h. n. s. et repet.
3 si opus sit.

9- Iufus. Senna Jjifs. Magn. Sulpli. 5hj- M. ft. Syr. Zinzib. 5j- 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 ale 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. — 9-. Pulv. Rhei. PH. Hydrarg. a. a. gr. iv. M. ft. Pd. ij. nocte
sumendus.

9- Haust. Aper. ut antea, mane post pil.

9- Sp. iEther Sulph. co. jij. Liq. Ammon. Acet. 3ij. Aq. Rosse ^iv-
Aq. ad gxvj. M. ft. Lotio capite continue admovend.

loth. — -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 liis mind was evidently more
healthy and natural, as he 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 lamb 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 counting 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 feeliug 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 bad 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 headache, but Ihe eyes bright, and pupils dilated, and his countenance
vacant. He became restless ; wanted his boots, &c., to go to town; in-
quiring of the servants where the omnibus went from, &c. For an hour

2 ij 2

GGO

HUMAN BRAIN.

and a half, his friends had great difficulty to keep him amused and quiet,
but as it poured with rain, lie could not' then get out. He had some fish
at five, and Ihe weather clearing, he went for an hour’s drive, when he got
quite cheerful, and enjoyed 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 labouring, occa-
sionally slightly intermittent. It appeared to me very clear that tve had
now to contend again with the old mischief, and that from an anaemic state
of brain, we had now an hyperaemic condition. I recommended the appli-
cation of forty leeches, and the head to be shaved.

1>- Spirit Terebinth 3j. Mist. Cath. Com. £iv. M. ft. Mist, pro Enema.

9>. Hydrarg. Prot. Clilor. gr. ij. sit. pulv. 3'“s- lioris sumend. Mitte viij.
Enema Terebinth.

He was so restless, that not more than fifteen leeches were applied.

18th. — Impossible to rouse him, either for his breakfast or the hair-
dresser : lie 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, Tflij.
was given, and another at six o’clock, after which the bowels were relieved,
and lie rallied wonderfully, his hands and feet becoming warm, and his
pulse rising to 60. Was not able to get up at all.

$t>. Hydrarg. Prot. Chlor. gr. iij. Sacchar. gr. v. 01. Croton, lqij. M.
pro pulv. statirn 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 appe-
tite, 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 coidd 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 nourishment. Not much
pain in his head, and he was evidently suffering from exhaustion.

Ijt. 01. Croton tqij. Ext. Coloc. co. gr. viij. M. ft. Pil. ij. statim su-
mend. (11 A.M.)

(I. Potass. Bicarb. 5'j • Aq. Histillat. 3 v i i j . M. ft. Mistur. Alkalin.

(1. Acid Citric 9iv. Aq. viij. M. ft. Mistur. Acid. Cap. Coch. amp. duo
sing, dosis. Mistur. Alkalin. 2d,s vel 3tils' horis in actu effervescenti*.

Liq. Opii sedat. iqxx. Conf. Arom. 5j- Aq. Cinnam. Jvij. M. ft.
Haust. Signa. the soothing draught. Mitte ij. One taken early in the
morning of the 21st.

21st. — 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 nourish-
ment, or medicine, which he swallowed at all times with difficulty, and
sometimes could not swallow at all.

ORGANIC DISEASES OE T11E BltAIN.

CGI

8 p.m. — I found him sleeping, and spoke to him, and with difficulty got
him to put out his tougue : 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 stimulate the kidneys.

It. Ammon. Sesquicarb. jfs. Tinct. Cardamom, co. sfs. Syrup Aurant.
Jiij. Sp. Myrist. 3j. Aq. Auctlu. 5iv. M. Capt. Coch. j. amp. omni liora.
Commenced about mid-day, and continued till 6^ p.m.

bt. Acet. Lyttse jj. pro capitis applicatione.

14. Potassre Bicarb. Sit's. Sp. Junip. co. §fs. Tinct. Lyttse 5j. Syrup
Aurant. 5ij. Aquae sviij. M. Capt. Coch. amp. duo statim et 3tia- vel
4“- q. q. liora sumend.

22nd. — 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 tire cheeks.
The application of tinct. lyttse 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
nisrht had a troublesome cough, with difficulty of breathing. Pulse low
anil fluttering, and wras certainly unconscious : passed a tolerable night,
alternately restless and heavy ; took half a cup of beef-tea, in spoonfuls ;
but the pulse rather better on Wednesday morning.

23rd. — Pulse 55 ; face still red, but did not complain (when asked) of
pain, anywhere, except 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 re-
lapsed into the same 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.

25th. — At 2 a.m. this poor sufferer was released, after a most severe
struggle.

Pod mortem, 28 hours after death, temperature 60 : —

External appearance .■ — Ecchyfhosis 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 ; veins of pia mater full ;
brain generally full of blood ; cortical substance rather darker than usual,

662

HUMAN BRAIN.

but not inflamed; all the ventricles very much dilated, especially the de-
scending cornua; 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 colour presented itself, in the medul-
lary 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 tumour. The softened brain was about the sixth of an
inch in depth, and was of a reddish colour as it approached the tumour.
The tumour was the size of a pullet’s egg, nearly circular in form, medul-
lary fungus in texture, 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 convolu-
tions of the Insula of Iteil 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 exercise
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 commencement or in the
course of the arteries, or some other circumstance which has
called its powers unusually into play, such as a defective
condition 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 certain degree of intel-
lectual 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 sacri-
ficed 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, inflammation 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 imbe-
.cility. The late Mr. Deville related to me an interesting

HYPERTROPHY OF THE BRAIN.

GG3

case of this kind. An extremely intelligent boy, of about
twelve years of age, was brought to him lor phrenological
examination by a parent who was very proud of the intel-
lectual endowments 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
labour 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 endeavoured to save the child,
but the father would not attend to the warning. Two
years from that time the father again called on Mr. Deville,
and in reply to his inquiries after his child the lather buist

into tears — his child was an idiot.

Hypertrophy of the brain is easily recognised after death,
in consequence of its immediately bulging out the dm a
mater as soon as the skull-cap is removed. The textrne of
the brain is so extremely elastic and compressible that as
soon as the box is opened it rises up, showing most unequi-
vocally 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 inflammatory 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 result-
ing from a change in texture. I think it very doubtful it they
are not one and the same disease. Induration of the biain
does take place quite independent of hypertrophy, wlieie
there is no pressure to account for it, as will be mentioned
further on. It appears that this disease was first dis-
tinctly recognised by the celebrated Laenncc. It has been
asserted that it was known to Morgagni, but 1 see no reason
for this opinion. The only observations of this famous
observer which could countenance this idea arc in hisiouith

664

HUMAN BRAIN.

epistle, in which he treats of serous apoplexy. The exist-
ence 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 endeavouring to account for
apoplectic symptoms being produced by a very small effu-
sion, he says, “ This must be accounted for from the bulk
ol the cerebrum or cerebellum being disproportioncd to the
bulk ol the cranium ; and as this want of symmetry fre-
quently happens betwixt other parts, why may it not some-
times happen betwixt these also ?” He says he was led to
this opinion by “ 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 hypertrophy.
11 is observations are so accurate and his perception so
acute that he would not have passed it over if he had seen it.
The first observations 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 Mor-
gagni. 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 hydrocephalus 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 1
have regarded as attacked with internal hydrocephalus, and
who on opening the bodies have presented but a small
quantity of water in the ventricles, whilst the convolutions
of the brain strongly flattened showed that this viscus had
undergone compression, which could only be attributed to
too great volume, and consequently to a too active nutrition
of the cerebral mass.”

In 1823 he again treats of this disease, having evidently
seen several cases in the meantime. The following descrip-
tion, which is in his own words, gives so complete an
account of the disease, that it is impossible to add much to

* Journal tie Meclecine de MM. Corvisart, Leroux el Boyer, tom. ii.
p. 669. Neur. 1806.

HYPERTROPHY OF TIIE DRAIN.

G65

it ; — “ This alteration, comparatively common in infants, is
rare in the adult. It is characterized by very great firm-
ness of the cerebral substance, by a considerable widening
of the cerebral convolutions of the brain, although the
ventricles contain little or no scrum. It may be developed
slowly, but more frequently it is an acute affection, the
symptoms of which arc very analogous to those of hydro-
cephalus. Tt appears to be the result neither of inflamma-
tion 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. Scoulteten 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. Ib25. 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 con-
sciousness on the day of his death. The post-mortem appear-
ances 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 received 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 suf-
fered but little in his head, except from cold, any exposure
to which gave him pain. Previous to his death his principal
symptoms were violent paroxysms 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 flat-

* Observations pour servir a l’llistoiro de lTIypertropliie du Cervenu,
par la Donee, Rep. G6n6ral d’Anat. de Physiol, ct du Pathol., p. 197.

