ticularly the case over the parietal and frontal lobes. On section, a great part of the centre of the anterior lobe of the right hemisphere, and many of its convolutions, were found to be atrophied, the place of the neurine, white and gray, being taken by a flocculent, gelatinous, fibrous material. The outer layer of the gray matter of those convolutions was found to be normal looking. On the left side of the brain the white matter was generally lacking in consistence-pale in some places and congested in others. The lining membranes of all the ventricles were very granular. The basal ganglia on the right side were softened and congested.

An examination of the arteries of the brain showed a hypertrophy of all the coats, causing extraordinary obliterations of the lumen in places, irregular contractions, and nodulated thickenings. Every form of irregular local arteritis was found, all the vessels being more or less affected, but especially the branches of the middle and anterior cerebral passing to the atrophied part of the right hemisphere.

The spinal cord was found to have undergone general atrophy with anæmic and softened portions in the dorsal region, and intensely congested portions in the lumbar region. The dura mater, pia mater, arachnoid, and cord were all matted together in some places. The liver was found to be puckered with cicatrices, and to have a small gummatous tumor the size of a bean in one portion of it.

It was evident that here there had been a syphilitic inflammation of the membranes; but the great bulk of the mental and bodily symptoms could be traced to the effects of the arteritis causing first irritation in the brain convolutions and then a slow process of blood starvation. The real character of the case was never diagnosed during life.

In the following case the arteritis seems to have ceased to get worse at a very early period of the disease, and its effects mental and bodily were therefore almost stationary for thirty-five years: H. S., æt. 30 on admission. Patient had a severe attack of syphilis at seventeen, for which he was treated with mercury. After this he was always irritable, and sometimes violent. On one occasion he attacked his mother, and smashed the door of a neighbor's house with a poker, and, when taken to the police office, that night had a partial hemiplegic attack. He was for ten years in a private asylum at Musselburgh, and then was taken to Morningside. On admission, he had delusions of suspicion, impulsiveness, violence, and also hallucinations of hearing, fancying he heard voices calling him "low," "mean," and seeing figures that he imagined jumped down his throat. He was taciturn and melancholic, too.

In three years his delusions were worse. He seemed to have had a slight difficulty of speech, and he imagined a woman had located herself in his mouth and was the cause of this, as well as of a bitter taste in his mouth. His gait was a little unsteady, straddling, and ataxic, and he dragged one leg a little. His bodily condition was never strong, and he looked weary and pale, and he always suffered more or less from dyspepsia. His delusions, impulsiveness, and excessive irritability of temper continued for the twenty-six years he lived in the asylum; and superadded

1 This case was more fully reported by the late Dr. J. J. Brown, then assistant physician, Royal Edinburgh Asylum, in the Journal of Mental Science, July, 1875.

to these there was considerable general enfeeblement of mind. His legs got weaker before death in 1875. He died of diarrhoea. The brain membranes were thickened, a thin layer of blood-clot was found under the pia mater, and the convolutions were much atrophied. There was a small cyst in the pons, evidently from old apoplexy. The microscopic appearances were the most striking (see Plate VIII., Figs. 1 and 2). The arteries in the pons were thickened, the muscular coats being hypertrophied to an enormous extent, the outer coat being also much thickened, and in and around this coat was a molecular deposit (Plate VIII., Fig. 1) containing also granular masses, this deposit in many instances filling up the perivascular space. At some parts the vessels were patent, at others completely occluded, and the lumen absent, the artery presenting the appearance of concentric rings in the centre of a granular deposit. The gray matter of the convolutions was found to be degenerated, the cells being atrophied, and their spaces in many instances being occupied by a few granules (see Plate VIII., Fig. 2). The spinal cord was also affected in the same way in its arteries, and in its gray and white substance. There were many microscopic apoplexies in the white substance of the cord.

No better demonstration of chronic vascular disease of syphilitic origin, and its effects of brain starvation, degeneration, and atrophy, with the resulting mental suspicions, hallucinations of hearing, and lack of selfcontrol, could have been afforded than this case.

I have seen some of the most extraordinary pathological effects in the brain from slow syphilitic arteritis. I have several specimens of brains in which the whole of the white substance in the inside of the anterior and middle lobes, lying between the outside convolutions and the central ganglia, had gradually and entirely disappeared, leaving a vacant space filled with fluid and a few fibrous flocculi. The gray substance of the convolutions, looked at from the inside in an antero-posterior section of a hemisphere, presents the most extraordinarily defined appearance, just as much so as when looked at from the outside (see Plate V.). The convolutions looked as if the white substance had been carefully pared off them, leaving the gray matter intact. The effect was exactly what would have resulted had that portion of brain been steeped in a fluid which had the power of dissolving away the white substance and leaving the gray entire. The cause of this is no doubt the histological facts that (1) the gray substance of the convolutions has five times the amount of capillary blood-supply of the white; and (2) the source and mode of supply is different, the gray substance getting it from the already divided and anastomosing network forming the pia mater, and the white substance getting its supply from single vessels, which in dividing form only an infrequent anastomosis, and a network with large, long meshes. The white substance, in fact, slowly dies, and disappears through an arteritis which only causes partial atrophy, anæmia, and lessened mental function in the gray convolutions. Looking at such a brain, many questions suggest themselves. How do the convolutions act whose white fibres of communication inwards and their interconvolutional fibres have quite disappeared? Is there a general power of conduction in the convolutions from one through the next, and so on till it reaches one whose ingoing fibres are intact?

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