which contained a portion of small intestine completely mortified, and as black as a coal; and another, where the lungs were extensively diseased. As the brain, in both these patients, was not examined, the accounts are imperfect, and, consequently, the cases have not been included in the list now submitted to the Society, seeing they do not sufficiently bear upon the present discussion to warrant their insertion. I mention these circumstances, lest it might be thought that the above dissections are brought forward to support a particular theory; there was no such intention; and I would add, that they are now detailed solely as a collection of facts, in order to illustrate the pathology of insanity. Respecting the seventy-two examinations described in the preceding pages, the following general statement may be given of the pathological changes of structure observed in the head. In 59 cases, there was infiltration of the pia mater. In 59, turgidity of the blood-vessels of the brain and membranes. In 41, effusion of water in the ventricles. In 27, water was met with at the basis of the brain. In 19, bloody points on the cut surfaces of the medullary substance. In 16, thickening and opacity of the arachnoid coat. In 14, the colour of the medullary or cortical substance of the brain was altered from its natural hue to brown, pink, grey, violet, ochre, or white. And in 13 cases, there was an effusion of blood in the brain. Besides these diseased appearances, various other alterations of structure were met with in par ticular patients; such as effusion of pus on the brain; changed consistence of its texture; greater dryness than usual of the membranes; flattening, a shrunk, or a swollen state of the organ itself; with other changes different from a normal condition; for an account of which I would refer to the synopsis, to avoid superfluous repetition. Although diseased alterations of structure were not so frequently met with in the organs of the chest, as in the brain and its membranes, nevertheless, 55 insane persons in the above list of dissections exhibited changes of a morbid description in the thorax. Indeed, the apparent cause of death, in many of the patients, could be clearly traced to disease in the organs of respiration. Of the 55 instances of pectoral disease met with, on examining the bodies after death, 43 cases showed either recent or old adhesions in the chest, and 31 had the lungs consolidated. In 24, suppuration had commenced. In 15, the pleura or lungs bore marks of recent or previous inflammation. In 12 cases, there was effusion of lymph into the pleura, &c. In 9, considerable effusion into the bronchi and air passages. In 9, the lining membrane of the trachea and bronchi was deep red. In 8, tubercles were met with. In 6, the lungs had assumed a dark, or blackish tint. And in 7, the lungs did not collapse when the chest was opened. Besides these diseased alterations of structure, others were noticed, which it is unnecessary again to particularize, as they are amply described in the previous synopsis. Respecting the morbid appearances which the abdominal viscera exhibited on dissection, the instances of diseased alteration of structure in any of the patients were so few, as scarcely to admit of many remarks. However, it is right to state, that the liver was found to be affected in 5 cases; dropsical effusion had taken place in three patients; and in 3 other cases, there appeared decided marks of recent and violent inflammation of the contents of the abdomen; in two of which examples, the intestines had actually given way, so as to allow fæcal matter to escape into the peritoneal cavity; and a similar result would have likely supervened in the other case of intestinal inflammation, had the patient lived for a longer time. Considering the present communication to have already much exceeded the limits originally proposed, I will not attempt to discuss cursorily the important question which now occupies many pathologists, regarding the rationale of the diseased appearances usually met with in the brains of lunatics on dissection after death, namely, whether the morbid alterations of structure, then observed, be the cause, or only the consequence of the patient's previous mental malady. In short, whether the opinions promulgated by the section of pathological physicians, denominated "the Anatomists," or the views entertained by the other party, "the Vitalists," be the true doctrine. The former considering that the diseased alterations of structure observed in the brain produce the attacks of insanity: whilst the latter confidently assert the contrary. I therefore shall leave the decision of such important questions to others more competent than myself to give an opinion; although I must confess, the numerous illustrations now detailed, the facts recorded in medical works, as well as the reasoning of authors upon insanity, greatly preponderate in favour of the Anatomists; whose conclusions, in my judgment at least, appear to be the most rational, and quite consistent with the present state of our pathological knowledge respecting mental diseases. DONATIONS TO THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY, 1842-43. Those works which have been presented by their respective Authors are distinguished by an Asterisk. ARNOTT, J. M., Esq. *The Hunterian Oration, delivered at the Royal College of Surgeons in London, 1843. BAILLI ERE, H. Bulletin Bibliographique des Sciences Médicales et des Sciences qui s'y rapportent. Nos. 1 & 2. 1843. BELL, JACOB, Esq. *A Concise Historical Sketch of the Progress of Pharmacy in Great Britain, &c. London, 1843. BELL, THOMAS, F.R.S. *The Anatomy, Physiology and Diseases of the Teeth. Second edition. 1835. BERNARD, C. A., D.M. *Les Bains de Brousse en Bithynie (Turquie d'Asie) avec une vue des Bains et un Plan des Environs de Brousse. CHILD, GEO. CHAPLIN, M.D. Marienbad et ses differens moyens curatifs dans les |