G66

HUMAN BRAIN.

tened, 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 adherent, as was the pia mater to the convolu-
tions, 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 Avas considerable,
it did not fall to pieces, and resisted under pressure.
When drawn out, it elongated considerably, and then re-
sumed 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 me-
dullary whiter, than usual. The ventricles contained no
fluid ; their cavities appeared 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 Avas slightly in the
same state as the brain ; but the cerebellum and medulla
oblongata presented no abnormal appearances. The other
organs Avcre quite healthy.”*

In the second case, the subject of it, tAventy-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, Avith
dilated pupils and stertorous breathing, died.

The post-mortem appearances were strikingly similar to
the last. The cerebellum Avas healthy in every respect.

In the third case, the intellect of the patient, who Avas
thirty years of age, had been for some months gradually
giving Avay. A few days previous to death he Avas found lying
on the ground, insensible and paralysed ; he slightly re-
covered his consciousness, but not to any extent. The post-
mortem appearances Avere the same as in the two last cases.

* Op. cit., p. 200.

HYPERTROPHY OF THE BRAIN.

667

The fourth case is too interesting to abridge :* —

Case 98. — “ A house-painter, thirty years of age, of an athletic constitu-
tion, was takeu to the Hotel Dieu, having epileptiform paroxysms, which
recurred three or four times in the day.

“ AYe did not see him till the day after his admission ; he spoke with ex-
treme 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 ot their exactitude, lie 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 ot any of the limbs.

“ For six years previously lie had been subject to determination ol blood
to the head ; at times he was attacked by a giddiness, which lasted from
three to four minutes ; he then lost the use ot his senses and became quite
stupified. 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 aug-
mented Iris malady. On the 12th of March, three days before his admit-
tance 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 epigastrium ; 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, ot a
true epileptic character. On the morning of the 17th he had a disti acted
air, not answering questions ; soon became comatose, with loss ot sensa-
tion and motion. Eyes closed, pupils contracted, mouth half open, tongue
raised, respiration stertorous, profuse perspiration, pulse 140. Sometimes
tension and stiffness 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. f In all the cases there were epileptic fits or epi-

leptiform convulsions. In all, the post-mortem appearances
were the same ; all characteristic of hypertrophy ot the
brain. In three of the cases the patients had suffered from

* p- 206. . , „

t Observ. pour servir l’Histoire dc l’Hvpertrophic dn Gervcau : Revue

Med., tom. iv. 1828.

60 8

HUMAN BRAIN.

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 appear-
ances were found.

In the second, the patient, 44 years of age, was ill ap-
parently about one month ; the symptoms were those of
cerebritis, and the appearances those belonging to hyper-
trophy ; there was hardening and flattening of the convo-
lutions, and absence of blood in the substance.

In the third case, the patient, astat. 43, had an epilep-
tic fit on the 1st of January ; they Avere repeated at inter-
vals ; 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, aetat. 22, had an epi-
leptic attack on the 30th of March, and died on the
2nd of April, having had several fits previous to her
death.

In the fifth case, the patient, aetat. 13, was a delicate
child from birth ; Aveak 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 turges-
cences.

Dr. Sims published some cases of hypertrophy and atro-
phy of the brain in the nineteenth volume of the Transac-
tions of the Medico-Chirurgical 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. I)., set. 60, a lunatic for twenty years, with lucid intervals ;
lie was approaching to a state of fatuity ; lie complained much of great
weakness of the lower extremities ; he had a carcinomatous disease of the
lower lip, which Mr. Perry removed. The wound looked well at the time
of his death.

HYPERTROPHY OP THE DRAIN.

C69

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 usually. The right corpus striatum was
twice its ordinary size; the left slightly enlarged. The left thalamus was
verv 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. Mautlmer, of Vienna * The following account
is taken from an admirable review of the work in the
British and Foreign Medical Review, vol. xxi. p. 387.

Dr. Mautlmer weighed the brain of 21 G 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, “ we find a minimum of
10 oz. G dr. rise to a maximum of 444 oz. The ave-
rage weight begins with 134, and rises to 354 oz.
During the first year it grows from 134 to 204, or 7 oz. ;
in the second, from 204 to 254, or o oz. ; in the third,
from 254 to 32, or G4oz. ; and between the fourth and
eighth year, from 32 to 354, or 34 oz. Hence it appears
that the brain grows more rapidly in the first year ot life ;
that in the second and third years its increase is still con-
siderable, 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.

lie points out the frequent coincidence with enlarge-
ments of the thymus 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 thymicum
with hypertrophy of the brain. He describes an indura-
tion of the brain in anatomical characters similar to hyper-
trophy ; but in which the brain is not larger than natural.
The skull is smaller, probably the result of excessive acti-
vity of the process of ossification; and hence the pressure

* Die Kranklicitcn dcs Gehirns timl Iliickenmavks bci Kiiulcni. Diivcli
Krankheita falle ntia dein ersten Kiiulerspitalc crlautert, von Dr. L. W .
Mautlmer. Wien. 1844.

670

HUMAN BRAIN.

to which the brain is subjected. In these cases the child
is always deficient m 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 unusually prominent.

ouch children present none of those indications of rachi-
tis 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 hyper-
trophy of the brain, M. Mauthner distinguishes the passive
from the active form of the affection.

“ I'1 passive hypertrophy the cranium early presents a
striking deviation from its natural appearance, in the en-
largement and globular prominence 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 fontanellcs 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 arc accompanied by, regu-
lar 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 supervention of
some other disease.

“ When hypertrophy of the brain has reached this stage,
the skull deviates still more from its natural shape : the

UrPERTllOPlIY OF THE BRAIN.

071

forehead sometimes becomes prominent and globose like
the occiput ; and while the skull goes on acquiring an
increased curvature, the region of the temples continues
Hat, and thus contributes to give to the head the appear-
ance of being formed by the union of the segments of
four spheres. During this stage of the affection the pre-
ternatural softening and thinning of the cranial bones,
corresponding to the prominences of the convolutions, are
distinctly perceptible, especially at the occiput. The func-
tions of the brain become now much disturbed ; head-
ache, 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 grows soft, and the muscular
power rapidly diminishes.

:£ Hence these children lie usually on their back, breath-
ing with habitual wheezing, and suffering from constant
dvspncea, with occasional asthmatic seizures, such as have
been already described. When in this condition, slight
causes suffice to produce a general excitement of the vas-
cular system, and to excite diseased action in other parts,
which render still more obvious the influence of the hyper-
trophy on the nervous system generally. If the child hap-
pen 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 par-
tial, 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 consequent conges-
tion.” .

In the chapter on chronic hydrocephalus, the diagnosis

between that disease and hypertrophy of the brain is stated

672

HUMAN BRAIN.

at great length. The chief differences insisted on by
M. Mauthner are thus thrown into a Table by the Re-
viewer : —

Hypertrophy of the Brain.

1. The posterior part of the
skull first preseats 'an unnatural
prominence.

2. Children lie horizontally, or
throw the head back.

3. Face puffy, eyes inexpressive
and staring ; mouth half open.

4. Functional disturbance comes
on very gradually ; not before
the period of dentition or wean-
ing ; and consists, at first, in affec-
tion of the respiratory apparatus,
difficulty of breathing, and attacks
of apnoea.

5. Patients fat and leucoplileg-
matic.

Chronic Hydrocephalus.

1. The forehead is the first part
to present 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 on the belly, with
the head lower than the rest of the
body, burying the face in the pillow.

3. Countenance withered, having
expression of premature old age.

4<. Functional disturbance occurs
early, and involves the cerebrum
from the very beginning.

5. Patient ill-nourished, subject
to rickets and tabes mesenterica.

Dr. Mauthner* has pointed out a peculiar form of in-
duration 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 diminution in
the size and weight of the organ, is sometimes met with
independent 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 emacia-
tion. 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 evi-
dent when it affects the taenia semicircularis. The indu-
rated portion usually has an elongated form, is distinguish-
able by the gray colour of the cerebral substance, but es-
pecially by its cartilaginous hardness. The form of indu-
ration of the brain, of which Dr. Mauthner relates three

* British and Foreign Medical Beview, loc. cit., vol. xxi. p. 390.

HYPERTROPHY OP THE BRAIN.

673

instances, lias, to the best of my knowledge, never been
noticed by any other writer. It is, therefore, worthy of
mention, though, at present, little more than a pathological
curiosity.

The treatment of hypertrophy of the brain necessarily
differs according to the circumstances under which it
occurs. In that form which is connected with rickets,
absorbents with rhubarb and preparations of iron, and a
properly-regulated diet continued for months, are often very
useful. Cold sponging of the surface is frequently of ser-
vice, but in consequence 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.

arm baths and the occasional application of the moxa,
and blisters to the back of the neck, have likewise been of

INDE X

COMPARATIVE ANATOMY AND PHYSIOLOGY OF

BRAIN.

