extremities of the right side, and of the tongue. Soon after, symptoms of cerebro meningeal inflammation, attended with wild delirium, ensued.

From the latter disease, as well as from the paralysis, he recovered, and continued, during several years, to enjoy a fair amount of health. At the end of that time, however, a change took place in that respect, and he became subject to sundry symptoms of a nervous disorder, which occasioned him considerable annoyance. Among these was an almost entire inability to obtain comfortable sleep, due principally to the impression, when unconsciousness fully came on, that his body, losing its horizontal position, with the lower extremities high in the air, seemed to slide rapidly down in bed, head foremost. This impression, which invariably caused him to awake suddenly with a start, was repeated, at short intervals, till late in the night, when it grew fainter and fainter, and, at length dying away, allowed him a few hours of broken and unrefreshing rest.

It is not necessary, for the object in view, that I should crowd these pages with the details, with the varying phases, of this long, tedious, and harassing case, or describe the course of treatment pursued by the late Doctor Chapman and myself. Suffice it to state that, after a while, the general health of the patient gradually became impaired. His appetite and digestive functions failed. He lost flesh and strength, and was finally confined to his rooms, and often to his bed.

During this time-the latter portion of it particularly-his mind, though completely free from any thing approaching to delirium, was somewhat confused when he first rose in the morning, and continued so for a

was

couple of hours. At the expiration of these, and during the course of the day and evening, he was perfectly free from mental embarrassment. Being naturally fond of society and conversation, and taking great interest in the political affairs of this country and Europe, he received the visits of his friends; and read the newspapers with the greatest pleasure, and as freely as it was thought safe for him to do. He attended to his pecuniary and other affairs; conversed with animation, and as rationally as he had ever done. In no instance did he manifest any thing like delirium. Being a widower, and without family, and living alone, with no one near him but servants, his mode of life, in contrast especially with that he had been accustomed to, notwithstanding all his friends could do to remedy the evil, and the diversion obtained from conversation and reading the papers-monotonous in the extreme. Experiencing, as he did, the depressing effects of this, and fully aware, from the nature of his disease, and its evidently progressive aggravation, that there was no chance of matters improving in that respect, life at last became, as he often expressed it to me and others, a burden to him. This went on increasing, till one morning, rising from his bed, while laboring, it is presumed, under the state of mental confusion mentioned above, he seized a razor, which, while passing from his chamber to an adjoining room, he found in an open closet, and with it divided completely his right femoral artery. The hæmorrhage was profuse, and death followed in a few minutes.

On examination, after death, the brain, and especially its membranes, were found highly diseased, and bearing marks of inflammation of long standing. The former was congested, while the latter, as well as that

This

portion of them covering the convexity of the hemispheres, as other portions of them, were considerably injected, opaque, and thickened; the whole associated with serous effusion in the ventricles and other parts. I may add that, in the substance of the middle lobe of the left hemisphere, was found a cavity, large enough to contain a good-sized hazelnut. cavity -the remains, doubtless, of the above-mentioned apoplectic attack-was empty of blood. walls were in close approximation; while the surrounding substance, to the depth of nearly twoeighths of an inch, was softened, and of the consistence, and of about the color, of the rotten pulp of an apple.

Its

But enough has now been said on the subject. From all that precedes, we derive an illustration of the fact that, while the disorder of the mind constituting delirium is generally an attendant onnay, the product of cerebro-meningeal inflammation, idiopathic or consecutive, it, in many cases, exists independently of, and without the least connection with, that morbid state of those tissues; and, on the other hand, that inflammation of the membranes of the brain, associated or not with disease of that organ, may, and does often, exist, to a considerable extent, without giving rise to, or being associated with, delirium.

Such being the case, it follows, I think, as a just consequence, that the fact of the absence of delirium, in spite of the existence of cerebro-meningeal inflammation, must put an effectual bar to an objection raised against the explanation suggested, as regards the resumption of the mental functions in cases such as those I have reported, based on the fact that symptoms of such inflammation had been observed during

life, and that textural changes, characteristic of that morbid state, had been found, in one case at least, after death; for if clearness of intellect can exist in association with cerebro-meningeal inflammation, a return to that condition of mind, after a certain continuance of delirium, may certainly occur, although these parts have been highly inflamed during the course of the attack, and exhibit, after death, the usual marks of that disease.

ART. VII.-Unilateral Sweating of the Head: its Relation to Disorder of the Sympathetic System. By ROBERTS BARTHOLOW, M. D., of Cincinnati.

RAYER and other dermatologists allude to partial or unilateral sweating, as a cutaneous disorder. Wilson,' who has devoted a chapter to the subject, under the title of "Partial Idrosis," furnishes us with particulars of several cases of partial sweating, apparently dependent upon derangement of the stomach. He reports a case, also, in which the sweating was limited. to one side of the head; but he does not offer any explanation of this phenomenon.

Gairdner,' of Edinburgh, observed unilateral sweating of the head in cases of aneurism and other tumors of the thorax. He thus alludes to this symptom in his clinical observations on thoracic aneurism:

"The curious symptom of strictly unilateral sweating, stopping short quite abruptly at the median line and occurring (in one case almost constantly) over the face and scalp of the affected side, has been ob

'Diseases of the Skin, Phila. ed., p. 543.

2 Clinical Medicine. Edinburgh, 1862, p. 557.

served by me in two cases only, in each of which it concurred with a contracted pupil."

1

Dr. Anstie relates, in his work on Stimulants and Narcotics, the occurrence of unilateral sweating of the left side of the head, in an epileptic boy. In this case, the sweating preceded the epileptic paroxysm. Dr. Anstie was, unfortunately, unable to state the condition of the pupil in this case.

In the Medical Times and Gazette of April 7, 1866, two cases of unilateral sweating of the head occurring in epileptics are reported. One of these occurred at the Birmingham General Hospital in the care of Dr. Russell, and the other at the National Hospital for Epilepsy and Paralysis under the care of Dr. Ramskill.

The report in regard to Dr. Russell's case states that "as the heat reached the face, the cheek became much flushed, so that his wife frequently became aware of what was happening by this circumstance alone. The perspiration, which accompanied the heat and affected all the left side, was most profuse; the moisture poured off him." The state of the pupil is not mentioned. In Dr. Ramskill's case "the perspiration was profuse on the right side, and was abruptly limited at the middle line of the nose and lip, but extended very slightly to the left of the median line of the forehead." Statical electricity "produced profuse perspiration on the right side and not on the left." The pupil on the sweating side was "a little larger than on the other."

In the same number of the Medical Times and Gazette reference is made to a case in the London Hospital, under care of Dr. Andrew Clarke, in which unilateral sweating of the head occurred in connection