The other acute febrile diseases affecting the functions of the brain are continued fever, "gastric remittent fever," and the febrile form of "delirium tremens."

In the two former the head symptoms are accidental, and in the latter the previous history, as well as the characteristic form of delirium, serve to distinguish it from allied diseases.

The seventh chapter is devoted to "apoplectic diseases;" there

are

"I. Congestion of the brain, or 'coup de sang.'

"II. Hæmorrhage, extravasation of blood (apoplexy' proper).
"A. Hæmorrhage into the substance of the hemisphere.
"B. Ventricular hæmorrhage.

"C. Arachnoid hæmorrhage.

"III. Serous effusion in large quantity. (Serous apoplexy.') "IV. Local cerebritis, or 'softening of the brain.'

"V. Tumour of the brain, or meninges.

"VI. Tubercular meningitis.

"VII. Urinæmia and diathetic states.

“VIII. Anæmia, morbus cordis, vascular obstruction."

The phenomena of apoplexy are too well known to require specification. Dr. Reynolds says, "The essential nature of apoplexy is the occurrence of some static or dynamic change which, pro tanto, severs volition and perception (the brain functions) from motion and sensa

tion."

"As congestion frequently accompanies or precedes all apoplectic diseases, its symptoms are often present as their prodromata. Where congestion, however, forms the whole anatomic basis of developed apoplexy, they are more marked in intensity, and have commonly existed for a longer period." Hæmorrhagic apoplexy is characterized by the suddenness of its invasion. "The patient, as a rule, if standing, falls instantly, as if knocked down." The accompanying paralysis is generally hemiplegic if the hæmorrhage be into the substance of the hemispheres. If it be into the ventricle, "the most frequent combination of symptoms" is profound coma, with general paralysis and rigidity. In arachnoid hæmorrhage the symptoms are more slowly developed, and "rarely simultaneously."

"There is no certainty in the diagnosis of "serous apoplexy."

"The clinical history" of "acute red softening" "closely resembles that of cerebral hæmorrhage". "in some case the differentiation is impossible." Apoplexy may occur in the course of the growth of a "tumour of the brain,' or in the progress of "tubercular meningitis;" it may also be the result, or at least the accompaniment, of various poisoned states of the blood, as in Bright's disease, jaundice, or diabetes.

"Morbus cordis," anæmia, and vascular obstructions are the remaining causes of apoplexy.

The diseases (Chap. VIII.) marked by delirium, unaccompanied by fever, are

"I. Hyperæmia of the brain and meningitis.

"II. Partial cerebritis, or red softening.

"III. Delirium tremens.

"IV. Extrinsic diseases, including urinæmia, icterus, diabetes." The first of these is marked by "the simplicity of the delirium—i. e. its freedom from complication with other intrinsic nervous symptoms.❞

In "acute softening," the " delirium is mild and inoffensive," and in the intervals of delirium there is distinct mental weakness, loss of memory, confusion of ideas, &c.

Delirium tremens, on the other hand, is "of a fearful, wandering, but tractable type, with delusions; a peculiar tremor, wakefulness, a non-febrile state, with clammy, cool skin, and disordered, offensive secretions."

In "diathetic diseases," ," "the delirium is commonly mild, and 'low muttering' in its character, attended by subsultus tendinum, or chronic spasms.' centric" or an "eccentric"

Convulsions (Chap. IX.) may have a

origin. The latter are―

"I. Blood diseases, or toxæmiæ.

"1. Introduced poisons, including the acute specific diseases, the exanthemata, mineral poisons, &c.

"2. Retained poisons, or excreta, such as urinæmia, icterus, rheumatism (?), &c.

"II. Eccentric irritations (not toxæmiæ).

"1. Gastro-intestinal dentition, dyspepsia, worms, constipation, &c.

"2. Bronchio-pulmonary. Laryngismus, pertussis, &c.

"3. Genito-urinary. Morbid uterine conditions, calculoid affections, &c."

The "convulsive diseases of intrinsic origin (centric)" are

"III. Idiopathic, without assignable static cause.