A.

Ai, or three-toothed sloth, 128
Accessory, spinal, 300
Acrita, of MacLeay, 27
Agouti, 123 — 125

Alcock, Dr. B., root of fifth pair, 217,
295, 296

Alimentary canal, its relation to the ner-
vous system, 39
Amphibia, 71, 87
Analysis, chemical, of brain, 8
Anastomosis of nerves, 13, 14
Animals classified according to nervous
system, 27

Animal kingdom, divisions, 27, 28

lowest form, 27, 39, 43, 44

simply nutrient, 39

Animalcule, the wheel, 45
Anteater, 128
Antennae, nerves of, 51
Ape’s brain, 108, 112, 119, 121, 123, 128,
132

cerebral vessels, 137

Aqueduct, Sylvii, fcetus and fish, 79, 81
Arabians, their physiology of the nerves,
37

Arachnoid tunic, 143, 148, 150, 158, 159,
189

Arbor vitse, 245, 265.

Area germinativa, 312
Aristotle’s physiology, 35
Arms and stomach, earliest animal form,
27, 39, 46, 57, 65

Arnold, F., nerves of dura mater, 148
159

Arteries of brain, 302 — 304

Arteries, spinal, 1 58, 304

vertebral, 132—135, 147, 152, 179,

304

Articulata, 27, 39, 41, 50, 54, 57, 71

spinal ganglia of, 211

Arsakay, encephalon, 6
Ascaris, simple nervous system, 28
Ascidia mammillata, 45, 46
Atrophy, senile, of brain, 9
Axis cylinders, 11 — 15, 23, 24

B.

Baboon, carotids, 133
Badger, cerebral vessels, 137
Baillarger, cortical substance, 248
Basilar artery, 134
Beaver, cerebral vessels, 137
Beclard, ganglionic nerves, 37
Bell, Sir C., decussation of the spinal
columns, 222, 234, 238, 243

fifth pair, 223

nerves of sensation, 330

physiology of the brain, 12, 26, 41,

60

roots of spin.il nerves, 198, 208,224,

244

Bellingeri, roots of spinal nerves, 202
Bonnet, fcetal brain, 6
Bercnger, grey matter, 3
Bichat, arachnoid, 148 — 150

physiology of brain, 35 — 36

foramen of, 193

ganglionic nerves, 38

Bidder, ccrebro-spinal system, 20, 21
Bird, Dr. G., excretion of phosphorus,
17, 19

2x2

67G

INDEX.

Birds’ brain, 71, 90, 92, 94, 124, 249,
271, 274, 278, 317, 318, 334
Bischoff, foetal brain, 312

spinal nerves, 205

Blainville, nerves, 286
Blane, reflex functions, 60
Blumenbach, ganglionic nerves, 37
Bouillaud, cerebellum, 230
Bowman, axis cylinder, 11

and Todd, 15, 334

Brain alters its form during life, 339

base of, 116, 176, 178

convolutions, 122, 124 — 132, 179 —

185

cortical substance, 33, 186 — 192.

earliest development of, 63, 65, 68,

72

how to remove it from skull, 156

instrument of mind, 328, 338, 340

in mammalia, 94

movements of, 1 52

progressive development of, 72,

311—325

its relation to generative process,

96, 331, 333

series of ganglia, 32, 33

size in insects, 53, 63

• system, 36

four ganglia, 51

vertical section, 176, 236

wastes, 9, 19, 155, 162, 341

Brain and nervous system of,

Agouti, 123 — 125
Ai, 128

Amphibia, 71, 87
Anteater, 128

Ape, 108, 112, 119, 121, 123,
128—132
Asterias, 30
Baboon, 119, 131
Badger, 112, 127
Bat, 119, 124, 128
Bear, 112, 118, 125, 127, 128,
132

Beaver, 95, 97, 120, 125
Boar, 132
Blackbird, 91
Butterfly, 63, 64, 65, 73
Buzzard, 91

Calf, 108, 136, 216, 300, 315
Canary, 93

Carnivora, 112, 115, 118, 120,
121

Carp, 83, 102, 274, 324

optic nerve of, 289

Caterpillar, 63

Cat, 11, 21, 108, 118, 126, 128,
132,137, 216

embryo of, 313

Cephalopoda, 66 — 69
Centipede, 51
Cheetah, 124

Brain and nervous system of,

Cheiroptera, 119, 124
Chimpanzee, 119, 130
Chilognatha, 52
Civet, 127
Coati, 127
Cod, 77

optic nerve of, 288, 290

Conchifera, 43, 47
Coney, 128
Corals, 43
Crab, 62
Crocodile, 93
Crow, 91
Cuckoo, 91
Cuttle-fish, 67 — 69
Cymothea, 51

Dog, 120, 126, 132, 286, 336
Dolphin, 108, 120, 121
Duck, 91, 93
Edentata, 103
Eel, 73, 77, 85, 88
Egg, 30

Elephant, 108—113, 123, 128,
129, 132, 137

its weight, 161

Embryo, 73, 79, 180, 182, 311 —
325

Ferret, 120, 125, 127, 132, 179

Foetus, 135, 312

Fowl, 91, 93, 386

Fox, 125—128, 132, 182

Frog, 22, 87, 249

Gasteropoda, 48, 49

Genet, 127

Giraffe, 137

Goat, 108, 137

Goose, 93

Guinea-pig, 21

Haddock, 77

optic nerve, 288

Hare, 124, 268, 275
Hedge-hog, 60, 119, 123
Horse, 108—110, 120, 190, 216

its weight, 161

olfactory nerve, 286

cerebellum, &c., 276, 286,

300, 315
Hyrax, 124, 128
Idiot, 9, 180
Imago, 63 — 65
Infant, 249, 280
Insect, 53

Insectivora, 119, 124
Invertcbrata, 140
lulus, 52, 56

Kangaroo, 95 — 98, 115, 127, 132

Leopard, 137

Lemur, 119, 132

Lymax ater, 49

Limpet, 48

Lion, 118—122, 127, 132

INDEX

G77

Brain and nervous system of,

Lizzard, 88, 90, 318
Lynx, 112, 122
Magpie, 91

Mammalia, 71, 94, 119, 120, 121,
249, 313, 318, 334
Marsupiata, 94 — 97, 119, 124
Marten, 118, 127, 132
Megatherium, 103
Mollusc*, 27, 30, 39, 42, 43, 47,
4S, 51, 87

Monkey, 108, 119, 120, 121. 122,
12S '

Monotremata, 94, 124
Moth, 63 — 67
Mole, 119, 190

optic nerve of, 289, 291

Mouse, 95

Myriapoda, 51, 52, 55, 59
Mammalia, brain of, classified
according to convolutions, 122
— 132 j with comparative ana-
tomy of the human brain, 123
—133

Narwhal, weight of brain, 161
Necroph. leophag. 51
Negro, ISO
Newt, 88

Nautilus, 66, 67, 69, 71
Old age, 249
Opossum, 120, 121
Otter, 132
Ourang-outang, 120
Oyster, 46

power of vision, 46, 47

Ox, 98, 108, 110, 120, 132

spinal cord, 225

cerebellum, 276

Panther, 127
Parrot, 93
Partridge, 93
Peccarv, 132
Pig, 108, 128, 132
Pigeon, 91, 93, 336
Pike, 85

Polecat, 125, 127
Polypus, 39, 43
Porcupine, 102, 125
Porpoise, 1 08—118, 1 20, 1 21 , 1 32,
216

Pteropus, 128

Rabbit, 95, 98, 99—103, 120

embryo, 313

Rat, 95, 123

Reptiles, 71, 88,90, 114,316,317,
323, 334
Roebuck, 132

Rodentia, 95 — 102, 1 15, 119, 122,
124, 137

Ruminantia, 103, 109, 115, 120,
127, 319

Salamander, 88, 90

Brain and nervous system of,
Sandhopper, 50, 72
Scolopendra, 56

Seal, 112, 118, 120, 121, 128,
132

Sepia, 71, 73
Shark, 86 (no air bag)

Sheep, 103— 111, 116, 127, 128,
132, 190, 216, 225, 243, 275,
286

Skate, 73, 77, 85—87, 274, 324

optic nerve of, 289

Sloth, 103, 127
Slug, 48

Snake, 88, 90, 318
Sparrow, 93

Spirostrepti, Spiroboli, 57
Sponges, 43

Squirrel, 95, 98, 102, 103, 125
Stag, 135, 136
Storks, 93
Sturgeon, 77

optic nerve of, 290

Swine, 137

Starfish, 30, 39, 250, 253
Talitrus locusta, 50, 52
Teeth, 22
Tiger, 133
Toad, 88

Tortoise, 21, 274, 318
Tunieata, 43
Turtle, 88, 89, 90, 245
Vertebrata, 27,41, 140,211,280

olfactory nerve of, 52

Weazel, 127, 132, 137
Whale, 117, 128, 132

weight of brain, 161

Whiting, 77, 78, 102, 274
Wolf, 126

Wombat, 95, 97, 98, 127, 132
Woodpecker, 91
Wren, 93
Branchial sac, 44
apertures, 311

Branchiogastric nerves, in the electric
ray, 84

Brachet, ganglionic nerve of, 37, 38

veins of cord, 158

par vagum, 218

Broussais, ganglionic nerve, 38

cerebellum, 231, 333

Burrowes, cerebro-spinal fluid, 155
Budge, Dr. J., spinal cord, 206
Burdach, membranes of cranium, 141,
150

decussation of nerve, 220, 258

C.

