during life. He divides the various collected cases into five categories. 1. Those which run their course without any, or with but very obscure symptoms. 2. Cases in which epilepsy exists without mental disturbance; in these cases death occurs either independently of epilepsy, or so far connected with it that the epileptic symptoms first set in shortly before death, or the attacks increase exceedingly shortly before death, or a kind of cerebral disturbance is developed from one or more of the attacks which leads to death. 3. Cases in which, along with epilepsy, a psychical disturbance is at the same time set up, whose continuation and character warrant the designation of a mental disease. The psychical disturbance is expressed at one time as mania, true delirium or confusion of mind, at another as obstinacy or imbecility, and appears either before or after epilepsy. 4. Cases in which epilepsy is wanting, but in which the mental disturbance exists, accompanied frequently by other motor and sensitive disturbances. In some of these cases other pathological changes within the cranium appear to form the basis of the psychical disease. 5. There are cases in which neither epilepsy nor mental disturbance exists, but cerebral symptoms of irritation or torpor, which come on shortly before death, or assume a chronic form. The cysticerci were situated chiefly at the periphery of the brain, in the grey cortical layer; whence it is inferred that they had not been themselves carried thither, but that their germs had. The epilepsy from cysticercus is in all respects like cerebral epilepsy, and the psychical disturbances in general have nothing characteristic about them. Very often also other cerebral symptoms coexist, such as squinting, alteration in the pupils, avoidance of light, headache, coma, anomalous sensations in the limbs, &c. The following propositions are set forth as results of our author's experience : 1. The diagnosis of cysticercus must be based on a twofold series of considerations: on the one hand, resting on the improbability of any other cerebral affection, the symptoms not corresponding; and on the other, on the presence of definite series of symptoms. 2. Cases of convulsive attacks being more or less epileptic, are chiefly suspicious, which come on in a subacute way, or quickly increase to a certain pitch, and presently, after a steady increase in number and intensity, assume the general appearance of a very severe cerebral disease. 3. The probability of cysticercus is increased if these symptoms come on in patients of adult age, being previously healthy, or in men in whom neither hereditary disposition nor traumatic or syphi litic influences, nor lesions of the vessels or heart, could have given rise to them. 4. A suspicion of this disease would be aroused if, under the circumstances last named, mental depression and confusion, accompanied with giddiness, loss of sight and hearing, headache, coma, &c., occur. 5. Symptoms of cerebral lesion, if conjoined with paralysis, are to be looked upon almost with certainty as not having origin in the cysticercus. 6. The manifestation of cysticerci in external parts under such circumstances naturally elevates the probability into certainty. ART. 31.-On the Pathology of Insanity. By Dr. JAMES GEORGE DAVEY. (Pamphlet. London. 1853. Pp. 16.) This pamphlet is a reprint of an article which appeared in The Zoist as far back as July, 1843. It shows very plainly that Dr. Davey enunciated these opinions full twenty years ago, and so far makes good a claim to priority on the part of its author. 66 "I am disposed," says Dr. Davey, "to regard insanity as of two kinds the one dependent on nervous irritation of the brain, and the other on inflammation. The very common indications of the existence of past or present inflammatory action of the brain or membranes, I consider a proof of not only the occasional associations of diseased cerebration with inflammation, as its immediate cause, but also of the frequent occurrence of such in the progress of insanity -that is, of that form of the disease consequent on 'nervous irritation.' "The patients in Hanwell are very liable to attacks of cerebral and meningeal inflammation, and which not unfrequently prove the immediate cause of death. In such cases the general symptoms which indicate the existence of inflammatory disease assume the same asthenic character which belongs to peripneumonia, enteritis, erysipelas, &c. &c., when occurring in nervous and irritable subjects. Upon the same principle that such persons are more liable to the more ordinary derangements of the general health, of which chronic inflammatory diseases form a great part-so are the insane predisposed to the occurrence of cerebral and meningeal inflammation, and hence the ordinary appearances observed after death. 66 The origin and progress of many cases of insanity are sufficient to prove this position: e.g., suppose, for the sake of illustration, that an individual of delicate fibre is suddenly frightened by some cause or other, and, instead of her recovering from the consequences of alarm, they continue with aggravated severity. The faintest sound which reaches the ear is construed into a renewal of the first cause of her deep affliction; the gentlest wind which may happen to blow seems to threaten her yet more sorely. Every surrounding object at length appears tinctured with the cause of her misery, and each effort of herself and friends to shake off the horrid incubus is vain. Time rolls on only to show how much she is the instrument of her involuntary feelings. At length the judgment is betrayed into acquiescence. She no longer merely feels her sufferings, but she seeks a cause for them which shall not only excuse them to herself, but be in strict harmony with her predominant feelings; and thus, in passing from bad to worse, she at length realizes the precise condition of one labouring under acute mania. The deranged cere bration (insanity) is, in such a case, necessarily the effect of an irritation of the ultimate fibrous structure of the brain, and which must be regarded as the consequence of the application, through the medium of the external senses, of a stimulus so intense as to prove incompatible with the healthy physical capacities of the organ. That a similar abnormal effect results from the application of a stimulus very much less concentrated, so to speak, if it be permanent, is quite certain. 