On failure of brain power (encephalasthenia); its nature and treatment

Front matter

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Preface

When a medical book which is not a Student's Manual reaches a fifth edition, it must be allowed to have filled up a hiatus which had existed in medical literature. Such a fact naturally imposes on the author the obligation to revise his

^wofk with particular care, and to endeavour to the best of his

inability to keep it up to the ever-advancing tide of medical ^^/^ogress. I trust that I may not have failed in this ; and I

V have added a new chapter on the intimate structure of the .^bi-ain, as revealed by the most recent anatomical researches.

^» These latter have enabled me to give a further development

-to a theory which I have held for a considerable time, viz.,

"S^that the action of the nervous unit or neurone, with its cell,

cJ its axone and its dendrites, is of an electrical nature. An "SLfbsolute proof of the correctness of this theory can only be 1/ 'Wen by special work in the physiological laboratory ; and I rJ hope that this necessary corollary may soon be achieved by ^one who may be particularly qualified for scientific work of \j that description.

^j[^^The therapeutical results which I have obtained in the ^ neurosis under consideration, with the aid of electricity applied 51 to different areas of the brain, have become more striking in

VI PREFACE.

proportion as the methods of using that agent have become more fully and definitely elaborated ; and I entertain no doubt that my results will in every instance be confirmed by those who will take the trouble of following the plan of treatment I have laid down in the last chapter of this book. As with the increasing changes in our habits of life the neurosis under notice is constantly becoming more frequent and apparently more severe, while it is so often found rebellious to purely medicinal and hygienic measures, I trust that the methods of electrical treatment which I have recommended for it, and which experience has proved to be highly beneficial, may be found to constitute a distinct advance in therapeutics.

•

26, Queen Anne Street, W., March, i8g8.

Contents

PAGE

Introduction — Influence of the Struggle for Life — History of our

Knowledge of the Complaint i

Chapter I. The Structure And Functions Of The Brain

Historical Retrospect — The Greek Philosophers and Physicians — The Arabs — The Renaissance — Vesalius, Varoli, Descartes — The Dutch, French, and Germans — Golgi and Ramon y Cajal — Experiments by Ablation of Portions of the Brain — Electrical Experiments — Clinical Observations and Autopsies — Developmental Researches — Myelination — The Sensory Areas and Mental Centres 7

The Neuroglia — The Neurone — The Nerve-cell — Nissl Bodies — Pyramidal Cells — Association Cells — The Nucleus — Weight of Brain and Intracranial Capacity — The Axone — The Neuropilema — Nutrition of the Axone — Trophic Action — The Myeline Sheath and its Function — The Dendrites — Rabl- Riickhard's Hypothesis of Amoeboid Changes — Electrical Theory of the Author 23

The Functions of the Brain :

I. — The Intellectual Sphere — The Pre-frontal Area — Bianchi's and Flechsig's Researches — The Posterior Association Centre — The Great Composers of Music — The Ape-fissure — The Island of Reil — The Anterior Association Centre — The Two Hemispheres Enable the Brain to do Double Work 58

Vlll CONTENTS.

PAGE

II.— The Speech Centre— The Motor Area— Broca's Convolution — Gambetta's Brain — Oratorical Powers and the Intellect — Mr. Gladstone and Lord Salisbury — Agraphia and Amimia — The Sensory Speech Area —Word-blindness — Word-deafness — Paraphasia — The Association Centre of Speech 68

III.— The Sensory Spheres— No purely Sensory or Motor Areas in the Cortex —

1. The Visual Centre — The Occipital Lobe . . . 73

2. The Auditory Centre— The Temporal Lobe . . 75 5. The Olfactory vSphere — The Gyrus Uncinatus . . 76 4. The Somaesthetic Area — The Rolandic Convolutions

— Movements of the Head, Eyes, Face, Tongue, Pharynx, Larynx, Upper and Lower Extremity — Jacksonian Epilepsy . . . . . . 77

