occasional pain in the chest, although the cough and expectoration continued. He rarely perspired at night; his appetite was good, and bowels generally regular, some simple laxative medicine being used when required. His habits, latterly, had been very temperate, although in former years it seems he occasionally indulged in wine, etc.

About the beginning of October 1854, an aggravation of his cough induced him to send for me early in the morning, but, by and by, he once more enjoyed his usual good health, and was able to drive out every fine day.

This improvement was only temporary, for in the morning of the 20th of October, he was suddenly seized with severe tremulous motion of the right leg, which continued for six or eight minutes. The attacks continued to recur for three days, at shorter intervals, and with great severity, when the arm of the same side became affected, and was soon followed by a sense of numbness over the right half of the face, with difficult articulation in speaking. The hemiplegia continued to increase down to the 31st of the month, when it might be said to be complete. Mr A. B., after this period, was of necessity confined to the horizontal posture, having lost all sense of feeling, and power of motion of the right side. A professional friend in the neighbourhood had visited him with me, but without any beneficial result. The pulse at this period was firm, but with a very perceptible difference between that of the right and left arms-the latter being stronger.

On the 5th of November, his speech was totally lost, the pupils refused to contract on the application of a lighted candle. Foeces and urine were voided involuntarily; he lost all power of memory, and was incapable of recognising surrounding objects. On the 6th and 7th of November the pulse sank to forty-five, on the succeeding day was hardly perceptible, and he died on that day comatose. It is unnecessary minutely to detail our course of treatment. At the commencement of the disease small doses of the tartrate of antimony were given; at a later period blisters were applied to the neck, and strychnia to the blistered surface, but without effect; gentle laxatives were given, and latterly stimulating enemata were administered. The head was shaved, and cold cloths constantly applied, but the patient invariably removed them with his left hand, and seemed rather inclined for warmth. This fact was frequently remarked to me by the nurse in waiting. Never, from all the history of this case, or during my attendance, did Mr A. B. ever complain of his head, and, indeed, I never could discover any symptom of an acute affection of the brain.

We

A post-mortem examination took place thirty hours after death. found the left lung large and healthy, while the right was very much condensed and atrophied, dark and closely adhering to the posterior aspect of the chest; it only weighed eleven ounces; there was no tubercular disease, but we found a large quantity of bloody serum in the cavity of that side of the chest. On removing the calvarium, and incising the dura mater, pus flowed out, and after its removal from the right half of the cerebrum, pus was observed between all the convolutions; and on dissecting the brain from above downwards, we discovered a large chronic abscess immediately above the right ventricle, out of which flowed three ounces of green putrid pus, mixed with bloody matter; the cavity had the appearance of a pouch with a firm rough or villous looking lining membrane. There was no appearance of redness or ramollisement of the brain; in the neighbourhood of the abscess the membranes were quite healthy, but some of the cerebral veins on the surface were gorged with dark blood.

It is my opinion that this abscess must have existed in the brain for several months, and had only burst into the membranes some days prior to death. It affords a well marked instance of how capable the brain is of accommodating itself to disease of the most formidable character, so long as that disease is produced slowly.

The absence of vomiting during the formation of such an abscess is also worthy of observation. The facts arrived at by the postmortem examination were carefully written down at the time, in the presence of my friend, Mr Todd, surgeon, of Colinsburgh.

Note by the Editor.

The really important fact in this case appears to us to be that the hemiplegia and the lesion supposed to occasion it, occur on the same side of the body. Instances of this occurrence are few; and it may well be doubted whether disease of the cerebral lobes ever causes paralysis directly-that is, without crossed action. Numerous instances have occurred of cerebral abscesses, or softening, having been 1 found after death, in which there was no paralysis during life; and a still greater number are on record, in which there was well-marked paralysis during life, but no appreciable change found in the brain after death. It is by no means improbable, therefore, as paralysis may be induced without leaving any traces, that in the few exceptional cases to the law of crossed action, it was caused by unknown changes in the opposite hemisphere of the brain, and as is sometimes the case, that the lesion found in the hemisphere of the paralysed side had produced no symptoms whatever. At all events, we consider this to be a more probable explanation of these exceptional cases than would be the assumption that in them, and them only, the cerebral lobes exerted a direct rather than a crossed action.