66 'Again if we imagine an individual labouring under intense avarice, grief, or pride, it would follow that the increasing physical action of the same portion or portions of cerebral substance would tend to the development of such a state of susceptibility and irritation of the parts concerned, that at length the volition would become suspended; or, in other words, the morbid action would acquire so great a supremacy as to subjugate every other feeling and propensity, and which of course must be, as above asserted, incompatible with the healthy physical capacities of the brain. Under such circumstances, the cerebrum may be compared to any ordinary muscle which from long use has acquired the habit of executing a certain movement involuntarily, although perhaps it may be painful or disagreeable. 66 Now if such an abnormal state (irritation) of the cerebrum remains unrelieved, nothing is more likely than the occurrence of inflammation of the brain and its membranes, more or less insidious; and which progressing, would necessarily induce those palpable disorganizations of structure, effusions, &c., so generally observed. Such, I repeat, are generally the effects of disease, and not its first cause. "In this light, then, it is seen that I consider insanity to be essentially a nervous disease, and the consequence of an irritation of the ultimate structure of the brain, consisting in a neuralgia of the sensory fibres. 66 Insanity, like other nervous diseases, when not depending on local inflammatory action, is invariably aggravated by general bleeding: the exceptions to this rule are in the cases consequent on meningeal or cerebral inflammation, whether or not dependent on local injury. What very materially confirms this position is the fact, that the most violent forms of furious mania most commonly occur in persons of weak and delicate fibre and great susceptibility. I frequently witness the most urgent symptoms of acute insanity in combination with a small and feeble and quick pulse, cold skin, and a retracted and anxious countenance, &c. Neuralgic and nervous diseases generally are for the most part associated with similar constitutional symptoms. And, moreover, the most appropriate and successful treatment, in both instances, consists in the administration of sedatives, with a generous diet, and the employment of those various means calculated to improve the general health. Many cases of violent mania are cured at Hanwell by the administration of wine and steel. "I mention this, of course, only in support of the pathological views." ART. 32.-On the Symptoms of Softening of the Cerebellum. By Dr. E. BROWN-SÉQUARD. (Lancet, December 28, 1861.) After relating several cases of softening of the cerebellum, Dr. Brown-Séquard calls attention to the extreme differences presented by them. He says: "Not two are alike; but, although differing one from the other, they concur in showing that the inflammatory softening of the cerebellum differs notably from the same affection of the cerebrum. Excepting one case (1, Woillez) in which there had been some temporary pains in the lower limbs, and another (8, Andral) in which formication had been felt-most likely depending on the alterations of the crura cerebelli-nothing in these cases had been noted similar to the referred or local sensations or pains in the paralysed limbs which are so characteristic of the inflammatory softening of the cerebrum. The various kinds of involuntary movements (such as cramps, twitchings, jerking, trembling), which are prominent symptoms of inflammation of the cerebrum, are also almost completely missing in the above cases of cerebellar softening. In only one case (9, Andral) a contracture was observed. The pulse also, except in a few cases, did not exhibit the irregularity in rapidity and strength which are to be observed in cerebral inflammatory softening. The only symptoms that were noted several times in the above cases were: "1st. Headache.-In all the cases recorded with details, except two (1, Woillez; 10, Andral), there was a fixed pain in the back of the head, and generally in the side of the alteration in the cerebellum. 66 2nd. Amaurosis.-In two cases (4, Duplay; 8, Andral) it was complete in both eyes, although one half alone of the cerebellum was altered; in another case (11, Andral) it existed in the right eye, while the left side of the cerebellum was alone altered. "3rd. Hemiplegia.-This was complete in two cases (7, Lallemand; 8, Andral), and incomplete in one (1, Woillez). In one case the left arm alone was paralysed (4, Duplay). That these symptoms are not due to a loss of function of the cerebellum is proved by the fact, that in many cases of softening of one lobe of the cerebellum (as well as of other affections of that organ) there was no paralysis. "4th. Paraplegia.-In two cases (3, Bianchi; 7, Lallemand) there was a paralysis of the lower limbs. This is not also a symptom of loss of function of the cerebellum, as it does not exist even in cases of a much more complete alteration of the cerebellum. "As regards the other symptoms observed in the above cases, the most interesting were a tendency to walk backwards (2, Binard); a tottering gait (1, Woillez; 2, Binard); vertigo or giddiness (1, Woillez; 8 and 9, Andral); an emotional and a semi-convulsive agitation of limbs (3, Bianchi; 11, Andral); audition obtuse (4, Duplay); aphonia (1, Woillez). It is worthy of remark that vomiting, which is a frequent symptom of other diseases of the cerebellum, has not been noted in any of the above cases. A facial paralysis has been observed in one case in which there was a complication (7, Lallemand). There was no anæsthesia except in one case (1, Woillez), in which it was incomplete, and probably depended upon some unseen alteration elsewhere than in the cerebellum." ART. 33.-On the Diagnosis of Hæmorrhage into the By Dr. E. BROWN-SÉQUARD, (Lancet, November 2, 1861.) The following table will show at a glance that there are striking differences between the symptoms of hæmorrhage in the cerebellum and those of hæmorrhage in the other parts of the encephalon, not including amongst them the pons Varolii and the medulla oblongata : Table of Symptoms of Hæmorrhage in the Cerebellum. 1. Coma rarely very deep. 3. Great weakness in every part 4. No facial paralysis. Cerebrum. No part very weak, except, of stant. 5. Loss of expression of the No marked loss of expression, face. 6. No deviation of the tongue. 7. Loss of speech not frequent. the eye. 10. Anesthesia very rare. except as a consequence of the Tongue very frequently devi- Such a paralysis not rare. * By the word hyperesthesia, Dr. Brown-Séquard means simply an increase of the power of feeling, and not the existence of pains, |