51

variably caused bleeding. This observation suggested twothings : first, that the lesion which caused the hfemorthagcwas not identical with that which produced the epilepsy ;and, secondly, that the condition of the circulation of thebrain during epilepsy was, in this instance at least, widelydifferent from that present in vomiting.On the evening of April 20th, the patient, after a respite

longer than usual, had a frightful outburst of bleeding fromthe mouth, nostrils, and left ear. When the medical officerarrived, B. W-- was found to be having slight generalconvulsions, and immediately afterwards he had two orthree stertorous respirations, after which life appeared to begone. He was turned on to his side, and his mouth wascleared. Artificial respiration was practised. At the sametime a stimulant injection was administered. The respira-tion was re-established, but only for a very short time.Passive movements of the respiratory muscles were main-tained for half an hour, but resuscitation was impossible.

It may be added that in this case the epileptic convul-sions were so general that no exact localisation of the lesionproducing the epilepsy could be suggested. There was noparalysis.

Post mortem examination,.-The autopsy was held fortyhours after death. The body was fairly nourished, but itssurface very pale and blanched. Rigor mortis was present,but there was no hypostatic congestion. On the right sideof the head, in the region of the frontal eminence, and ex-tending backwards as far as the outer end of the superiorcurved line of the occiput, there was a white puckered scarabout an inch in breadth. The upper eyelid of the righteye was also involved in and drawn up by the cicatrix. On

removing the scalp there was found to be a depression inthe skull, commencing at the right parietal eminence, ex-tending downwards and backwards for about an inch and ahalf, and gradually deepening till at its termination itsfloor consisted of fibrous tissue filling up a breach in bothplates of the bone, which was circular in form and about asbig as a threepenny piece. In front of this depression therewas slight roughening and elevation of the external plate.In this region, and over the cavity, the periosteum wasthickened and adherent. On removing the skull-cap itwas found that at the site of the small opening in thecranial wall the subjacent membranes adhered to the bone,to each other, and to the brain, and that in the act ofremoval a portion of dirty softened grey matter was leftadherent to the inner surface of the calvaria. There wasonly slight opacity of the membranes and little or nowasting of the convolutions except in the neighbourhood ofthe opening in the skull. At this spot there was browndiscolouration, softening and wasting of the cortical sub-stance extending ever the surface for about an inch inlength and half an inch in breadth, and affecting theangular gyrus on the right side. On the orbital lobule onboth sides there were lines of brown staining runningparallel to the olfactory sulci, and apparently resulting fromprevious pressure of blood. On the first temporo-sphenoidalgyrus of the right side there was a brown film evidentlyformed by altered blood, and about the middle of the leftorbital lobule there was a small pit with brown walls, alsoapparently resulting from the pressure of blood. Thewhole brain-substance was blanched and anaemic, and therewas no trace of internal clot. The degeneration of the

grey matter corresponding to the breach in the cranial

wall was found to be continuous with a distinct cavityin the white matter, the walls of which were of a browncolour. On examining the base of the skull it was foundthat the upper and inner aspect of the petrous portion ofthe temporal bone on both sides presented a ragged, rough,unsymmetrical surface, being in some places formed intosharp, irregular ridges, about a quarter of an inch inheight. The upper aspect of the petrous portion on bothsides was very rough, and immediately posterior to thecarotid canal on the right side there was a deep depression,the walls of which were anteriorly elevated into a sharpridge overhanging the upper end of the canal. The canalitself was partially obstructed by rough projections fromits bony walls. On the left side the roughness and browndiscolouration of bone extended much farther back, andthe upper end of the carotid canal was almost occluded bya cribriform projection of bone, which was rough and of a

deep brown colour. With pressure the canal admitted e

round instrument about one-eighth of an inch in diameter

There was brown staining of the dura mater over thepetrous portion of both temporal bones. The other organswere healthy.

Observations. —There were two main elements in thiscase-(a) epilepsy, and (b) haemorrhage. That the epilepsywas due to injury of bone and membranes over the angulargyrus of the right side, and probably to damage of thebrain-matter itself, admits of little doubt. How far theappearances of inflammation and degeneration of bonearound the carotid canals were traceable to the primaryinjury it is almost impossible to determine. With regard tothe epilepsy, one or two passing observations are admissible.First, when the patient was brought to the West RidingAsylum the fits had become dependent on too wide a rangeof causes to admit of exact localisation of the original lesion.Secondly, the development of excitement after partial sup-pression of convulsions by large doses of bromide of £potassium is an instance of what is frequently observed inthis asylum. Repeatedly patients who appear to be almostif not altogether cured of their fits by the use of that drug,

! break out into unexpected attacks of destructive or homi-cidal excitement, and afford striking evidence of the cor-relation of mental with motor irritability. This observationhas acquired strong confirmation from the interesting in-

