attacks, of more or less severity. Her intellect became enfeebled, and her feelings blunted. She declined in every way, and, in the beginning of 1834, she died.

Inspection, the Day after Death. Head. Skull hard, with a thick os frontis. The arachnoid and velum interpositum were opaque, and of a light slate colour: there was some fluid between the membranes, and from four to six ounces in the ventricles. There was an old fawn-coloured deposit in the left hemisphere of the cerebrum: the thalamus of the right side was softened. The blood-vessels were thickened with white deposit. Many small holes were observed, appearing like worm-eaten cavities, in both hemispheres of the cerebrum; some were also found in the cerebellum; they were of various sizes, some spherical, and others of an irregular shape; some were quite clean, and not at all discoloured, especially in the white matter; others were lined by a light fawn-coloured membrane. Several small black spherical bodies were observed, much resembling melanotic matter, in two or three places they were afterwards found to be portions of coagulated blood inclosed in a membrane; the surrounding white matter was not tinged by the blood. The substance of the cerebrum, with the exception of the right thalamus, was harder than usual.

Thorax. Hypertrophy of left ventricle of the heart. Other viscera examined, natural.

Dr. Sims' explanation of the preceding case may be omitted. It is more ingenious than satisfactory-probable, perhaps, but difficult of proof. He says, for example, that "the various holes found in different parts of the cerebrum and cerebellum, the fluid effused, and the hardening of the cerebrum, are traces of previous disease in the organ, which I take to have been ramollissement without extravasation, excepting in the holes where yellow matter was found." This may or may not be the case, but as such conjectures prove nothing, we may at present pass them by.

The next case we shall offer (the sixth of Dr. Sims), is brought forward as an instance of cure of ramollissement of the gray matter.

CASE 3-Richard Bailey, æt. 53, brought to the workhouse April 10th, 1835, in a state of diarrhea and exhaustion. On the 22d he died.

Dissection. The arachnod lining the dura mater laterally, and throughout nearly the whole of the base of the skull, was generally, and more particularly in patches, discoloured by a granular deposit of minute rusty-coloured points, evidently the traces of effused blood between the dura mater and the arachnoid. The arachnoid on the right parietal region was separated from the dura mater. Several of the convolutions at the surface of the base of the posterior lobes were in various degrees absorbed, and the fawn-coloured deposit placed there; in one or two places, the whole of the gray matter was removed and the white matter exposed, in others an external thin layer only, the arachnoid covering these places was entire. From 8 to 10ozs. of serum were effused between the membranes and into the ventricles. The brain was atrophied. The vessels were but little loaded, and had no appearance of disease. Weight, 2lbs. 7ozs.

There was fluid in both pleural cavities and in the pericardium-tubercles, and cavities, and pneumonia, existed in the lungs.

Dr. Sims looks on the absorption of the gray matter and the fawn-coloured

deposit as ample evidence of the previous existence of red ramollissement with slight extravasation.

The heading of the tenth case is illustrative of the many lesions found in the kind of cases that fall in the workhouse under the inspection of Dr. Sims. His sexagenarian patients have probably, many of them, hardly one organ sound. The lesions of old age are so numerous and so general, that it is difficult to determine the contribution of each towards the mental and bodily decay. But we spoke of the heading of this case. It is styled one ofapoplexy-hemiplegia-attacks of angina pectoris-ramollissement of gray matter-traces of ramollissement in central parts-hypertrophy of the heart -ossification of the coronary artery. With this enumeration we shall rest content, and proceed at once to the conclusions of our author. He thus advances them.

"1. In some of the cases the account of symptoms is necessarily very limited, but this circumstance I do not consider of much importance, as I am desirous of placing the subject on its true basis, the anatomy of the brain in other cases, however, we have a sufficiently copious detail of symptoms which indicated the nature of the disease, and the progressive improvement in some of the paralytic symptoms corresponded with the traces of the cure or arrest of ramollissement observed in the brain. The cases, No. II., Mrs. A. S. and No. X., Thomas Wood, are examples in illustration.

2. The traces of the cure of ramollissement of the gray matter are, absorption of one or more layers of this substance on the convolutions, and adhesion of the pia mater to the part: holes in the gray matter of the corpora striata and other central parts, together with atrophy and flattening. When transudation from the blood-vessels, or extravasation, has taken place, constituting red ramollissement in the gray matter, a permanent fawn colour of the atrophied convolutions, and of the small holes in the other parts, is observed. The slightest form of this softening of the grey matter is noticed in the case of purpura hæmorrhagica; in others we have one or more layers removed, or the entire gray matter, leaving the white matter of the hemisphere visible. We sometimes see merely small holes in the corpora striata; at others, cavities of various sizes and forms, with a marked wasting of these bodies.