IV. — The Centrum Ovale, Corona Radiata, and Internal Capsule 81 V. — The Basal Ganglia — Their Relation to the Temperature of the Body — Lower Centres for Automatic Work — Somnambulism and Hypnotism . . . . . . , 81

VI. — The Mid-Brain — Equilibrium of the Body — Emotional

Centres 87

VII. — The Pituitary Body — Swedenborg's "Arch-gland " . . 87

VIIL— The Cerebellum 89

IX. — The Medulla Oblongata or Bulb — The Cardiac, Respiratory Vasomotor, Pupillary, Sudorific, Salivary, Gastro-intestinal, Renal and other Centres .... 90

Chapter II. The Causes Of Failure Of Brain Power

Influence of Heredity — Darwin's, Haeckels, and Weismann's Views — Germinal Plasm — Chromatine of the Nucleus — Biophores or Life-carriers — Determinants and Ides — Amphimixis— Conservative and Acquired Transmission — The Law of Uninterrupted Transmission — Of Latent Transmission — Reversion or Atavism — Sexual, Mixed, or Amphigonous Transmission — Crossed Inheritance — Prepotency — Adapted Transmission — Established or Habitual Transmission —Contemporaneous or Homochronous, and nomotopic Transmission .... 97

CONTENTS. IX

PAGE

Inheritance of Disease — Some Princely Families — Heredity in Less Exalted Persons — Imperative Words and Ideas — Agoraphobia — Morbid Fears — Kleptophobia — Advanced Age or Disparity of Age of Parents — Influence of Race — Marriages of Consanguinity . . io8

Influence of Sex and Age — Of Uterine Disorders — The Menopause — Sexual Troubles in Men — Mental Influences — A Faulty Education . . . . . . . . . .123

Influence of Over-work, Worry, and Prolonged Mental Strain — Reading for Examinations — Omnivorous Reading — Nursing the Sick — Disturbed Cerebral Dualism — Case of Prof. Fechner — Influence of Dissipation — Of Want of Occupation — Of Syphilis 132

Influence of Acute Diseases — Typhoid Fever — Dysentery — Small- Pox — Scarlet Fever — Septicaemia — Diphtheria — Influenza . 144

Influence of Dyspepsia — Exposure to Heat and Cold — Poisons — Leucomaines and Ptomaines — Offences against Hygiene — Injury to the Head — Railway Accidents — Traumatic Neuroses . , 75

Chapter III. The Symptoms Of Failure Of Brain Power

I.— Symptoms in the Intellectual Sphere: Undue Excitability and Depression — Difficulty in Fixing the Attention— Cerebral Dualism — Loss of Memory — Of Self-control — Insomnia — Physiology of Sleep — Relative Value of the Symptom— Cases of Apollonides, Alexander von Humboldt, and Sir Henry Burdett — Distressful Awakenings — Hypnotics . . 153

2. — Symptoms in the Speech Area : No Aphasia, but Polyphasia and Polygraphia — "L'homme aux

Petits Papiers " — Breakdown of Oratorical Powers . . . 165

3. — Symptoms in the Sensori-Motor Sphere : Fatigue — Tremor and Muscular Twitches . . . . .171 Paresthesia — Pain — Akinesia Algeria — Atremia — Vertigo — Altered

Sensibility in the Viscera — The Superficial and Deep Reflexes . 172 4. — Symptoms in the Sensory Centres : a. The Visual Centre — Hypersesthesia and Paresis . . . .178 d. The Auditory Centre — Tinnitus — Sensitiveness to Noise — Hallucinations of Hearing — Not Confined to the Insane . . .179 c. The Centres of Smell and Taste — Olfactory and Gustatory

X CONTENTS.