Calamus scriptorius, 242
Calf, vetebral arteries of, 134, 135, 136
Camel, carotids of, 136
Camper, optic ganglia, 80

678

INDEX.

Capillaries, uses of, 13
Cardiac plexus (Cuttlefish), 69
Carotids, 133—135, 302
Carpenter, cerebral ganglia, 334-

development of ovum, 311

— — excito-motory nerve, 333

nervous system, 17, 19, 26,42, 47

wasting of brain, 19

Carus, optic ganglia, 79, 80
Cat, vertebral arteries of, 133
Cauda equina, 177
Caudate vesicles, 16
Cavernous sinus, 146
Celia cordte Willisii, 146
Cells of glands, 2, 16

nucleated (Goodsirs) 16, 17

theory of, 16

Centrum ovale, 186 — 188
Cephalic ganglia, 49 — 51, 76
Cerebellum, 218, 245, 266, 278, 332

of animals, 104, 1 13 (elephant), 1 19,

271, 275—278

arteries of, 305

birds, 91, 92

fishes, 6

flying fish, 5

ganglia, 76

laminated ganglia, 270

commissures, 257, 263, 271, 285

man, 225—231, 241

Cerebral or brain system, 36
ganglia, 189

vessels, 132—138, 158, 302, 306

Cerebro-spinal axis, 140, 212, 250, 326
—342

spinal fluid, 153, 155

chemical analysis of, 156

• nerves, 20 — 36

Cetacea, brain contains oil, 9, 114 — 118,
128

dura mater, 143

Chamois, carotids, 135, 136
Chaussier, ganglionic nerve, 37
Cilia, class Tunicata, 44
Cinereum tuber, 82, 83, 87, 102, 178, 179
Cineritious matter, 2, 7, 32 — 34, 72, 73,
92—95, 186, 215, 246, 256—258, 263,
279, 287, 291, 300

of cord, 200, 202—205, 212

Clendinning, weight of brain, 168
Cloquet, nervous system of Ascaris, 28
Cod, optic nerve, 288, 290
Columns, spinal, 54, 55, 140, 224 — 228,
237, 241, 331

Combe, phrenology, 327, 328, 337
Commissures, cerebellum, 177
inter-cerebral, 246 — 265

• great transverse, 250 — 265

longitudinal, 253 — 255, 331

Chaussier, 257

mollis, 256

optic nerve, 177

Commissures, organs of comparison, 34

spinal cord, 197, 202, 231

The, 7, 28, 34, 56—58, 78—86,

89, 93, 98, 99, 105, 111, 188, 190,
191, 194, 202, 246, 249—265, 286,
329, 342

Conductors, insulated, nerves, 13, 14
Conolly, lunacy, 340
Consciousness, the nervous system no
proof of, 26, 39, 337
Continuity of nervous filaments, 13, 14
Convulsive diseases, 40
Convoluted surface of brain, 175, 179 —
186, 189, 248

Convolutions, an index of intelligence,
122—132

birds, beasts, &c., 91, 92, 104, 105,

119, 122, 180

classified, 124 — 132, 180

of brain, 252 — 263

• longitudinal, 128, 180, 182, 186

Cooper’s, Sir A., experiments on rab-
bits, 17

Mr., spinal nerve, 204

Cord, spinal, 26

Corpora geniculata, 120, 190, 194, 292

mammillaria, 178

olivaria, 213—215, 223, 239, 240

ganglia of lingual nerve, 112,

332

striata, 79 — S6, 100, 105, 121, 189,

204, 235, 246, 257, 333, 334
Corpus callosum, 34 — 99, 121, 250 —
317

Corpus denticulatum, 263,270

fimbriatum, 262

Corpuscles, Pacinian, 11
Cortical substance, a distinct ganglion,
33, 246

Cranium, a series of vertebra:, 140
Crocodile’s heart, 310
Crura cerebelli, 272 — 274

cerebri, 52 — 57, 100 — 106, 177,

204, 214, 233, 241, 243, 260, 263
Crustacea, aganglionic, 56, 62
Cruveilhier, arachnoid, 1 50

• decussation of spinal cord, 221

medulla spinalis, 203

mode of dissecting brain, 197

nerves of dura mater, 147, 148

Cryptoneura, 27

Cuvier, ganglionic nerve, 27, 29, 38
Cyclo-gangliata of Grant, 27, 36
Cycloneurose of Grant, 27

D.

Decussation of pyramidal bodies, (Hip-
pocrates, Aretseus, Dion Cassius, &c. )
219—222, 256

of spinal columns, 225, 243

Deglutition, 40

Dementia, condition of brain, 153, 155

INL) EX.

r»7‘J

Desmoulins, optic thalami, 79
Development, brain and nerves, 307 —
325

law of, 29, 307— 310

Deville, phrenology, 339, 340
Diemebrouk, grey matter, 3
Diploneurose of Grant, 27
Divisions of animal kingdom, 27, 28
Dog, cerebral vessels, 137

nerves, 286

hemispheres, 336

Dura mater, 142 — 144, 152 — 159, 279

cetacea, 143

nerves of, 147, 148

E.

Edentata, 103
Egestion, 40

Ehrenberg, medullary neurine, 9
Electric ray, Cruveilhier, 84
Elephant, cerebral v essels, 137
Embryo, heart, 310
lungs, 311

Encephalon, configuration of, 175
Eustachius, trigeminal nerve, 37
Excito-motory nerves, 7, 26, 36, 39, 41,
43, 52, 203, 223, 285, 295, 299, 330,
334

Eye, theory of sight, decussation of optic
nerves, 288
Eyelids, action of, 40

F.

Falx major and minor, 144, 148
Fat of brain, M. John’s analysis, 8, 9
Fibres of nerves continuous, 13, 60, 161

insulated, 14, CO

grey, 19

• , size of, 20

individually endowed, 60

of re-inforcement, 55 — 59, 243

of spinal cord, 54

connected with cerebellum,

228, 230, 232, 233

connected with cerebrum, 237,

238, 241—248

Fibrous matter of brain, 2, 9, 10, 14, 19,
24, 34, 161, 251—264, 272, 273,274
Fibrous neurine of cord, 200 — 207
Fignrate surface of brain, 186 — 196, 253
Fishes, brain and cerebellum, 6, 71 — 86,
92, 114, 180, 186, 194, 195, 217, 249,
271, 280, 288, 289, 314—318, 334

heart, 310

lungs, 31 1

sight of, 288

skull, 77

thyroid gland or branchiola, 305

Fissura Sylvii, 124 — 128, 179, 182, 183,
255

Fissure of spinal cord, 198, 202
Fletcher, grey matter, 6

Fletcher’s Lecture*, history of ganglionic
nerves, 37

Flourens, cerebellum, 230

hemispheres of brain, 75

manifestations of intellect, 335

Fluid, cerebro-spinal, 153 — 155

chemical analysis of, 156

Fornix, 34, 121, 190, 191, 253, 255,258
Foville, analysis of brain, 9

auditory nerve, 298

cerebellum, 231

convolutions of brain, 180

corpus callosum, 251, 252

decussation of nerve, 243

pneumogastric, 300

restiform bodies, 214

spinal cord, 208, 209

Frog, heart, 22

spinal cord and sympathetic, 21,

22, 207

G.

Galen, physiology of brain, 35, 37, 133,
190, 210

Gall, cerebellum, 333

grey matter, 4, 125, 202

olivary bodies, 216

phrenology, 338

spinal canal, 199

weight of brain, 170

Ganglia, 27, 31—39, 48, 189, 190, 250,
329

auditory and pneumogastric, 48,

82, 88, 89, 102, 109, 213—218, 300,
331, 332

at base of optic nerve, 76

branchial, 49, 50, 84, 86

cerebral or cephalic, 49 — 51, 189,

244, 246

lingual, 112, 216

medulla oblongata, 213, 332

nerves enter and leave, 21, 22

of sensation, 74, 76, 89

of 7th and 8th pairs, 76

of spinal cord, roots of nerves, 199,

200, 211, 231

of volition, 52

pharyngeal, 50

respiratory, 50, 54, 87, 89, 218

semilunar, 32, 235

their nature, 31—35, 329

hemispherical, 17, 33, 247 — 251,

334, 335

tentacular, 334

pedal, 47, 48, 50, 53, 54, 57, 62

Ganglionic system of the sympathetic,
35—50, 69

Garner, vision of oyster, 46
Gasteropoda, their reproduction, 48
Gelatinous neurine, 19, 24
l Generation, relation of brain to, 96, 231,
331, 333

680

INDEX.