3. The traces of the cure of ramollissement in the white matter are, the numerous clean or scooped out holes containing a limpid fluid, some of which are observed to be lined by a fine transparent membrane; others appear as if worm-eaten. These holes are of various sizes and forms, from minute points to the magnitude of a bean; the porous cheese or new bread appearance; the hardened state of the white matter generally in these brains, and particularly in the parts contiguous to the holes; the granular state of the white matter indicating cicatrices; the hardened state of the corpus callosum, fornix, &c., found in the brains of children and young persons, with fluid in the ventricles, probably the consequence of previous inflammatory ramollissement at an earlier period of life. When there is observed the fawn-coloured deposit in these holes of the white matter, they are traces of red ramollissement of the white matter, or probably, in some instances, of what has been sometimes termed capillary apoplexy.

4. I have perhaps to assume in this argument that ramollissement is by some means or other stopped in its progress; and, if this be granted, the preceding detail of the morbid appearances will readily fill up the several steps of the process of cure: the absorption of the softened parts; the adhesion of the pia mater on the surface; the secretion of fluid into the holes; the granular state of the white matter, probably from cicatrization; the hardening of the white matter, probably from effusion of lymph; and the fawn-coloured traces of previous transudation and extravasation. And I think this assumption ought to be granted,

from the improvement in the symptoms of some of the patients, corresponding with the state of the brain after death; and because it is consistent with all analogy in the powers by which nature arrests or cures disorganization in other parts of the body.

5. There are some points connected with the subject, as the spherical spots of coagulated blood, the extravasated layer on the arachnoid, the fawn-coloured trace of extravasation between the arachnoid and the dura mater, and the connection of the traces of previous ramollissement with apoplectic clots: these are subjects well worthy of attention, but I have sufficiently adverted to them in the remarks on the respective cases in which they occurred.

6. The preceding facts and observations are, I believe, sufficient to attest the cure of ramollissement of the brain, and to set the question at rest on the solid basis of pathological anatomy." 416.

It is difficult to know exactly what to say on the preceding observations. That Dr. Sims is satisfied is clear-that he mixes with his facts a large share of speculation is quite obvious-but that those facts are deserving of consideration cannot in fairness be denied. The cure of the red ramollissement attendant on extravasation is unquestionable. There is scarcely a hospital pupil of two or three years standing who is not perfectly familiar with the fact, that in the brains of persons who have had hemiplegiac attacks, and sometimes when no such history can be obtained, the cerebral mass displays here and there the marks of former extravasations with their attendant softening, in a condition more or less advanced towards cure. But we shall not pretend to determine if our author's general statement be correct or not-we shall not pretend to pronounce on the question whether he is right or wrong in his description of the cure of the red and the white ramollissement.

One circumstance has struck us, and must make an impression on the minds of all-that the examinations so pursued by Dr. Sims were all in the bodies of old persons. The youngest of the individuals, who form the subjects of the cadaveric researches of our author, was 53 years old; the majority were from sixty to seventy years of age. At that period of life, the lesions of the organs, more particularly of the brain, are comparatively seldom simple. The great fault is usually in the circulating system. The vessels are more or less inelastic, perhaps actually diseased-the left ventricle of the heart is probably hypertrophied-the various organs are more or less altered in their several ways-sub-arachnoid effusion is found in the brain-the texture of that organ has most likely undergone minute and subtle changes which escape our coarser means of examination—and the investigations of Dr. Sims shew that wasting of all or of parts of it is common. Their senses have failed because the minute organization of their matériel has undergone certain modifications. Amidst this general mass of disorganizations it may be interesting and curious to single out one, and, making it the subject of special study, to see what share it has in destroying the rusty and worn-out machine-it may be interesting and curious as a matter of abstract pathological science, but in the eye of the utilitarian it will seem as nought, and the practical physician will be too apt to regard it as a pathological play-thing-a subject for school-boys to pore over in the dead-house, or for doctors who see more of the dead than of the living to muse or to discourse upon in the closet or the lecture-room.

We do not participate in this practical contempt for abstract science. It

is the mixture of abstraction with matter of fact, that gives to medicine much of its interest. The mere routinist who looks on all knowledge for just what it will bring, may put guineas in his pocket, but will seldom materially advance his art. The great improvements are rarely made by your mere practitioner. Genius and speculation discover truths, which men without genius or speculation apply. Mr. Pott was a much better practical surgeon than John Hunter, but how much more has John Hunter advanced the science of practical surgery than Mr. Pott. That one idea, that the ligature of an artery above an aneurism might cure an aneurysm, has done more for humanity, directly and indirectly, than the labours of almost all the empiric sect from Hippocrates to the meanest drug composer of this day. We say, then, to Dr. Sims-" Go on. Persevere in your laborious and scientific investigations."