PAGE

5. — Symptoms in the Area of the Central Ganglia . 181

6. — Symptoms in the Emotional Centres : Morbid Fears — Agoraphobia— The Reverse of Agoraphobia —

Acrophobia, Claustrophobia, and other Forms of Fear . . 182

9. — Symptoms in the Pituitary Body and the Cerebellum not yet Recognisable 189

10.— Bulbar Symptoms: (i.) The Cardiac Centre :

Palpitations — Asthenia — Tachycardia — A Benign and Malignant Form — Bradycardia — Arythmia — The Intermittent, Alternating, and Twin Pulse — Anarchy of the Heart — Pseudo- Angina Pectoris 190

(2.) The Vasomotor Centre :

Spasm — Paresis — Blushing . . . . . . .196

(3.) The Respiratory Centre :

Spasmodic Asthma — Dyspeptic Asthma — Sighing Inspirations 197 (4.) The Pupillary Centre :

Ilippus — Inequality in the Size of the Pupils — Not so Ominous

as is generally Believed . . . . . . .198

{5.) The Sneezing and Cough Centres :

Sneezing and Coughing Fits ....... 200

(6.) The Sudorific or Sweat Centre :

Anidrosis— Hyperidrosis — Paridrosis 200

(7.) The Lachrymal Centre . 201

(8.) The Salivary Centre :

Dryness of Mouth 201

(9.) The Vomiting or Gastro-Intestinal Centre :

Regurgitation and Rumination — Irritative Dyspepsia — Atonic Dyspepsia — Bulimia — Nervous Anorexia — Nervous Vomiting — Gastroxynsis — Spasmodic Belching — Atony of the bowel . 201 (9). The Renal Centre :

Polyuria, Anuria and Oliguria — Diabetes Insipidus — Polydipsia — Phosphaturia — Inversion of the Phosphates — Glycosuria — Albuminuria — Oxaluria ..... 20(1

Concluding Remarks . . . . . . . .211

General Metabolism — Disturbances of the Sexual Function, not Causes, but Consequences — Local Sexual Neurosis — Neurosis of the Lumbar Spine — Ccrebro-spinal Neurosis — Onanistic Neurosis — Sexual Troubles in Women — Clitoridism . . . . . . . . . . .212

CONTENTS. XI

Chapter IV. The Nature Of The Neurosis

PAGE

Absence of Structural Changes in the Brain — The Finer Nutrition of the Neurone Disturbed — Vascular Influences — Theory about Disordered Brain -currents — Comparison of the Neurone with a Galvanic Battery — Ohm's Law — Increased and Diminished Resistance — Effects of Artificial Electricity on the Brain . . . . . . . . . , .215

Arndt's Theory Refuted — Views of Sir Andrew Clark, Goodhart, and Playfair — The Patient is not "perhaps," but really Suffering — **Hell on Earth" — The Neurosis always owing to Disturbed Cerebral Mechanism . . . . . .216

Chapter V. The Diagnosis Of Encephalasthenia

Objective Symptoms — The Urinary Triad — Increase of Tendon Reflexes without Rigidity — Differential Diagnosis from Softening of the Brain — Rolandic and Medullary Softening — Tumour of the Brain — General Paralysis of the Insane — Pseudo-General Paralysis — Hysteria — Hypochondriasis — The Uric Acid Diathesis — Charcot's Views ..... 22

Chapter VI

THE PROGNOSIS OF FAILURE OF BRAIN POWER. Can Heredity be Modified? — Law of Transmission at Corresponding

Periods of Life — Prognosis of Borderland Cases . . . 242

Chapter VII. The Treatment Of Failure Of Brain Power

Strengthening of Nervous Force — To be Commenced from Infancy — Neurotic Children — Physiology of School-children — English, Irish, and Jewish Children — Period of Development — Hygienic Rules — Work and Relaxation — "Globe-Trotting" — Medicinal Treatment — Bromine — Opium and Morphine — Cocaine — Alcohol — Amylenhydrate — Hypnotics — Treatment of Irritative Dyspepsia — Arsenic — Phosphorus — Strychnine — Caffeine — Cerebrine Alpha — Hypnotism — Electricity — Weir-Mitchell Treatment 244

ON

FAILURE OF BRAIN POWER.

