550

the one case, how far was the state cerebritis ? In theother two the use of the term was questionable. Prolifera-tion of the connective tissue of the brain was a matter ofgreat and unusual inierest. He himself was only acquaintedwith partial encephalitis, and had only seen this either arti-ficially produced by injuries, or existing at the borders ofmorbid growths.

Dr. CHARLTON BASTiAN knew nothing of uncomplicatedcerebritis, from knowing no anatomical distinction charac-teristic of it. He thought the evidence did not entitle Dr.Elam to call himself the discoverer of such a disease. Dr.Elam had brought forward three cases which agreed in noone particular. In the first the most noticeable morbidchange was hyperæmia, in the second general softening, inthe third induration. These surely could not be placed inthe same category. Of the first it would be very hazardousto speak. In the third it was impossible to believe thatinduration could have taken place from any acute change.It was a chronic process in all organs; in the brain, a

chronic overgrowth of neuroglia. In the second case thechief point was the existence of exudation corpuscles,and these are now known to be the ordinary accompani-ments of all degenerative changes; so that there was

nothing to differentiate the change described from ramol-lissement. The very universality of the change was an

argument against its inflammatory character, because thebrain is a multiple organ as regards its blood-supply, sothat inflammation would affect its different portions inde-pendently. We should look for the causes of inflammationin one of three elements-either in the connective tissue,the nerve tissue, or the bloodvessels; and pathologicalchanges in any of these three may be followed by otherpathological changes in the region implicated. No reliancecould be placed on symptoms as evidence of the nature ofdisease. An affection of the hemispheres would producedifferent symptoms from the same affection of the ponsVarolii or of the cerebellum. Symptoms would not bedependent on the nature of the structural change, but onthe part in which that change took place.

Dr. RADCLIFFE said that thoughts like those to which Dr.Bastian had given expression had passed through his mindwhile listening to the paper. He could scarcely allow thatthe post-mortem evidence adduced in support of the ex-istence of cerebritis, as defined by Dr. Elam, was conclu-sive, but he was chiefly disposed to call in question thesymptomatology of the disorder. He believed that theaccounts of encephalitis in the ordinary text-books re-

quired revising; that acute pain in the head, and activedelirium or high fever, or active symptoms of any kind,were not the symptoms commonly met with ; but that men-tal dulness and indifference rapidly deepening, ushered inby vomiting, with little or no feverishness, and with littleor no disposition to paralysis beyond weakness of thebladder, were the usual symptoms, not only when the sub-stance of the brain without the membranes, was affected,but also when the membranes were implicated in the in-flammation. He therefore would not regard the symptomsgiven by Dr. Elam as diagnostic of cerebritis put’ et simpleas being really so diagnostic.

Dr. WYNN WILLIAMS inquired how soon after parturitionthe disease had shown itself in the case of the adult lady,and mentioned instances in which somewhat similar sym-ptoms, leading to a fatal issue, had been attributed to theabsorption of putrid matters after delivery.

Dr. HABERSHON believed that everyone must frequentlyhave been perplexed by the absence of post-mortem changein cases of apparent tubercular meningitis. Dr. Bastianhad drawn attention to a correct division of these instances,according as they might be due to changes in the tissueelements or in the bloodvessels. In the latter case hebelieved that manifest hyperaemia was often due to capil-lary embolism; and he doubted if we should be warrantedin regarding the changes described by Dr. Elam as beingdue to acute general inflammation.

Dr. CHARLTON BASTIAN wished to supply an omission inhis former observations. He had frequently found thatgeneral turgescence was due to capillary obstruction, occlu-sions of various kinds disseminated throughout the brain ;and he had found similar obstructions in other organs, as

the liver, with clear evidence, from the consecutive tissuechanges around them, that they had been formed duringlife.

, Dr. ELAM, in replying, said that he had selected threecases having a certain distinct clinical relationship. Thechanges were general-universal over the brain. The dis-ease was acute-sudden in its invasion, without premoni-tory symptoms, rapid in its progress to death. The post-mortem changes were general, and had a certain relation.In the second case the brain was diffluent; and if the firstpatient had lived twelve days, his brain might probablyhave been in a similar condition. In the third patient therewas no induration, but the texture was a little firmer thannatural, with the hardness of the first stage of inflamma-tion. This case lasted as long as No. 2; but the differencein the rate of morbid change might be due to the differenceof age-one patient being a boy of thirteen, very youngfor his years; the other the mother of three children. Ir

all, the changes were such as we are accustomed to callinflammatory. In No. 2, besides the very great softening,there was the roseate tint of the tissue, which stained a

knife, and the presence of the exudation corpuscles. It waE

certainly much to be regretted that disease should be sc

illogical as to produce results -which it ought not to pro.duce, but it was our most important duty to trace facts asthey occurred.

PATHOLOGICAL SOCIETY OF LONDON.TUESDAY, MARCH 3RD, 1870.

DR. QUAIN, PRESIDENT, IN THE CHAIR.

A REPORT on Mr. De Morgan’s case of Recurring Fibro-plastic Tumour showed that it was not cancerous, but con-sisted of cells, spindle-shaped and myeloid, enclosed byfibrous bands.

Mr. GAY exhibited a specimen of Gangrene of theFemoral vein, following obliteration of the saphena. The

patient had cancer of the scrotum and glands adjoining, oneof which latter was excised. In the operation the saphenavein was cut across; bleeding frequently occurred, and,finally the femoral vein and artery sloughed, and the man.died.

Dr. WEBER showed a specimen of Tuberculosis of theArachnoid and Lungs, apparently consequent on caseationof glands.

Dr. DowN brought before the notice of the Society aliving specimen of the disease described by Duchenne as-paralysis with muscular hypertrophy. The patient was aboy of eleven years of age, of dull heavy look and sallowcomplexion, who had lost the power of walking, and whoon falling could not rise ; the arms could only be raised bya swinging movement. The fingers and feet, however, couldbe moved readily. The muscles were hypertrophied,especially the gastrocnemius, and those in the dorsal

region, and they did not respond to the induced electriccurrent.Mr. ADAMS confirmed the diagnosis made by Dr. Down.Mr. CARR JACKSON showed a Knee-joint, the bones of

which were affected with acute necrosis. The operation forexcision was intended, but on opening the joint extensive-disease was found, and amputation was performed.

Dr. ROBINSON exhibited a Double Aortic Aneurism, withossific deposits in the walls of the vessel, taken from aguardsman, admitted into hospital with small pulse, numb-ness of the left arm, cardiac distress, and a diastolic mur-mur at base, and who died suddenly two days subsequently.Two sacculated pouches were found just above the valves,and the inner and middle coats of the vessel were destroyedby disease.

Dr. PAYNE showed a specimen of Abnormal FibrousStructures in the Wall of the Left Ventricle of the Heart,and careful inspection seemed to show that they wereabortive valves-a second set, in fact, which reached a cer-tain stage of development, and then became stationary..The heart was hypertrophied, and the aorta markedly di-lated, the semilunar valves being incompetent.

Dr. DICKINSON observed that these structures clearly re-sembled valves.

Dr. DucCwoORTH exhibited some Sarcinæ which had beenvomited three years ago, but had undergone little change,.if any, since, save that the " pack " character had become

indistinct, and the bundles had assumed a granular ap-pearance.