found again useful in other countries where the disease is still prevalent.

A good hospital for the lepers of Syria would not only be a great boon to a class of miserable sufferers who are generally neglected, and often thrown into circumstances of great destitution and want, but would afford an excellent opportunity for the further study of this terrible disease.

II. On the Morbid Histology of the Brain and Spinal Cord, as observed in the Insane. By J. BATTY TUKE, M.D., F.R.C.P.E., Visiting Physician, Saughton Hall Institution for the Insane; late Medical Superintendent of the Fife and Kinross District Asylum.

(Continued from vol. lii, p. 460.)

PART II.

EVERY observer must have noticed differences of consistence in brains recently removed from the skull, some being softer and others harder than normal, some being oedematous and others abnormally dry. These peculiarities have a considerable influence on the behaviour of specimens when undergoing the hardening process, and increase or diminish the difficulty of preparing thin sections. In very old standing cases, and in subjects of advanced age where there is much general atrophy, considerable difficulty is experienced in obtaining the proper degree of hardness; such specimens will not stand the ordinary strength of solution or too prolonged immersion without becoming brittle and breaking down under the knife. The same is true of oedematous brains, whilst sclerosed, healthy and comparatively healthy brain-matter does not suffer so much from prolonged immersion; but, as has been already said, it is preferable to cut all specimens as soon as they are hard enough to stand the knife.

In using the knife a manifest difference is experienced in the feel of a healthy and an unhealthy brain; in the former the section glides pleasantly over the surface of the blade, and can be made of almost any size within that of the calibre of the section machine, whilst, in the latter, friability prevents the obtaining of more than limited specimens for the microscope, and even these have, in extreme cases, a tendency to curl up and become fissured.

The process of staining with carmine also indicates changes of structure. It may be taken for granted that a section which refuses to take on the stain of carmine acts so in consequence of its structure being composed mainly of morbid plasma. There is only one morbid product which is readily amenable to carmine, viz. amyloid bodies.

After trial of many clearing agents I have found nothing so satisfactory as glycerine; the results it gives are not nearly so brilliant as turpentine, oil of cloves, &c., but it does not destroy healthy structure or morbid appearances, and its use lessens the number of chemical agents brought into play. Specimens cleared in glycerine should be set up in a mixture of equal parts of glycerine and gelatine.

Changes in the neuroglia.-The changes in the neuroglia which have been observed in this series of autopsies are

1. General sclerosis, or hypertrophy.

2. Disseminated sclerosis (gray degeneration). 3. Miliary sclerosis.

4. Atrophy.

5. Colloid degeneration,

1. General sclerosis.-Although there is reason to believe that this morbid condition is by no means rare, it has been demonstrated only once in this series of cases. The full particulars of the autopsy in which it was noted are published in the Journal of Anatomy and Physiology,' for May 1873. The subject was an epileptic idiot, thirty-seven years of age, the right hemisphere of whose cerebrum and right lobes of whose cerebellum were found hypertrophied, coexistent with which was atrophy of the left side of the body. Ten days after birth fits occurred, and subsequently hydrocephalus appears to have supervened. His mind never became developed : the left side of his body was always smaller than the right. At nine months of age his fits ceased and he remained free from them. till he was ten years old; they then recurred and continued till his death. In September, 1871, he is described in the case-book of the Fife and Kinross District Asylum, as "a man of middle height; the whole of the left side of the body is considerably atrophied whereas the right appears normal. The face is drawn to the left; the left side of the face seems on a lower level than that of the right, which is fuller. The mouth is drawn to the left. The left arm is hardly half the circumference of the right. The left forearm rests at right angles to the arm, and the hand to the forearm. The whole arm is kept applied to the trunk. No anchylosis exists in either joint, passive movements can be made though there is no power of voluntary movement. The left leg is atrophied to a half, the knee is kept in an inverted position, and the foot is both slightly extended and inverted. The knee-joint is capable of slight passive movement, but is not so as regards voluntary action. The anklejoint is incapable of either. Progression is solely performed by the right leg, the left being lifted and carried after by the pelvic muscles. The atrophy of the trunk is best seen in the thorax; the thorax is flat, its antero-posterior diameter being 6 inches; its left side is lower than the right. The circumference is 314 inches, the right half being 174 inches, the left 15. The forehead is low and retreating; the right side is higher than the left, the vertex being formed by the right parietal bone. The patient died of phthisis in May, 1872. Post-mortem examination showed the calvarium to be very thin, dense and hard; only two limited points of diplöe were found in the whole circumference. The right side of the calvarium was one half the thickness of the left. Skull large, dome high,