Giraffe, rete mirabile, 137
Glands, cells and tubes, 2 — 16

two-fold structure, 1 — 16

Glandul® Pacchionee, 142
Grainger, corpus callosum, 251

excito-motory nerve, 330

nervous system, 26, 41, 42

spinal cord, 203

— third pair nerves, 294

Grant, divisions of nervous system, 27, 36,
50

Grey fibres, 19

matter of brain or neurine, 2, 13,

16, 32, 40, 42, 52, 92, 186, 200—215,
246, 256, 258, 262, 263, 270, 271, 300

neurine, source of power, 2, 6, 20,

34, 210

— — tubercle in brain, 82
Goat, vertebral arteries of, 135 — 137
Good, Mason, ganglionic nerves, 37
Goodsirs, Messrs., nucleated cells, 16
Gottische, optic ganglia, 80
Gunz, corpus fimbriatum, 262

H.

Hall, Dr. M., excito-motory nerve, 7,
26, 39, 40, 43, 50, 55, 60, 61, 203,
330

Haller, cerebro-spinal system, 26

fluid, 153

grey matter, 3, 80, 92

nerves of dura mater, 147

weight of brain, 169

Hamilton, Sir W., weight of brain, 168
Hannover, corpuscles of brain, 21
Hanwell Asylum, 340
Harwood, rete mirabile, 137
Heads, long, indicate intelligence, 124
Heart, progressive development of, 310
Hedgehog, cerebral vessels, 137

carotids, 134

Hehnhotz, corpuscles of brain, 21
Hemispheres, not the seat of sensation,
335

Hemispherical ganglia, 17, 33, 75, 180 —
186, 190, 246—248,250, 251, 334,
335

birds, 91

fish, 75—78, 84—86

sheep, 103, 122

Henle, grey matter, 17, 19
Hetero-gangliata, 27, 28, 36
Hertwig and Flourens on intellectual
manifestations, 335
Hippocampi, 121, 261, 262, 263

sense of smell, 262

Hoare, ganglionic nerve, 37
Holmes Coote, spinal cord of fishes,
73

Homo gangliata, 27, 28, 50
Human brain, anatomy of, 139 — 306
• protective apparatus for, 139

Human brain, weight, 161—174. Tables
of, 164—167

Hunter, John, whale’s brain, 117
Hydra viridis, 39

I.

Idiot, convolutions of brain, 180
Imperceptible sensation, 38
Implacentalia, 94
Incident nerves, 39
Incubation of egg, 30
Infants’ brain, 9, 249, 280
Inflammation, chronic, of brain, 247
Infundibulum, 178, 279
Ingestion, 40

Insanity, change of cortical substance,
188, 247, 249, 339—341
Insects’ brain, size of, 53
Insectivora, 119, 124
Intellect, its seat in brain, 19, 75

convolutions, 122, 123, 124 — 132,

328

long heads, 124

Intestinal villi, 16
Instinct, nerves of, 51, 52, 335
John’s, M., analysis of brain, 8
Irritability of muscle, 6
Jules Cloquet, Ascaris, 28

K.

Kangaroo, 95 — 115, 128, 132
Knox, arachnoid, 148 — 159
Kolliker, cerebro-spinal system, 20, 21

L.

Laennec, nerves of Ascaris, 29
Laminae, cerebellum of birds, 92
Lancisi, ganglionic nerve, 37, 38
Larynx, pneumogastric, 299
Lateral sinuses, 146
Lautli, grey matter, 3
Law of development, 29, 307, 310
Legallois, cerebro-spinal system, 40
Leopard, cerebral vessels, 137
Leuret, brain of animals, 109, 118 — 123,
124—132

birds, 91, 92

fishes, 76, 77, 87, 89

convolutions, 180

Lieutaud, nerves of dura mater, 147
Life, animal and vegetable, 34, 36

organic, of Bichat, 36, 37

phaenomena, two kinds, 34

Ligamentum denticulatum, 159
Lingual nerves, ganglia, 112, 116, 216
Lobstein, nerves of dura mater, 147
Locomotion of Gasteropoda, 48, 50
Locus perforatus, 179
Locus niger, caudate vesicles, 16, 237,
238, 244, 260, 263, 333

quadrilateralis, 179, 255

Long heads indicate intelligence, 124

INDEX.

681

Longitudinal commissure, 253 — 255, S3 1 , j
332, 331)

sinuses, 140

Lumbar nerves, 331
Lunacy, 340, 341

M.

Macartney, filiform process, 159, 100
Magendie, cerebellum, 230

cerebro-spinal fluid, 153 — 155

nerves of sensation, 330

roots of spinal nerves, 198

Mammalia, classified according to con-
volutions, 122 — 130, 132

number of cervical vertebrae, 200

Mammillary tubercle, 121, 17S
Man's brain, comparative anatomy of,
123—133

Mayo, cerebellum, a voltaic pile, 271

decussation of optic nerve, 287 —

2S9

fibres, corpus callosum, 252, 253

fifth pair, 223

grey matter, 4, 40, 203

lingual nerve, 301

nerves of sensation, 330

Meckel, auditor)- nerve, 299

ganglionic nerve, 37, 38

grey matter, 3

spinal columns, 227

Medulla oblongata, dissection of, 230 —
234

- — — ganglia, 48, 53, 69, 108

man, 195, 201, 212—245, 269,

332

respiration, 40 — 47, 177

sheep, 107 — 113, 116

spinalis, 197

Medullary matter, 2 — 9, 14, 19, 246

neurine, conductor of power, 3, 7,

20, 34, 329

neurine of cord, 200

Membranous matter, basis of organs, 1
Mental exertion, excretion of phospho-
rus, 17

Mesentery of cat, Pacinian corpuscles,

11

Monro, ganglionic nerve, 37
Morgagni, spinal canal, 199
Motor and sensory columns, 189, 190,
213—222, 234, 239, 244
- tract, 222—238,246, 264, 274,284,
294, 296, 297

root of fifth, 296

Movements of brain, 152
Mu Her, continuity of nervous fibres, 161
— *- contraction of muscles, 330

decussation of optic nerve, 289,291

-- intellect, 335
Muscle, irritability, 6
Muscular contractions, 329, 330
Myelencephala, 27, 28, 71

N.

Nematoneura, 27, 28
Nerves, base of brain, 179
cerebral, description of, 284 — 301,

329

commissures of, 7, 28, 31, 329

conductors, 34

entering and leaving ganglia, 21, 22

— — excito-motory, 7, 28, 31, 36, 39,
199, 200—218

gelatinous, 2, 19

lingual, 112, 116

medium of connection with exter-
nal world, 26, 328

not similar to blood-vessels, 13

of antennae, 51

of dura mater, 147

of instinct, 51, 61, 335

of involuntary muscles, 23

of mandibles and maxillae, 52

of spinal cord, roots, 1 98, 202,

330

origin of, porpoise, 117

peripheral anastomosis, 13

spinal accessor)-, 300

their number, 284, 285

— - — 1st, olfactory, 284, 285, 286

2nd, optic, 284 — 287

3rd, oculo -muscular, 285, 293, 297

4th, pathetic, 294

5th, trigeminal, 32, 37, 289, 295,

296

6th, abducentes, 285, 296

7th & 8th, 284, 285, 297

7th, facial, portio dura, 297

8th, auditory, portio mollis, 297 —

299

9th, glosso-pharyngeal, 284, 285,

299

10th, pneumogastric, par vagum,

284, 285, 299

11th, lingual, 300, 301

Nervous fibres, continuous, 13, 34, 60,
161, 330

pressed, the consequences, 23

protected, why, 23

sympathetic, 23

ring, oesophagus, 30, 39

system, absent in hydra viridis, 39

classifies animals, 27

its magnitude in relation to

animal endowments, 27, 65, 67, 70,
72—75, 86, 90, 92, 96,98, 114, 123
—132, 188, 197, 328, 335, 336—338

no proof of consciousness, 26,

27

relation to alimentary canal,

39

simplest form, 30 — 39

Neurilema, 21, 159, 20 1
Neurine, its nature and mode of distri-
bution, 1, 2, 14, 15, 23 — 27,31 — 33,

082

INDEX.

