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are they due to simple instability of the grey matter? If effusion does or did exist, they may be the effects of its present or past existences.

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It may next be interesting to inquire whether the muteness, or rather the loss of expressing words, coming on as it did immediately before the convulsive seizures, is in any way connected with them, or depending upon the same cause. It certainly appears to be so. We have the mother's statement that "the boy was beginning to speak well, when, as the head began to affect him, he ceased to do so, and became foolish." Is the loss of speaking power "ataxic" from inability to bring into co-ordinate action the muscles requisite for articulation? or is it "amnesic" from loss of memory of words, the former being low down in the scale of sensori-motor processes, the latter being high up in that scale? The difference between these forms is more of degree than kind, the one gradually merging into the other, and both being in the same series of nervous processes. appears to me, from observation of the case-particularly from noticing the attempts at articulation the boy makes when pressed, as, for instance, when shown any familiar object, such as his cap, food, &c., and repeatedly asked to name it-that the defect is of the "ataxic" degree, and not from loss of memory for words. Now any injury done to the corpus striatum or convolutions close to it, according to the temporary or permanent character of the lesion, causes loss of co-ordinating power in the muscles of articulation, and as I have before showed that the anatomical origin of the convulsions may probably be in the same region, may it not be that the latter, and the defect of speech, are due to the same pathological conditions; the "discharges" giving rise to the former being of a temporary character, while the lesion which has caused the latter is of a more permanent character? Here, then, we must leave this case, until, should it be the will of Providence to remove the boy, a post mortem examination may render the case pathologically complete.

Case of Syphilitic Caries and Perforation of CalvariumEncysted Abscesses in Cerebral Hemisphere, discharge of one of these externally-Alternation of Epileptic Convulsions and Purulent Discharge. By JAMES HOWDEN, M.D. J. S., admitted 5th Oct., 1871, from Dundee, æt. 51, a gardener and weaver, married, Protestant. He has been under treatment in the Dundee Infirmary for an injury to his head, and has, within the last

few days, become insane, the cause of the insanity being alleged to be the injury to his head. He is stated to be epileptic, and dangerous to others.

The medical certificates state regarding him, that he suffers from almost complete loss of memory, does not know his own name, the day of the month, or year; he thinks he is only three weeks old, and again that he is 300 years old; he is restless, and occasionally outrageous.

On admission, his bodily condition was bad, and several bruises were observed on different parts of body and head. A day or two after admission his memory had returned, but he was constantly asking to be ripped open.

Nov. 6th. He is now apparently sane. A large abscess has formed in the left temporal fossa, otherwise he is in good health.

1872. January 2nd.-The abscess mentioned in last entry was opened, and a quantity of pus escaped. Sometimes the discharge was copious, at other times it ceased. Later on another abscess formed over the coronal suture.

He knows everything going on around him, answers questions slowly but correctly. He then began to have epileptic fits, when the discharge from his head stopped, but they ceased on the recurrence of the discharge. Latterly, after the fit he became unable to speak or swallow, but always rallied, until about the 10th of January, when he had fit after fit for a day or two, and died comatose on the 13th.

Sectio.-15th January, 1872, at 2.30 p.m. Temp. 46°. Height, 5ft. 9 in. Rigor mortis slight. An inch and a half above the inner angle of the left eye there was a fistulous opening in the skin covering the frontal bone. Two-and-three-fourth inches above the outer angle of the same eye, at the junction of the frontal and temporal bones, was a second fistulous opening, and about four and three-quarter inches from the first, and an inch above the left ear, was a third opening.

On reflecting the scalp, caries of the bones was observed immediately below the fistulous openings in the skin. A probe was passed through the bone in all of them, resting on a soft membranous-like substance; on removing the calvarium, its inner surface presented three orifices lined by a milky-white membranous structure, the lower orifice being open. The dura mater on the left side was adherent to the brain-substance over its anterior third, and to the membranous structure lining the orifices previously mentioned. On removing the dura mater the pia mater presented much venous congestion.

On section of the left hemisphere, a cavity filled with foetid pus was opened into in the anterior lobe. This cavity was situated anterior to the ventricle, and was about two inches in diameter, and lined by an irregular pinkish membrane. There was no communication between this cavity and the ventricle, but it appeared to communicate anteriorly through the grey matter, dura mater, bone, and scalp. At the back part, and under the left ventricle, another cavity the size of a walnut was found also filled with pus.

