feebled and idiocy and hemiplegia are established. M. Cruveilhier thinks that this train of symptoms is sufficient to point out the nature of the case, but we fear he is too sanguine. Even in those who are attacked with sudden symptoms, he believes that severe pains in the paralysed limbs, epileptiform seizures, long-established pains in the head and disturbance of intellect before the occurrence of hemiplegia, somnolency, &c. may furnish an intelligible guide to correct diagnosis. We need scarcely observe to practical men that these criteria will often prove deceptive; but still we believe that, if a careful practitioner has his wits about him, he may not unfrequently prognosticate, from such data, the nature of the disease. It is well ascertained that these cancerous tumours are seldom in themselves the cause of death. The fatal termination is induced by serous effusion between the membranes, arachnitis, more frequently still an apoplectic extravasation of blood, or extensive contiguous ramollissement. An important point is the difference of effect produced by disease of the same intensity in different individuals. As this, however, is little susceptible of satisfactory investigation, we leave it to those who have leisure or talent for unravelling the mysterious doctrine of susceptibility of habit. No doubt the position of the tumour and the direction which it takes must exercise influence in determining the relative quantum of mischief. With these remarks we proceed to the detail of particular cases. These are illustrated by coloured lithographic plates of the morbid lesions, conveying their nature to the eye in a very clear manner; if not so highly finished as some in this country, they are equally faithful, and, by reason of their cheapness, more generally useful.

CASE 1. Hemiplegia-Epileptic Convulsions-Cancerous Tumor of the Dura

Mater.

Lecouvreur, æt. 65, was brought to the Maison de Santé in August, 1829, with hemiplegia of the right side. There were also severe pains throughout the body, and attacks like epilepsy occur

red at long intervals. The intellectual faculties continued unimpaired, and the patient died at length worn out with sloughs on the sacrum and trochanters, the consequence of pressure.

Sectio Cadaveris :-On raising the scalp a considerable tumour was discovered over the parietal, and near the coronal suture. Its texture was spongy with bony spiculæ intermixed; it extended through the cranium to the dura mater over the superior longitudinal sinus. The inner table of the skull was in part absorbed, the tumour extended still farther in the diploë, and on slitting open the longitudinal sinus it was found to contain some small végétations of medullary matter. Besides this, two roundish cancerous bodies, grew from the dura mater in the angle between it and the falx; they pressed upon the brain, and the larger had occasioned a deep excavation in the left hemisphere, whilst the smaller was lodged in a similar manner in the right. The convolutions beneath had disappeared, and in the left hemisphere the contiguous white cerebral matter had undergone a remarkable gelatinous ramollissement. A very good plate of the disease is appended, together with some learned observations on the case. It is enough to remark that it offers an example, both of medullary tumour growing from the inner surface of the dura mater, and arising in the cranial diploë.

CASE 2. Medullary Tumour growing from the falx, in a patient recently lithotomized.

M. R. ætatis 65, having undergone lithotrity without success, was, sometime afterwards, attacked with a cerebral affection, succeeded by paraplegia of the lower extremities. In spite of M. Dupuytren's objections, he insisted on submitting to lithotomy, which was done on the 13th of August last. Cerebral symptoms supervened, and the patient died on the 16th.

Sectio Cadaveris. A large quantity of serum flowed from between the membranes; the brain itself was healthy. On the anterior extremity and right side of the falx, was "a fibrous tumour," the size of a large nut, lodged in a cor

responding depression of the hemisphere. The arachnoid was healthy. The kidneys were large and soft. There were three sacculated stones in the bladder, and several little hollows capable of containing calculi. The cerebral tumour itself was hard, almost cartilaginous, and yielded on pressure a milky juice.

CASE 3. Fungus of the internal surface of the Dura Mater—torpor—diminution of voluntary motion.

