rape-seed; the left lung in addition was found highly engorged, and of a bright red colour throughout, a vomica about as large as a walnut lined with a smooth membrane existed in its apex; the right lung was of a greyish colour, in this respect strongly contrasting with the left organ. On cutting into the left lung, many of the vessels were seen distended with almost decolorized plugs, which formed perfect casts of them.

Microscopical Examination.-Sections were taken from the various lobes, and on examination the following appearances were observed:1st, Frontal Lobe.-Many of the vessels were packed with blood corpuscles and dilated, but the greater number were empty, a few globules only clinging to their sides; outside the walls, and attached to them, in numerous instances, was seen a bright yellow exudation, occurring in masses of a dimly granular appearance; this was present in greatest quantity in those vessels the walls of which were extremely thin and delicate. The outer fibrous coat of many of the arterioles was thickened and corrugated, and in these vessels the exudation spoken of was not at all so apparent.

2nd, Parietal Lobe.-Many of the vessels ramifying in the pia mater, and passing from it to the cortex of the brain, were seen crowded with yellowish blood corpuscles, but, as in the frontal lobes, many were quite empty. Numerous minute extravasations were seen between the pia mater and brain substance, some visible to the naked eye, whilst others were distinctly seen with a low power; these minute hæmorrhages were both globular and stratiform, the blood being effused into the meshes of the pia mater, and lying in delicate layers on the surface of the convolutions. These little extravasations were most numerous where the pia mater dipped down into the sulci between secondary and minor convolutions, and at the bottom of these sulci the grey matter was a purplish-red color, having imbibed the colouring matter of the blood; this condition, however, was not general. None of these extravasations were to be seen in the brain substance itself; the yellow exudation, so apparent on the vessels of the frontal lobes, was not so observable in the parietal sections examined. Many of the arterioles had their outer coat thickened, and, in several, minute thrombi were seen occupying their calibre, which was much contracted beyond.

3rd, Occipital Lobe.-The same appearances detailed above were also present here in greater or less degree; and in the various sections from all the lobes the cells were perfectly healthy as to arrangement and structure, and the neuroglia was beautifully transparent and homogeneous.

Sections through the lungs showed the tubercular granules to be more or less "massed," but under the microscope the focus of origin of each was distinctly and beautifully seen, existing in the tissue between the alveoli, which were destroyed by compression; thus the breathing surface of the lungs was greatly diminished.

Remarks. The result of this examination well illustrates the somatic origin of the mental derangement present, and the appearances observed explain its nature. The minute hæmorrhages, vascular exudation, and thickening of the outer coat of the vessels, were all plainly the result of congestion and its consequences; and to the condition of the lungs this state may at once be referred. The breathing surface of the lungs already encroached upon by the masses of tubercles, compressing and destroying the air vesicles, must undoubtedly have given rise to a difficulty in the aeration of the blood and in its passage through the organs; added to this, the rapid engorgement of the entire left lung which supervened, caused a gradually increasing difficulty, amounting almost to a condition of stasis, as evidenced by the lividity observed during life, and the plugging of the vessels seen post mortem; this condition of the lungs led in turn to an almost similar condition of the cerebral vessels, and hence as a consequence, through disturbance of nutrition of the nervous tissues, to the mental disorder. Although excessive vascularity of the brain is, in a great majority of cases, the true cause of mental disease in its earlier or active stages, yet it is not always so easy to discover the origin of this condition as in the present, instance, it most frequently depending on some influence on the muscular coats of the vessels themselves, the result probably of a primary change in the vaso-motor apparatus. Here, however, the congestion was without doubt dependent on the disease in the lungs, and, as such, is a good example of a not uncommon class of cases, where the mental disorder is either directly dependent on, or predisposed to, by primary disease in other organs of the body.

A Case of Impaction of a Knob of Wood in Esophagus, which had been swallowed with suicidal intent. Esophagotomy -Death. By Dr. RORIE, Dundee Asylum.

M. M., female; single, æt. 37; admitted into Dundee Asylum 24th December, 1874. Patient had been more or less insane for eight months, during which time she had frequently threatened suicide, and declared that she had often tried to poison herself, but could never succeed in doing so. Has been in the habit of taking laudanum freely, although the quantities consumed could never be ascertained. Has taken no solid food for three days, giving as a reason that she could not get it over, as she had swallowed the knob of a mirror,

and which was sticking in her throat. Her friends assured me that this must be a delusion, as she swallowed fluids easily. The first medical certificate on patient's admission paper testified that she "is highly nervous and excitable, insists that she has swallowed a round ball of mahogany to destroy herself;" the second one that she " says she has swallowed something that will be sure to kill her, and although quite able to swallow, declares that she is not able to let over even a mouthful of water. She has various other delusions."

