was of a highly nervous, but not insane family, and had not been robust in general health. She was very religious, and belonged to a denomination that is apt to be strongly emotional in its religious manifestations, and apt to refer any strong religious feeling to the direct influence of the Holy Spirit, as well as to look for and expect that direct influence in the direction of conduct, even in regard to the smallest matters. It cannot be doubted that such a hereditary brain constitution and such a training would tend towards hallucinations of the senses and "affective insanity," if the inciting causes of insanity were present in sufficient strength to upset the normal brain working. We have then a severe attack of a disease of the nature of blood-poisoning, with fever and delirium. When this passed off the brain was left anæmic, poisoned, and exhausted. No doubt the prevailing current of thought would be of a religious kind, and the emotion of thankfulness much excited, with a direct mental reference of her recovery to the Almighty, with much allusion to this in prayer by herself and her friends round her. Then there was wakefulness and want of brain rest. And all this while her eyes were shut, so that no normal impression was sent to the brain from the outer world by sight, while there were only a few muffled sounds in the invalid's room. What more natural, according to the accepted facts of brain physiology, than that the exhausted and still slightly poisoned brain convolutions should mistake the working of the centres of special sense for real impressions from without, as in a dream, and that the voice should be the voice of God talking to her? It is a curious fact, but one quite in accordance with experience, that as the religious emotionalism was thus excited, the emotionalism that relates to the love of the sexes was also greatly exalted, that in fact the strongest acquired and the strongest natural emotions should be excited; and a modest and exemplary lady applied the warmest terms of affection to her doctor and minister, wanting constantly to put her arms round them and lay her head on their breast, and fancied she had a child. It is equally consistent with what we know of the functions of the brain that stimulants would send more blood into its convolutions; that impressions from the real world, through the eye, would tend to correct the hallucinations, as when one is roused from a nightmare; that being got out of bed and fresh air let into the room, would strengthen the power of the brain to differentiate the

real from the unreal; and that then the influence of a vigorous, healthy mind, in rousing the comparing faculty by reasoning as to the absurdity of previous beliefs, should finally wake her out of this dream (for I look on the whole attack as much allied to this) into which she had fallen.

Two Cases of Epilepsy with Lesions of the Convolutions after Death. By T. S. CLOUSTON, M.D.

I. M., æt. about 38, on admission 25th August, 1863. No history was got about him as he had been found in a stupid condition wandering about the town, by the police, and sent at once to the asylum, being certified by the medical man who saw him to labour under " Stupidity, forgetfulness of words, and incoherence in answering questions." After he became more sensible he was a particularly reticent man as to his previous history, never admitting that he took fits, and therefore resenting any enquiry as to what caused them, or how they came on. His obstinate silence may be inferred from the fact that he entirely baffled the Inspector of l'oor and his assistants to find out his parish of settlement, his birth-place, or his relations; in fact the latter offered a reward of £10 to anyone in the asylum who would get from him definite information on these points, but without success. He admitted that he had drunk very hard, affirmed that he had been put here for drinking alone, and that he might have had "fainting turns" sometimes. He also admitted having had some sort of venereal disorder, and had, in fact, the cicatrices of healed buboes.

On admission he was very dull and stupid in mind, had a stolid expression of face, like a general paralytic, which, with his speech, that was slow and like that of general paralysis, led the assistant physician, who admitted him, to the diagnosis that he laboured under that disease.

As the lethargy and weakness of body present on admission passed off, it was found that he had partial paralysis of one arm. Unfortunately it is not stated in the record which arm was affected, but it is a legitimate inference from the pathological appearances found after death, that it was the left. This passed away in about three months after admission, and about six months after coming in he began to take epileptic fits of a severe kind, having had four or five in the three months between the March and June following. He had a fit on June 24th, one on Sept. 29th, one Nov. 2nd, and four in rapid succession on Feb. 28th. The distance between these dates pretty well represents the times between his fits for years thereafter, only that he almost always after that took them through the night. He often complained of very severe headache both before and after the fits, looked ill, and was a good deal exhausted.

He gradually got more lively and rational, though still remaining stupid and slightly melancholy for a time. He then got into the state in which he remained for the ten years he lived, viz., a slightly weak-minded but coherent, intensely irritable man, who would strike out at anyone on the slightest provocation or contradiction. He was most irritable after the fits. When he wanted anything he was fawning in manner, when denied his request he would as likely as not strike the refuser, or if he did not go that length he would certainly abuse him in the foulest and most vituperative language. He was a most unreasonable man to have no delusions or decided maniacal excitement. He would sometimes work at his trade as a shoemaker, and then without any sort of reason, stop work, resenting as a personal insult any arguments used to induce him to employ himself.

In the course of years he came to take a fit about every fortnight, and if a longer period elapsed he usually had two or three.

In 1872 he had cancer of the penis, for which the organ was amputated, but "neither the operation nor the subsequent healing process had any effect on the epilepsy." But in 1874 the glands of his groin began to swell and get hard, and soon ulcerated; and after this he had only one epileptic fit up till his death in Oct., 1874, a period of eight months. During that time also he was less irritable, though more feeble-minded. He had much hemorrhage from left groin towards the end of his life, this no doubt hastening his death. fits had continued for eleven years.

The

Post-mortem Appearances.-Body very thin, and there was an enormous ulceration in left groin, with hardened cancerous tissue surrounding it. The glands of right groin were enlarged, cancerous, and an abscess had formed in one of them.

