siderable fissures in the upper lip and jaw bone. Between the fissures was a portion of bone containing two incisor teeth, and connected to the end of the nose by a strong cartilage. This projecting portion of bone appeared to keep the palate bones much apart. It was but slightly covered by integuments, which were indurated by repeated attempts made to unite the side portions of lip to this scanty strip of skin. Mr. Harrison determined to remove entirely both it and the piece of bone containing the two teeth; and effected his object with the metacarpal saw, having first separated, with a scalpel, the integument and cartilage from the nose. This finished, he observed the palate to be more complete, the canine teeth to be more in the front of the mouth, and the circle of the upper jaw lessened. The end of the nose, which had been bound down, obtained freedom and a more natural shape. He found that there was very little want of substance in the lip, after paring the edges, which were readily brought together, and kept in union by pins and the twisted suture. He applied adhesive straps over small cushions, to bring forward the cheeks. The little patient took nourishment through a tube introduced at the angle of the mouth. In five days the pins were removed, and in a very short time the boy was perfectly well.

34. Pathology of the Brain in Mania, &c.* The exceptions to general rules are undoubtedly more numerous in medicine than in any other science. Idiosyncrasy of constitution so modifies the phenomena of the same disease, as to leave it scarcely cognizable, or assignable to the same class, in different individuals. This is the grand cause of medicine being termed reproachfully a "conjectural art." The reproach does not rightfully lie at the door of the physician, but of the disease. If the same causes uniformly produced the same effects or if there was a possibility of drawing general conclusions as legitimately in medicine, as in other sciences, then indeed we might be justly reproached as a faculty of conjecturers. But this is not the case. We have a PROTEUS to deal with, in every disease, which assumes as many forms as there are individuals in the world! Those therefore who sneer at the "conjectural art," are generally those who do not know, or do not consider the difficulties attending it :--and, at all events, even these will fly to it for aid, whenever the evil hour comes, as come it must to all. Mean time the accumulation of facts, and the more diligent study of morbid anatomy, are daily clearing away the rubbish of conjecture with which the healing art has been defaced since its first institution.

Dr. Hebreart has had excellent opportunities of examining the organ of thought at the Bicetre, where so many maniacs are col

Observations sur quelques Maladies du Cervelet, du Cerveau, et de leurs Membranes, Recuellies à l'Hospice de BICETRE. Par M. Hebreart Medecin Ord. des Alienêes. ANNUAIRE MED. CHIRURGICALE.

lected. He has been able to correct some errors into which physicians have fallen, especially respecting the cerebellum, the diseases of which have generally been considered as very speedily fatal. Our author has accumulated several facts at the Bicetre, which prove that organic affections of the cerebellum may pass into the chronic state, the same as those of other organs, and not destroy life till after a long period of suffering. Again, it is pretty generally supposed that inflammation of the meninges of the brain can hardly exist without producing the phenomena of phrenitis. Yet out author has proved by dissections, Ist, that in persons who exhibited all the symptoms of phrenitis, no morbid appearances could be detected in the meninges; and 2dly, that in cases where the said membranes were found greatly disorganized, no phenomena of phrenitis were apparent during life. These cases are brought forward not to discourage enquiry, but to check presumption, and thus to save the physician from the disgrace of a false prognosis into which he is not seldom led by too great propensity to generalize, without considering the numerous exceptions to all general rules in medicine.

AFFECTIONS OF THE CEREBELLUM.

Case 1. A young man fell into a state of idiotism, six years before the date of report, after a course of severe study. He then, during the winter, became so debilitated and scorbutic, that he sunk, exhibiting, for the last month of his life, that prostration of strength and aridity of the tongue and lips which characterize the low fevers. On dissection, the four ventricles of the brain were found distended with serous effusion. The parietes of the fourth ventricle were disorganized, having degenerated into a yellow and lardaceous substance, that extended more than a line, in all directions, into the cerebellum.

