the convolutions, for the irritative inflammatory softenings, for the hæmorrhagic softening of the grey substance of the convolutions, for the gelatinous softening of both white and grey matter, and for the simple local absorptions of brain substance. Unquestionably a good terminology would help to prevent immense confusion in regard to the whole subject of "softening of the brain." At present some medical men habitually describe to juries and patients anything and everything as softening of the brain that weakens any of its functions, from general paralysis to idiocy.

He thinks that grey degeneration is merely an advanced stage of sclerosis. In this we think he is entirely mistaken. We think there is a kind of grey degeneration that is allied to sclerosis, and another that is totally distinct from it. In the latter we believe that the increase of a greyish tissue is not true neuroglia, but of a soft grey gelatinous stroma whose existence is merely negative and compensatory, the nerve tissue having been absorbed in limited spots. This condition is in no degree allied to true sclerosis at all.

On the whole Dr. Fox's description of the different kinds of sclerosis is the best to be found in any English work. It says, however, but little for the advance of our knowledge in regard to nervous pathology, that we should be content with "softening" and "sclerosis" to express so many different conditions.

His theory of the causation of delirium is thus expressed :

My own belief is that in all cases delirium is an expression of functional inactivity, or perverted activity, accompanied or caused by deficient blood supply; in anæmia from deficient circulation; in toxæmia from the circulation of the blood, part of which at least is unfit for functional purposes and therefore useless; in hyperæmia, because from the very pressure upon the vessels the due interchange between tissues and nutritive material is rendered abnormally difficult. It stands to reason, therefore, that except in the latter condition the post mortem appearances will be few.

In regard to the actual appearances of the brain he is content to deal in generalities, and to quote Calmeil's catalogue of the appearances in 19 cases of acute delirium accompanying periencephalitis in insidious forms. Now if there is one thing more confusing to ordinary minds than another, it is those catalogues of the morbid appearances found in a certain number of cases of an obscure disease. They are only fit for the original records or a book of reference, and should

never be quoted in this form in any book that the author wishes to be read through.

Dr. Fox is decidedly of opinion that delirium tremens is not caused by the deprivation of alcohol. He says that atrophy of the convolutions from insufficient nourishment by the alcoholised blood is one of the most common appearances in those dying of this disease. "The increased excretions of carbonic acid which accompanies digestion is considerably checked by the use of spirits. The constant diminution in carbonic acid secreted gradually causes a sure augmentation of carbon in the blood. This carbonaceous blood, unfit for the nutrition of any organ, is especially unfit for the due performance of those regulated conditions of osmosis in so fatty an organ as the brain." Such is the opinion adopted by the author as to the causes of the brain atrophy and delirium. To many it will be a new idea that such an organ as the brain should undergo atrophy in a few days, but we believe such a change is quite possible. Probably all nutritive changes can take place more quickly in the brain than in any other organ in the body, and we know how soon the liver can shrink in acute atrophy.

In treating of insanity, Dr. Fox recognises at least four conditions that might induce it, and yet leave little or no change after death. These are (1) blood conditions, e.g., uræmia, spanæmia, phthisis, &c.; (2) variations in blood supply, (3) reflex irritation, and (4) shock. It is possible to imagine each of those causing purely "functional" disorder of the brain, but it is quite as realizable that each of them may cause cell-degeneration and cell-atrophy, which by improved modes of examination may be detected after death. We have much more hope of brain disorders from such causes as these revealing their pathological anatomy to us, than such psychical abnormalities as are often seen in the case of persons highly predisposed hereditarily to insanity, e. g., a short attack of mania lasting for twenty-four hours and then disappearing suddenly. One hour this man is a raving lunatic, without coherence of speech, without memory, without power of attention, without love for wife or child, without appetite or passion, and without power of rest in sleep; the next he is a man again, in all the glory of intellect and emotion, and in all the enjoyments of animal life. Or to take a still more remarkable case which we have seen. A man who had been acutely maniacal for months, suddenly came to his senses one evening, was coherent and sane, asked

most affectionately for his wife and children, felt wearied and tired, and went off to sleep, but woke up again maniacal, and passed into dementia, never again to have the veil lifted off his higher powers of mind and emotion. Or take a man sane on all points except one gross and preposterous delusion. Such cases seem more and more puzzling the more one thinks about them from the pathological point of view. Dr. Fox takes rather an unfortunate example of how an organic change may arise in the brain. He says that Dr. Thompson has demonstrated by sphygmographic tracings that in general paralysis there is persistent spasm of the vessels in the very early stages, and from this he concludes that this spasm could be detected before any brain changes or psychical symptoms appeared, and that Calabar bean, if given then, would probably cure the spasm, and stop the paralysis. Now we fear most persons who have seen much of the disease would question the significance, if not the correctness, of the tracings, would assert that in the preparalytic stages of the disease there was no sort of arterial abnormality, would deny the vascular origin of the disease in toto, and would scout the notion of the Calabar bean doing any good at all in any stage.