A woman, ætatis 45, complained habitually of head-ache, and shortly before her admission into the Maison de Santé, was totally unable to walk. On admission, in September, 1829, her symptoms were, constant reclination on her back-immobility both when asleep or awake-involuntary discharge of urine -constipation. The left inferior extremity appeared to be weaker than the right; the left commissure of the lips to be depressed; she spoke but gruffly and with slowness; and she complained of pain in the forehead. The pulse was feeble, but varied in frequency. M. Cruveilhier suspected some tumour within the head. She died suddenly on the 3d of October.

Sectio Cadaveris. A tumour reached from the inferior surface of the dura mater to the right of the falx cerebri, lodged in a depression in the anterior part of the right hemisphere of the brain. The depressed convolutions were atrophied, but not disorganized. The tumour was knobbed, traversed by numerous vessels, soft in texture, and consisted of a pulpy substance with innumerable granulations disseminated through it.

CASE IV. Fungus from the interior of the Dura Mater, penetrating into the nose.

A man, about 30 years of age, was affected with perfect amaurosis, from which he recovered for one day, but imnediately relapsed. He died suddenly and unexpectedly. On dissection, the inferior and internal parts of the anterior lobes of the brain were converted into a tubercular mass, which had destroyed the cribriform lamella, and entered the nasal fossæ and the ethmoid

No. XXVI. FASCIC. II.

cells. No vestige remained of the olfactory nerves, the optic commissure was pressed upon, and the orbital portion of the optic nerves was reduced to little else than neurilema. It was said that the patient complained of the fetor of pus, and took tobacco with pleasure.

CASE V. Fungus on the surface of the Brain-sudden Hemiplegia- Epileptic seizure.

J. D. Glaber, ætatis 66, had long complained of head-aches and debility, when in June, 1829, he was suddenly attacked with hemiplegia on the left side. On the 15th of August, he was seized with violent convulsive motions, confined to the paralysed limbs, which lasted for half an hour. Debility made progress, slight stupor succeeded, and on the 9th of September he expired, retaining all his consciousness to the last.

Sectio Cadaveris. Beneath the arachnoid, on the surface of the right hemisphere, near the union of the anterior and middle lobes, was a fungous tumour the size of a nut. The brain was pressed on, and its convolutions destroyed; around it presented the yellow ramollissement.

This completes the list of cases related by M. Cruveilhier. We have abridged them considerably, but probably our readers will not quarrel with us for that. We have given sufficient details to shew that the symptoms will vary in different individuals, but still the majority suffer from head-ache, partial palsy, or other slight cerebral symptom, before the hemiplegia, or the coma, or the sudden apoplectic seizure supervene. If these circumstances be considered with care, if the patient have a more than ordinarily sallow aspect, and if his age be rather advanced, the practitioner may frequently be enabled to prognosticate the existence of a tumour within the cranium. We have said that the age is commonly advanced, and for proof of the assertion we appeal to facts. In the present series of five cases, three patients were above sixty, and the youngest was thirty. We should mention before we quit the subject, that all the cases are accompanied

Kk

We had only room to glance at this publication in some late articles, and introduce an extract from the life of Dr. Gooch. We shall probably, however, find that several passages in these lives may be capable of furnishing wholesome food for reflexion from time to time. Speaking of HARVEY, the biographer informs us that, though choleric and passionate in youth, that great anatomist was goodnatured and cheerful in manhood and age. His antagonists were treated with modest and temperate language a great contrast to their own and he ever praised those from whom he differed in opinion.

"He was a great martyr to the gout, and his method of treating himself was as follows:-He would sit with his legs bare, even if it were frosty weather, on the leads of Cockaine House, where he lived for some time with his brother Eliab, or put them into a pail of water, till he was almost dead with cold, and then he would betake himself to his stove, and so it was done. He was troubled with insomnolency, and would then get up and walk about his chamber in his shirt, till he was pretty cool, or even till he began to shiver, when he would return to bed and fall into a sleep."

But the more interesting topic relates to the practice of so great a man. He died worth 20,000 pounds-a sum not very large to be left by a court physician, who must have been at least 50 years in practice. One of his intimate acquaintances declared that he would not give threepence for Harvey's prescriptions, they were so complicated and heterogeneous-an error not now run into, but rather the reverse. The following passage might be made to bear upon some living characters-and

still more upon some who have lately gone to their long homes.

