This fit was

transacted some business, and then called on me. evidently owing to the violent exercise and mental excitement. From this period till March 1850 he continued to have fits at intervals of from one to six months. On one occasion he had three

in one day. All the seizures since 26th May 1848 were undoubtedly epileptic. Latterly, a rash over the forehead appeared after each, and extravasation on both sclerotics after several. During the intervals of these attacks, although in good general health, and able to take a great deal of exercise without fatigue, he continued subject to daily attacks of slight stupor, and was generally nervous, excited, anxious, and unable to bear much mental exertion, although the mind was commonly clear, and the bodily functions natural. The pulse was frequent, but otherwise natural.

There did not appear to be any adequate cause to which the first attack could be attributed. Betwixt thirteen and fourteen years before, he had sustained a severe contusion on the head, from a beam of wood falling upon it; but this did not seem to produce any serious inconvenience at the time, although his friends say he had been subject ever since to occasional severe headachs. There did not appear to be any epilepsy in the family; but his father died, after suffering for many years from some nervous complaint, which greatly affected his spirits, rendering him incapable of mixing with society. His mother died of an affection of the spinal cord, slow in its progress, and producing general paralysis. A sister, who had been long in delicate health from a chest affection, died of erysipelas. These three deaths, as well as that of his grandmother (a woman beyond ninety), all occurred within two years, and greatly unhinged him; for he had lived with them in family from his infancy, and was warmly attached to them. The treatment employed hitherto had been local bleeding, blistering, cold applications, aperients, spare diet, and abstinence from all stimulants, exercise in the open air, which he always enjoyed and bore well, and the careful avoidance of inordinate mental excitement and exertion. A caustic issue was kept open in the nape, and full courses of the metallic tonics-zinc, copper, and silver-employed, with regular cold sponging every morning. These means, till the unfortunate occurrence in May 1848, promised to be attended with permanent success.

In February 1849 he went to Edinburgh, for the purpose of consulting Professor Christison, who advised perseverance for another month in the use of ammoniuret of copper,-the tonic he was then using, a month's excursion, and separation from business, and, if no amendment, a cautious trial of arsenic, continuing its use till its physiological action should begin to appear, at the same time giving the volatile tincture of valerian; -a trial of extract of nux vomica, or of strychnia, was also proposed, if the disease should not yield to the other means. These suggestions were acted upon till February 1850, but without any satisfactory result. Dr C. was, therefore, again consulted. His opinion had been, from the first,

that there was organic disease within the head. As the patient continued to be well nourished and muscular, he proposed the trial of a system of very low diet.

It was some time before I could persuade his relations to allow him to be subjected to this severe plan of treatment; but in the course of a month, convinced of the hopelessness of the case, they were brought to give their full consent to a trial of it.

Having first withdrawn blood pretty freely from a vein, his diet was gradually reduced till he was allowed only three ounces of animal food and six ounces of bread daily, or their equivalents. Tartar emetic and digitalis were also used as auxiliaries. He never had an epileptic fit after this, and for three or four months enjoyed better health, both of body and mind, than he had done for a considerable time previously; but afterwards he became gradually feeble and languid, so that it was necessary to make some improvement in his diet; and he fell into a most distressing state of hypochondriasis and nervous irritability, which continued till within the last few days of his life, when he gradually fell into a state of complete coma, and died on the 20th December.

The head was examined by me two days after death, along with my brother, Mr John Traill, who also saw him frequently during his illness; and the following were the appearances noted:-Membranes natural, but strongly adherent to the bones; veins rather enlarged, and containing dark fluid blood; slight serous effusion between the arachnoid and pia mater; substance of the brain healthy, but rather pale; nearly in the centre, and towards the lower part of left hemisphere, a tumour, fully the size of a walnut, of an oval form, of a dark pinkish colour, and of somewhat firmer consistence than the brain, in its centre partially softened and broken down, and mixed with purulent matter; in the lower and anterior part of the same hemisphere, another similar tumour, about the size of a large hazelnut, of like structure, but without softening-both completely circumscribed, and the portions of brain with which they were in contact appearing entirely of their natural structure. The ventricles contained about an ounce of limpid serum. The pituitary gland enlarged, and of a dark colour, and that portion of the dura mater which covers it, and lines the sella turcica, preternaturally vascular, and of a livid colour. The bone which forms the sella turcica also dark coloured, and on the left side its process partially absorbed. The other contents of the cranium appeared to be in a normal and healthy state.

