Portal predicated an attack of apoplexy in a gentleman (apparently in perfect health) from observing a slight fixedness of his left eye and a trifling weakness (incipient paralysis) on the same side of the body.

Previously to an apoplectic seizure, patients have been known to complain of objects appearing to be coloured red. Others fancy that a line of a like tint borders all bodies, or complain of a sensation similar to that experienced by the eyes when they have been exposed for some time to a strong light. Objects appear as if they were dotted with black or red spots, or the patient imagines that a mist or thin veil intervenes between the eyes and the objects at which they are directed.

Meningitis, congestion, or cerebral hyperæmia, and other acute diseases of the brain are occasionally preceded by double vision, strabismus, and other derangements of sight. These are also the well-recognised premonitory symptoms of acute inflammation of the substance of the brain.

Andral had an opportunity of observing a person who for several years was constantly tormented by the imaginary sight of small bodies of different forms and colours dancing before his eyes. If he looked steadily at an object, he saw it dotted with red or black points. These ocula spectra, which were permanent, prevented his reading or writing. He did not complain of vertigo,

with that period of the disorder marked by the change from an acute to a chronic state: for example, in the transition from mania to dementia; 2. That the existence and persistence of these ocular movements among patients give to the prognosis a very great gravity, justifying the notion that the insane who were in a supposed favourable condition were already, or were about to become, incurable.

M. Morel (who refers to the previous facts), adds, that in these same patients the eye throws out an extraordinary and undefinable brilliancy; but this last phenomenon is scarcely ever remarked except during the period of transition. When dementia is confirmed, the eye is as it were extinct, and the gaze has that stupid and doltish expression quite in harmony with the weakness of the intellectual faculties.

or headache. The conjunctivæ were habitually congested, and he could not endure, without considerable suffering, a more than ordinary strong light.

Among the aberrations of the sense of sight precursory of cerebral disease are the following:-Seeing objects cut in half, double vision, inversion of objects.* A lady who had complained of being out of health, of slight headache and partial deafness, found, in the early part of one morning, that her sight was disordered. In attempting to read a book, she remarked that the printed letters and sentences were running one into the other. Subsequently the page appeared as if a piece of finely glazed paper had been placed over it, through which she was just able to discern the letters. In the afternoon of that day she had an attack of apoplexy which ended fatally!

Vitiated perception is one of the common precursory symptoms of apoplexy. A lady of vigorous and cultivated understanding, whom Dr. Cheyne attended, was menaced with apoplexy. Previously to the attack, she complained of being annoyed by numerous unusual appearances in luminous bodies; the flame of a candle was

*Dr. Wollaston relates that it twice occurred to him not to be able to see but on one side of the axis of vision. The first time the left side of each eye was affected; he saw but the half of a man's face or of any object he looked at; and in attempting to read the name JOHNSON over a door, he saw only

.. SON, the commencement of the name being totally obliterated from his view the complaint was of short duration. About nineteen years afterwards the visual phenomenon recurred; this time the right side of the eye, about three degrees from the centre of the retina, was affected, and its duration was ten minutes. Two analogous cases are also mentioned by Dr. Wollaston. Desmoulins states that M. Arago has experienced this affection of vision three times on the first two occasions objects situated to the right of the axis of vision were invisible; the third time he saw objects on the right only of this axis. The same author notices also the following remarkable case. In consequence of a cerebral fever, the external side of the left retina of M. de M became insensible: with his eye he saw objects only situate to the left of the centre of vision, and, as at the same time there was an outward deviation of the axis of this eye through a paralysis of the nerve of the third pair, when he employed both eyes, he saw objects double; but, what was still more singular, the right eye being closed, he saw with the left eye the objects removed from twenty to twenty-five degrees to the right of their real position.

enlarged to the shape of a tulip, and with a red centre ; the moon appeared oval with a central portion of a bright scarlet. All distant objects were hazy, yet she read and wrote without any difficulty.

