mining the therapeutics of mental diseases. To illustrate this subject, I have selected typical cases from the well-pronounced forms of insanity, and will briefly describe the pathological conditions found in each.

Acute Mania.-In one case of acute mania, death having taken place on the tenth day after the earliest manifestations of insanity, the capillaries were found in the first stage of fatty degeneration; the granules were situated along the inner walls of the vessels, and also between the vessels and their sheaths; and many of the capillaries which were undergoing this change were found plugged by minute thrombi. The perivascular canals were not seriously dilated, and the adjacent brain-tissue had not undergone atrophic change. The nerve-fibres were not impaired; small spots of degeneration were seen, but they were few in number, not more than six or eight being seen in a section; they were of an inch in diameter, and were molecular, but with no nuclei; the margins were distinct. Sections stained with carmine presented the same general appearance; the perivascular sheaths were more distinct, and the contrast between the patches of degeneration and the nerve-tissue was greater; the patches were slightly tinged with the coloring matter. The pyramidal cells were clearly defined, and larger than in the normal state; in these enlarged cells fine molecular material was found in the plasma. In the parts of the convolution which had been deprived of blood by thrombi, the cells were more seriously impaired, the molecular matter in the body of the cells being more abundant, and some of the cells being atrophied.

In a case of puerperal mania, in which death occurred six weeks from the first manifestation of the disease, the pyramidal cells were found slightly enlarged, and molecular material was deposited in the plasma. The cells were not well stained, apparently repelling the coloring fluid, and the outlines were a little indistinct. The capillaries were undergoing the first stage of fatty change, and many were found plugged; there was also slight engorgement. The white matter was studded with spots of degeneration, ranging from 0 to 300 of an inch in diameter; these spots had no nuclei, and were not stained by the carmine.

In a third case, in which the acute symptoms were prominent for six months before death, the changes were much more evident. The pyramidal nerve-cells were decidedly granular and atrophied, the walls appearing shrivelled, and the poles having undergone atrophic change; the masses of degeneration were larger, ranging from 1866 to 8 of an inch in diameter; they were characterized by a distinct margin, and were round, while their structure was molecular. Their cut surface appeared concave; they were not stained by carmine, and presented a yellow tinge. Some large masses were found in the cortex; these were of an inch in diameter, and were lobulated, and without nuclei; they were unstained, and were found near capillaries.

Melancholia. In typical cases of melancholia of short duration, the lesions observed in the early stages were the appearance of fatty granules in the walls of the vessels, with slight hypertrophy of the muscular coats, and some irregularity in the course of the affected vessels. The perivascular sheaths were slightly distended, sufficiently so to show a departure from the normal state, and to indicate that at some period the vessels had been engorged. The masses of degeneration were confined to the white matter, and ranged from ' to ' of an inch in diameter; they were molecular and without nuclei. The pyramidal cells were cloudy, slightly granular, but with distinct nuclei; the polar prolongations were unchanged. A notable feature was that the cells were

surrounded by clear spaces, although the bodies of the cells were not appa rently atrophied. These spaces were more distinctly marked in recent, than in prolonged, cases of melancholia, in which latter the capillaries were found engorged, tortuous, and unsymmetrical. The canals and sheaths were well shown, the former being much enlarged. Crystals of hæmatoidine were found in quantities about the bifurcations, and in many cases there were miliary hemorrhages. The neuroglia was proliferating, the extremely fine fibres appearing coarse, so that its ramifications could be easily followed. The pyramidal cells were distinctly granular, and some were much hypertrophied. The small spots of degene ration were found in large numbers, unstained by carmine, and without nuclei.

Chronic Mania.-The microscopic appearances of brain-tissue varied somewhat in these cases, but certain changes were quite constant. The evidences of engorgement were marked, the coats of the vessels being extensively hypertrophied, and the remains of vessels being outlined in parts of the tissue. The perivascular canals were large, often dilated to six or eight times the calibre of the vessels. The sheaths were fibrous, and large quantities of minute crystalline material were found deposited upon them, this being noted even upon some of the finer capillaries Crystals of hæmatoidine were also found in greater abundance than in some acute forms of disease. The large pyramidal cells were extensively degenerated, the shrunken atrophied cells, and the granular masses into which the cells are sometimes changed, being quite common; the nuclei were less distinctly seen than in other forms of disease, and the polar prolongations were impaired. It was in cases of prolonged insanity that the hypertrophied nerve-fibres were found, although these were not common, atrophied nerve-fibres being more frequently met with. The masses of degeneration were large, often of an inch in diameter, and could easily be detected without a lens, in carmine-stained sections.