"IV. Congestion of the brain, and meningitis.

"V. Softening of the brain (local acute cerebritis).

"VI. Tubercular meningitis.

"VII. Tubercle and tumour of the brain.

"VIII. Cerebral hæmorrhage.

"IX. Cerebral hypertrophy.

"X. Acute chorea.

CEPHALALGIA as an acute symptom may be of extrinsic or intrinsic origin; under the former we have it, 1, in the acute specific diseases; 2, rheumatic cephalalgia; 3, sympathetic headache. Where of intrinsic origin it may be, 1, congestive; 2, inflammatory; 3, connected with organic diseases; 4, neuralgic.

Of chronic diseases of the brain, the first, treated of in Chapter XII., are those "characterized by exalted activity." "A. Excessive ideation.

"I. Hypochondriasis.

"II. Tarantism.

"B. Excessive sensation.

"III. Hemicrania, or hyperalgesia cerebri.
"IV. Hallucinations.

NO. I.-NEW SERIES.

H

"V. Illusions (vertigo of sensation, &c.).

"C. Excessive motility.

"VI. Vertigo of motion (rotatory movements). "VII. Co-ordinated spasm (muscular tic).

"VIII. Chorea.

"IX. Tremor (paralysis agitans)."

The diagnosis of hypochondriasis from melancholia, says the author, "is based upon the hypochondriac's constant self-regard, and the habitual reference of his delusions to the corporeal sphere."

"The predominance of motor disturbance" in hysteria "will generally serve to distinguish" it from hypochondriasis.

By "hallucinations," the author means those which are unconnected with insanity; so that the subject of them, "although his phantasms may have the appearance of reality, does not believe in their objective existence."

A somewhat similar distinction should be drawn between the illusions of the sane and insane. Muscæ and tinnitus aurium are illusions common to every one, and the result of a real impression on the sensory nerve; but where the muscæ, on the one hand, are firmly believed to be furies or devils, or the ringing in the ears, on the other, is transformed into "voices," then the mind is insane.

The same thing holds good in reference to optical illusions, as spectra; the sane mind can by experiment convince itself of their real nature, whereas no process of reasoning will ever unseat the delusive impressions of the insane.

"The most important chronic diseases of the brain, and nervous system generally, present a combination of exaggerated activity in some portions and diminished function in others."

Those so characterized are as follow:

"I. Hysteria, and allied affections, catalepsy, &c.

"II. Epilepsy, 'le haut' and 'le petit mal.'

"III. Tumour of the meninges, cerebrum, and cerebellum.

"1. Carcinomatous, sometimes separable.

"2. Tuberculous,

"3. Aneurismal, fibroid, hydatid, &c., not separable. "IV. Chronic meningitis.

"V. Chronic softening.

"VI. Induration of the brain.

"1. In the adult (from epilepsy, lead poisoning, &c.)
"2. In the child (hypertrophy of brain).

"VII. Chronic hydrocephalus.

"VIII. Urinæmia."

There is nothing pathognomonic in the symptoms of specific tumours. The tuberculous and carcinomatous are inferred by the presence of the cachexia; the aneurismal by the existence of arterial disease elsewhere; while the other varieties may be guessed at from the discovery of similar growths in other parts of the body.

As indications of the "special locality" of a tumour, the following are valuable. "Pain is most commonly situated on the same side as that in which the tumour exists." "Motor phenomena (both spas

modic and paralytic) are observed almost invariably on the opposite side."

66

"Convulsions are most frequent in tumours of the cerebellum." 'Amaurosis, on the other hand, is most common in tumours of the anterior cerebral lobes."

"The implication of the special senses generally (but not exclusively) indicates a location near the base."

A suggestion of Romberg's, confirmed by one case observed by Dr. Reynolds, will form a valuable means of diagnosis, if more extended observation proves it to be trustworthy; namely, that when the tumour is situated on the upper surface of the encephalon, a "forced expira tion increases the pain ;" whereas when affecting the base, "this effect is produced only by inspiration."