Case 2. A maniac in the Bicêtre, who had, for several years, been considered as incurable, was seized with a complaint which our author looked upon as a common gastric affection, but soon put on the character of low fever, as great prostration of strength, dry and red tongue, encrusted teeth, &c. This state lasted four months, in despite of tonic and stimulant treatment, which produced no amelioration of the symptoms. The patient at length sunk, having the rattles in his throat for eight days before his death. On dissection, a disorganized portion of cerebellum, six lines in diameter, situated at the inferior part of the right lobe, was observed, of a hard consistence, lardaceous, and yellow colour, occupying not merely the cortical, but extending several lines into the medullary substance of the cerebellum. Opposite to this diseased portion the pia mater was destroyed, and the dura mater partook of the yellow appearance of the disorganized cerebellum.

The morbid structure in this and the preceding case, our author rationally imagines to have been of considerable standing. They were probably, he thinks, in both cases, the cause of the insanity.

Case 3. A man of strong constitution, a sawyer of marble, (an occupation not very much calculated to excite the passions,) experienced an accession of mania in 1811, he being then in his 50th year. This attack lasted three months without any lucid interval. Partly by time, partly by the lowering plan of treatment pursued at the Bicetre, the malady was overcome, and the patient returned to his wife and his former trade, having been six months in the hospital. He continued sane for two years, when he was again brought to the Bicetre labouring under a milder form of mental derangement than before; but considerably debilitated in physical power, without any apparent disorder of the great functions of the body. His speech was faltering-his tongue slightly paralyzed-his memory obliterated. This state continued several months, and then gradually changed into a kind of low fever characterized by dryness of the tongue, incrustations of the teeth, and general prostration of strength, which symptoms resisted all the tonics and stimulants that could be employed. The debility gradually increased, with scarcely any deviation from a natural state in the pulse or animal temperature-in short, without any of that reaction which is generally obsérvable even in the lowest fevers. The patient at length ceased to exist, after lying fifty-five days without speaking a word, without turning in his bed, without exhibiting any nervous movement or symptom of irritation.

On dissection, the thoracic and abdominal viscera presented nothing remarkable. In the head, all the parts were infiltrated with black blood. ("Toutes les parties infiltrés d'un sang noiratre.") The lateral ventricles were distended by a considerable quantity of water; but what was most remarkable was a gelatinous degeneration in the left lobe of the cerebellum. All the inferior surface of this lobe had the consistence of jelly to the depth of three or four lines. It was only necessary to scrape the parts gently with the handle of the scalpel, in order to reduce them to a fluid. When this was done, the lobe, instead of presenting a convex surface, had a concave aspect, the parietes of which concavity were hard, polished, and formed a kind of cyst. Our author queries if it be not probable that the attack of insanity, in 1811, was owing to inflammation in this part of the cerebellum, which becoming chronic, produced at length the alteration of texture above described.

CEREBRUM.

Affections of the brain are much more common in maniacal cases than of the cerebellum.

Case 4. A soldier, 32 years of age, of sanguineous temperament, was admitted as insane into the Bicetre. He had been rendered deaf by exposure to a long and tremendous cannonade, after which he showed symptoms of mental alienation. He was attacked by phthisis pulmonalis while in the Bicetre, and after going through the different stages, died. On dissection, the viscera of the abdomen were found healthy-the lungs filled with tubercles in a

state of suppuration-the meninges of the brain healthy—a tumour the size of a nut in the anterior lobe of the right hemisphere. This tumour was enveloped in a peculiar membrane or cyst, intimately connected with the surrounding cerebral mass. Cut into, the tumour presented a substance of a lardaceous consistence.

The two next cases related by our author were epileptics, between whom and maniacs there is but too much relationship.

Case 5. A man, aged 40, had been epileptic since the age of 18, the complaint having been brought on by a fright. The paroxysms of the disease were not, in general, more frequent than once or twice in the month. During one night, however, while in the Bicetre, he had several paroxysms of epilepsy in succession, and no alarm being given by the nurses, the man died with all the symptoms of asphyxia-an accident which not uncommonly happens, under such circumstance, unless bleeding be had recourse to in time. On dissection, a portion of the posterior lobe of the left hemisphere of the brain was found disorganized, and converted into a yellow pultaceous matter, and surrounded by a portion of indurated brain.