"It is probable that Harvey was too much occupied in the pursuit of knowledge, too intent upon making discoveries in the world of science, to have cultivated the habit of quickly discrimi➡ nating ordinary diseases, or to have become very expert and ready in the em ployment of the resources and expedients of the practical art of medicine. That his business declined after the publication of his doctrine of the circulation of the blood, he himself complained of, and ascribed to the opposition and jealousy of his rivals; but it is more likely that the habits of abstract speculation in which he now began to indulge caused him to neglect the usual arts of gaining the confidence of the public, which if a physician once possess, he needs not the countenance, and may boldly set at defiance the envy, of his professional brethren. The example of Harvey may be regarded, therefore, as a splendid illustration of the truth of the opinion of a late celebrated physician, as declared in his posthumous work: That the most successful treatment of patients depends upon the exertion of sagacity or good common sense, guided by a competent professional knowledge.' If anatomy alone were sufficient to make a great physician, who ever could have been put in competition with Harvey?"

We are inclined to think that there is some foundation for the popular notion, that he who is an ardent cultivator of any collateral science, or even of any one branch of the elements of medical science itself, is seldom a good practical physician or surgeon. The reasoning by which this notion might be supported must be based on the melancholy fact, that the longest life of attentive observation, at the bedside of sickness and death, is insufficient for the acquisition of an accurate knowledge of the phenomena of diseases and the operation of their remedies. The seduction of the auxiliary sciences, then, might be urged as a bar, or at least an impediment, to the highest advances in prac tical knowledge of which an individual was capable. That there is some truth

in this train of reasoning there can be no doubt; and many dead as well as living examples might be quoted in illustration. But we fear that such examples and such reasonings are too eagerly laid hold of by the indolence of mankind to cloak ignorance-or rather to palliate its existence. We do not like therefore, to hear the auxiliary sciences despised by practical medical men; while, at the same time, we would advise those who are candidates for public patronage, to beware of dedicating more than a rigid and wise proportion of their studies to the auxiliary sciences-or to any one branch of elementary medical knowledge. A distinction gained in this way may prove gratifying to the feelings, but injurious to the professional interests of the individual.

We are inclined to believe that it was the incessant devotion to physiological pursuits, rather than the "jealousy of his rivals," that caused the declension of Harvey's practice. We cannot, indeed, judge accurately of the operation of the same causes in the time of Harvey, as compared with our own days. But, in the present state of things, the jealousy of rivals, we apprehend, goes for little in obstructing real talent. Patronage and favouritism may and do push people into notice, who, if left to their own resources would never be heard of; but we question whether the most rancorous hatred or jealousy can materially obstruct the progress of genenuine talent and undeviating rectitude of conduct. This last is generally indispensible to final and complete success. For although the CHARLATAN may fill his pockets, and the manœuvring REGULAR may gain a march on his more honest and honorable competitor, TIME usually dispels the illusion, and proves that "HONESTY IS THE BEST POLICY."

XXIX.

DIFFICULTIES OF ANATOMY IN AMERICA.

We see by the American journals that our brethren on the other side of the Atlantic labour under the same embar.

rassment as we do, in regard to dissection. The Massachusetts Medical Society has issued an address to the community, on the necessity of legalizing the study of anatomy, in which they appeal to the feelings-and indeed to the self-interest of their non-professional countrymen, by relating_nume rous facts illustrating the dire effects of a defective knowledge of anatomy. We hope, and indeed believe, that these illustrations are somewhat too highly coloured-and one of them we grieve to see not only inserted, but, in some degree warranted by our esteemed contemporary, the Journal of Medical Science for May last. We shall quote this melancholy case, and we trust that every thinking reader will agree with us that it is a misrepresentation-an almost palpable impossibility.