Dementia.-In cases of long standing dementia, intense engorgement of the cerebral vessels was a prominent feature. Fusiform enlargements, miliary aneurisms, and miliary hemorrhages, were all frequently observed in this form of disease. The nerve-tissue adjacent to the vessels was stained with the coloring matter of the blood, and numerous small cysts, indicative of old miliary hemorrhages, were found in the gray matter. In a case of dementia of long standing, miliary hemorrhages were abundant in the gray matter of the parietal convolutions, and the cysts of former hemorrhages were numerous. The nerve-cells were granular, and sometimes enlarged; the nuclei and nucleoli indistinct; and granular masses often occupied the positions of the nerve-cells. In these cases, the granular cells appeared to have undergone disintegration, the molecules spreading over a considerable space, and free oil-globules being found

near.

General Paresis.-The cases of general paresis presented some features in common with those of dementia. The lesions in the membranes have already been described; well-marked cases had extensive fatty degeneration of the capillary walls, and tortuosity of the vessels; crystals of hæmatoidine were found in great abundance, and the minute crystalline granules encrusted the walls of the vessels and the perivascular sheaths. The nerve-cells were shrunken and granular; the nuclei indistinet, or completely obscured; and the polar prolongations not to be seen. There was a marked increase of connective-tissue elements. In the cortical substance, in several cases, a number of stellate, crystalline bodies were

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found; these varied from oo to go of an inch in diameter, and had distinct, black nuclei. The masses of degeneration were lobulated, and were not as numerous as in other forms of insanity; they were usually attached to the walls of vessels, which were shrunken, and were often found close to the gray matter. The nerve-fibres were atrophied, and the appearance of the tissue was indicative of active degenerative processes. In the spinal cord there were frequent departures from the normal state, involving the membranes, which were in many cases affected like the membranes of the brain; the nerve-fibres of the posterior columns of the cord were atrophied in the advanced stages, and there was an increased growth of connective tissue.

Insanity of Epilepsy.-In insanity following epilepsy, the nerve cells were found pigmented to some extent, particularly in the medulla and upper part of the spinal cord. The cells of the posterior convolutions of the brain were similarly affected, the bodies of the cells being pigmented and atrophied, while the prolongations were not so seriously affected. Small cysts were found in some cases, and masses of degeneration appeared in the medulla in great numbers, the masses being of the largest size, cellular in structure, and with a fine fibrillar matrix. Changes in the nervefibres of the spinal cord were not infrequent; gray degeneration in its various stages was quite common, and longitudinal sections showed atrophied nerve-fibres, and increased growth of connective tissue.

There are, of course, broad divergences from the above described conditions, the great range of diversity being in the various states of the neuroglia and the masses of degeneration. We know very little about the physiology of cerebral connective-tissue, and still less of the influ ences which affect its integrity. The spots may all be due to an abnormal state of this tissue, but up to this time I have not been able to demonstrate this point satisfactorily. It does not seem probable that the various changes can be due to different stages of the same disease. In the cerebral tissue in one case, there was gray degeneration of the columns of Turck; and in this degenerated tissue, patches of so-called miliary sclerosis were found, and, at its side, the smaller masses which have been described under the name of colloid degeneration. In the patches of gray degeneration, connective-tissue fibres were abundant; in the masses of sclerosis situated in the degenerated columns, the spots were composed of cells imbedded in a fibrous matrix; and in the adjoining tissue were found the small spots with distinct margins and molecular structure. The patches of gray degeneration were deeply stained with gold, the masses of sclerosis much less so, and the molecular spots not at all. In unstained sections, the differences were as marked as in those which were stained. The polariscope and tourmalines gave evidence that the formations were not all of the same structure, and aided materially in determining the differences of the several forms of disease; none of the spots, when under the polariscope, gave the black cross and ring of amyloid bodies.

From a study of these varying conditions, the conviction has forced itself upon me that the degenerations are not always the result of proliferation of the neuroglia, but that in some instances they follow slow inflammatory processes, resulting in degeneration of portions of the nerve-tissue, and causing atrophy of nerve-fibre by direct pressure. It is noteworthy that in all cases in which well-formed spots of degeneration were found, of whatever type, there was an inflammatory condition of the meninges, and an exudation of serous fluid into the sub-arachnoid space, and into the lateral ventricles.

These observations are based upon an examination of one hundred and fifteen cases, embodying all common forms of mental alienation; and while they do not cover the entire ground, the principle microscopie lesions observed have been given. It need hardly be said that one of the results of this investigation; has been to place me among the ranks of those who believe in the somatic origin of insanity; and, further, I believe that the only successful method of arriving at a definite knowledge of the pathology of insanity, is to be found in a study of the pathological histology of the cerebral tissues. We must appeal to the microscope for an explanation of those mysterious phenomena which, under the name of insanity, have so long baffled the Philosopher, Theologian, and Physician. The mysteries will yield to the careful student of Microscopic Pathology.