A gentleman complained a few hours before he was attacked with paralysis of his being able to recognise only half of everything he saw. If he looked at a person, there appeared to be but one eye, half of a nose, and mouth. In another case, every part of the body was enveloped in a thick mist. This was among the premonitory signs of a severe attack of phrenitis, and existed some days before severe headache excited alarm as to the state of the brain.

When speaking of the affections of vision connected with cerebral hemorrhage, Andral remarks, "Sight is sometimes, but not always, disturbed. We see individuals struck down with apoplexy and affected with paralysis and loss of sensation, where, nevertheless, consciousness and vision remain. Different sensations, resulting from disturbance of this function, are experienced by patients, who describe them in different ways; some say that they have motes before their eyes; others, they see the light as through a cloud, just as on the onset of cataract—yet here the crystalline lens is clear; others see various colours. Sometimes, those who at a later period are attacked with apoplexy, have the sight modified for a longer or shorter time before the attack in such a manner that all objects appear double, a symptom which is sometimes transient, being present one day and not another. In other cases the loss of sight is nearly complete, but such cases are very rare. When the sight is lost, this may take place on one side or on both; and this blindness coincides with the loss of numerous other senses."* Photopsia, or the appearance of luminous phenomena,

"Clinique."

objects in a state of ignition, or surrounded by a phosphorescent halo, are common incipient symptoms of acute disease of the brain.

The late Dr. James Johnson relates the particulars of an interesting case of the kind. "A distinguished artist for several years suffered from photopsia, to which afterwards headache and diminution of vision were added, terminating in complete blindness. Nevertheless the luminous phenomena continued night and day, occasionally assuming the appearance of angels with flaming swords, whose movements were apparently accompanied by an electric light. The forms, however, frequently varied. The mental powers of the individual remained unimpaired, and whenever he went out he was very attentive to everything that did not require eyesight. In the spring of 1835 he had an apoplectic seizure which deprived him of movement, consciousness, and speech. There was complete paralysis of the sphincters, and the pupils were dilated. He recovered from this condition, and after a few weeks was again able to go about the town and attend to his business. But the visual phenomena returned, and the sight was as painfully dazzling, and more continuously so than before. In the month of August an apoplectic attack occurred, and death ensued in three days. The right lateral ventricle of the brain was found after death to contain nearly three ounces of clear fluid. The left was full of bladders resembling hydatids of various sizes, and containing fluids varying in consistency. This accumulation sprung from the floor of the ventricle by a kind of pedicle, and penetrated into all the recesses of the cavity, pushing its branches forwards so as to extend the thalamus of one side into the opposite half of the brain, destroying everything that opposed its passage. Both thalami optici were converted into a pulp, as well as the

whole anterior lobe, which was so diffluent as scarcely to bear the slightest pressure. The optic nerves were compressed by the hydatids so as to present a mere thready appearance. Pressure at the back of the neck caused great uneasiness, extending to the lower trunk and extremities. It was not pain, but a horrid feeling that was induced. This pervaded the whole frame, and it was only by the greatest entreaty that he could be induced to permit a repetition of the manual examination. The sensibility had now so much increased that simply touching was sufficient to renew these distressing sensations. A pint of blood was taken from the arm. During the operation the vision returned. He said he saw three women standing behind the gentleman who was bleeding him. Being asked were they as large as life? he replied, 'that they were rather low,' and pointed to the place where they stood. It was inquired, Had he ever seen them before?' 'No.' 'Were they speaking to each other?' 'No.' What were they doing?' They were usually minding their business, but sometimes stopped to watch him, and kept their eyes fixed on his for some moments.' The sense of feeling was quite as much disturbed and illusive as that of sight, for in a few moments after he called out, that he felt 'one of them thumping up against that part of the bed on which he lay;' and presently again looked abruptly behind him, saying, 'that somebody had hit him two or three times on the back.' All this was very different from the usual raving of the insane, as he scarcely felt the impression before he was himself aware of its being an illusion. In fact, his chief distress arose from the alarming nature of the disordered perceptions. 'Rid me of these sights and sounds,' was his entreaty, and get me some sleep, or I shall lose my senses!'

"Active purgatives were exhibited, after venesec