Head. The inner plate of the skull-cap, in a circular space three inches in circumference behind and above the internal ear, was rough and eroded-looking. Portions of the temporal, parietal, and occipital bones were so affected. The dura mater lying under this was very rough on its outer surface, had many fine spicule of bone projecting from it, and was thickened in the centre of the patch to a quarter of an inch on section. It consisted at this part of an outer layer of very firm white fibrous matter, then a space containing a mere lubrication of clear fluid, and then the thickened dura mater, with an inner fibrous lining separable from it. It consisted, therefore, of three layers altogether at this part. Its inner surface all over the right hemisphere above and below was mottled, and slightly roughened by dark iron-mould-looking spots, as if from small extravasations of blood of a somewhat old date. The dura mater over the left side of the brain was much thickened in a limited spot, about two inches in diameter, in a position somewhat higher and anterior to the thickening on the

* This fact was noted by Mr. Maclaren in his account of "Cases illustrating the effect of Peripheral Irritation in Epilepsy."-Ed. “Med. Jo.,” Jan., 1875.

right side. The former was not nearly so thick, and seemed to consist of thickened dura mater with an inner fibrous lining separable from it. The bone was not roughened under it. The dark spots of old extravasations existed on left side, but were smaller and less numerous than on the right.

The upper part of the brain appeared almost normal, except that the arachnoid was thickened over the sulci. The pia mater was very exsanguine, and easily separable from the convolutions.

The base of the brain presented the following unusual lesions:The under parts of both anterior lobes lying on the orbital plates were of a dirty-brown colour, the convolutions indistinct, shrunken, and softened, but the softening not going further apparently than the grey substance of each convolution. This condition was most marked, and the softening deepest in the centre of each space affected, becoming less marked towards the circumference, when it seemed as if some of the convolutions were just tipped on the centre of their convex surface with the diseased condition. The tips of both middle lobes were affected in the same way to a very slight extent, the right side being worst. On both sides at this point it was merely the convexities of a few convolutions that were affected, and on the convolutions near them were a few single dark shrunken-looking spots, about an eighth of an inch in diameter, quite separated from the main part affected.

Several of the convolutions on the lower part of the middle lobe had undergone simple atrophy to a considerable extent.

The tips of both olfactory bulbs had shared in the softening that surrounded them, and were quite dark and shrunken.

The rest of the brain was very exsanguine, and slightly œdematous, but otherwise normal.

Microscopic Examination.-The dark softened spots on the convolutions were found to consist of broken-down brain tissue, the cells being indistinguishable, and masses of blood-colouring matter, evidently the result of small apoplexies. This was confined to the crust of grey matter and did not extend to the white. The rusty spots on the inside of the dura mater were found to consist of masses of bloodcolouring matter under the epithelial lining of the dura mater, or if anatomists had not succeeded in demonstrating that there was no arachnoid lining of the dura mater, one would have said that it was under a very distinct tough fibrous arachnoid membrane.

D. G., æt. 30; admitted 15th Oct., 1868; engineer; been five years an epileptic; fits followed a fall he had on the left side of the head in a ship; been getting worse mentally for some time and the fits more severe; has been very dangerous and suddenly violent to those near him; his mental state has tended to confusion, incoherence, and dementia, of late.

On admission he was a pale-faced, cachectic-looking man, very stupid in mind, and unable to give any account of himself. He soon began to take very severe epileptic fits every fortnight or three weeks, tak

ing four and five in succession; often after each attack was very stupid and confused. He took them both by night and day. He never complained of headache.

At times he was clear enough in mind to give an account of his injury, and was quiet and comparatively rational, but was usually stupid and very confused in mind, and was never able to employ himself in any useful occupation. The fits were so severe and frequent that he was constantly running down in flesh, and looking pale and cachectic. He was very irritable and violent in an impulsive way. He fell off very much indeed in general health and strength for the last two years of his life. Tubercular disease of the lungs was suspected, and looked for from the general symptoms, but was never detected by physical examination. No abnormal symptoms were present during life. He took the fits to the last, as he had done in the first part of his disease. He died on the 8th April, 1875, twelve years after the fits began.

Post-mortem Examination.-Ext. Appearances.-Body very thin and poorly nourished.

Head.-Skull-cap thin but dense. In the squamose portion of the temporal bone, about an inch above and posterior to the fibrous portion, there was an irregular excrescence of bone projecting upwards, and closely adherent to this the dura mater, arachnoid, pia mater, and brain, all being matted together by tough fibrous tissue all round this part to the extent of three-quarters of an inch in circumference. Two or three of the brain convolutions near the part were atrophied and softened, and of a dirty-grey colour.

There was considerable ordinary adherence of the dura mater to skull-cap, and this membrane was much thickened, especially at the attachment of the falx, and under the left parietal bone. In the centre of this thickening there was a small spiculum of bone in the arachnoid about a quarter of an inch in diameter, and over this there was a small thin clot of blood on the dura mater, about three-quarters of an inch in diameter. This clearly bore a relation to the spiculum. There was considerable effusion under the pia mater, and the arachnoid was thickened and tough, but was everywhere, except at the point mentioned, easily removable from the convolution.

On section of the brain, it was found that the softening under the excrescence on the left temporal bone extended inwards as far as the ventricle, and the posterior end of the corpus striatum was also slightly affected.

The brain substance generally was pale, and there was interstitial atrophy round the vessels, giving on section a cribriform appearance. The medulla and pons were also in this state; cerebellum seemed normal. The right side of the brain was otherwise normal.

Other Organs. The lungs were found both congested, and both had a very slight deposit of tubercle at apices of old formation. The peritoneum was studded with deposits of tubercle, varying in size from