, vestigations of Dr. Bevan Lewis, of this institution, who,, in papers published during the present year establishes- the belief that this correlation exists not only between con-

vulsions and excitement, but also between convulsions andr the evolution of heat. With regard to the haemorrhage, theb appearances presented after death went to confirm thei opinion formed during life, that the bleeding resulted from1 rupture of some large vessel or vessels at the base of the- brain. The condition of the bone around the carotid canals, renders it probable that at their upper part the internals carotids were very much reduced in calibre, and also sug-i gests that friction of the walls of the carotids, or more likelys of some of their large branches, against the roughenede bone may have produced recurrent ruptures and consequent. haemorrhages. The diminished arterial pressure followings on great loss of blood must have led to a comparative cesaa-t tion of the mechanical rubbing of vessels against thee roughened osseous surfaces. To this cause may be traced, the total freedom from hæmorrhage between the severe out-t’ bursts, while the recurrence of the latter as soon as thet patient’s physical condition improved and his bloodvesselss became fuller, is also explicable by the increasing and conse-o quent tendency to laceration of the vascular walls by theirf pulsatile grating against denuded and roughened bone.n

Reviews and Notices of Books.An Introduction to Animal Morphology and Systematic Zoology.

By ALEXANDER MACA.LISTER, M B, Professor of Com-parative Anatomy and Zoology, University of Dublin.Part 1. Invertebrata. London: Longmans.THIS is a sound and accurate introduction to Animal

Morphology, its only fault being that it is almost too muchcondensed, so that the meaning sometimes becomes obscure.Dr. Macalister states that his reason for writing it has beenthe desire expressed by students " to have a text-book intheir hands to enable them to learn the terminology of thescience, and, by giving them a connected view of the varietiesof animal forms, to assist them in remembering the prac-tical instruction of the class-room." The present volumeembraces only the Invertebrata. We can entertain no doubtthat it is well adapted to enable Dr. Macalister’s studentsto follow his lectures, and freely admit that it is extremelydifficult to make a book of this kind interesting. Still, ifits pages are looked over by anyone who will place himselfin the position of a student and with no more knowledgethan a student is likely to possess, we can scarcely imagineanything more uninviting. Fancy the amount of informa-tion a lad of twenty, who had no opportunity of seeingdrawings or specimens of the animals referred to, wou’dobtain from reading-

52

"Amphicteneidæ—tubicolous, heteronomous, with three occurred to him; and of the remaining group-viz., casesbody regions; prostomium united to the peristorm, with a of amyloid kidney-no fewer than sixty-three fell to hismiddle lobe and two bundles of thread-like gills; tail seg- share. The comparatively large number of the latter formments with imperfect rings; gills simply (Pectinaria) or of disease cannot fail to attract notice, and the authorcomplexly comb-shaped (Scalis) or elongated; anal cirri one of disease cannot fail to attract notice, and the author(Scalis) or two (Amphicteis)." himself draws attention to it. The etiological history ofA few pages of this would, we think, go a long way with the amyloid kidney is the same in all countries, and the

the most earnest student. striking fact about these statistics is the relatively small

What an improvement the introduction of a large num- amount of the granular and inflammatory kidney. It

ber of outline drawings, which really need not be very would appear that granular kidney is rare in Norway.expensive, would be to the book-such drawings, for in- This is the more evident when we find that the eighteenstance, as illustrate Wedgwood’s Treatise on Insects, c-tses collected are out of a number of 1837 autopsies madeWe cannot give a better example of the general style in at the Rigs Hospital in the fifteen years. The author

which the book is written than the following account of the remarks that cirrhosis of the liver is equally rare in that

alimentary canal of the Gasteropoda, p. 290:- country. The essay, although interesting, contains but

,,The stomach is usually simple, thin-walled, pouch-like, little that is new. ____________

rarely four-angled, with four tooth-like projections (Ptero-trachea), often with ceecal pouches projecting from it OUR LIBRARY TABLE.towards its cardiac or pyloric ends; its epithelium is co-

,.,,,.,.,,.

lumnar (Heteropoda) or ciliated in tracts, and often elevated A Manual of Midwifery. By ALFRED MEADOWS, M D.,into tooth-like processes (Telescopium) or lobular projections F.R.C.P. Third Edition. London: Henry Renshaw.-We(Mitra). It is gizzard-like in Aplysia, with cartilaginous are glad to see a new edition of this useful little manual, topyramids in its wall, and is lamellated with cartilage-plates which new matter and upwards of sixty drawings have beenin Umbrella. The folds of its lining may be armed with added. The chapter on Puerperal Fever has of course beenhard, epitbelia cutting rl .d ges (Tntonia, Soyllæa). In [n ,. - 13 c on , .., ever has of course . been

hard, the large stomach fills half the body-cavity, and altered, in accordance with the recently expressed views onhas thin bony plates in its wall. Scaphander has similar the subject, but it would have been a further improvementthree-sided plates, with rounded angles. The beginning of the had Dr. Meadows omitted from the part on treatment allintestine in Aplysia, Teth.ys, and Pleurobranchus is dilated; the transcribed portions about venesection, " pleno rivo,"in Aplysia bidden in the liver, and is sometimes regarded as ,from a large opening, » " to syncope, » to be repeated ifa third stomach. The intestine is short, ciliated, simple, and

necessary, and followed by nauseating doses of tartar emetic,ends usually forward and on the right side, rarely posteriorly ly necessary, and followed . by nauseating doses of tartar emetic

