tion was performed. Subsequently a blister was applied over the ninth dorsal vertebra with great benefit. He soon recovered under the continued use of gentle alterative aperients, combined with counter-irritation.

"He had a recurrence of the attack some months after in consequence of hard drinking; but though he complained more of the head, especially at the back of it, there was no material fulness or frequency of the pulse, or febrile irritation. He was relieved by purgatives and blistering, and was afterwards treated with camphor and other nervine medicines."

A nobleman, for some weeks previously to an attack of apoplexy, was subject to a curious phantasmal phenomenon. He, on several occasions during the day when suffering from acute headache, saw clearly a spectral image resembling himself. This form of hallucination is termed deuteroscopia. The phenomenon is considered of rare occurrence, even among the insane. Aristotle refers to this type of illusion in his essay, “ De Memoriâ et Reminiscentiâ," but it is explained more at length in his Meteorology.

A certain Antipheron, Aristotle says, when he was walking, saw a phantasmal reflexion of himself advancing towards him. A traveller who had passed a long time without sleeping, perceived one night his own image, which rode by his side. It imitated all his actions. The horseman having to cross a river, the phantom passed over it with him. Having arrived at a place where the mist was less thick, this curious apparition vanished. Goethe relates having had a similar hallucination. This form of hallucination is frequently observed during the delirium of typhoid fevers.*

Morel relates the case of a lady who was restored

"Anatomie Comparée du Système Nerveux," par Fr. Leuret and P. Gratiolet. Paris, 1857. P. 539.

to health from a state of general paralysis. In the incipient phase of the disease she affirmed that she constantly saw at the end of the garden a man without a head. When she directed her steps boldly towards the place where the apparition appeared to be, it immediately vanished. She said nothing about this phantom to her family, fearing that she would be thought insane. This patient observed, after her alleged restoration to reason, that the first trial she made of her intellectual powers whilst communing with herself, consisted in her occupying the place where the apparition formerly appeared. The absence or presence of the phantom ought to prove, she said, the validity of her cure.

In many cases the ocula spectra, illusions of visions and phantasms are supposed to be referable to spinal disease or irritation. I, however, suspect that when morbid psychical phenomena of this kind are present, the affection is to be viewed more as one of a cerebro-spinal character than as a disorder exclusively localized in the spinal column.

An instance occurred some years since of a young girl being haunted, whilst labouring under spinal irritation, by a spectral figure which she described as standing by her bedside. She was frequently seized with fits of screaming as she fancied the phantom approached her. She kept her relatives in the greatest state of alarm and astonishment. A few active purgatives gave immediate and effectual relief. Dr. Griffin cites the particulars of two cases presenting singular phenomena.

A man, aged thirty-six, of a good constitution, but very intemperate habits, complained for some days of occasional pains in the stomach and arch of the colon, with costiveness, loss of appetite, and general nervous excitement. He had constant slight pain in the brow with disturbance of vision and extreme sensibility to

noise, conjoined with a morbid state of exaltation of the senses. His eyes were suffused, tongue white, pulse about ninety. He had a pain in his chest, accompanied with great anxiety. His chief distress, however, arose from optical visions, with which he was continually troubled. Figures of persons, almost all of whom were wholly unknown to him, were frequently before him, sometimes so plain and distinct, that although his reason assured him they were mere illusions, he could scarcely avoid believing that they had an absolute existence. They were not always the same nor always present, but went and came, renewing his anxiety and irritation of mind as often as they appeared. On examining the spine tenderness was found at the three upper cervical vertebræ, pressure on any of them exciting much pain. The eighth, ninth, and tenth dorsal vertebræ were excessively tender, the slightest pressure on any of them occasioning an exceedingly distressing sensation along the spine to the sacrum.

J. H., aged fifteen years, complained that, at night, he invariably became blind: he could not see the furniture or people about the room, when they were perfectly visible to every one else. The candle or fire-light appeared like a broad red haze, just distinguishable from darkness, but making nothing perceptible. He could perceive any dark object between him and the light, and no more. He was affected in this way for about a fortnight, and had a similar complaint a year ago, which continued a long time. There is great tenderness on pressing the second cervical vertebra. He perfectly recovered in less than forty-eight hours, by a small bleeding, an active calomel purgative, and a blister to the nape of the neck, and has since continued well.

In the following case the vision was affected in an extraordinary manner.

A young gentleman, aged seventeen, is frequently attacked with violent headache and sickness of stomach, which symptoms are always ushered in by indistinctness of vision. His first warning of the fit is a sudden appearance of something misty and tremulous before his eyes; soon afterwards he perceives only the vertical half of any object he looks at, and eventually the outlines fade away altogether into thick darkness. This almost total blindness continues generally for a very short period; the thick dark mist gradually clears off, and the forms of everything around him are again distinctly observed. He is then instantly seized with intense headache, chiefly affecting the forehead, usually so dreadful in its nature, and accompanied by such distressing nausea or sickness, that he says he could scarcely live if it lasted a second day. He commonly finds relief by lying down: the pain is thus more easily endured, and the paroxysm is shorter, terminating in four or five hours, when it might otherwise continue for twenty. Instead of pain, a deep lethargy sometimes supervenes on the affection of vision, during which he lies as in heavy slumber, but frightfully conscious of time passing, and of terrific sights and sounds crowding upon his imagination. He awakes out of this state of mind in a state of temporary delirium; does not know for some time where he is, or what has happened, and speaks incoherently. Even after the subsidence of the headache, although there is much less confusion of mind than after the lethargy, the memory is always very imperfect for some hours. He cannot recollect the words he wishes to make use of, but employs others wholly inapplicable in their stead; and of this mistake he is always conscious at the moment. To these attacks he has been subject for about two years, but in their intervals he has sometimes been affected in a very different way. He awakes

suddenly out of his sleep at night in dreadful apprehension, for which he cannot account. There is a continued crowding and rushing of ideas through his mind. He feels as if everything he did, and all that was done about him, passed over with a frightful and hurried rapidity. This at last wears away, and is generally, even from the first, more or less under the influence of his will; an effort to check the current of his ideas, and divert it into another direction, frequently proving successful.

On examination, there was found great tenderness of the second cervical and of the seventh or eighth dorsal vertebræ. When this last was slightly pressed upon, he felt a horrible sensation shoot through his whole frame. It was quite indescribable, and nearly made him faint. He expressed the greatest apprehension at the thought of the pressure being repeated, and had a disagreeable feeling in his back for the entire day afterwards.*

STRABISMUS. This is occasionally observed among the early signs of disease of the brain, particularly in the cerebral affections of children; and, if present, should be carefully noted. A slight squint in the eye has occasionally been found precursory of an attack of apoplexy, and is often diagnostic of the commencement of effusion on the brain.

A gentleman, who had complained for a few days of headache and depression of spirits, was observed, whilst at dinner, to have strabismus. A few minutes subsequently, he dropped down in a fit of apoplexy. Illustrations of a similar character could be cited, in which other forms of acute brain disease have been ushered in by this symptom.

DOUBLE VISION.-I have not yet spoken of this per

* Vide "On Functional Disorders of the Spinal Cord," by W. L. D. Griffin, M.D.