means. It is impossible here to enter into details. respecting the treatment of this most important type of cerebral disease. I can only, in this work, deal with general principles. Every case as it presents itself to the physician will exhibit peculiar and characteristic idiosyncrasies, or morbid phenomena, requiring a modification of treatment, medical, moral, and hygienic.

Do we estimate in a manner commensurate with its grave and vital importance the necessity of watching, with the most scrupulous care, the cerebral symptoms that follow all mechanical injuries to the head? I am satisfied that a vast amount of organic, chronic, and incurable disease of the brain and disorder of the mind can be directly traced to this cause.

In many cases, positive and undoubted evidences of disease of the brain are present without exciting a suspicion as to the cerebral origin of the affection, or character of the symptoms. A man receives a blow upon the head. He may suffer from partial concussion of the brain, or be merely stunned. He recovers without any apparent inconveniences from the injury, but subsequently head symptoms exhibit themselves, clearly the consequence of the injury which the brain has sustained many years previously!

I am satisfied that the importance of this subject cannot be exaggerated. Repeatedly have I had cases of epilepsy bidding defiance to all treatment, tumours, abscesses, cancer, softening of the brain, as well as insanity in its more formidable types, under my care, whose origin could unquestionably be traced back, for varying periods of one, two, five, eight, ten, fifteen, and even twenty years, to damage done to the delicate structure of the brain by injuries inflicted upon the head!

In some instances, accidents of the kind may not be followed by serious results; but in certain temperaments,

conditions of bodily health, and in particular predispositions, we may safely predicate the development of chronic disease of the brain as the result of neglected blows on the head. Injuries of this character occurring to persons of a strumous habit, or to those suffering from longcontinued debilitating diseases, impaired and perverted nutrition, overwrought and anxious minds, or inheriting a constitutional liability to mental or cerebral disease, are frequently followed by serious and often fatal results.

It is therefore highly necessary to keep a vigilant and watchful eye upon those who have been exposed to accidents of this kind, with a view of anticipating if possible the development of important cerebral symptoms. I am satisfied that we have it in our power, by timely and judicious measures, to arrest the progress of many of the organic affections of the brain originating from mechanical causes, if the patient's condition immediately after the injury be attended to, the state of his cerebral health for a time carefully regarded, the incipient symptoms of brain disorder, when they present themselves, recognised, and the patient immediately subjected to prompt and appropriate treatment.

Softening of the brain, the formation of cerebral abscesses, the slow growth of encephalic tumours, subtle degeneration of the nervous tissue in the form of cancerous growths (all the remote effects of injuries to the head) are, in my opinion, preventable diseases of the brain, if the unmistakeable warnings afforded in the majority of cases of their existence are not neglected, unrecognised, and untreated.

A gentleman was actively engaged, apparently in excellent health, in playing cricket. He suddenly complained of faintness; he then began to vomit, and in a few seconds dropped down dead! A post-mortem examination being made, the brain revealed the existence

of a chronic encysted abscess that had emptied itself into one of the ventricles. It appeared that this gentleman. had been thrown from his horse six years previously whilst hunting, and had suffered from partial concussion of the brain. He quite recovered from all the acute head symptoms, but two years after the accident he complained of repeated headaches, not, however, of a violent character, as well as of occasional loss of memory. These symptoms, however, were of so trifling a character that he did not consider it necessary to apply for medical advice. In this case how much good might have been effected if the cerebral symptoms had been at this time recognised, and viewed in connexion with the injury of the head he had sustained two years previously? Judicious treatment, adopted at this early period, would, in all probability, have saved a valuable life.

A man, aged fifty-two, fell from the mainyard of a ship upon the deck. He was removed to the cabin in a state of unconsciousness. In the course of the day he became sensible, and in about a fortnight he was able to resume work. For four years this seaman never complained of any head symptoms. He continued active in his habits, as well as intelligent in his conversation. Five years after the accident he became subject to headaches of a severe, but paroxysmal type. These attacks were accompanied by occasional acts of vomiting, coming on immediately after meals. At times he exhibited much depression of spirits. He was treated for what was considered to be a gastric affection, and appeared greatly to improve; the headache was less severe in character, and became more intermittent. In the sixth year from the accident the patient complained of numbness down the left side, and the headache returned with increased violence. It was still considered that all his

symptoms proceeded from hepatic and gastric disorder, and nothing was done for the relief of the cerebral symptoms beyond giving him occasional doses of blue pill in combination with extract of rhubarb, mineral acids, and bitter infusions. In a few months from the appearance of the numbness he became parayltic, and died in this state eight weeks subsequently. An encysted abscess was found after death in the left hemisphere of the brain.

A boy received a violent blow on the head from a cricket bat. He did not appear to suffer any inconveniences from the injury until ten or eleven years after wards, when he became subject to paroxysmal attacks of headache, associated with extreme vertigo, clearly of an epileptic character. He eventually had a succession of severe attacks of epilepsy, which continued for a period of five years. He ultimately died in a violent epileptic paroxysm. An encysted abscess, of the size of an egg, was found in the cerebellum.

What course of treatment would I advise under these circumstances? In severe blows upon the head it is important to keep in check all tendency to cerebral congestion and inflammation in the portion of the brain immediately under the part of the scalp and skull that has been injured. By closely watching for local cerebral disorder, we may prevent those states of chronic irritation, congestion, and inflammation that so frequently induce disorganization of structure in the form of tumours, softening, and abscesses. In the days of Pott, venesection was almost universally practised after the head had received a mechanical injury. This mode of treatment has, in modern times, been altogether exploded. In these cases the local abstraction of blood by means of leeches applied over, or in the immediate neighbourhood of the injury is decidedly advantageous in preventing the development of organic alterations in the brain. It

will often be necessary also to give mercurials, and to apply cold evaporating lotions to the head.

I have, in some cases of severe cranial injury, applied a seton to the nape of the neck, as well as issues in the scalp near the situation of the blow, when I have had reason to believe that local, cerebral, and meningeal mischief existed. It may often be necessary, in particular diatheses, to sustain the vital powers by means of iron, quinine, stimulants, and generous diet, whilst the cerebral irritation and congestion is being attacked by the means suggested. I am satisfied that it is in our power to arrest the progress of the fatal cerebral disorganization that so often follows, after the lapse of years, injuries to the head, if we do not sleep at our posts, and are on the look-out for the first scintillations of brain disorder. It is our duty, under such circumstances, to watch for head symptoms. "It is not enough," as Dr. Graves remarks, when referring to the obscure cerebral affections observed in some cases of fever, "to treat them when they come, they MUST BE SEEN and MET COMING.' Wise and sagacious counsel!

I have paid anxious attention to this subject, and, as the result of much experience, I am fully convinced that in many instances the advance of softening, tumours, and abscesses of the brain has been checked by means of the local head, combined with the constitutional treatment previously referred to.

I have spoken of impairment of attention, the effect of certain morbid conditions of the cerebral health. Such cases of psychical debility are generally associated with a depressed state of the nerve and vital force, impoverished condition of the blood, and impaired state of the nutrition. of the brain. A stimulating plan of treatment, generous diet, cod-liver oil, combined with the sulphate and valeria