Paraplegia rarely occurs from encephalic tumour, unless the cerebellum is its seat."

The

"When softening has observed a chronic course throughout, its most difficult differentiation is from tumour and meningitis. three may, however, be distinguished in many cases by the following characters.

"A. Tumour,—intense, locally limited, paroxysmal pain; anæsthesia of special senses; local paralyses; epileptoid convulsions without paralyses; unimpaired intelligence; coma at close of life.

"B. Chronic meningitis,-pain, not very severe, not limited; mental and emotional excitement; disorderly spasms and paralyses; with frequent, but irregular accessions of fever.

"C. Chronic softening,-oppressive, not intense pain; with gradual failure of intelligence, motility, and sensibility."

The nervous symptoms of urinæmia may resemble those of these three affections, but then "the pain is rarely acute; there is drowsiness, or a peculiar coma and stertor, and the extrinsic symptoms furnish the means by which a diagnosis may be established."

The third part of the book is devoted to diseases of the spinal` cord.

With regard to the special locality-the cervical, dorsal, or lumbar regions may be affected.

When the lumbar or lower dorsal portions of the cord are the seats of disease, the "lower limbs are alone implicated." "The bladder and rectum are paralyzed." If the upper dorsal region be affected, "respiration is impeded;" "unless the lesion extends above the second dorsal vertebra, the upper limbs retain their function." Affections of the cord opposite the first dorsal, or the last two cervical vertebræ, implicate the movements of the arms."

"If the disease extends no higher than the sixth cervical, the arms retain their movements at the shoulders;" if above the sixth or fifth, "and the phrenic nerve is implicated, the dyspnoea is most urgent." "If the lesion exists higher than the fourth or third vertebra, death is extremely rapid, owing to asphyxia from paralysis of the respiratory muscles."

"The locality of disease may be discovered by the existence of spontaneous pain, or tenderness, at a particular point of the vertebral

column; and the latter may be estimated by pressure, concussion of the spinous processes, or the application of heat (by means of a sponge or cloth wrung out of hot water)."

"Where motility is at first exclusively affected, the anterior and antero-lateral columns are most probably diseased; and vice versa, when sensibility is primarily deranged, the probability is, that the posterior, or postero-lateral columns are principally affected."

"Acute diseases of the spinal cord and its meninges" are as follows:

"I. Plethora spinalis, or congestion.

"II. Meningitis.

"III. Myelitis (acute softening).

"IV. Meningo-myelitis.

"V. Tetanus (idiopathic).

"VI. Hydrophobia.

"VII. Hæmorrhage, meningeal and spinal.

"1. Into the spinal cord.

"2. Into the tuber annulare.

"VIII. Concussion of the cord."

Spinal meningitis is ushered in by "highly marked fever," and is accompanied by "pain referred to the spine, at first slight, but rapidly increasing in severity, and becoming almost intolerably violent." Tonic spasm is the chief motorial symptom.

Myelitis, on the other hand, is denoted by "peripheral pain, or anæsthesia, and paralysis;" it is "commonly hyper-acute, and terminates in a few days; but if this is not the case, sloughing of the integuments occurs, and hastens the prostration of the patient to a final issue."

Meningo-myelitis "is more common than either of its elements in an isolated form."

The chronic diseases of the spinal cord are―

"I. Chronic myelitis (or softening).

"II. Chronic meningitis.

“III. Induration and hypertrophy.

"IV. Tumours.

"1. Diathetic-e. g., tubercle, carcinoma.

"2. Non-diathetic-e. g., hydatids.

"V. Idiopathic paraplegia (dynamic)."

In the fourth and last part of this work, Dr. Reynolds considers the diseases of the nerves.

The diagnosis of the particular nerve affected

can be arrived at

only by a knowledge of the anatomical distribution," "and physiological functions of each division."

The functions of a nerve may be modified by

"I. Excessive activity.

"A. Of sensation or sensibility.

"B. Of motility.

"II. Diminished activity, or complete loss of function.

"A. Of sensation, or rather of impressibility.

"B. Of motility."