G3, 91, 101, 159, 161, 200, 214, 222,
250, 329

subtle in insects, 26, 27

medullary, 329

not visible in foetus, 312

pulpy, 14, 34, 200, 234, 270

nuclei, 15 — 19

two kinds, 2, 32, 34, 200, 329

vesicular, ganglia, 329

Newport, nervous system, 26, 41, 51, 53,
54, 326, 330

Niger locus, caudate vesicles, 16, 237,
238, 244, 260, 263, 333
Noble, phrenology, 339
Nucleated cells, 16, 17, 19
Nutrition an organic function, 38, 60,
61

O.

Occipital sinuses, 147
(Esophagus, nervous ring of, 30, 48, 49,
52, 61, 62, 65, 69, 71, 73
Oil, brain of Cetacea, 9
Old age, brain, 249

Olfactory ganglia, 76, 78, 88, 89, 91, 93,
99, 103, 118, 120, 195, 262, 286, 331

whiting and carp, 78, 84

Opossum, 120, 121

Optic ganglia, 76, 78, 80, 88, 91, 93, 94,
95,97,98,99, 102, 118,177,194,239,
245, 264, 287, 331, 333, 334

nerves, whiting and carp, 78, 84

thalami, 120, 121, 244, 246

Organic life, 35 — 37, 52, 53
Orycteropus, 128
Ostrich, 93

Otter, cerebral vessels, 137
Otto, membranes, brain, 29, 151, 152
Ovum, development of, 311
Owen, divisions of nervous system, 27,
61, 67

placentalia, 94

convolutions, 124

Ox, cerebral vessels, 136
Oyster, 46 ; vision, 46, 47

P.

Pacchionus, 142

Pachydermata, 109, 115

Pacinian corpuscles, 11, 12

Paget, cerebro-spinal system, 20

Pappenhein, nerves of dura mater, 148

Paralysis, loss of exercise of will, 7, 23

Peacock, weight of brain, 168

Pedal ganglion, 47, 48, 50, 57, 62

Pellatan, decussation, optic nerve, 291

Peripheral nerves anastomose, 1 3

Permanent skeleton, 139

Petrosal sinus, 147

Pharynx, 40, 50

Philip, Wilson, 37

Philosophy, Newtonian, 308

Phosphorus in brain, 9, 17, 18
Phrenic nerve, diaphragm, mammalia,
200, 218, 331

Phrenology, 141, 263, 328, 329, 337—
340, 342
Physiology, 309

cerebral, ofthe older physicians, 329

cerebro-spinal system, 326 — 342

Pia mater, 150—159, 190, 313, 314

• filiform process, 159, 160

spinal cord, 1 98, 204

Pig, carotids, 134

Pineal gland, 88, 89, 98, 99, 100, 115,
120, 121, 194, 256 (Amphibia)
Pituitary gland (skate), 87, 107, 279
Placenta, similarity to plexus choroid,
151

Placentalia, 94, 98
Plexus choroid, 116, 150, 151, 190
Polydermidae, 52, 56
Pneumogastric, 40, 46, 87 — 89, 102, 116
Polypus, 39, 43

Pons Varolii, 98 — 109, 119, 172, 195,
214, 227, 233, 234, 241, 243, 245, 257,
268, 271—273, 332

deficient in birds, reptiles, &c., 93,

94

Porpoise, carotids, 133
Portal, nerves, dura mater, 147

spinal canal, 199

Portio dura, 161
Posterior roots spinal cord, 32
Pritchard, cerebellum, 231
Prochaska, excito-motory, 299, 330
Propagation by germs, 44
Prout, phosphate urine, 17 — 19
Purkinge, axis cylinder, 10
Pulpy neurine, 14, 200, 234
Pyramidal bodies, and decussation of fibres,
219—221, 222, 240, 243, 256, 332

R.

Rabbit, embryo of, 313
Radiata of Cuvier, 27, 45
Rapp of Tubingen, vertebral arteries,
134—137

Reflex, functions of nerve, 39, 54, 55, 59,
60, 203, 335, 336

Reid, medulla oblongata. 216, 238, 239,
240

weight of brain, 162, 168

Reil, cerebellum, 268 — 271

of birds, 274

grey matter, 4, 92

mode of preparing cerebellum, 266

Remak fibres, 20

Reptiles, 71,88, 90, 114, 316, 317, 323,
334

Respiration, 40 — 50, 89, 217, 218
Rcstiform ganglia (Ruysch and Rolands,)
213—218, 227, 240, 272 ,332
llete Mirnbile (Galen), 133 — 135, 303

INDEX.

083

Retains, fcetal brain, 322
Rieherand, ganglionic nerve, 3S
Rodentia, 95 — 137
Rolando, corpus callosum, 252

foetal brain, 313

optic thalami, 293

nerves, 2Stj

septum lucidum, 2111

spinal cord, 203, 213 — 229

Roots, posterior spinal cord, 32
Rosenthal, axis cylinder, 10
Ryan’s Journal, grey matter source of
power, 6

Rudolphi, divisions of nervous system, 27
Ruminantia, 103 — 137
Ruvsch, grey matter, 3, 4

S.

Salivary glands, 52

Scarpa, ganglionic nerve, 37, SO

Schleidan, villi, 16

Schoeps, experiments on cerebrum, 336
Schwann, white substance of brain, 10,
16, 24

Scolopendra, 56
Section, vertical, of brain, 176
Secretion, an organic function, 38
Senile atrophy of brain, 9
Sensation, imperceptible, 38

, nerves of, 7, 199—223, 285, 295,

299, 330

Sensory tract, 222 — 224, 241 — 245
Septum lucidum, 190, 261
Serosity of brain, 8
Serres, brain of birds, 92

fishes, 76, 83, 87

spinal cord of foetus, 316

Sheep, rete mirabile, 135 — 137
Sight and smell of Gasteropoda, 4S
Simon, theory of thyroid, 305
Sims, weight of brain, 162, 168
Sinuses, cerebral, 145 — 158
Skate, optic nerves of, 289
Skeleton, earliest development, 68

shelly, dermal, 139

to protect nerves, 68, 71

Skull alters with age, 141

mode of opening, 141, 142

of fishes, 77

to protect brain, 71, 139, 141

Soemmerring, number of nerves, 285

weight of brain, 169

Speech, organs of, 332
Sphincters, 40 — 45
Spina bifida, 155

cerebrata of Grant, 27, 50

Spinal arteries, 1 58, 30 1
Spinal cord, 7, 1 3, 20, 26—30, 32, 40,
42, 50—53, 71, 102, 176, 195—197,
213, 313, 381

commissures, 331

connection with cerebrum, 212

Spinal cord, dissection of, 197 — 211,219,
223

distinct nervous centre, 206, 211

dura mater, 158

fishes, 73

fissures of, 198

foetus, 73, 314, 315

ganglia, 199, 200

grey matter, 200—211, 218

how to remove it, 157, 158

incubated egg, 30

roots of nerve, 32, 198 — 207

structure in insects, 54

transverse section of, 199 — 202

various nerves of, 203 — 209, 222,

239, 330, 334

Spinal system, 36 — 38, 50, 330, 331
Spirostrepti, Spiroboli, 57
Spurzheim, decussation of pyramidal bo-
dies, 219

— — grey matter, 4, 125

number of nerves, 285

optic thalami, 293

phrenology, 339

spinal canal, 199

weight of brain, 170

Stadelmann, axis cylinder, 11
Stag, carotids, 135, 136
Stein, optic thalami, 293
Stilling, lingual nerve, 301

nervous fibres, 13, 14

pneumogastric, 300

spinal canal, 200

Stomach, simplest animal construction,
27

Substantia perforata, 180
Swammerdam, arachnoid, 143
Swine, cerebral vessels, 137
Sylvius, grey matter, 3
Sympathetic, the, 2,19 — 23,35 — 37, 52,
69, 297

pituitary gland, its ganglion, 280

T.

Tactual ganglia, 334
Taenia semicircularis, 190, 261
Temporary skeleton, 139
Tentacula, 46 — 48
Tentorium, 144

Thalami nervum opticorum, 190, 244,
246, 256, 263, 279, 293, 320, 333,
334

Theca vcrtebralis, 203
Thyroid, theory of, 305, 306
Tiedemann, corpus callosum, 250, 251,
257

foetal brain, 79, 312 — 319

grey matter, 4, 6

nerves, 287

starfish, 30

weight of brain, 169

Tiger, carotids, 133

084

INDEX.