IV. SOME CASES OF MENTAL DERANGEMENT, SUCCESSFULLY TREATED BY THE ACETATE OF MORPHIA. By EDWARD J. SEYMOUR, M.D. &c.

This Paper is of a widely different character from that of the three we have quitted. After perusing pathological articles, we turn with pleasure to those which exhibit curable or cured disease. The mind finds repose and a gleam of satisfaction at the prospect which wooes it from the contemplation of death. A successful case is like a novel. The page closes with the cure, as with the marriage of the parties, and nothing but health and happiness are in the future.

The laudable object of Dr. Seymour is to shew the good effects that sometimes attend the exhibition of the acetate of morphia in cases of insanity. He observes with justice that too much has been attributed to inflammation of the brain in the production of mental derangement. Experience, he says, has shewn that blood-letting in maniacal cases, unconnected with disease of other organs than the brain, is seldom attended with good effect, and of late years the soothing system has very generally been adopted by medical men, and founded as it is on true principles of pathology, is more likely to lead to success than any other. To diminish the increased and morbidly acute perceptions, and to effect a decrease in the sensibility of the organ, and to reduce the exaggeration of its natural functions, seems to be the great object; and so far from such a condition being always the result of too great a flow of blood to the head, morbidly stimulating the organ, it often occurs in those who have rather less blood than usual for the maintenance of life in the brain, occasioned by excessive evacuations, watching, anxiety, and bad living.

The cases which form the subject of the present paper are three. Each is interesting.

Case 1. "A lady, aged about forty-eight, was attacked in the month of August, 1833, (after exposure to severe distress by the death of a relation who expired in her presence,) with mental derangement. Her usual habits of thinking were those of great deliberation; she had lived much in society, and from her station, mixed much with the world, nor had there at any time been any, even the slightest, indication of eccentricity or weakness of mind. Her mind was, at the time I saw her, filled with gloomy ideas; imaginary neglect of great and solemn

duties, and a belief of having committed indescribable and even ill-defined crimes, constituted the principal features of her malady. Her bodily health was unusually robust, and she had scarcely ever suffered even from trifling bodily ailments. In the first instance the patient was bled, and took repeated doses of purgative medicine, but without any beneficial effect. The pulse was not weak; the nights were sleepless, and there was constant watchfulness present; there was no pain in the head, but a sense of weight was described, and there was restlessness of the body always present, so that the patient would often endeavour to jump out of bed and run about the room. During an unavoidable absence from London, the patient was seen by my friend Dr. Southey, and she was kept under nauseating doses of tartar emetic without any satisfactory result.

It was now resolved to try the morphia, and a grain of the acetate was ordered to be taken every night, the bowels to be kept open by small doses of castor oil; the severity of the symptoms became greatly diminished, and it occurred to me that the sedative effect of cold would greatly assist the operation of the remedy. Ice was therefore kept to the head in a bladder, day and night. The morphia never failed to procure a good night, and thus by degrees, without any other remedy, except those mentioned, the mind cleared up. The use of ice was gradually abandoned, but the morphia continued to be administered every night during three months, although all traces of insanity had disappeared six weeks from the commencement of the employment of the remedies, during ten days of which the ice was kept constantly to the head. No relapse whatever has occurred in this patient." ~ 171.

Dr.

Case 2. A married lady, æt. 34, the mother of several children, who had over-exerted herself previously to commencing a journey, and in whom the catamenia were reported to have been, in consequence, suddenly checked, was attacked with what was thought to be inflammation of the lungs. For this she was bled, &c., but the blood displayed no buffy coat. She was then seized with mania, the prevalent idea being fear of some object near her, or of some serious accident having happened to those she loved. Seymour saw her once and ordered a dose of morphia, which gave her sleep but was not repeated. In about a fortnight, the patient was removed to London, and placed under Dr. Seymour's cure. The mind was seriously affected, the patient was violent, and her imagination strangely disordered. She fancied her children were murdered, and their spirits returned to torment her, and that some similar evil menaced her husband. Her sleep was broken, and her conversation incoherent. The pulse was 100, and not strong. The tongue white, but not loaded; there was no fever, but occasional flushing of the face. The catamenia had returned at the usual period. A grain of the acetate of morphia was ordered to be given every night at bed time-ice was applied to the head-and the bowels were kept open by castor oil or senna every other morning. In three weeks the patient began to recover, but she was not well before several months had elapsed. On one occasion opium was substituted for the morphia, but it greatly disagreed.

Case 3. A lady whilst greatly distressed in mind bore a child. Her confinement was followed by mental derangement, and a state of utter imbecility. Aroused occasionally by the importunities of those who watched her, she uttered a short quick cry and relapsed into her usual state. Her fæces and urine were passed all unconsciously. The skin was cold, the pulse