and to take something either to eat or drink, but to no purpose. All solicitations were useless; she declined, shook her head, and when urged to speak, said she did not want it. To those who were around her, it appeared that she was stupid from intoxication; yet, whenever much teased, she spoke, and that perfectly in reason. Once during the night she said something in reply to an inquiry what ailed her, and observed, that once before she had, from a fit of illness, lost the use of her limbs, and that from her present feelings, she feared that this would soon be the case again.

The following morning, with several other girls, she was taken before a magistrate, to give an account of herself. Those who then saw her could not help supposing her to be still under the influence of intoxication; but the persons who had spent the night with her, declared she had neither drank nor eaten any thing whatever in the night. As nothing satisfactory could be made out, she was brought back, and received into an infirmary, where she remained much in the same state, from the Tuesday night, when she was first brought into the watchhouse, till the Saturday evening following, when, notwithstanding every exertion that had been made to save her, she died without any apparent struggle.

From the first she had continued in an uniform dull, silent, and stupid state, though not particularly disposed to sleep. When, with much persuasion, she was once prevailed on to take her medicine, she kept it on her stomach without difficulty.

She had always spoken rationally enough, but was observed to become more and more dull and inattentive to what passed around her, from the hour when she first came in to that of her dissolution.

EXAMINATION.

Upon opening the head, the first appearance of disease was found within the dura mater, which being raised and laid aside, exhibited the pia mater very much altered in deed from its natural state. The membrane was in every part highly vascular, both in the number and magnitude of its vessels. The most remarkable circumstance however, in the condition of the pia mater, was a degree of extravasation of blood, which might be traced all over the surface of almost every part of the brain. The extrava sated fluid had formed superficial coagula, corresponding. to the spaces between the convolutions of the brain.

This

This extravasation of blood appeared to have taken place very universally, not only from the capillary vessels of the pia mater, covering the external surface of each hemisphere, but also from those that form the tomentum cerebri, by dipping down between the circumvolutions of the brain; hence, upon making a section down through the substance of the cerebrum, several coagula of extrasated blood were cut asunder.

That particular extravasation however, which, in all probability, had been the immediate cause of death, was very distinct from the morbid appearances above describ ed. Paring away the superior portion of the right anterior lobe cerebri, a coagulum was found deposited in the very central part of the medulla. In this situation, a vessel had ruptured and poured fourth a quantity of blood to the extent of nearly an ounce.

The engraving represents the coagulum that was discovered in the course of examination in the medullary part of the brain. Its precise size was not ascertained, as it was not disturbed from the cavity in which it was imbedded.

A. The inferior surface of the anterior lobe of the right hemisphere of the brain, where it lays immediately over the orbital cavity.

B. Points out one of those parts of the superior surface of the brain, where the pia mater was detached from its immediate contact with the convolutions, by the deposi tion of an angular stratum of coagulated blood. This appearance, from its being general upon every part of the surface of the brain was presumed to be the necessary consequence of severe rheumatic inflammation, when it attacks the membranes of the brain with so great a degree of violence, as was manifest in this case.

The circumstance of the extravasation having taken place only on those parts of the surface which mark the separation between the convolutions, may perhaps, be explained upon the principle of the circulating vessels having, in these parts, more freedom of action, and less support; whereas the vessels upon those portions of the membrane more immediately spread over the projecting ridges of the brain, meeting with more support, and to a certain degree even sustaining pressure, are less liable to yield.

This conjecture, however, affords no explanation why the same thing was found to have taken place in situations, where the substance of the brain lay in close contact with the pia mater, because the natural elasticity of

H 2

the

the structure of the brain is the same throughout the whole of its substance.

C. The appearance of the divided portion of a thin coagulated stratum of blood, thrown out from the vessels of the pia mater, dipping down between the convolutions into the substance of the brain.

D. The large deposition of blood scarcely coagulated, that was found in the medullary portion of the brain. From the circumstance of the large coagulum being yet in a gelatinous and almost fluid state, while the superficial coagula, connected with the pia mater, were all of a much more dense, firm, and dry texture; it seems almost more than probable, that the opinion given with regard to their date, is correct.

Case of fatal Apoplexy, in which from the Rupture of Vessels, Blood was effused into the substance of the Medulla Oblongata.

J. M, an old man, aged 85, was apparently well in health on Sunday, February the 4th, 1810. In the night following he got out of bed to make water. A person who lay near him, being awake, enquired what he was about; to this he replied, that he only wanted to find the chamber pot. These words were no sooner out of his mouth, than he fell suddenly over the bedstead with his head to the floor, which he struck with great violence.