4th February 1851.

ARTICLE IV.-Case of Tumour in the Anterior Lobe of the Brain. By A. KIRKWOOD, M.D., &c., Surgeon to the Berwick Dispensary, and to the Infirmary of the Berwick Union.

THE subject of this case, Thomas Helay, æt. 44, sailor, was admitted into the Infirmary of the Berwick Union Workhouse the 7th November 1850. The following is his history, as gathered from himself some time previous to his death, and since from his relations.

Towards the end of 1839, or beginning of 1840, while on board a vessel on her voyage from Liverpool to America, he was precipitated from the topsail yard into the tops, by the mast giving way during a heavy gale of wind. He alighted on his head, part of the wreck at the same time falling upon him,-causing fracture of the femur, compound fracture of the leg, and, as we shall afterwards see, though he was not himself aware of it, a dislocation of the thigh upon the pubes-all of the right side. He remained for about an hour and a half insensible, and for several hours after felt stunned and confused. About the third or fourth day he became affected with jaundice, which lasted above a week. The vessel, being much damaged by the storm, put into Greenock for repair, where she arrived a fortnight after the accident occurred. During the whole of this time the poor fellow was without medical or surgical aid, except some rude bandaging from his messmates,-there being no surgeon on board. He was taken to Greenock Infirmary, where he remained above four months; and it was, after a few days' residence in that institution, that he was seized with his first epileptic fit.1

From that time till the period of his death these paroxysms continued, at first at intervals of six or seven weeks, and gradually becoming more frequent, till latterly they occurred about every ten days, though not with any degree of regularity.

With the exception of this disease, he enjoyed good health, and, indeed, after leaving the Greenock Infirmary, he went three voyages as cook. At first he was not unconscious during the fits, but for the last four or five years he was so.

When standing erect, the right inferior extremity appeared much shorter than the other; the thigh was considerably abducted, and capable of motion to a very limited extent, and the foot completely everted-causing, as may be supposed, a great halt and peculiar mode of walking. This, with the increasing frequency of the fits,

I regret that I cannot give any history of the case while he resided in this hospital. I wrote a few days after the patient's death to the "senior surgeon" of the institution, and received a reply from the house surgeon, stating that he could find no such case recorded; nor, upon inquiry of the medical officers, did they recollect it. Thinking this might arise from a mistake of seven years that I had inadvertently made as to the time of his admission there, I wrote to that effect, but have not received an answer.

rendering him incapable of following his vocation, he became about four years ago an inmate of the Berwick Union Workhouse.

On the 8th of November last he complained to me of intense headach, with a feeling of great anxiety and restlessness, which, with total want of sleep, made me apprehensive that a paroxysm of unusual violence was about to ensue. He was accordingly removed to the hospital, and ordered an active dose of calomel and compound extract of colocynth; a mustard cataplasm to the nape of the neck; a hot foot-bath, and the application of cold water to the shaven scalp. For the remainder of his case I shall give a brief abstract of my private journal.

November 9, 11 A.M.-The nurse states that at 3 A.M., after a fearful scream, he was seized with a very violent paroxysm, lasting till 7; and after half an hour's remission another occurred, which continued till about half an hour ago. At present he is in a semicomatose state; head hot; pupils contracted; pulse 110, very feeble; respiration laboured. Bowels have not been opened; ordered turpentine enema, a blister to the nape of the neck, and the application of ice to the head; small quantities of beef-tea at frequent intervals.