Another epileptic, 30 years of age, had had paroxysms of the disease twice a week for the last five years; the disease having arisen without ostensible cause, and not as yet attended by intellectual aberration. He was suddenly seized one day, without evincing (according to the report of the nurse) any of those struggles which attended all former paroxysms, and carried to the infirmary of the institution in the following state:-face flushed-vessels of the conjunctiva gorged-tongue embarrassed-ideas confused-pulse strong and frequent-respiration sibilant. Notwithstanding bleedings, sinapisms, and other means, the apoplectic state increased, and the patient died on the third day of the attack.

On dissection, the viscera of the thorax and abdomen were found healthy, with the exception of the heart, which was very large in proportion to the size of the patient. The cerebral vessels were greatly gorged with blood. On the borders of the hemispheres opposite the falx, were developed, very gradually no doubt, red, callous excrescences, similar in appearance to those syphilitic vegetations called cauliflower excrescences. The lateral ventricles, especially the left, were very much distended with serous effusion. The following case is remarkable.

Case 7. Francis 56 years of age, who had been three years in prison, evinced, towards the end of November 1814, a certain absence of mind, which was remarked by his comrades. On the 1st December, he experienced a sudden attack of general paralysis, and was carried to the infirmary, being incapable of speaking, hearing, seeing, or feeling-the muscles were relaxed, the respiration natural, the animal temperature moderate, the pulse slow and not very strong. Four grains of emetic tartar were exhibited, but produced no effect. In the evening four grains more were given, which produced only a few stools. He now swallowed, though

with difficulty, some stimulating potions-sinapisms were applied to the feet. It was not till after 48 hours that he recovered from this lethargic state resembling a profound sleep. Seven hours after this, he experienced an attack of mania, which lasted but a few hours, and then changed into the original lethargy, in which he lay insensible. After applying blisters to the thighs, and taking a large quantity of blood from the arm, the patient recovered sense again for nine or ten hours, after which he relapsed once more into a state of carus, as above described. During the lucid interval he complained greatly of his head, and of pains in his limbs. He continued to relapse and revive alternately, till the 15th December, when he found himself so well as to be able to take some food. He had no other attack till the 21st, when he fell out of a window into the street, and was taken up paralytic, as in the first instance. This state continued two days, during which he was insensible. From this he revived, and was rather violently insane for some hours, when he fell back into carus, which lasted 36 hours. This state of alternate carus and mania continued till the 12th January, 1815. The perodicity of the attacks, and the want of well marked pyrexia, determined our author to exhibit the cinchona, both in powder and decoction. In three days from the commencement of this mode of treatmeut, the symptoms, both of mania and paralysis, disappeared. The medicine was continued five days, and the man was so well in a month, as to return to his domestic avocations.

Our author has no doubt in his own mind, that the above was a case of masked intermittent fever of a malignant nature—“ fievre intermittente pernicieuse larvée."

MENINGES.

in

There can be no doubt that, in the great majority of cases, flammation of the cerebral meninges will exhibit the usual phenomena of phrenitis-as fever, exaltation of the intellectual functions, delirium, and functional disturbance in various other organs than the brain. The following observations are brought forward to prove that the rule is not absolute, and that the phrenitic excitement is not always in proportion to the meningeal inflammation.

Case 8. A professor of music, 47 years of age, from some domestic inquietude, fell gradually into the following state:-agitation and delirium-insomnium-physical sensibility greatly increasedhard and full pulse-skin moist. If not confined, the patient was constantly in motion, upsetting and breaking every thing in his way. When confined by means of the straight waistcoat, &c. he struggled incessantly to disengage his limbs. He only pronounced some incoherent words and sentences, showing that his ideas were as disorderly as his muscular movements. After continuing nine days in this state, an inflammation arose in his right leg, which quickly took a gangrenous turn from the continual friction of the part, in consequence of the patient's restlessness. He died on the 17th day from the invasion of the phrenitic state.