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Remarks. The private history of this man, with which I happened to be acquainted, as well as the character of the caries of the calvarium, left little doubt in my mind that his illness was of a syphilitic origin. At one time in circumstances of comparative comfort, he sunk, through intemperance and improvidence, to the social rank of a pig-sticker. A daughter became a prostitute, and he latterly lived with her in a brothel in Dundee. Whether the alleged blow on the head had to do with the formation of the cerebral abscesses, there is, I think, room to doubt. The perforations in the calvarium had that clear, well-defined, round outline, as if cut out with a punch, so characteristic of "syphilitic caries." I am disposed to think that the cerebral abscesses had also a syphilitic origin, but whether syphilitic or traumatic, it seems certain that they had existed when the patient had lucid intervals, during which his intellect was almost unimpaired. This may be added to other cases already recorded in evidence, that there may be very extensive destruction of the central white matter of the cerebrum, with comparatively little mental derangement, so long as the grey matter of the convolutions is not materially implicated. Though one of the abscesses in this case had pointed to the surface, the opposing surfaces of the arachnoid had become so glued together as to render escape of the pus into the arachnoid sac impossible. The most interesting fact, however, was that the largest abscess discharged itself externally through one of the perforations in the temporal bone. There was an evident connection between the suppuration and the epileptic seizures: when the discharge was arrested, and the pus probably pent up within the cerebrum, epileptic fits supervened, and conversely a free discharge of pus from the forehead was invariably followed by cessation of the convulsions, and an amelioration of the other head symptoms. It is also worthy of note in this case that, though there was general muscular enfeeblement, the patient never presented any hemiplegia or other distinct paralysis.

PART II.-REVIEWS.

The Methods of Ethics. By HENRY SIDGWICK, M.A. Macmillan and Co., 1874.

Mr. Sidgwick declares the plan and purpose of his book to be "an examination, at once expository and critical, of the different methods of obtaining reasoned convictions as to what ought to be done, which are to be found-either explicit or implicit-in the moral consciousness of mankind generally; and which, from time to time, have been developed, either singly or in combination, by individual thinkers, and worked up into the systems now historical." Avoiding any inquiry into the origin of the moral faculty by the simple assumption that it is something under any circumstances which it is right or reasonable to do, and that this may be known, he has endeavoured to expound and criticise from a neutral position, and as impartially as possible, the different methods which have been used to get at this knowledge of "what ought to be done." The aim of the book, then, is a purely scientific criticism of method, and it is characterized throughout by subtile analysis, precise definition, and scholastic learning. We must confess, however, that our attention has not seldom been prone to wander as we read, for, notwithstanding much originality and freshness in the exposition of the subject, there is a want of method in it which has entailed frequent repetition. A question once dilated upon is apt to come up again and again, sometimes, no doubt, in a new relation, and to be further discussed; the result being to produce a considerable haze of mind and an impatience of attention. Whether the fault be in us or in Mr. Sidgwick's style, we must confess too that we have often been obliged, even with the best attention, to read sentences two or three times over, in order to apprehend their meaning.

It will be deemed by moral philosophers an ignorant heresy, no doubt, but we cannot help sometimes asking ourselves the question whether there has been any real profit in the elaborate disquisitions which have been put forth respecting the right end which men ought to strive for in life-whether pleasure, or perfection, or virtue, or the greatest good of the greatest number. It is a problem concerning which it might

be said, Solvitur ambulando. Will not the time come when, possessed of a mental science founded on the study of the course of development of mind from its earliest beginning in nature to its latest evolution, and upon a thorough knowledge of physiology, men will look upon such disquisitions very much as they look upon the wasted labour of the alchymists now that they have attained to a knowledge of chemistry, or as they looked upon the futile labours to solve the problem of perpetual motion when they had once attained to a sound knowledge of the principles of mechanics. It would be wrong certainly to place the endeavours to discover the summum bonum on the same level with the futile experiments made to transmute the baser metals into gold, even though chemistry was much helped into being by the latter. All that it is intended to convey by the comparison is that a great advance in positive knowledge of mind, may, as has happened with other branches of knowledge, open a new and direct road to the goal which men have striven in vain to reach by devious and uncertain paths, and shew their former strivings to be but gropings in the dark.

Mr. Sidgwick might certainly say that he is not concerned with speculations concerning what the future may disclose; the task which he has set himself being to expound and criticise the different methods which have been used to get at the knowledge of what ought to be done. The only question is, whether that aim has been successfully fulfilled. So far as criticism goes, there can be no doubt that it is elaborate and subtile almost to an extreme degree; so far as exposition goes, however, we do not feel so sure of Mr. Sidgwick's success. He does not mark out plainly the distinct track of a method; he is for ever starting off on some bye-path, and proceeds sometimes so far and so eagerly in the pursuit of its sub-divisions, that he hardly seems to get back to the main track at all; and if he does come round to it again, he is sure to leave it at the first opportunity. Thus there is a failure to present a clear idea of what the method is. The channel of the stream is lost, not in a swamp certainly, but in a multitude of small streams. We are apt to come upon such an expression as this-" This leads me to a remark which to some extent qualifies what was said in the preceding chapter;" that is, when we suppose we have done with the subject, we find that the author is incidentally led in a following chapter to a remark which qualifies to some extent what was said in a preceding chapter. Surely the

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