recognised, not immediately subjected to proper treatment, chronic, irreparable, and incurable organic alterations in its structure may be the result, succeeded, when it is too late to remedy the mischief, by the bitterness of self-accusation, or the unceasing lamentations and regrets of those who ought to have been the first to observe and attack the fatal disease!

How often is the physician called upon to witness the melancholy consequences, to health of body and mind, life and reason, of a neglect of well-marked premonitory symptoms of cerebral disease! It is frequently his painful duty to hear both relatives and friends reproach themselves, when the time for action has, alas! passed away, for their criminal negligence in wilfully closing their eyes to the long-existing evidence of positive disease of the brain.

The late Dr. Marshall Hall, when addressing himself to the consideration of head affections, remarks—“ A useful work might be written on the subject of insidious and impending diseases, with the view of making their first or antecedent symptoms known to the public, and of thus suggesting the care and means necessary for their prevention.'

No one was better qualified, by habits of thought, educational attainments, practical sagacity, and enlarged experience, to form a right estimate of the importance of an accurate acquaintance with the incipient symptoms of the diseases of the brain, and nervous system, than this justly distinguished and accomplished physician.

It was his painful province, in the course of a long and brilliant career, to witness the sad consequences of the non-recognition of the precursory or premonitory symptoms of those organic affections of the brain, for the

* "On Diagnosis,” sect. iv. "Diseases of the Head." By Marshall Hall, M.D., F.R.S. 1817.

relief of which his great skill and extensive knowledge was so often called into requisition.

This able physiologist fully appreciated, that many of the fatal cases of brain disease with which he had to grapple formed so many sad illustrations of the neglect of premonitory symptoms.

Upon investigating the history of the diseases of the encephalon, how frequently does the medical man discover that positive and unequivocal symptoms of brain affection have existed, and perhaps, during the early stage, been observed for months, and in some cases for years, without exciting any apprehension on the part of the patient, his family, or his friends!

In the majority of these instances, clearly manifested head symptoms were entirely overlooked, and, if noticed, no right estimation was made of their value. My attention has been called to cases, in which serious mischief to the delicate structure of the brain and its investing membranes, has been thus allowed by the patient's friends to proceed uninterruptedly for years, no treatment being adopted to arrest the progress of the fatal disorganization!

The brain, the most important, and exquisitely organized, of all the structures of the human body,

"The Dome of Thought; the Palace of the Soul,"

the material instrument of the intelligence, the centre of sensation, the source of volition, is permitted to be in a state of positive disorder, in fact disease, without exciting any attention, until some frightfully urgent, alarming, and dangerous symptoms have been manifested, and then, and not till then, has the actual extent of the mischief been appreciated, the condition of the patient recognised, and advice obtained for his relief!

Other deviations from organic conditions do not, as a general rule, meet with similar systematic neglect. In affections of the stomach, liver, bowels, lungs, and skin, &c., the first symptoms of approaching disease, or departure from a healthy condition of those organs, are observed, and the patient, without loss of time, seeks the aid of his physician.

Under such circumstances, he does not hesitate to place himself under curative treatment; he feels no delicacy in describing his physical sensations; is not ashamed at being thought ill, and readily adopts the treatment suggested for his recovery. But when the brain is affected, and the patient is troubled with persistent headache, associated with some slight derangement of the intelligence, disorder of the sensibility, illusions of the senses, depression of spirits, loss of mental power, or modification of motility, his condition is, in many cases, entirely overlooked, or studiously ignored, as if such abnormal symptoms were signs of robust health, instead of being, as they undoubtedly are, indications of cerebral disorder requiring the most grave and serious attention, prompt, energetic, and skilful treatment!

It will be well to consider, briefly, the cause of the neglect to which the brain is subjected when under the influence of disease. It is a notion too commonly entertained, that many fatal cerebral diseases are suddenly developed affections, presenting no evidence of any antecedent encephalic organic change, and unaccompanied by a premonitory stage, or incipient symptoms.

It is indeed natural that such an idea should be entertained, even by educated professional men, whose attention has not been specially directed to a study of this class of disease, or whose opportunities of watching the

progress of such affections have been limited, and circumscribed.

A man, apparently in vigorous health, mixing daily with his family, going to his counting-house, engaging in the active pursuits of commerce, or occupying his attention in professional or literary duties, whilst stepping into his carriage, or when entertaining his friends at the festive board, falls down either at his door in a state of unconsciousness, or quietly bows his head on his plate at the dinner table and dies, surrounded by his family, in a fit of cerebral hemorrhage!

A midwife, whilst sitting by the bed of a patient whom she is attending, suddenly exclaims, 'I am gone," and immediately falls down in a state of apoplectic coma !

A gentleman during dinner, complains suddenly of giddiness and sickness. He retires to another room, where he is found a minute afterwards supporting him. self by a bed-post, confused and pale. Being put to bed, he soon becomes comatose, and dies.

A person in good health, after using rather violent exercise in the forenoon, returns home to dinner, and whilst sitting near the fire, without any warning starts up, pushes his chair backwards with violence, exclaiming, "Oh, my head!" Immediately afterwards he falls on the floor in a state of apoplectic insensibility.

A literary man, whilst speaking at a public meeting, is suddenly seized with an uneasy sensation in his head. He says it feels "as if it would burst," "as if the brain was too big for the skull." He returns home, becomes apoplectic, and dies on the evening of that day.

A clergyman, whilst preaching, is observed to stop, and put his hand to his head. He then attempts to proceed with his sermon, but talks indistinctly, and has evidently lost his recollection. He keeps himself from

falling by grasping the side of the pulpit. He is immediately removed from the church, and is found cold, pale, speechless, and paralytic. He dies in a few days after the attack.*

A young lad who had not previously complained of ill health, or of any uneasy head symptoms, suddenly awakes from an apparent state of profound slumber, and begins screaming, "Oh, my head! my head! my head!" Before his parents could be summoned into the room, he becomes insensible, and dies without being restored to a state of consciousness !†

A lady, apparently in excellent health, is riding with her brother in Rotten Row. Whilst engaged in active and cheerful conversation, she suddenly complains of giddiness and sickness, and becomes deadly pale. A few minutes afterwards it is found that she could not articulate. She is carried home, soon becomes unconscious, and dies on the following day!

A gentleman who had formerly been in Parliament, and who had been for many years engaged in electioneering contests, is in the act of getting into a railway carriage. He complains of vertigo, mental confusion, and defective power of articulation. He, however, takes his seat apparently restored to his usual health. Once, during a three hours' journey, he has a slight recurrence of these symptoms, but they again pass away. On his arrival home, he complains of nausea, and an indisposition to take food. He has no headache, and can speak

After death there was found in this case extensive extravasation of blood in the left ventricle, which had passed partly into the right, by laceration of the septum. All the arteries of the brain were extensively ossified.

ABERCROMBIE.

All the ventricles were completely filled with coagulated blood. In the substance of the left hemisphere, there was a cavity formed by laceration of the cerebral substance, filled also by the coagulum, and communicating with the ventricle. There was no other morbid appearance.ABERCROMBIE.