Failure of brain power is one of the most frequent disorders nowadays met with in practice, but it is often not properly recognised, and very often improperly treated. It may be said to exist where there is an absence of sustained mental and physical force, with deficient power of resistance to unfavourable influences acting upon the individual; where fatigue of body and mind is too readily induced by comparatively slight efforts ; where sleeplessness, depression of spirits, exaggerated introspection, and morbid feelings of terror and alarm disturb the tenor of life ; where pressure on the head and an immense variety of other distressing sensations are commonly experienced; and where in spite of all such and other symptoms, which will be presently fully described, there is yet no organic disease of the brain to which these troubles could be referred. Functional or nutritional disorders of this kind have unquestionably always existed, more especially at times when civilisation had reached a high standard, when there was great political or religious excitement, and during wars, famine, and the prevalence of epidemics. In our own time, however, such affections have become particularly frequent and severe, owing to the profound changes in the general conditions of life which have taken place of late years.

I. A powerful influence in this direction has been the large increase of population which has occurred during the present century. This has led to a greater disproportion between the number of people and the necessaries of life, which latter are

B nowhere scattered in profusion, but are always more or less limited. The competition for necessaries, comforts and luxuries, that is, the struggle for life, has, therefore, more especially in our own time, become much more severe than it ever was before. Darvvin has shown that this struggle goes on amongst all organised beings : in plants, which compete with each other for sunshine and moisture ; in animals, which compete for food and sexual pre-eminence ; and in men, who compete in all the different branches of human activity.

2. Another influence which has further intensified the competition already existing I consider to be the decrease of religious feeling, and of a belief in a future life, which was to redress the inequalities and apparent injustice of the present. Those who no longer believe in the immortality of the soul are now generally profoundly dissatisfied with existing conditions, and show themselves particularly keen in their avidity for the good things which make this present life of ours worth living.

3. Finally the inventions by means of which the forces of steam and electricity have been utilised for the ordinary purposes of life, the facilities for travelling, and the extraordinary development of the newspaper press, have completely revolutionised and transformed the mode of living w^hich obtained in the time of our ancestors, and thereby greatly increased the calls which are habitually made upon the power and endurance of the nervous system.

The result of the action of these different causes has been that the pace at which we live has become much faster, and the clash of opinions and interests much keener than formerly, more especially in the ceaseless turmoil of great cities, to which by far the larger part of the population is now gradually being attracted. The fierce competition which at present exists, not only between the classes, but also between the sexes, nations and races, has led to a greater wear and tear of life, and entails more liability to a break-down of nervous force than was habitual in former times, when most people lived quietly and contentedly, far from the madding crowd.

In this bellum onifiium contra oj?ifies, which Malthus foresaw with a prophetic glance, it is only too natural that many unlovely features should come into view, and, in the fierce light which is now thrown upon everything, attract more attention than they perhaps deserve. Thus we are often struck by the excessive avidity displayed for the acquisition of wealth, and the feverish desire for amusement exhibited by so many persons.

The reverence of children for their parents, which is the base of all that is good and honourable in life, appears to have perceptibly declined. Many children adopt the American custom, and treat their parents with a kind of supercilious condescension. Young men entertain exaggerated notions about what is due to them, and will not be satisfied with anything but complete license. By their reading and their contact with modern life, they acquire " advanced " ideas ; they feel all the fermentation of the period at work in them ; their nervous system is unduly excitable, they are eaten up with selfishness, and rebel against the existing order of things. They are incapable of sustained eifort or serious application, change from one walk of life to another, and give each up in turn as soon as the fi.rst difficulties present themselves ; yet they continue to indulge in tall talk, and think that they are the cream of the age. They soon drop out of the race, and have nothing left but dislike and contempt for others, and hatred against a society which they consider out of joint. Other young men embark in wild speculation, and lose their own and other people's money, or join the ranks of Anarchists and Nihilists.