Part Second.

REVIEWS.

The Principles of Physiology, by JOHN AUGUSTUS UNZER; and a Dissertation on the Functions of the Nervous System, by GEORGE PROCHASKA. Translated and Edited by THOMAS LAYCOCK, M.D., (Göttingen), Physician to the York Dispensary, etc. London: Printed for the Sydenham Society. 1851. 8vo, pp. 463.

The Brain in Relation to the Mind. By JOSEPH SWAN. London, 1854. 8vo, pp. 113.

Clinical Lectures on Paralysis, Disease of the Brain and other affections of the Nervous System. By ROBERT BENTLEY TODD, M.D., F.R.S., Physician to King's College Hospital. London, 1854. Small 8vo, pp. 462.

Epilepsy and other Affections of the Nervous System which are marked by Tremor, Convulsion, or Spasm; their Pathology and Treatment. By CHARLES BLAND RADCLIFFE, M.D., Assistant Physician to the Westminster Hospital, etc. London, 1854. 8vo, pp. 144.

Eutherapeia: or, an Examination of the Principles of Medical Science, with Researches in the Nervous System. By ROBERT GARNER, Surgeon to the North Staffordshire Infirmary, etc. London, 1855. 8vo, pp. 282.

On the Pathology of Delirium Tremens; and its Treatment without Stimulants or Opiates. By ALEXANDER PEDDIE, M.D., Edin. Edinburgh, 1854. 8vo, pp. 51.

It is impossible to review our knowledge of the physiology and pathology of the nervous system, without recognising three great epochs or eras in discovery, which are inseparably connected with the names of three distinguished men. The first of these epochs is characterised by the establishment of contractility and sensibility as inherent properties of the muscular and nervous tissues. Such was the great work of Haller. The second is indicated by the demonstration of motor and sensitive columns in the spinal cord, and by the existence of nerves of sensation, of nerves of motion, and of mixed nerves in connection with these columns. Such was the doctrine established by Charles Bell. The third epoch is marked by the separation of numerous combined actions, from sensation, volition, and contractile movements; the demonstration that the spinal cord was their centre, and the fact that it was endowed with a reflex function acting through a series of incident and excident nerves, which were named. Such were the views introduced and successfully maintained by Marshall Hall.

Each of these great doctrines has given rise to an astonishing amount of discussion, mingled with no small degree of acrimony. The controversy between Haller and Whytt, on the doctrine of inherent irritability and sensibility may still be considered as one of the most important and famous to be found in the whole history of medicine. Sir Charles Bell's life was embittered by the necessity of combating the claims of Dr Walker, who first conceived the idea of distinct function, in the anterior and posterior columns of the spinal cord, and of Magendie, who maintained he had first demonstrated it experimentally. Lastly, Dr Marshall Hall has been accused first of having merely given to the sympathetic actions of Whytt a new name, and secondly of having borrowed all his ideas from Unzer and Prochaska.

It would occupy far too much time to enter into the history of these discussions. The two former have ceased to excite attention. The latter was almost entirely carried on by the British and Foreign Medical Review, a journal which, under the editorship of Sir John Forbes, from first to last attacked Dr Hall, with a pertinacity truly remarkable, and raked up incomprehensible passages from Unzer and Prochaska, in order to diminish his just title to the establishment of the reflex junction of the spinal cord, in a way anything but

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creditable to the medical literature of this country. The controversy, however, led to the translation of the works of Unzer and Prochaska into English, for the Sydenham Society, and has thereby enriched our literature. The result seems to have been that all these attacks have ceased, and that the merits of Marshall Hall with regard to the important theory of reflex nervous actions, is now universally acknowledged.