The author then enumerates the appearances, naked eye and microscopic, that other observers have found in the brain in insanity, and we are obliged to say that the general impression produced by the perusal of this part of the book is not that of luminousness, or satisfactory deductions from the facts, or any great clearing up of opposing views. Possibly this results from the present half-way stage in which the whole subject lies, but it would have been pleasant and satisfactory to have got some few general deductions, or, at all events, some unequivocal sign-posts pointing to main roads in the midst of the meshwork of crossing paths and lanes leading nowhere. That is surely what we have a right to expect when a man sits calmly down and maps out a country for us in a systematic treatise.

When he gets to aphasia, our author evidently gets to better known ground, and his description of glosso-laryngeal paralysis is exceedingly good. Definiteness in the pathological anatomy of the neuroses reaches its climax in locomotor ataxy, and then begins gradually to wane, through progressive muscular atrophy, infantile paralysis, and paralysis agitans, until we get to a region of great obscurity again in epilepsy and chorea.

On Paralysis from Brain Disease in its Common Forms. By H. CHARLTON BASTIAN, M.A., M.D., F.R.S., &c.

This book consists of eight lectures to Students, and it would be a good thing if all such lectures were as clear, as systematic, and as interesting as these are. When will lecturers to students learn that the amount of information given is of much less importance than the kind, and the way it is presented? Dr. Bastian's book is of interest, not only to students, but to all who make nervous diseases a study. We think that those whose practice lies chiefly among the insane should, on principle, read, or re-read, a good book on motor affections every six months. The problems discussed are so much simpler than the neuro-mental ones; the pathology is so much more definite and regional; while the analogies are so striking to any thoughtful physician that the perusal of such a book induces a more scientific and logical state of mind for the elucidation of the more difficult questions of mental paralysis, mental convulsion, and the absence of mental coordinations.

Dr. Bastian first shortly discusses the blood supply of the different parts of the brain. This is a subject that is equally interesting, and equally important, to the alienist. He makes one statement as the result of his own observations, that the perivascular canals in the corpus striatum are three times as large as the blood vessels which lie in them. Surely the cases examined were those of insterstitial atrophy, or Dr. Bastian is talking of the empty and contracted vessels. That the holes in the healthy brain substance through which the full arteries pass during life are three times the size of the vessels is certainly not the case, and such a statement must have given a most wrong impression to the students who heard it.

The great frequency of meningeal hemorrhage, as compared with any other kind, is pointed out. Among the insane, both in the acute and chronic cases of the disease, the relative frequency of meningeal hemorrhage is still more marked. It is, in fact, one of the most common of all the lesions found, though it seldom goes on to any great extent, or seems to produce many symptoms during life. It is, in fact, much more a symptom and indication of certain states of atrophy of the brain, leaving the vessels very much unsupported, or of disease of the vessels, or, in the acute cases, of an intense pathological condition in which a certain kind of stasis of the blood in the capillaries and smaller

vessels is a chief symptom. The rusty spots so often seen on the inside of the dura mater, or on the false membranes that occur under the dura mater, are nothing but apoplexies. The small deposits of blood-colouring matter seen in all sections of brain in acute insanity have resulted from the same cause. The reddish discoloration of the sub-arachnoid fluid we so often meet with in insanity is due, of course, to ruptures of minute vessels in the pia-mater. Who that has made many post-mortem examinations among the insane does not know the tortuous and varicose vessels of the pia-mater in many chronic cases? They are, no doubt, the preliminary stage of the apoplectic state, actual rupture not taking place at all when their coats remain healthy, or no unusual strain is put on them. In examining sections of the brain in chronic insanity we have been often exceedingly struck by the immense amount of blood-colouring matter scattered about. Apoplexies of various kinds, therefore, are an important element in the pathology of insanity.

A fact noted by Dr. Bastian it is well for those who have to explain the occurrence of insanity pathologically to keep in mind, viz., that ramollissement from embolism, or thrombosis, may take place in a few days. We have no doubt that this is so, but it is well to remember along with this fact that there are kinds of white softening that don't result from embolism at all, and take very much longer than a few days for their production. We mean the kinds of softening seen as the result of the irritation of spiculæ of bone and of syphilitic deposits, and that nearly always form the outer boundary of red and grey softenings. The irritative and the embolismic white softenings are often indistinguishable to the naked eye, but they are very different things pathologically.

Dr. Bastian thinks that hemiplegia is not a very hereditary disease, but he produces no statistics in support of his view. We think that in this opinion he is wrong, but as we have no statistics on our side either, it must remain a case of difference of opinion. He divides hemiplegia in its onset into the apoplectic, the epileptiform, and the simple. He thinks that spasm of the vessels plays an important part in the production of transient hemiplegia. To substantiate the theory, can any analogous, irregular and local spasm of vessels be pointed out elsewhere in the body lasting so long as to produce such an effect? Surely the vessels of the brain are not the only arteries that manifest this extraordinary power. And yet we have seen, as a matter of fact, one of the large branches of