Many girls, on the other hand, aspire to be '' new women," and dream of gaining a brilliant position in the world, either by their beauty or their talents. They feel sure that they can make a name for themselves in history, and are intended for

B 2 great deeds. In order to accomplish them, however, they consider it indispensable to lead an unfettered life, to be children of their time, and free to act as they understand it. They detest the absurd prejudices of a decrepit society, and do not want to marry, but to keep all men with whom they may come in contact, subject to their charms. While flirting rather strongly, they make it understood that they are guided by the highest principles. They mostly lead utterly useless lives, eventually become bored to death with everything, and end not unfrequently in mysticism or insanity.

Persons of this kind cannot be looked upon as an improvement upon the last generation, which m.ay have been a little heavy, yet conscientious, hard-working, and practical. Fortunately, however, such cases as I have just described are by no means the rule amongst us ; and I take it that evolution is, on the whole, working satisfactorily, and in the right direction.

In the struggle for life some are favoured from the very beginning and throughout their career by advantageous external conditions, and even more so by having inherited a healthy and well-organised brain from their ancestors ; for man's brain is his most powerful and terrible weapon. Others again are handicapped by finding unfavourable conditions on starting in life, and by an inefficient or fragile nervous system. The fittest must therefore survive and flourish, while the weak must suffer, break down and perish ; and this natural law, however sad may be its operation in individual instances, must, on the whole, prove beneficial to the race, which will thus gradually become more perfected by selection. I therefore do not hold with those who fear that the majority of people will presently be unable to bear the strain of life, and hopelessly deteriorate in their higher faculties ; on the contrary, I believe that our capacities and powers will be gradually increased in proportion to the higher claims made upon us, and by the clearing off of those who are inefficient. At a time when we hear so much about "degeneration" (MaxNordau)and "dry-rot" (WoChang), and when evidence for this is even found in the practice of adjourning for afternoon tea at a cricket match, it is consoling to see in the passing events of the day, such as the fighting on the Indian frontier, in the autumn of 1897, that whatever may be the fate of the decaying Latin nationaUties, the Anglo- Saxon race, at any rate, still shows evidence of vigorous life. The British, whose character is formed by a happy blending of Norman initiative and adventurous spirit, with Saxon grip and endurance, are still

*' Strong with the strength of the race, To obey, to command, to endure;"

while science and the arts of peace and war have never flourished more abundantly in Germany than in the present day.

Again, to take a single class, with whom I have had an extensive and intimate acquaintance during the last forty years, viz., the medical profession of this country, together with their appendages of hospital matrons and sick nurses, I feel bound to state that an immense and steady advance has taken place in all our ranks during that period, not only as far as knowledge, but also skill, character and sense of duty are concerned.

As the nervous system has always had to bear the brunt of the battle of life, it follows that failure of brain power cannot be a new disease, as has been asserted by writers apparently but slightly acquainted with medical literature. Indeed, we find indications of a knowledge of it in the works of Hippocrates. Later on Willis, Sydenham, Whytt, Brown, Pridgin Teale, John Marshall, and others in this country ; Tissot, Lallemand, Villermain, Valleix, and others in France ; and Jaeger, Horn, Henle, Griesinger, Wunderlich, Hasse, and others in Germany, have devoted considerable attention to this disorder, which has from time to time been described by the names of hypochondriasis, nervousness, cerebral irritation, spinal irritation, spinal debility, nervous marasmus, general neuralgia, convulsibility, nervous erethism, neuropathy, and others. More recently Bouchut^ made an able study of this condition, and termed it " nervosisme" (i860), while Beard,^ who was unacquainted with Bouchut's and other writings on the subject, investigated the matter independently, and believed that he had discovered a new disease,; for which he coined the word "neurasthenia" (1869), which rapidly became popular. In the first edition of the present work, which appeared in 1881, I called the affection "failure of brain power," and this still appears to me the most appropriate name for it. I then recommended, amongst other remedies, a special treatment for some forms of the malady, which I had used for a number of years past and found most efficient, and which has stood the test of time and much further experience, viz., the application of electricity to different portions of the head, in accordance with the origin of different forms of trouble from loss of power in corresponding areas of the brain. Since then a very large literature has sprung up on the subject, the principal works being those of Krafft Ebing,^ Bouveret,* Franz Carl Miiller,^ Lowenfeld,^ and Binswanger.^