Todd and Bowman, 15, 334

axis cylinder, 11, 12, 334

cerebro-spinal fluid, 154, 155

filiform process, 159, 160

glandulse Pacchioni, 142

olivary bodies, 216

pituitary gland, 280

— spinal canal, 200

Torcular Herophili, 147
Tract, sensatory and motor}', 222 — 235,
237, 238, 271, 274, 284, 294, 296,
297. 332, 334

Tractus opticus, 177, 234, 291, 292
Transverse commissure, 250, 331, 332
Treviranus, grey matter, 3, 80
Trifacial ganglia, 76
Tuber cinereum, 82, 83, 87, 102, 178,
179

Tubercula quadrigemina, 76, 79, 81, 100,
106, 333, 334
Tubes of glands, 2

Tubular neurine, 2, 7, 8, 10, 12, 15, 19,
23, 33, 248

Tunica arachnoidea, 143, 148, 149 — 158,
159

Turtle, respiration, 89, 90
Twain band or fornix, 259

V.

Valentin, grey matter, 13, 14, 20
Valsalva, nerves of dura mater, 147
Valve of Vieussens, 194, 264
Vauquelin, analysis of brain, 8
Veins, cerebral, 144, 145, 190

of spinal cord, 158

Velum interpositum, 194
Vena Galeni, 190
Ventricle, fifth, 190

fourth (whiting), 78, 182, 242

of brain, 78, 105, 121, 149, 150,

154, 180, 1S7, 189, 190—192, 242,
253, 255, 256, 320
Vertebrata, 27, 41, 52, 140, 211, 280
Vertebral arteries, 133

column, 139

Vertical section of brain, 176
Vesicular neurine, source of power, 2 — 7,
14—17, 24, 248, 329, 332
Vessels of brain, 132—136, 190, 302—
306

Vermiform process, 267, 269,277,278

Vicq d’Azyr, cerebellum, 270

corpus callosum, 250

— — optic ganglia, 80
Vieussens, ganglionic nerve, 37, 38

grey matter, 3, 259

nerves of dura mater, 147

Villi, intestinal, 16
Vimont, cerebellum, 333
Visceral nerves (lulus), 52, 53
Vomiting, 40

Volckmann, cerebro-spinal system, 20,
21

Volition, lost by paralysis, 7, 199

nerves of, 7, 51—53, 199, 208, 210,

223, 299, 329, 330, 337

W.

Wagner, Rudolph, weight of brain, 162
Walker, posterior columns, 231
Wallach, spinal canal, 200
Wasting of brain, 9, 19, 155, 162, 341
Weazel, cerebral vessels of, 137
Weight of brain, 161, 174

tables, 164—167

Wengel, glandulae Pacchioni, 142
Wenzel, corpus callosum, 250

foetal brain, 318

grey matter, 3, 4

hippocampus, 261

optic nerve, 289

weight of brain, 169

Whale, brain, its weight, 161
Wheatstone, decussation of nerves, 289
White substance of brain, 19, 23
Whytt, excito-motory, 330

reflex function, 60

Will, on corpuscles of brain, 21
Will or volition, excito-motory, 26, 42
Willis, ganglionic nerve, 37, 38

grey matter, 4

nerves, 286

weight of brain, 1 62

the circle of, 134, 136, 304

Winslow, ganglionic nerves, 37

nerves of dura mater, 147

Wollaston, semi-decussation of optic
nerves, 288, 290

World, external, medium of connection
with, the nerves, 26
Wrisberg, nerves of dura mater, 147
Wutzer, ganglionic nerves, 38

INDEX.

085

PATHOLOGY OP THE BRAIN.

A.

Abercrombie, anaemic coma, 362

apoplexy, 4S9— 492

simple, 52S

of cerebellum, 521

bleeding in apoplexy, 536

cerebral fullness, 345

coma, 458

inflammation membranes, 410, 41 1

organic disease of the brain, 594

ramollissement, 379 — 381

treatment of inflammation. 471 —

473

tumours of brain, 642, 650, 652

Abemethy, trephining, 570
Abscess of cerebellum, 521
Aconite in epilepsy, 616
Actual cautery, 471
Adams, simple apoplexy, 529
Alison, determinations of blood, 591

inflammation of brain, 486

simple apoplexy, 529

Andral, apoplexy, 443

of cerebellum, 520

convulsions, 449

corpus striatum, lesion of, 506

effusion, 466

induration, 469

meningitis, 410, 414, 415, 452

ramollissement, 376 — 379

Anaemic affections, 348 — 352, 486, 493

coma, 361 — 372

Apoplexy, 488 — 505

simple, 528 — 535

base of brain, 492 — 505

cerebellum, 517 — 520

meningeal, 490, 510, 512, 651

premonitory symptoms, how treat-
ed, 534

serous, 493, 524 — 528, 664

treatment, 534 — 552

Arachnoid, inflammation of, 397, 410 —
414, 424

Armstrong, delirium tremens, 353
Amott, determinations of blood, 592
Asthma and hypertrophy of brain, 669 —
671

Atrophy of brain, 394, 668, 669

B.

Bayle, mental alienations, 413
Bell, B., trephining, 571
Bennett, hydrocephalus, 367

Hughes, ramollissement, 382

Blake, delirium trernens, 353, 351,360

Bleeding, in epilepsy, 615, 616

apoplexy, extent of, 533 — 538, 541

Blood corpuscles in inflammation, 382 —
385

determinations of, 591 — 597, 610

Brain, debility of, 593

elasticity of, 663

organic disease of, 594, 641 — 663

weight of in disease, 669—672

Bright, bleeding in apoplexy, 538

cerebral irritation, 397, 399 — 401,

456, 593, 594

congestive epilepsy, 615

danger of calomel in apoplexy, 547

nux vomica in paralysis, 548

pituitary gland, 602

sanguineous apoplexy, 521

— - — tumours of brain, 649
Burrowes, bleeding in apoplexy, 542

cerebral fullness, 345 — 349, 593

meningeal apoplexy, 511

— — simple apoplexy, 528
strychnia in paralysis, 548

C.

Calomel, danger of, in apoplexy, 547
Carotids, effects of tying, 350

in epilepsy, 351, 601

■ throbbings of, 592

Carswell, meningeal apoplexy, 511
Case of abscess cerebellum, 520
— - — amaurosis, 481

anaemic apoplexy, 493

— — apoplexy, 490, 498, 500, 506, 507,
' 509, 512, 514, 517, 519, 520, 525,
527, 530, 537, 539

from fright, 443 .

atrophy of brain, 395

cerebral anaemia, 372, 373

concussion, 418, 420, 422

convulsions, 458, 500, 553, 577

delirium tremens, 356, 361

epilepsy, 587, 590, 606, 610, 612,

616, 618, 632, 634, 636

from cold, 603

- from syphilis, 604

■ hysterical, 607

tying carotid for, 601

use of digitalis, 598 — 600,

621, 626

use of turpentine, 636, 640

erysipelas, 368, 372

fracture of skull, and convulsions,

561

hydrocephalus. 385

C8G

INDEX.

Case of hypertrophy and induration of
brain, 662, 665- — 668

inflammation of brain, bleeding,

472

cortical substance, 403 — 410

dura mater, 424, 428

from fright, 433, 434

use of purgatives, 475

inflammation of the brain with effu-
sion, 465

injury of the head, 559

mania, 399, 431, 432, 442, 473

meningitis, 464

chronic, 483, 485

mental irritability, 445, 447, 451,

452

ossification of dura mater, 426,

428

otitis, 424

paralysis, 504, 549

softening of brain, 375, 388

syphilitic inflammation of brain,

430, 432, 604

thalam. nerv. optic., lesion of,

509

trephining, 561

tubercular deposit of brain, 650

tumour of brain, 648, 656

Cautery, actual, 471
Circulation through the encephalon, va-
riable, 344 — 349

Centric and centripetal convulsions, 586
Cerebellum, abscess of, 521

apoplexy of, 517 — 520

inflammation of, 396

Cerebral anaemia, 373
Cerebro-spinal softening, two kinds, 386
Chevers, Norman, effects of tying the
carotid, 350, 351

Chlorosis, anaemia of brain, 354, 374
Choroid plexus, hyperaemia of, in epi-
lepsy, 592

seat of organic disease, 651

Cineritious matter, source of power,
402

substance of, diseased, 400

Cold, cause of epilepsy, 603

ablutions, effect of, in apoplexy,

475, 533

Colles use of mercury, 484
Coma, 457, 529

anaemic, from exhaustion, 361

Concussion, 416 — 422
Congestive apoplexy, 529
Convulsions, 449, 457, 458, 552 — 579,
585, 600, 666, 670

Convulsions after injury of the head,
559

Cooper, Sir A., epilepsy, 584
experiments on cerebral and verte-
bral arteries of dogs, 349, 350
Copeman, bleeding in apoplexy, 546

Copland, apoplexy, 593

bleeding in, 538

cause of epilepsy, 596

delirium tremens, 353

induration of brain, 469

tumours of brain, 649

Corpus striatum, lesion of, 505 — 508
Corrigan, digitalis in epilepsy, 619,
620

Creosote in epilepsy, 611
Croton oil in apoplexy, 547
Crowing inspiration, 670
Cruveilhier, atrophy of brain, 391

ramollissement, 379

tumours of dura mater, 645, 649

D.