ridged at the summit, to the right of which the parietal bone was round and full, the left being flattened. Capacity of skull 110 cubic inches. Sutures faintly marked, ossification almost complete. The right side of the facial portion was uniformly on a lower level than the left. The bones on either side were mere shells immediately posterior to the condyloid foramina. On the internal surface the sutures were perfectly ossified. The area of the right middle fossa, and the right cerebral fossa of the occipital bone were much more extensive than on the left side. There were other abnormalities of the skull, but as they have no bearing on the present subject they need not be detailed. The brain weighed sixty ounces, was of firm consistence, tough and resilient, the left occipital lobe was manifestly larger than the right; the relative weights of the two hemispheres were, right 30 ozs., left 23 ozs., the difference being 6 ozs. The specific gravity of the two hemispheres as proved en masse was exactly 1036, and separate portions taken from either hemisphere were of the same specific gravity. On section there was a marked difference between the gray matter of the two hemispheres as to colour and thickness. The gray matter of the left hemisphere was markedly darker than that of the opposite side; the colours were on the left side dark gray, on the right light pink gray in the outer layers, the inner ones being of a darkish brown, a white band separating them. The gray matter of the left side, as measured by Dr. Major's tephrylometer varied from 11-100ths of an inch in the frontal lobe to 4-50ths of an inch in the occipital. On the right side it was much thicker and much more even over the whole hemisphere. In the frontal and anterior convolutions of the parietal lobe the thickness was 7-50ths of an inch; in the posterior convolutions of the parietal (more especially the annectant convolutions) and the occipital lobe, the thickness was 15-100ths of an inch. The cerebellum was much deformed. The medulla oblongata was markedly larger on the right side above the point of decussation. The pons Varolii and the spinal cord were symmetrical. Microscopic examination revealed in the lobes of the left side only a degree of atrophy of the cells of the outer layers; on the right side there was observed:-1, an increase of the granular material of the outer layer of gray matter; 2, normality of the cells of the two inner layers; 3, irregularity of the cells of the intervening layers as regards their number, shape, size and distribution; 4, thickening and displacement of the nerve fibres of the white matter; 5, an increase of the neuroglia; 6, proliferation of the nuclei of the neuroglia and blood-vessels. The last three abnormalities claim attention at present. The nerve-fibres lay in fasciculi consisting of four, five or six strands, separated from one

'The above description is abridged from the original paper in the 'Journal of Anatomy and Physiology,' May, 1873.

another by very clear plasm in which were more than normally numerous nuclei, and a fine fibrillar structure. The plasm was in no way opaque, and contained no morbid products other than those mentioned. This condition was best marked in the occipital lobe, less so in the parietal and in a still minor degree in the frontal lobe; in fact it was coexistent with the degrees of hypertrophy of the several lobes. Sections of almost all the convolutions were cut and the disease was found distributed over the hemisphere increasing from before backwards.

The differences between this condition and disseminated sclerosis (sclerose en plaques disseminées are, that although the nuclei are considerably proliferated, they are not so much increased in number or in size, the opacity which characterises the latter disease is entirely absent, and no definite morbid products, such as amyloid, and colloid bodies, or atrophised fibres exist. It appears to be simply an increase of neuroglia which separates the fibres widely and pushes them into bundles. It differs from Virchow's Interstitial Encephalitis in that there is no increase in the size of the nuclei. That it is not caused by oedema is shown by the more than normally dense consistence of the recent brain.

The reason for the existence in this case of the increase of packing material appears to me to be as follows:-Ossification of the sutures having become complete in a unilaterally distended calvarium before the hydrocephalic fluid was quite absorbed, the rigid skull demanded a compensatory substance whilst the process of absorption was going on to completion. This not being met by an increase of the diplöe, as sometimes happens, the most rapidly produced structure of the encephalon was called on for the produc tion of a compensatory substance, and the neuroglia, pari passu with the process of absorption of the fluid, exerted itself to supply the demand. This theory appears to me to receive support from the fact of the increase of neuroglia being only present in the right, or hypertrophied hemisphere. That this half of the brain was the seat of lesion is apparent from the trophesial influence it exercised on the left side of the body.

Weighty brains are not unfrequently met with in idiots who in infancy had been the subjects of hydrocephalus; and such persons are often ill-formed, rachitic, dwarfed, or atrophied. I would suggest the probability, that in them the trophesial impairment has arisen from a bilateral general sclerosis of a nature identical with that which occurred unilaterally in my patient; and that the bulging brain occasionally met with in epileptics is possibly due to the same histological condition.

It is worthy of notice, that unilateral atrophy and hypertrophy of

1 See woodcut, loc. cit.