Sclerosis of the Cornu Ammonis in Epilepsy.—Dr. W. L. Worcester (Journ. Nerv. and Ment. Disease, April and May, 1897) details his experience as to the frequency with which this lesion is found when systematically searched for, and discusses its relation to the pathology of epilepsy. He prefaces his own observations by a summary of previous ones, dating from those of Meynert in 1868. From these it would appear that the preponderance of authority is in favour of the view that the lesion in question is a result rather than a cause of the convulsions observed during life. Worcester's experience is based upon the appearances presented by the brains of forty-three epileptics, which he examined at the Arkansas and Danvers Asylums. In only nineteen of these was there an absence of any gross cerebral lesion. The one under consideration, namely, sclerosis of the cornu ammonis, was present on one or both sides in twenty cases, in eleven of which no other abnormality was found; while in nine it was accompanied by other and more extensive lesions which he believed had a common origin with it; and this association appeared to him to throw light on the nature of the connection between it and convulsions. Of these associated abnormalities the most frequent he found to be microgyria of an entire hemisphere. The histological characters of the diseased cornu ammonis seemed to have been remarkably uniform, and consisted of a general sclerosis, involving destruction of the neurons having their origin in the stratum pyramidale and nucleus fasciæ dentatæ. Such a condition the writer failed to note in a series of over a hundred and fifty brains of insane patients, save in those of epileptics. Exception, however, must be made to this generalisation, for the case of a patient dying subsequently to the printing of this monograph. It was that of a general paralytic in whom there was no history of epilepsy, nor had he suffered at all from convulsions; yet after death changes were noted identical with those above described. Still, the frequency of this condition in epileptics and its great rarity in those not subject to this disease, would seem to place it beyond the pale of mere coincidence. The question is whether the epilepsy causes the anatomical changes or they the epilepsy. The chief reason why the former view is held by the majority appears to be due, rather to the improbability of this convolution, from anything that is known, having any special relation to epilepsy, than to any definite theory as to the way in which epilepsy could bring about such changes in a single convolution. The writer himself would rather lean to the supposition that the condition of the cornu ammonis is the cause of the convulsions. In support of this view, he cites the fact that it is known that a cicatrix of the cortex may act as a focus of irritation, and gives references of evidence proving that irritation of the temporal lobe may excite convulsions. He does not wish it to be understood that he believes in this convolution having any special prerogative in this respect, but rather that a scar in any part of the cortex may have such an effect. Neither, also, would he assert that all epilepsies originate in any part of the cerebral cortex, for the certainty that epileptiform convulsions may be due to peripheral irritations and to toxæmic conditions is too clear.

The Effect of Poisons on Nerve Cells.—Nissl gave a demonstration of the result of his researches to the meeting of German alienists, held at Heidelberg, 18th September (Centralblatt für Nervenheilkunde, October, 1896). He thinks it useless to discuss the question how far the nerve cell which we see under the microscope resembles that in the living organism; but he aims at having a pattern or typical cell not altered by our treatment. For this purpose the animal should be killed in a particular manner, and the preparation always made in the same way. Then any deviation from the pattern cell must be owing to some other causes. In this way he has studied the changes in the large motor cells of the anterior horn of the spinal cord of the rabbit after administration of strychnine, veratria, arsenic, alcohol, phosphorus, and the toxin of tetanus. He had also studied the motor cells and the cells of Purkinje and those of spinal ganglia of the rabbit after giving lead, the cells in the sympathetic after poisoning by arsenic, and the cells of the cortex of the same animal after poisoning by alcohol, morphia, and lead. He had also studied the cells in the human brain in a case of poisoning by phosphorus and typhus fever. Nissl's method is to give the animal sufficient doses to maintain a toxic effect without ending life. He compares the cell thus acted upon with a healthy cell from the same locality. He has found that after the action of these poisons the effect is not uniform in all the nerve cells; some are more affected than others, while different cells are affected through different poisons. He observes that in some the nuclei are altered, becoming rounder and more homogeneous and take a deeper colour. Dr. Nissl gave twenty-four illustrations of his preparations coloured in his own methods; he also demonstrated the various kinds of nerve cells and pointed out the relation of different species of cells in the nervous centres of vertebrate animals to the different functions. He thought that with the help of a more thorough clinical and psychological analysis we might hope yet to find out the function of different cells in the nerve tissues. He observed that when there are marked alterations in the nuclei, the cells can no longer be restored to their normal functions. Hitzig observed that in tetanus there was found vacuolisation of the nerve cells on dyeing with carmine; but Nissl holds these vacuols to be an artificial product.

The Sedative Effect of Calomel in Large Doses.—In an interesting little book, entitled “Rough Notes on Remedies,” Dr. Wm. Murray, of Newcastle, draws attention to the danger of forgetting some of our old friends amid the host of new remedies. Speaking of calomel he instances the great sedative value of this drug in large doses and the good effects which follow the administration of ten grains at the outset of delirium tremens occurring in a robust subject. Such was the practice, he tells us, of the late Mr. Sep. Rayne. He farther gives his own experience of the beneficial action of large doses of calomel in states of maniacal excitement: thus, in one case, an epileptic, suffering from acute mania, having first by a little manóuvring got the patient sufficiently under chloroform, he administered 30 grains of calomel to him. On returning in two hours he found the patient “on the night commode, perfectly subdued, very limp and nauseated. After much profuse purging and vomiting he became as quiet as a child and fell into a sound sleep, to awake in a perfectly calm frame of mind.” In another case “the patient was a man of immense strength, and naturally of a ferocious disposition;” he was in a state of acute mania, and though secured hand and foot could scarcely be approached, having bitten his attendants severely. Dr. Wm. Murray contrived to throw a towel saturated with chloroform over the patient's head and to maintain it there until the man was unconscious. He then administered a teaspoonful of calomel, which proved to be about 80 grains. The patient became “nauseated, subdued, and occupied by his own internal sensations, and ere long his fury entirely left him.” The patient was then removed to an asylum and made a good recovery. Dr. Murray thinks that the “nausea peculiar to calomel” is most valuable in these cases, also that the action upon the disordered secretions generally present in these cases is most beneficial. These are the remarks of a practical man.