"The Address, after some general observations on the indispensable nature of anatomy to the accomplished physician, which are sufficiently familiar to every medical man, goes on to quote several striking instances of the loss of life from patients falling into incompetent hands. An aged practitioner reports more than a hundred persons, under his own observation, dying from strangulated hernia, and the question is very naturally asked, how great must have been the number in the whole of New England, who perished miserably from the same cause?' There are also several interesting cases given, somewhat at large, of death from the accidental wounding of large arteries by the ordinary implements of husbandry, and other instruments. There is much good sense in making these statements, because positive instances of evil, are always more readily comprehended than mere abstract argument, and where a question of human misery is concerned, our sympathies are inevitably excited. It has been our misfortune to witness several of those horrors in the practice of surgery, arising from an ignorance of anatomy on the part of operators. If there were no other object in view than to stigmatise an individual, charity would induce us to suppress the narrative, but as an important argument is in question, it is proper to adduce it.

During the brilliant campaign of our army, in 1814, on the Niagara frontier, many cases of severe wounds required surgical operations. A surgeon occupying a distinguished station through his commission, but certainly not through any professional qualification, was a chief operator. We saw this person, in an amputation of the thigh, fail to cut through the great sciatic nerve; after the bone was sawed through, the -limb still hung on by this nerve; ignorant of its nature, he made a plunge at it with his saw, the screams of the poor soldier attested the concentrated agony of a thousand operations, until the operator was implored by an assistant to desist and to use a knife. A captive officer of the enemy was wounded in the fore-arm, by a musket ball, and from the division of an artery, the bleeding was profuse; several days were spent in attempting to arrest it with a tourniquet. The pressure of the latter at length caused great tumefaction of the limb, and threatened mortification. The same operator instead of taking up the main artery above the wound, amputated the limb, and the operation being performed while it was in a state of inflammation, the pain was immeasurably augmented, and the poor fellow finally fell a victim to the want of scientific skill."

We have put a passage in italics, and we conscientiously believe than an error has crept into the recital. How could the integuments of the thigh be retracted so as to leave the bone bare for the saw, with the great sciatic nerve, and many soft parts between it and the bone undivided? We think the thing impossible! And as to the attempt to saw through the nerve-it is so absurd, that the most ignorant carpenter would not have dreamt of such a procedure. It is also a great inconsistency to suppose that any man who was a "chief operator," and consequently who must have been able to tie arteries and amputate limbs, should have been entirely ignorant of what a large nerve was when laid bare in an operation. We consider ourselves as DENIZENS of America -and for the honour of that land which has adopted us, we take the liberty of

remonstrating with our transatlantic contemporary, and request him to reflect on a passage which casts a deep reflexion on his professional brethren.

XXX.

MOLLESCENCE OF THE BRAIN, WITH DESTRUCTION OF SEVERAL Important PARTS, UNATTENDED BY PARALYSIS OF MOTION OR FEELING. Reported by M. SABATIER.*

THE following case is calculated to awaken caution in our confident diagnosticators, who can pronounce on the most obscure, as well as on the most palpable diseases.

Case. Ant. Gallopin, aged 42 years, a baker, entered the Hospital Saint Louis on the 2d of April, 1830. He had come from the country to Paris, for the cure of pains in his limbs. He had travelled on foot a long journey in cold weather, which exasperated the pains in his legs. Sometimes these pains were attended with numbness of the parts. He never had rheumatism-nor swellings of the legs. He appeared (3d of April, when examined) to be of a robust constitution, muscular, and possessing a good appetite-pulse a little accelerated-abdomen soft-no pain of head. He was left without medical interference for a few days, to see what repose and warm baths would do. On the 5th, it was found that the pains still continued without any diminution. He was, therefore, subjected twice to an alcoholic fumigation, without any relief. A rigorous examination of the lower extremities was made, but nothing whatever could be detected. When desired to walk, it was evident that he stagger ed. In the middle of the night (7th) he got up in a state of delirium and lay down on the stairs, where he remained till carried back to the ward. When visited on the morning of the 8th, he was found lying on the right side, his

* Hôpital St. Louis.