The experiments illustrative of reflex action are in their nature the same as those performed by Le Gallois and Sir Gilbert Blane, and the same results were derived from them as were observed by Flourens, Rolando, Hertwig, and many others, who found that after removing the brain from animals, they could walk or fly. It is the inference derived from these experiments which we regard as important, and the demonstration that such actions are independent of sensation and volition, and strictly connected with integrity of the spinal cord. Now, this was not clearly stated by Unzer or Prochaska, for whom priority in this matter has been claimed. The latter physiologist, after enumerating the different seats given to the common sensory by his predecessors, all of whom understood by it the seat of sensation, distinctly says, "The sensorium commune, properly so called, seems not improbably to extend through the medulla oblongata, the crura of the cerebrum and cerebellum, also part of the thalami optici, and the whole of the medulla spinalis; in a word, it is co-extensive with the origin of the nerves" (p. 430). It is true he distinctly says that reflexions of sensorial impressions may take place, either with consciousness or without consciousness, but then he proceeds to confound together, convulsions in apoplectics and other motions truly spinal with the movements of the heart, stomach, and intestines, p. 432. Unzer taught that the ganglia reflected motions without going to the sensorium commune, and that they were special sensoria.

A careful analysis of the writings of Unzer and Prochaska should be made conjointly with a critical study of the works of Haller, and then we think it will be evident that great confusion has been thrown over the whole subject by the use of the term sensorium commune, which, since the days of Willis, has been considered as the seat of sensation. It is easy now when the subject has been unravelled, and the nature of sensation understood-at all events in its relation to consciousness-to maintain that Prochaska meant something different by sensorium commune, from what Haller did. We nowhere see any evidence of this, and the proof that so essential a point was not made clear in connection with reflex functions, is, that all his contemporaries as well as physiologists since his day, never understood it in this sense until Marshall Hall wrote.

The translation so elegantly made for the Sydenham Society by Dr Laycock, we regard as a wonderful specimen of patience and learning. We ourselves commenced the perusal of Unzer when his works were first mentioned in connection with reflex actions,

but of all the crabbed specimens of German and Germanic names we ever encountered it was certainly the worst. We could make nothing of it, and at once banished from our ideas the possibility of Dr Hall having understood it. In fact, we are told in the introduction, that according to Professor Marx of Göttingen, the antiquated style and singular phrases of the work, render it somewhat difficult for even the modern German physicians to comprehend. Dr Laycock himself has been obliged to draw up a synopsis of the German words and phrases used by Unzer, and their English synonymes, by which we only hope he has arrived at the true meaning of the author. Assuredly if he has not, no other living man

ever will.

Since the doctrine of reflex functions has been introduced, we do not observe that any very marked progress has been made in our knowledge of the pathology or treatment of nervous diseases. The great function of innervation, composed of mental, sensory, and motor phenomena, has only in a very trifling degree been elucidated by that histological research which, of late years, has thrown such a flood of light on the important processes of nutrition and development. The minute changes which take place in nervous matter during inflammation, ramollissement, suppuration, tuberculization or other alterations of its substance, have been shown to be strictly analogous to what takes place in other organs. There is nothing special or peculiar in the nature of nervous diseases themselves. The symptoms or phenomena they occasion are to be attributed to an increase, perversion, or diminution of nervous function, in the same manner that similar morbid changes produce exaltation or destruction of functions in other organs. The same diseases, therefore, affect brain or nerve, as attack lung or bone, the differences produced being dependent, not so much on the nature of the lesion, as on the derangement of those physiological laws which influence special textures and organs. Hence the only key which is capable of unlocking the secrets of nervous disorder, is a knowledge of the healthy functions of the brain, spinal cord, and nervesin one word, physiology. Although this truth may, in one sense, be said to apply to our knowledge of every malady, there can be little doubt that it especially does so in cases of nervous derangement.

With regard to mental phenomena and their connection with the brain, we think there is still something to be accomplished. When we reflect upon the nature of the minute and delicate texture of this organ, the tubular and vesicular structure of which is only to be seen by employing a high magnifying power, and then consider that if any morbid lesion be present it must affect these structures long before it becomes visible to naked sight, it will be evident that the pathology of insanity cannot yet be said to be on a level with that of many other disorders. Notwithstanding the thousands of cases which have died in our asylums and large establishments for the treatment of the insane, since histology has been cultivated