The pulse-tracing in general paralysis has never been thoroughly investigated, and although the tracing said to be characteristic of this affection has been figured and described in several works, I have looked in vain for those records of the amount of arterial tension as estimated by the pressure gauge, without which a mere pulse-tracing is of little reliance and value. I have therefore endeavoured to supply in part this want by a detailed account of the sphygmograms taken in about forty cases of general paralysis, with records of tension measurement and occlusion pressure, the latter taken by Dr. Handfield Jones' sphygmometer, which registers a pressure of 20 up to 600 grammes. The tracings have been all taken, by means of a very perfect sphygmograph, upon smoked enamelled paper, and every source of fallacy which could possibly be eliminated was very carefully excluded.

In the human subject, strictly limited traumatic brain-lesions are among the pathological conditions which bear most clearly upon the problems of cerebral localisation. Necessarily these accidental experiments upon the human brain are sometimes as sharply localised as are the experiments of the physiologist upon the brains of lower animals. For the purposes of the physician, indeed, they are more instructive than the latter.

The education of the imbecile is an enterprise the inception of which dates from a very recent period. The generation has not yet passed away, which frankly insinuated that the idea of teaching the idiot could only enter the brain of one somewhat closely related to the class. It is now everywhere recognised as an important and imperative duty which cannot be neglected without shame and loss; yet for efficient practical effort, it is still but the day of small things.

Hypertrophy of the Brain is a comparatively rare disease, and has attracted little notice in England. Laennec first drew attention to its occurrence in children, and to its similarity to chronic hydrocephalus in many of its symptoms, and the likelihood of its being mistaken for it. The cause of the disease is obscure. Brunet defines it “as an increase in the weight of the organ due to a disorder of nutrition, leading to an alteration in the nervous “substance.” The process is not one of mere increased growth, but the nutrition of the organ is modified in character as well as increased in activity. According to Rokitansky the augmented bulk is not produced by the development of new fibrils, or by the enlargement of those already existing, but by an increase in the intermediate granular matter, most probably due to an albuminoid infiltration of that structure. My own observations lead me also to the opinion that the disease, as seen in imbeciles, is due to an increase in what appears to be granular matter, for in some sections, which I have in my possession, this is seen. The change is accompanied by an increase in the number of the blood vessels, and the presence of a large number of leucocytes. Andral states that in two post-mortems made by himself, the white matter resembled the white of egg hardened by boiling. In one post-mortem only have I noticed any peculiarity in the white matter, and in that case I find I have recorded that it was of a “peculiar whiteness.” The parts affected are chiefly the white matter of the two hemispheres, sometimes the corpus striatum and optic thalamus, rarely the pons and cerebellum. MM. d'Espine and Picot consider the affection to be a congenital one, and in this opinion I concur. They hold, however, that imbecility only results when hypertrophy of the brain is accompanied by sclerosis. My experience does not lead me to this opinion, for in none of the seven post-mortems which I have made was sclerosis present. Brunet, too, describes two cases of hypertrophy of the brain without sclerosis which he has seen in idiots. Both d'Espine and Picot and Brunet describe two forms of the disease; in the one the hypertrophy is simple, in the other accompanied by sclerosis. The principal symptoms are headache, at times intensified, excitement followed by coma, blunting or arrest of development of the intelligence, difficulty in walking, and convulsions. The symptoms are said to be less marked in children than adults, because the brain is less compressed, the cranial cavity increasing in size as the brain enlarges. I proceed to relate particulars of some cases which have come under my observation.

During the autumn of last year I had occasion to visit the parish of Minto, in Roxburghshire, and on making enquiries as to the history of a certain patient, W. N., who was about to be sent to the asylum at Melrose, where I held the position of assistant medical officer, I was told that he was one of seven children who were imbecile, out of a family of eleven, and that the father of this family was popularly supposed to be not altogether right in mind. Thinking that if I followed up this case it might prove to be of some interest, I determined to investigate it.

Perhaps there is no system which in recent times has received more attention, from an anatomical as well as from a physiological point of view, than the central nervous system. The brain being built up of cells and fibres of a soft and friable material, imbedded in a still softer substance, and arranged so as to form a complicated network of fibres suspended between and connecting different systems of nuclei, it is not to be wondered at that its minute anatomy, previous to the employment of the various hardening methods now in use, was very imperfectly known. Even now, notwithstanding our present means of hardening nerve tissue, and improved appliances for preparing sections for microscopical examination, we often experience considerable difficulty in its investigation, not the smallest of which is encountered when we endeavour to follow the different nerve fibres and associate them with their proper nuclei. Sometimes this difficulty arises from several bundles of fibres connected with different nuclei running together, or occupying almost the same position and at other times from several nuclei connected with different groups of fibres being placed very close to each other, so that we may have in close proximity nuclei, or the fibres connected with nuclei, which differ greatly in function.