Assistance being obtained, he was raised up and laid in bed again, being in a state of insensibility, but breathing with much freedom, and laying in a state of perfect tranquillity, as if in a light repose.

The next day the pulse was full and hard, beating 92 in the minute; respiration was now rather heavy, and in some degree laborious; but there was no stertor. The eye-lids were still closed, and the jaw perceptibly falling.

On the day following (Tuesday) the respiration was attended with more labour and difficulty, as well as noise; the jaw more fallen, and the pulse slower than it was, but still very full and hard. In the evening he expired.

EXAMINATION OF THE BODY.

The head being opened, the vessels of the pia mater were found in a very turgid state, but they did not appear to have given way any where. The dark colour of the cortical substance in this brain, when compared with the medullary parts, formed a more striking contrast than is

often

often seen. Upon examining attentively the section of the cerebrum, a peculiar appearance, certainly of some disease in the extreme capillary blood-vessels was observed. This appearance was universally found but in the cineritious structure only. It resembled very much the appearance of petechiæ, or flea-bites, on the skin; and from the apparent correspondence with the known situation and distribution of the arteries in the cortical substance of the brain, it was concluded that this appearance arose from some diseased alteration in the structure of the capillary arteries, by which a portion of the colouring matter of the blood, just sufficient to stain the circumference of the ves sel, was allowed to escape without proceeding to a more sensible degree of extravasation.

This appearance was found in every part of the cortical substance of the cerebrum, but it was more apparent about the basis of the brain than elsewhere.

The lateral ventricle on the right side was of the natural form, and contained only the usual quantity of fluid. On the left side, however, the appearance was very different. The quantity of lymph deposited on this side was equal to between an ounce and a half and two ounces.

The horns of the ventricle had suffered considerable distension from this accumulation of fluid, the discharge of which was not, as on the other side, followed by a collapsed state of the cavity of the ventricle. The appearance after the fluid had run off, was that of a large, extended, vaulted passage, or tube, which to the eye, gave a bold and remarkable impression. This cavity still preserved its na tural turns, each of the cornua was equally enlarged with the others, and the whole space retained the exact form into which the contained fluid had moulded it.

In the ventricle on each side the plexus choroides was pale, but little changed from its natural state, except that on both sides this vascular expansion contained several small soft tumours, plentifully supplied with bloodvessels,

Upon examining various sections of the cerebellum, no appearance whatever of extravasation was observed, so that whatever might be the nature of the appearance in the cortical substance of the cerebrum, that of the cerebellum had not undergone any similar change, but was in all respects of healthy structure.

Removing that portion of the cerebellum, which, from its situation, makes the posterior part of the fourth ventricle, several small coagula of blood were observed, laying

H. 3

оп

on the opposite side, being on the posterior surface of the medulla oblongata.

In order to ascertain the precise extent of this extrava sation, the medulla oblongata was first removed from its situation, and then divided by a vertical section, carried from behind, forward. This section exhibited several thin strata of blood, approaching to a state of coagulation.

The disposition of these portions of extravasated blood was remarkable. Many circumstances in the anatomy of the brain favour the idea of the medulla oblongata being made up of a congeries of longitudinal fibres. This appears evidently to be the case, when some portions of its surface are observed with attention. On this supposition, however, it is not easy to understand upon what principle the blood, in escaping from its vessels, should have been disposed, as in this case it was found. Where blood is poured out into any muscular structure, it is known to separate, but rarely, if ever, to rupture the fibres. Should it, on the other hand, be taken for granted, that the structure of the medulla is merely a soft elastic matter, formed without any particular or essential arrangement of its particles, even then effusion of blood into its substance, would, as happens above in the medulla of the brain, assume the form of a mass, more or less solid; but in the present instance, the several very thin strata of blood were all disposed in the same manner exactly, laying transversely to the longitudinal fibres of the medulla, supposing such fibres to exist.

The coagula were found deposited at some small distance apart, one above another, not in a correct line, but so that estimating the probable effect of the whole, it would be a sudden and complete suspension of the functions of the medulla, considering it as the medium of connection between the brain and the system of spinal nerves. The arteries of the brain were, in many situations, completely ossified.

Upon opening into the cavity of the thorax, the heart was found in a very diseased state. The tendinous mar gin round the insertion of each auricle was converted into a firm mass of bone. The two great coronary arteries of the heart were, from their origin, behind the valves of the aorta, almost as far down as the apex of the heart, completely ossified.

The semi-lunar valves, at the mouth of the aorta, were much enlarged, and distorted from their natural form by the deposition of ossific matter within the margin of their

attachment

1