Before entering into a description of the malady, however, I consider it advisable to give a short survey of recent researches on the intimate anatomical structure as well as the functions of the different portions of the brain. Our knowledge in this respect has made gigantic strides of late, and what follows will, in my opinion, facilitate the comprehension of the pathological and clinical facts with which I purpose to deal in the present volume.

ON FAILURE OF BRAIN POWER.

Chapter I. The Structure And Functions Of The

BRAIN.

There is still considerable divergence between the foremost anatomists, physiologists, and pathologists of the day with regard to many points connected with this subject, yet all observers are agreed that the brain is the supreme controller of all our functions, and the source of all our powers ; for after the removal of both cerebral hemispheres in warm-blooded animals, and in extensive brain disease of a destructive character in men, all mental operations, all signs of intelligent volition, as well as purposive movements, are annihilated ; while destruction of the lower centres, more especially the pons and bulb, annihilates not only every function of the viscera, but life itself. It has, however, taken the work of more than twenty centuries to establish these simple facts ; and a short historical retrospect of the development of our knowledge of this subject may, therefore, be of interest.

We are inclined to look for the dawn of all knowledge in those nations which first arrived at a certain degree of civilisation ; yet we fail to trace any germs of brain-doctrine amongst the old Indians and Egyptians. The dreamy, imaginative Hindoos felt no temptation to unravel Nature's secrets by a laborious and repulsive dissection of viscera; while the Egyptians, whose minds were habitually clouded by gloomy forebodings, were inclined to look upon the natural forces as phantoms, which inspired them with awe. It is true that they opened the dead body for the purpose of embalming it ; but this did not lead to any anatomical or physiological researches, and only produced the mummy — an image of petrified life, well representing the general character of the people with whom it has always been identified. It was only in ancient Greece, where the natural development of mental culture proceeded, unfettered by external or internal restraint, that men began to study form and shape, as well as vital function, and endeavoured to recognise the intimate and mysterious union existing betwixt the two.

It is instructive to find, even at that early period, two opposite parties working on the same subject in different ways, and arriving at altogether contradictory conclusions, as has been the case more or less ever since. Philosophers loved to indulge in free speculation and deductive reasoning, and laid down the law on the functions of an organ, of the structure of which they knew nothing ; whilst physicians founded their opinions on clinical observation of injury to, or disease of, the brain, showing how the working of the mind and body was impaired through such occurrences. We can thus understand how it happened that such great thinkers as Plato and Aristotle committed themselves to fanciful and inaccurate theories, while Hippocrates and his successors were considerably in advance of the philosophers of their own time, as well as of many succeeding generations, in their insight into this intricate subject. Thus Aristotle stated that only the heart, being a unity in itself, could be the seat of the soul, which was likewise a unity; while the brain, being divided into two halves, could not be the seat of a single being, more especially as its connection with the organs of sense was only apparent. He found the organ of sensation, as well as of life itself, in the heart, which was the first organ formed in the foetus; and he looked upon the brain as a part intended to cause sleep, and to regulate the temperature of the heart ! Hippocrates, on the other hand, had already taught, long before Aristotle, that certain diseases of the mind, such as mania and melancholia, depended upon derangement of the brain. Polybos, his son-in-law, plainly stated in his work, " On the Sacred Complaint" (epilepsy), that the brain was the centre of the nerves, and the exclusive organ of the mind ; and Erasistratus, of Alexandria, in the third century B.C., maintained that the superior mental powers of man were owing to the variety and complexity of his cerebral convolutions, which were more considerably developed in him than in any animal.

