inability to consume the hydrocarbons which came from digestion*. This fat is partly brought to the liver ready formed, and there deposited and partly elaborated from the albuminoid substance in situ. We must bear in mind that the liver, in health, always contains some fat. Further examination reveals a localized atrophied condition of the hepatic cells, manifested by enlarged intercellular spaces. We also find necrosed lobules, the cells of which are entirely disintegrated. To recapitulate, we find the following evidences of partial cirrhosis.

(a) Hypertrophied hepatic cells.

(b) Atrophied cells.

(c) Fatty degeneration. (d) Fatty infiltration.

In section No. 10 fat crystals are to be seen.

Sections No. 16, 17, 18 and 19 are of the lung, examination of which reveals a few scattered cells (epithelial) within the alveoli, such as indicated lobular pneumonia. A nidus of miliary tubercles may also be seen. The vessels present a turgid appearance. Fat globules are present, indicating the third stage of pneumonic inflammation, they being due to retrograde metamorphosis of the pus corpuscles not expectorated.

Sections No. 20 and 21 are the aortic semi-lunar valves, showing the delicate connective tissue fibres of which they are composed, and No. 20 eepecially presents a granular appearance due to the atheromatous deposit. Section No. 22 is of interest macroscopically. It is a longitudinal section of the left carotid artery and a cross-section of the aorta, showing a thrombus in situ. The thrombus is partly organized, its margin being supplied with blood vessels. A large calcareous plate was found in the aorta just opposite the thrombus. Cross-sections of the basilar, meningeal, splenic and superior mesenteric arteries present microscopical evidences of commencing atheroma. The hyperplastic condition of the outer layers of the inner coat was quite marked. In this instance we find the atheroma is a combination of chronic arteritis, fatty and calcareous degeneration'. We also find that the atheromatous change has not progressed far enough to produce ridges -" ribbed or corrugated " appearance of the internal coat. The corrugation, however, is marked in the outer layers of the media. At one point there is complete degeneration of the intima, atheromatous ulcers. The calca

reous salts are seen deposited in small grains, lying in the muscle cells or intercellular tissue, and in the middle coat they are found in the spaces separating the elastic lamellæ. The visible retrogressive changes to be seen are fatty degeneration, necrosis and disintegration of the altered tissue.

BIBLIOGRAPHY.

1. Bramwell-Disease of spinal cord, p. 201; 2. Fig. 132, p. 61. 3. Westphal.

4. Cornil and Ranvier, Path. Hist., p. 558.

5. Ziegler's Pathology, Vol. II.

6. Delafield. Morbid Anatomy, p. 121.

7. Charcot and Lomis. Diseases of Old Age, p. 224.

GENERAL PARESIS.

Case No. 6195 was admitted May 4, 1886. Male. Aet. 66. Married. Five children. Vocation was that of a stone mason.

HISTORY BEFORE ADMISSION.

This is the first attack. The first symptoms were manifested eight months ago by violence. Disease is stationary with very little change. He threatens violence to his family. He claims he would commit suicide if returned to the poor house. Not disorderly. Past history not known. His mania has not assumed any particular form. Previous to seven years ago he was a moderate drinker. Not subject to physical disease. Cause of mental trouble unknown.

ABSTRACT OF HISTORY AFTER ADMISSION.

June 28, 1886.-This patient was extremely demented and disturbed when admitted. The dementia is very extensive and permanent. His mind is so confused he has no realization of time or place, and it is questionable if he recognizes those about him. He has a clumsy staggering gait, and his articulation is very imperfect, evidently due to paralysis of the hypoglossal nerves. There was no material change during July.

August 15, 1886.-Patient has been losing slowly under the progress of his disease. His mind is now almost completely obliterated. He is very careless and disorderly and at times irritable and quarrelHe is very filthy in his habits.

some.

October 13, 1886.—He eats and sleeps well, but some two weeks ago lost very rapidly, and there was a tendency to cerebral congestion and inflammation. He cannot articulate and swallows with great diffi

culty.

October 29, 1886.-He has steadily failed and died to-day at 1 o'clock P. M.

AUTOPSY.

The autopsy was held twenty-four hours after death. The body presented a well nourished appearance. There was quite marked congestion of the pia mater. No macroscopical evidence of disease was found in the brain or cord. There being no evidence of disease in any organs of the body during life, for obvious reasons they will not be considered in the following

PATHALOGICAL REPORT.

Sections of the cerebrum near the lateral ventricles show a marked repletion of all the blood vessels. The corpuscles in most of the smaller vessels are seen very distinctly, some presenting their edges, others their surfaces, the former being seen in the vessels, the calibre of which was equal to the diameter of the corpuscles. Folsom says, an opinion is beginning to gain ground, that general paralysis is primarily a disease of the small blood vessels functional or vasomotor."

