284

374

414

IV. Transverse Section of the Spinal Cord at the origin of the seventh cervical nerve (Case of G. B-, p. 280), showing Enlargement of Ventricle

V. Illustrating Cases of Chronic Bright's Disease with Contracted

Kidney
Ditto

ditto

VI.
VII-XIX. Illustrating Cases of Changes in the Spinal Cord and its
Vessels in Arterio-capillary Fibrosis

XX. Coils of Valvula Conniventes passed in the Evacuations in a
Case of probable Thrombosis of Superior Mesenteric Vein and
Renal Veins

470

LIST OF WOODCUTS.

Aneurism of left middle Cerebral Artery
Aneurism of left middle Cerebral Artery

Sketch of Capillaries of Spinal Cord incrusted with Oil Globules
Sketch showing Wasting of Muscles after a blow on the Neck
Diagram of Spinal Cord showing Enlargement of Ventricle
Portraits illustrative of Cases of Anorexia Nervosa

SECTION I.

DISEASES OF THE NERVOUS

SYSTEM.

(a) DISEASES OF THE BRAIN.

ON ABSCESS OF THE BRAIN.'

THE brain exhibits in disease a tendency to suppuration which gives it a pathological rank with glandular organs. The bearing of this upon the therapeutics of cerebral affections in general, is both obvious and important, especially as to the use of mercury, since it is admitted that the diseases of tissues having this predisposition, do not bear the full action of that remedy.

A recent excellent writer2 admits the occurrence of idiopathic cerebral abscess. I suppose he means no more than abscess whose origin is unaccounted for, since we have no evidence of any such intrinsic perversion of the nutrition of the brain as leads to suppuration. The nearest approach to such a result is in scrofulosis, but then only where the scrofulous deposit acts as an extraneous substance upon the tissue in the same manner as an hydatid cyst; in neither of which cases can the suppuration be considered idiopathic.3 A perusal of the cases given by Abercrombie may have favored the opinion referred to, as he seems tacitly to assume an independent origin in many of them. But it is to be remembered, in contradiction to such an inference, that the cases he records are principally intended to estabish the fact of suppuration, the different forms of it and its general symptoms, and not avowedly to trace the causes. This of necessity is a later subject of inquiry.

It is in, what has been called, "metastatic abscess," that

1 Reprinted from the 'Guy's Hospital Reports,' vol. iii, 1857, p. 261.

2 Lebert, "Über Gehirnabscesse," Archiv für pathologische Anatomie,' &c., Bd. x, 1856.

3 The distinction here insisted upon is obviously more than a verbal refinement. Daily experience proves how much clinical investigation is prevented by the inappropriate use of the word idiopathic.