[Thirty-six photo-micrographs, illustrating the various pathological alterations of braintissue described in the paper, were then exhibited by means of the lantern.]

DISCUSSION ON DR. KEMPSTER'S PAPER.

After the reading of the preceding paper, Dr. ISAAC RAY, of Philadelphia, said-I cannot see a paper of so much importance pass entirely without note or comment. Dr. Kempster deserves great commendation for his labors on the microscopic anatomy of the brain, and there can be no doubt that in this direction is the way to successful inquiry into the pathology of insanity. In the case of two persons dying of mental disease under apparently very similar conditions, we may find in the brain of one every possible lesion, and in that of the other, nothing at all. It is somewhat the fashion to sneer at these microscopic investigations, but however indifferent we may consider the results so far, it can scarcely be denied that it is to them that we are to look for further light on this obscure subject. It is foolish to taunt us with our inability to find a delusion packed away in some congeries of cells, or to see a crazy project stamped at full length on a slice of gray matter, but, certainly, if we learn from the microscope something of the initiatory steps in the morbid process if we are made sure that in every case there is a dilatation of some cells, or a plugging of some vessels-we have made a substantial advance in our knowledge. Very few of us, I suppose, feel competent to discuss such a paper as this, and all may not be prepared to accept the conclusions of the writer, but, none the less, it ought to receive our most careful study.

The President, Dr. JOHN P. GRAY, of Utica, said:-I am glad to hear the remarks of Dr. Ray on the value of the microscope in the study of insanity. In the institution at Utica, where I inaugurated this work in the asylums of this country, though we have been engaged in these investigations for a number of years, I consider that we are only in our infancy in regard to the development of this subject. I do not understand Dr. Kempster to claim that the lesions which he has mentioned are constant and peculiar to, or only found in, certain forms of insanity; and indeed such a claim could not be sustained. Winslow remarked, a long time ago, that insanity was due to a peculiar inflammatory process. A recent article in the British and Foreign Medico-Chirurgical Review, on the other hand, in referring to the investigations at Utica, said that we were no nearer to the discovery of the cause of insanity, or to an explanation of its phenomena, through these researches, than our predecessors were through their methods. And it is maintained by good authority that similar morbid changes are found in other diseases of the brain. What we are endeavoring to do by microscopic investigation, is to determine the exact character and extent of the morbid lesions in insanity, and we think that photographic illustrations and illuminated sections of tissues, such as Dr. Kempster has here thrown upon canvas, are valuable methods of demonstrating these lesions. And all this should tend to stimulate further investigation.

THE RESPONSIBILITY OF THE INSANE FOR THEIR
CRIMINAL ACTS.

BY

ISAAC RAY, M.D.,

OF PHILADELPHIA.

How far insanity should be received in excuse for crime, is a question. on which, as we all know, there still exists much diversity of opinion. Notwithstanding that the study of metaphysics has, of late years, engaged the attention of some of the profoundest thinkers of the time; notwithstanding that better opportunities for the study of insanity have been afforded by the modern practice of gathering its subjects into large receptacles for care and custody; and notwithstanding that cases for legal adjudication in the courts of justice have been increasing with remarkable rapidity, we are yet, apparently, as far as ever from well-settled conclusions respecting the exculpatory effects of mental disease. Among lawyers and among physicians; among men of science and culture as well as among men who pretend to neither; among men of extreme conservatism as well as among those who are never satisfied with the present-in each and all of these classes, we find, on this subject, most diverse and even opposite views. This we may be inclined to regard as unwarrantable under the circumstances, proceeding as it does from neglect or careless use of the information at our disposal, yet, considering the part which passion, prejudice, and illogical reasoning, have in the formation of all opinions, it is neither strange nor extraordinary.

In the history of English jurisprudence, insanity, as an excuse for crime, scarcely made its appearance until within a comparatively recent period. Towards the middle of the seventeenth century, it may have been recognized as such in some of its grosser forms. With that better understanding of mental phenomena, and that milder treatment of human infirmity, which began to be visible in the literature and science of a somewhat later period, insanity became an unquestionable element both of moral and of legal irresponsibility. Lord Hale undertook to define, with some show of precision, the exact extent of its influence upon the mental movements, and consequently of its effect in impairing the responsibility of its subjects. In this attempt he was guided, unquestionably, by the best medical opinions of his time, as he found them in books, and in the discourse of eminent members of the medical profession. As the result of his inquiries, he came to the conclusion that insanity in its milder forms was not necessarily incompatible with responsibility for crime, while he freely admitted that in its severest manifestations it was an ample excuse for any criminal acts that might be committed under its influence. And ever since, his successors on the English bench have been seeking for some tests whereby these two grades of the disease might be distinguished, the one from the other, but always with very indifferent success; although, moved by that spirit of humanity which has been steadily infusing itself into the English law, their instructions in par