104 PROGRESS OF 'microscopical SCIENCE. 



Eefereuce was made to an article in the ' Edinbui-gh Medical 

 Journal ' for September, 1868, by Dr. J. B. Tuke, as being the only 

 exception which Dr. Kempster was able to find. 



The student is met with the stereotyped phrase that there^ are 

 no discernible lesions peculiar to insanity. For a number of years 

 Dr. Kempster has been making systematic microscopical study of the 

 brain, and has examined the lesions of all forms of insanity, from 

 acute mania to dementia, including puerperal and epileptic insanity. 



In each and all forms he has found a marked lesion — so that certain 

 lesions may be grouped together as common to certain forms of in- 

 sanity, and to which lesions any particular type of insanity is palpably 

 due. There is a wide difference between the lesions of acute and 

 chronic mania. 



I. In certain forms of insanity, and notably in dementia, the finer 

 capillaries show marked indications of disease, the perivascular sheath 

 surrounding the vessel is distended, so much so, that sometimes the 

 vessel itself appears to lay in a tunnel, its calibre being much less 

 than the sheath, doubtless due to repeated capillary congestions of the 

 vessels often diseased — irregular in calibre, suggesting the idea of 

 aneurismal dilatations, but entii-ely distinct from the miliary aneu- 

 risms so ably described by Charcot. 



• II. Next, there is a degeneration, best studied in cases of dementia 

 of syphilitic origin, and in the medulla oblongata, in the wall of the 

 capillary, presenting dark red patches at various points outside its 

 walls, which gradually thicken, and appear to be due to a fatty meta- 

 morphosis or atheroma. The description by Meynert, though accurate, 

 is by no means so complete as could be desired. 



III. In 1871, while examining a section taken from the grey 

 and white matter of the third left anterior convolution, there was a 

 peculiar appearance of the tissue. Situated in the white substance, but 

 very closely to the grey matter, there were a number of small luliite 

 spots, some round, some ovoid, clearly defined, in sharp contrast with 

 the nerve tissue, varying in size, from 1-50 to 1-200 of an inch in 

 diameter — these appeared to be of a granular consistence, and much 

 more dense in structure than the surrounding brain substance ; each 

 disconnected from the other, and normal white matter intervening. 

 They did not absorb carmine, and were not connected with the capil- 

 laries. On the sm-face of some of the spots are fibres of connective 

 tissue and crystals of margarine. To determine the true character of 

 these sjjots and the degeneration, certain very elaborate and extensive 

 micro-chemical manipulations were made, not here necessary to be 

 stated. On allowing a section to dry, either with or without the nitric 

 acid treatment, these spots appear to project above the surface of the 

 section. By teasing, they may with difliculty be removed. None of 

 these spots have been observed in the grey matter. They are mr st 

 numerous in the medulla oblongata, and may be found in the white 

 matter of the spinal cord. 



IV. There is another form of degeneracy, one which was found in 

 cases of acute mania. The spots are less in size ; are far more nu- 

 merous than in the other variety (3J ; resist carmine staining ; do not 