With the decline and fall of ancient Greece the passion for speculation and the pursuit of science was extinguished. Natural philosophy, which had only just commenced to flourish, was embalmed in the libraries of Alexandria, and was afterv>^ards transferred to Rome, where it remained, however, an exotic, and was only scantily appreciated by the mistress of the world. The sum total of previous knowledge is found expressed in the writings of Galen, which authoritatively determined the direction of science for many centuries. He stated the brain to be the seat of thought and action, and believed its structure to be identical in the lower animals and man. He thought that it was composed of two halves, in order that one side might still continue to act after injury to the other, and that the soul resided in the ventricles of the brain. This theory was further developed by his followers, and Nemesius taught that the imagination resided in the anterior cavities, the thinking powers in the middle, and the memory in the posterior ventricles of the organ.

For more than a thousand years after Galen no real progress was made in our knowledge of this subject. Mankind appeared to be seized by a kind of fever, which was only much later recognised as an evolutional disease. Science could not flourish where barbarians ruled, where blind superstition overawed the people, and the yoke of princes led to unquestioning submission to authorities.

When the Arabs, led by Mohammed, reached the highest pinnacle of their political power, they received with deference European learning, the monuments of which they had conquered in Egypt and Greece ; yet neither anatomy nor physiology could thrive amongst the followers of Islam ; for religious precepts prohibited them from dissecting ; and the *- singular mixture of fatalism, enthusiasm, and inertia, which was the distinctive feature of their character, was unfavourable to scientific pursuits.

At last the inherent power of the European races overcame the tedious illness which had prostrated them so long. The struggle against the supremacy of the Church of Rome and literary authorities ; the renewed study of Greek classics ; the voyages of discovery, and the progress in the useful arts, were all so many symptoms of a fresh upheaval of mental energy. The era of the Renaissance began in Upper Italy, where the emulation of the smaller States, the republican spirit in them, as well as the support given by liberal-minded princes, electrified the minds ; and Bologna, Padua, and Pisa became the high schools of anatomy for the whole of Europe.

The crisis in anatomy was brought about by Vesalius^ (1542), whose passion for research was such as to subject him to great troubles and dangers, when attempting to procure bodies for dissection. At that time it was looked upon as blasphemous to mutilate human remains, and physicians and surgeons derived their anatomical knowledge from the dissection of dogs and monkeys. Vesalius was only twenty-eight years of age when he published his great work on anatomy, which, according to the saying of his contemporaries, laid a new world bare. He was the first to distinguish the white and grey matter of the brain, and described its general configuration more accurately. His teaching created the greatest excitement in the Italian centres of learning, and his merit was appreciated by the Emperor Charles V., and Philip of Spain, to whom he acted as physician ; yet his brilliant career was cut short by the Inquisition, and he was drowned on returning from a pilgrimage to Jerusalem, which had been forced upon him in order to get absolution. His work stirred up a host of eager successors, amongst whom Varoli^ of Bologna (1575) was one of the most illustrious. Although not persecuted like Vesalius, he had to suffer throughout his career from the meanness and envy of ill-natured detractors, and died at the early age of ^7,. He first described that portion of the brain which is now known as the " Pons Varolii," and examined carefully the base of the organ. He maintained that the soul resided in the substance of the brain, and that the theory assigning "the spirits" to the ventricles was a deceit, owing to a bad use of the organ which the Almighty had given to man for the purpose of thinking. According to him the substance of the hemispheres represented the images of things symbolically, disembodied from all things corporeal ; the ventricles did not contain air, but serum, and this latter served for eliminating the products of decomposition which were formed through the action of the brain.