(Vaginulus, Onchidium). in an often wart-like anus, never a course from which he most emphatically dissents, whichlying in the respiratory cavity. It3 wall consists of a mus- few would dare to follow, and the very perusal of whichcular stratum, mostly of circular fibres, but with longi- must confuse a student. We should prefer to have seentudinal intermixed, not in separate layers, often with oval more stress laid upon the intra-uterine injection of disin-calcareous concretions freely scattered in it. The rectum

fectant solutions, with more definite directions as to theiris differentiated in Prosobranchs, and is often dilated and , -. , . ci

longitudinally folded within on the right side of the mouth- strength and mode of employment. Still we can, as here-

cavity. The intestine is shortest in flesh-eaters like tofore, strongly recommend tLe manual to both studentsBuccinum, sometimes straight with no flexion (Apneusta and practitioners.Phlebenterata). In pulmonates and vegetable feeders, like Surgical Emergencies; together with the Emergencies at-

limpets, it is long and coiled. A crystal style, like that of tendant on Parturition and the Treatment of Poisoning. Abivalves, exists in Bithynia, Strombus, iroebus, &c., m a

1VIanual for the use of General Practitioners. By W PAULpyloric carcal pouch. The primary flexure of the intestine Manual for the use of General Practitioners. By WM. PAUL

is hoomal in branchiate, neural in ptilmonate forms. The SWAIN, F.R.C.S, Surgeon to the Royal Albert Hospital,anus has a sphincter, and in Purpura and Marex grape-like Devonport. Second Edition. London: Churchills.—We are

excretory glands open into it. Entoconcha, Rhodope, and not at all surprised at a second edition of this capital manualsome other Apneusta are aproctous. The mouth and anus having been called for, and, spite of the modest disclaimerare never on the same medial plane, but in some Opistho- on the part of the author to the effect that this is not abranchs the latter is medio-dorsal. A transverse mesentery

on the Part of the author the effect that this is not ais only found in the last-named group." proof of the intrinsic value of the book so much as of the

want that it partially supplies, we are of opinion that theKlinis7ce Studier over Kronis7c Morbus Brightii (Olinical Notes popularity of the work is due to both causes. The materials

on Chronic Bright’s Disease). By EDWARD BULL, Assis- are well selected and arranged, indicating that the authortant-Physician to the Rigs Hospital, Christiania. 1875. has been at the pains to make his book thoroughly what itIT is gratifying to find in Scandinavia so intelligent pretends to be-a practical guide in emergencies, clear and

an appreciation of chronic Bright’s disease as this trea- concise without being what such manuals often are, scrappytise affords. It is a work which, laying claim to no as to the thing that one does want to know, and full as tooriginality, is of value as showing the extent to which those matters which everybody knows.chronic renal affections prevail in the Norwegian capital, How to Use the Ophthalmoscope. By EDGAR A. BROWNE.being based upon cases that have come under the author’s London : Trubner and Co.-Experience in vivâ voce teachingobservation for the past fifteen years. Dealing only with has taught the author that students of ophthalmoscopy arethose examples which were examined after death, the especially prone to try to run before they can walk, and wenumber of cases upon which his conclusions are based is must all be aware of many instances in which failure in the

necessarily few, but for the same reason they are accurate coveted rapidity of progression has caused a valuable branchand beyond dispute. The essay opens with a brief summary of medical science to be discarded with dislike. These ele-of the present state of opinion regarding the varieties of mentary instructions have, therefore, been arranged forrenal affection, classed under the one head of 11 Chronic those who will patiently study the healthy structures of theBright’s Disease"; and, having pointed out the differences eye before they hasten "to flash the light unsteadily inof opinion regarding the various forms, Dr. Bull declares front of a case of glaucoma, or other disease with a definitehimself as in accord with the subdivisions of Dr. Grainger name"; and, accordingly, in four sections, comprising littleStewart and Bartels. He has thus three classes of disease- more than a hundred pages, the optical principles, the oph-viz., that typified by the large white kidney, of which he thalmoscope, appearances of healthy structures, and ap-has only observed seven fatal cases; that known as the pearances of disease, are treated in a simple rudimentarycirrhotic or granular kidney, of which eighteen examples manner, such as will give the student a sound basis-from