Dance, hypertrophy of brain, 665
Delirium, 414, 415

tremens, 852 — 361

Dementia, 468
Dentition, 470, 584
Depletion, delirium tremens, 358
Development of brain in foetus, arrest of,
394

Devil le, hypertrophy of brain, 662
Diet, delirium tremens, 360
Digitalis in epilepsy, 597, 598, 600,616,
619, 620, 626

Diseases of brain, divisions of, 343, 344
Douglas, paralysis, 521
Dupuytren, delirium tremens, 360

wounds of the head, 568

Dura mater, inflammation of, 423

lacerations of, 564, 567

ossification of, 426

pulsation of, 575

pus beneath, 576

tumours of, 642 — 644, 645

E.

Ear-ache, 424 — 425
Effusion, 466
Epilepsy, 579 — 641

cause of, 596, 603, 610

congestive, 595—615

essential, sympathetic and sympto-
matic, 608

forewarnings, 582, 601, 602, 618

hysterical, 607

intellect, state of, 582 — 633

prognosis, 606 — 615

pulse, 611

theory of, 590

treatment, 615

tying carotids for, 351, 601

Epileptic attacks, 444, 667

coma, 581

similitudes, 489, 524

Epidemic meningitis, 470
Eruptions of scalp, dentition, 470
Esquirol, epileptic plethora, 595

INDEX.

087

Esquirol, kinds of epilepsy, 608
prognosis in epilepsy, 60S)

F.

Fatuity, 359, 39 1
Fardell, ramollissement, 467
Fear, cause of meningitis, 433
Ferriar on digitalis, 620
Foville, epileptic plethora, 595, 616

G.

Georget, epilepsy, 5S4
Gluge, ramollissement, 382
Gooch, amende coma, 364
Green, tumours of brain, 649, 650
Guthrie, injuries of head, 56S

pulsation of dura mater, 576

trephining, 572

H.

Hamilton, digitalis in epilepsy, 620
Hall, Dr. XL, coma from exhaustion,
361—364

convulsions, 585 — 587

Hsematoma of brain, 651, 652
Hemorrhoidal evacuations, 473
Hardening of brain, 398
Head, determination of blood to, 592,
597, 601, 602, 610
Headache, meningitis, 452 — 457

organic disease of brain, 594

Heart disease, a cause of apoplexy, 494
—496, 542

epilepsy, 616

Hemispheres inflamed, 396 — ‘115, 424,
433—467

symptoms, 401, 552

Henle, ramollissement, 382
Hennen, trephining, 572
Hewett, meningeal apoplexy, 511
History of the pathology of convulsions,
616

Holland, epileptic plethora, 596

indiscriminate blood-letting, 543 —

546

inflammation of brain, 473

use of mercury, 487

Hooper, hamatoma, 652
Hunter, John, trephining, 571
Hydatids of choroid plexus, 592, 651
Hydrocephalus, 361, 367, 394, 664, 671,
672

Hydrocyanic acid in epilepsy, 616
Hyperamia of brain, symptoms, 359,
•367, 396—433, 470, 486
Hypertrophy of brain, 662 — 673
Hysterical epilepsy, 607

r.

Ice, application of, 475
Idiotcy, from hypertrophy of brain, 663,
670

Indigestion, cerebral disturbance, 497
Induration of brain, 468 — 470, 663, 669,
672

Inebriation, 402

Infants, coma of, 361

Inflammation, blood corpuscles, 382 — 385

of brain, external, 396

internal, 396, 433

Intellect, deranged, 401, 402, 413 — 417,
450, 457, 582, 666, 670, 671
Intellectual precocity, 662
Insanity, 394, 398, 413 — 431,442,468,
469, 473—481, 497, 591, 597, 610,
668

Joy, cause of meningitis, 433
IC.

Kellie, cerebral fullness, 345

L.

Laennec, induration and hypertrophy of
brain, 663, 664, 667
Lallemande, convulsions, 554

ramollissement, 376

Lawrence, trephining, 571
Light, effect of, delirium tremens, 353
Liver, enlargement of thymus gland,
669

Louis, tumours of dura mater, 642, 649
Lugol, tumours of the brain, 650
Lunatics, 469, 473

M.

Mania, compared with delirium tremens,
354

Martinet, meningitis, 413

Mayo, apoplexy, 553

Mauthner, hypertrophy of brain, 670

weight of brain, 669

Medulla, conductor of power, 402

inflamed, 396, 400 — 457

oblongata, apoplexy of, 499

Meningeal apoplexy, 510 — 516
Meningitis, 397, 410 — 417, 447 — 450,452
Mental imbecility, 398, 399, 479

irritability, 444, 450, 497, 552

Mercury, use of, 479 — 484, 485
Monro, cerebral fullness, 345
Morgagni, induration of brain, 663

lesion of corpus striata, 505, 506

paralysis, 556

schirrus of cerebellum, 521

serous apoplexy, 663, 664

softening of brain, 375

Munk, digitalis in epilepsy, 620

N.

Nux vomica, paralysis, 548

O.

(Enanthc crocata, produces epileptic
convulsions, 600

G88

INDEX.

Ollivier, apoplexy, 552
Opium, use of, delirium tremens, 358 —
360

inflammation of brain, 422,

486

Ossification of dura mater, 426, 429
Otitis, 424

P.

Paralysis, 449, 450, 521, 548, 554, 555,
556, 558, 577

Parent Duchatelet, meningitis, 413
Payen, induration of brain, 469
Peacock, ramollissenient, 388
Phthisis, atrophy of brain, 669
Pia mater, inflamed, 410, 424
Pinel, induration of brain, 469
Pituitary and pineal glands, (Copland,)
593

Pituitary gland, epilepsy,(Wenzels,) 593,
602

Pneumonia, increased weight of brain,
669

Pons Varolii, apoplexy of, 500
Portal, lesions of cerebellum, 521
Pritchard, inflammation of brain, 473

determinations of blood, 610

Pruss, meningeal apoplexy, 512
Pulsations of brain, 575, 576
Pulse, delirium tremens, 360
epilepsy, 611

Pupil, contracted or dilated, 458, 566

R.

Rachitis and hypertrophy of brain, 670 —
672

Radial nerve, removal for epilepsy, 584
Ramollissement, 361, 374 — 393, 398,
466, 520

its nature, 377 — 379, 382

Respiration arrested by apoplexy, 529
Rheumato- syphilitic inflammation of
brain, 429

Rogers, account of apoplexy at Madras,
532

Rollett, actual cautery, meningitis, 471
Rostan, ramollissement, 376, 379

S.

Saunders, delirium tremens, 353

Sauvages, epilepsy, 584

Scarlatina, increased weight of brain, 669

inflammation of brain, 432

Senile atrophy of brain, 394
Sensation, deranged, 402
Serous apoplexy, 525 — 528

effusion, 527, 538

delirium tremens, 353, 398

Sewell, Brodie, serous apoplexy, 527

Shower-bath in epilepsy, 638
Sieve-like softening of brain, 467
Signs of injury of brain, 565 — 570
Silver, oxide of, in epilepsy, 616, 619,
632, 636

Sims, hypertrophy of brain, 663, 668

ramollissement, 387

Skull, thick, insanity, 427
Smith, Mr. E., cause of epilepsy, 428
Spinal cord, softening, 386
Stimulants, use in delirium tremens, 359,
360

Strychnia in paralysis, 548
Sutton, delirium tremens, 352
Syphilitic inflammation of dura mater,
426, 603

T.

Thalamus nervi optici, lesion of, 509
Thymus gland, enlarged, 669
Treatment, apoplexy, 534 — 552
epilepsy, 615

inflammation of brain, 471 — 473,

488

premonitory symptoms of apo-
plexy, 534

Trephining, 565 — 577
Tubercular deposits of brain, 649, 650,
669

Tubular matter, inflamed, 396
Tumours of brain, 641

diagnosis, 646

symptoms, 652 — 655

Turpentine in epilepsy, 616, 638
Tyrrell, therapeutics, 477 — 483

V.

Valentin, ramollissement, 382
Velpeau, tumours of dura mater, 645
Ventricle, left, of heart, and enlarged
thymus, 669

Vogel, ramollissement, 382
Volition, deranged, 401, 402
Vomiting, inflamed medulla, 457

W.

Wagner, ramollissement, 382
Walslie, tumours of dura mater, 645, 647 ,
652

Watson, bleeding in apoplexy, 538

cerebral fullness, 348

delirium tremens, 355, 356

epilepsy, 585, 595, 638

inflammation of dura mater, 423,

424

treatment of apoplexy, 535

Wenzels, pituitary gland in epilepsy,
593, 602

tumours of dura mater, 644

Printed by Richard Kinder, Green Arbour Court, Old Bailey.

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