On admission her bodily condition was thin, frail and emaciated, and mentally depressed and melancholy, insisting that she could not swallow anything, and would die. No trace of any foreign body could be found by external examination. A glass of water was given to her, and she was requested to drink it. This she declared she could not do, but apparently with an effort got over several mouthfuls, and said she felt better. The manner in which she swallowed the water was exactly as occurs in ordinary hysterical cases, where patients refuse food, except that there was a scarcely perceptible regurgitation, which awoke doubts in my mind as to the true nature of the case, but as it was late at night when she came to the asylum, and she was tired and exhausted, she had a warm bath and was put to bed, the night attendant being instructed to give her wine and milk if she asked for anything, but not to urge her to take food against her wish. During the night she asked for and swallowed easily a glass of wine and some milk, but refused to take her breakfast. As she still persisted in her story about something being in her throat, before proceeding to administer food, and as a precautionary measure, I passed a probang down the oesophagus. This went easily till on a level with the top of the sternum, when its progress was arrested. Removing the probang the œsophageal tube of a stomach pump was then passed easily to the same point, when it could be felt and heard impinging on some hard foreign substance, apparently a piece of wood. The patient's story thus proved true after all, and I regret to say her prophecy no less so. The knob was found to be so firmly fixed, as was afterwards ascertained, by inflammatory action, that it could neither be pushed downwards into the stomach, nor brought upwards by forceps. After consulting with Drs. Nimmo and Greig, oesophagotomy was decided on as the only means left likely to benefit the patient. This operation was skilfully performed by Dr. Greig, and the foreign body removed, which proved to be the foot of a mahogany tea-caddy, circular in shape, and 14in. in diameter. Scarcely any blood was lost during the operation, but on cutting down on the oesophagus, a large abscess was opened into, which rendered the prognosis very unfavourable, as it indicated the existence of an extensive amount of inflammation. For three days afterwards the patient appeared to progress favourably, but the discharge from the wound now became very offensive, and all attempts to pass an esophageal tube failed. For a week longer the patient lingered on, her strength appearing to be supported, and all

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feelings of hunger and thirst allayed, by strong beef tea and wine enemata, but the gangrenous action continued increasing, and rigors suddenly supervened on the 3rd January, 1875, followed by death on the 4th, at 10.40 p.m.

A complete post-mortem examination was refused by the patient's relatives, but the following facts were ascertained next day :-On both sides of the trachea the neck was black and discoloured, and the discharge from the wound very offensive. Behind the trachea where the foreign body had been situated, a cavity existed about the size of a small orange, filled with putrid matter. At the upper part of this cavity the tissues were glued together by inflammation, while at the lower part no inflammatory action appeared to exist, or perhaps, to speak more correctly, the inflammation had given way to gangrene. About an inch of the oesophagus had sloughed, and the lower end was quite open, and through it a tube was easily passed into the

stomach.

The chief points of interest in the case are

1. The close resemblance of the early symptoms to those of ordinary hysterical refusal of food.

2. The fact that, notwithstanding the size of the obstructing body, the patient did swallow a considerable quantity of fluid.

3. The position of the obstructing body being in that part of the œsophagus where organic stricture is chiefly met with.

PART II-REVIEWS.

Pathological Anatomy of the Nervous Centres. By EDWARD LONG FOX, M.D., F.R.C.P., &c.

This is a work which was really needed, and now that it has fallen to the lot of a physician in practice in a provincial town to supply our desideratum, and we see how well it has been done, it seems a matter of much surprise that it had not been attempted before by one of our metropolitan pathologists. Not that we think the result would in that case have been any better. Dr. Fox has brought to his work much reading, great care in the selection of his materials, an extended personal experience, and the quality of judicial mindedness in dealing with different theories. The way in which the book is got up is admirable, and the illustrations are most creditable to all concerned. On the whole the arrangement of the materials is clear and systematic, if not

quite scientific in method. The style is condensed, and in many places savours a little too much of the descriptive catalogue; but this was almost unavoidable in the first part of the work. Altogether it is a book which will stand as a landmark as to the state of nervous pathology at the time it was. written, and which every one interested in the subject must, as a matter of course, consult.

Dr. Fox divides the book into two parts, the first being a description of the pathological changes found in the nervous centres, without reference to the symptoms present during life at all; and the second treating of the pathological anatomy of the various neuroses separately. In the first division he describes congenital malformations, changes in the vessels, inflammations, degenerations, and tumours, while in the second he treats in succession of the pathological anatomy of delirium, insanity, aphasia, and the neuroses of motility, concluding the book with two chapters, one on the lesion of the spinal cord in small-pox and diabetes, and another on ophthalmoscopy in diseases of the nervous system.

His descriptions of the various kinds of softening of the brain and of the different kinds of sclerosis and grey degeneration are clear, but exception will be taken to many of his positions by those who have devoted much attention to brain pathology, and have had practical acquaintance with the appearances presented by the brain tissue in disease. His apparent adoption of Jaccoud's opinion that red, yellow, and white softenings are mere successive stages of the same process, we think is very misleading indeed. The whole nomenclature of brain softenings is utterly bad, leads to endless confusion, and covers a great amount of complacent ignorance. He adopts the term "cerebral necrosis" to express the ordinary kind of tissue degeneration of the white matter when its blood supply is cut off by embolism. It might be a good enough term if it were strictly limited to that one pathological state, though even then it strikes one as absurd that brain and bones should be tied together in pathological terminology when they die, all the intermediate tissues being excluded. And when we remember that the death of the tissue in the one case is usually the result of acute inflammation, and in the other it is not, it seems objectionable to use the same term to both, and we would recommend Dr. Fox to discontinue its use. We think that he should, in his next edition, insert new and scientific terms for the simpler embolismic softening of the white brain matter and of the grey matter of