720 
mentary parts of the organ, has yet to be deter- 
mined by microscopical examination. 
It is most probable that the disease consists 
not merely in an increased, but also in a per- 
verted nutrition, and that new material is depo- 
sited between or in the proper anatomical ele- 
ments of the brain. 
In some instances there is, along with the 
signs of increased nutrition in the brain,evidence 
of a similar condition of the cranial walls. 
The bones of the skull are, in such cases, much 
thicker than usual. In others, however, the 
bones seem to yield under the pressure, from 
within, and they become thin, and more or less 
transparent in parts. 
There appear to be two classes of cases in 
which an hypertrophic state of brain occurs. In 
‘one class the functions are carried on well, and 
the only sign of the morbid change is derived 
from the undue enlargement of the head, which 
becomes almost too large for the body, and too 
heavy for the muscles of the neck to support 
conveniently ; in the other there may or may 
not be enlargement of the head, but there are 
marks of cerebral disturbance in more or less 
dullness of intellect, and in the frequent re- 
currence of epileptic fits. 
Dr. Watson has placed upon record two in- 
stances of this enlargement of the brain’s sub- 
stance which are highly interesting and will 
serve to illustrate the varieties above alluded to. 
One case was that of a young woman et, 19. 
Her countenance was sallow, lips pale. She 
complained of pain in her chest and limbs, of 
great and increasing debility and wasting, and 
of nightly perspirations, and she was subject to 
attacks of epilepsy. She died in a prolonged epi- 
leptic paroxysm. The following appearances 
were observed at the post-mortem examination. 
“ When the surface of the brain was exposed 
by the removal of the skull-cap and dura mater, 
it was observed that the convolutions were re- 
markably flattened, so that the little furrows be- 
tween them were nearly effaced, and the sur- 
face of the arachnoid membrane was perfectly 
dry. These are not very unusual, although 
they are unnatural appearances. I had often 
seen such before; and I ventured to say we 
should find some cause of strong pressure in 
the central part of the brain, effusion of serum 
into the ventricles, or a large extravasation of 
blood. But to my great surprise, and much to 
the discredit of my prophecy, we found nothing 
of the kind. The ventricles were even smaller 
than natural, and contained scarcely any 
moisture. The skull-cap was afterwards exa- 
mined, and the bone was found to be uncom- 
monly thick, dense, and heavy; and its inner 
surface without being rough was very irregular.” 
The state of the bloodvessels of the brain was 
not noticed. It is to be regretted likewise that 
the weight of the brain has not been stated, for 
it is obvious that a gradual and pretty uniform 
diminution of the cranial cavity by the thick- 
ening of the bone might have produced the flat- 
tening and condensation of the brain described. 
A second case recorded by Dr. Watson oc- 
curred in the practice of the late Dr. Sweatman. 
The patient was a little boy two years old; his 
NERVOUS SYSTEM. (Nervous Centres. AnnormaL ANATOMY.) 
head bad been gradually increasing from the 
age of six months until it had become so large 
as to prevent the child from continuing long in 
the upright posture. The boy was active ane 
lively although thin. He never had any cor 
vulsion, but occasionally seemed uneasy, @ 
then would relieve himself by laying his heat 
upon a chair. He had never squinted, no 
was he subject to drowsiness or startings durin 
sleep, and his pupils contracted naturally. H 
appetite was good, and all the animal function 
were properly performed. The head measur 
from ear to ear twelve inches, from the supel 
ciliary ridges to the occipital thirteen inche 
and in circumference twenty-one inches, T 
brain was sound. The convolutions were di 
tinct and retained their shape. The surfaces 
the medullary matter, exposed by differ 
sections, presented very unusual vascularity.* 
In this case the yielding of the cranial wal 
prevented compression of the brain, whilst 
admitted of the growth of the organ withi 
Hence, no doubt, the absence of any sympton 
of compressed or irritated brain. ‘ 
Ilypertrophy of the brain sometimes coe: 
with hydrocephalus, and is congenital, ai 
prevents by the great size of the organ the: 
velopement of the cranial bones. (Otto, I 
kitansky.) Af 
Hypertrophy may affect only particular p 
of the ebony as ths atid thalami, the pons, 
the medulla oblongata, instances of which 
been placed on record. 
Atrophy of the brain—At the advan 
alge: of life we generally meet with mor 
ess of wasting of the brain; resulting fron 
change in the nutrition of that organ whit 
experiences in common with all other org 
and which is only the natural result of the 
gress of age. It is remarkable, however, | 
much more of this senile atrophy is observ 
some individuals than in others. . 
In cases of epilepsy of long standing I 
invariably noticed wasting of the brain, aff 
ing chiefly the convolutions, or sometimes 
corpora striata, optic thalami, &e. The © 
wastes likewise in cases of long-cont 
intemperance, the patient generally dyi 
delirium tremens. In such instances all 
of the brain waste, but the convolutions 
rience the most marked change. 7m 
The following are the: marks of an atre 
state of brain. There is a considerable qt 
of fluid in the subarachnoid cavity, indicat 
increase in the interval between the sui 
the brain and the interior of the skt 
brain has a shrunk appearance. Its 
feels firm, and in cutting the knife grates: 
it as in cutting cartilage. In point o 
the grey matter is frequently extrem: 
and scarcely to be distinguished from th 
cent white substance ; in some instance 
ever, it is of a dark brownish hue. — 
cases the layer of grey matter which Cov 
convolution is much less deep than is nati 
The convolutions are evidently shrunk 
the sulci between them have greatly ine 
Ar 
* Lectures on the Practice of Physic, 
“ 