Frontal Lobe.-Here we found many round apertures and the same repletion of the vessels, and their walls having dropped out in the process of preparing and mounting, presented the appearance described by Lockhart Clarke, as "holes or vacuoles found in various portions of the white matter and convolutions in cases of general paresis." These he believes were the perivascular spaces, the contained vessels being destroyed and absorbed. Submiliary tubercles were quite numerous in these sections. This is the first instance in which I have found these tubercles, in case of general paresis, and in the works to which I have access no similar case is reported. These tubercles are almost invariably found in cases of melancholia. In these sections when the sublimiary tubercles are in focus, many of the axis cylinders and other elements are also in focus, whereas Fig. VI shows but little save the submiliary tubercles.

Parietal Lobe.-Aside from the repletion of the vessels we found in the subcortical layers, as they dip beneath the sulci parenchymatous swelling. Meschede claims that this condition on one hand and

fatty pigmentous degeneration on the other, as the beginning and the end of the organic changes in general paralysis. He says, "between these poles lie the destructive powers, which by analogy we conclude to be a parenchymatous inflammation." Tuzek and Wernicke say, "the primary disease is of the nerve elements-a diffuse parenchymatous and cortical encephalitis."

Parietal Lobe along the Longitudinal Fissure.-This portion of the parietal lobe presented many more submiliary tubercles than other regions of the same lobe. Fig. VI represents the tubercles as seen in this region. The vessels are filled to repletion.

Occipital Lobe.-Sections of the occipital lobe revealed the same pathological condition of the blood vessels, but were entirely free from tubercles.

Pons Varolii.-In the examination of the cross sections of the upper portion of the pons Varolii, no field was found free from submiliary tubercles. Hyperaemia of the vessels marked. These conditions were present at all levels of the pons. The tubercles were very numerous.

Medulla.—Same lesions were present throughout the medulla. The submiliary tubercles however not being nearly as numerous as they were in the pons.

Spinal Cord. Submiliary tubercles and distended vessels as described above, were found in all regions of the cord. Patches of sclerosis were quite numerous in the lower cervical region, and there was a rough granular appearance quite noticeable, due to the inflammatory condition — parenchymatous inflammation. We found here an atrophy of the nerve substance, which goes hand in hand with the increase of the connective tissue. Extravasated leucocytes were also found in this region. Submiliary tubercles were found in the upper, middle and lower dorsal regions; and in the middle dorsal region parenchymatous inflammation was especially marked. The crossed pyramidal tract or left side presented marked evidences of myelitis; presenting quite a similar appearance to that represented in Fig. III. In the lumbar region, aside from the submiliary tubercles and repleted vessels, we found a great number of extravasated leucocytes. The presence of these leucocytes is due, in a great measure at least, to the anatomical arrangement of the blood vessels of the cord. See remarks following pathological report of case 5425.

BIBLIOGRAPHY.

1. Blanford, p. 210; 2. p. 212.

3.

Pepper's System of Medicine, Vol. v., p. 196.

4. Da Costa's Physical Diagnosis, p. 105.

MELANCHOLIA.

Case 5762 was admitted April 29, 1885, 22 years of age; single; laborer; born in Germany. "He has been troubled for several weeks, and is getting worse. Thinks that he cannot get well, and that no medicine can help him. Says there are times when he does. not know what he is doing. Disease is increasing. Talks about it continually. No disposition to injure others. He has said several times he thought he would kill himself. He will not change his clothes. No relatives insane. Before the accession of the disease he was a pleasant, social man. Was somewhat dissipated.”

HISTORY AFTER ADMISSION.

The patient was in a state of profound mental disturbance and depression at time of admission; also restless, uneasy, anxious and suspicious. Feared some danger, and complained of great distress and confusion of thought and strange and fanciful sensations. By the middle of May he began to neglect bodily appearances and comfort. His appetite was variable and sleep broken. By the 10th of June he had gradually settled down into a deep and listless gloom. He would sit about without interest in what was going on about him, and would scarcely speak in reply to questions. He lost rapidly in flesh and strength. He remained very weak physically, and early in July was in a critical condition and remained extremely depressed mentally. By July 17th he began to improve in physical strength, and there was no immediate danger from exhaustion. A note made September 4th records that he continues to be in a state of constant mental depression, and he is occupied at all times by fears and delusions of various kinds, so that there is no time when he is rational or has a proper conception of his condition or situation. Hallucinations are troublesome, and he hears and sees all manner of strange things. There is a great irregularity of his pupils, the left being greatly dilated, but not to the same extent at all times. He understands well what is said to him. He has suffered lately with obstinate and recurrent attacks of diarrhea; often passes, undigested particles of food.