8 P.M.-Has had several slight fits during the day, and remains much the same as at the morning visit. The blister has not yet risen. The clyster brought away a large quantity of most offensive feculent matter.

10th, 11th, and 12th.-With the exception of a few hours' calmness on the night of the 9th, he has had a series of slight fits, lasting about five minutes, and with only about a quarter of an hour's remission betwixt each. On the evening of the 12th he became quite comatose; pulse 108, very feeble. Ordered a blister to the vertex and a turpentine enema.

13th, 11 A.M.-Appears better; is sensible to signs, but cannot speak, and is quite deaf; he follows with his eyes the movements of persons in the ward; the whole of the right side is paralysed; pulse 96, a little more firm; pupils not so much contracted.

He remained in this state till 9 A.M. of the 15th, when, after a violent scream, he was seized with a paroxysm, which continued without the slightest intermission till half-past 9 P.M., when he expired. The convulsions during this last attack were almost entirely confined to the left, or the paralysed side.

Inspection Sixteen Hours after Death.-The left arm was rigidly bent up towards the shoulder, and the fingers convulsively incurvated. The muscles of the left thigh and leg felt very rigid; the tibialis anticus and extensor communis muscles were so much on the stretch, in consequence of the convulsive flexion of the foot and toes, as to be distinctly traceable with the eye in their entire course. The muscles of the other leg and thigh were also rigid to the touch; marks of an old irregularly-shaped wound, about four inches long, over the middle third of the tibia, were very visible; and a hard

irregular swelling was distinctly to be seen and felt in the upper, anterior, and inner part of the thigh. This extremity was three inches shorter than the left.

On laying back the scalp there were no visible marks of fracture or other injury of the skull; neither, on opening the cranium, was there any evidence of disease or injury on its inner surface. The vessels of the dura mater were congested, but not more so than might have been expected from the difficult and imperfect respiration previous to death. Upon opening the membrane, a pale, greenish-yellow spot, not more than a few lines in diameter, and rising slightly above the level of the convolutions, was observable in the right anterior lobe of the cerebrum; it was hard to the touch, and in direct contact, but unconnected, with the dura mater, or rather its arachnoid lining. The brain having been removed, a corresponding spot was found on the inferior surface of the same lobe, along the inner surface of which, wound the olfactory nerve, smaller than its fellow of the opposite side. These spots were found to be opposite surfaces of a large tumour, completely surrounded, with these exceptions, by the cerebral substance, with which, however, it had no connection. A portion of the white substance opposite the middle of the posterior surface of the growth, of about three-fourths of an inch in diameter, showed marks of inflammation and softening; with that exception, the entire brain was healthy in appearance. The tumour was hard to the touch, having at the same time a feeling of elasticity, of a pale, greenish-yellow colour, with a somewhat rough and shaggy surface, and was of an irregularly round shape, measuring in its antero-posterior circumference eight and a quarter inches, and in the opposite direction eight inches, weighing five and a half ounces and fifty grains avoirdupois, the brain by itself weighing three pounds one ounce; it was supplied with blood by a branch of considerable size, proceeding from the anterior cerebral artery. On making a slight incision into the softest part of the tumour, a fluid, of a thick creamy consistence, and deep dull red colour, escaped, part adhering to the knife; and the entire contents were enclosed by a thick fibrous capsule. On examination by the microscope, the fluid matter which had escaped seemed to consist principally of blood corpuscles; but as I have had but little experience in the use of this most valuable aid to pathological research, I resolved to preserve the tumour entire for the benefit of some one more au fait with that instrument. [I have accordingly, at Dr Christison's request, sent it to Professor Bennett, whose well-known experience will, I trust, enable him to confer upon the_readers of the Monthly Journal the advantage of his researches.]

On comparing the tumour with the descriptions of cerebral tumours given by Monro, Abercrombie, Craigie, Copland, Rokitansky, and in the "Cyclopædia of Anatomy and Physiology," it appears to me, so far as I have examined it, to coincide most nearly with that

NEW SERIES.-NO. XV. MARCH 1851.

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