CASE OF TUBERCLES IN THE BRAIN

BY ROBERT DUNN, F.RC.SEng. IxPRSD with the conviction that every contribution to the pathology of the nervou system is important, I need offer no apology for placing upon record, in the pages of the AssoCIATION JOURNAL, the following detail of a case of Tubercles in the Brain which has lately come under my observation. We are all under great obligations to my friend, Mr. H. Ancell, for hi8 able and profound exposition of the subject of Tberculosis; yet, it must be acknowledged, there is still much truth in the remark of M. Lugol, "that the diagnosis of cerebral tubercle is involved in the greatest obscurity". I hope, therefore, that others will follow my example, and place upon record such instances of the disease as may come under their notice; so that the obscurity, if possible, may be lessened, if it cannot be entirely removed. It has not unfrequently happened, as in the present instance, that cerebral tubercles have been met with in post mortem inspections, in cases in which their existence during life had not been suspected. They have very rarely been found in adult life; and Abercrombie, in his work on Dieam of the Brain, gives but a single instance as having come under his own personal observation. In early life their occurrence is more frequent: and Dr. Hennis Green, in an admirable paper on the subject in vol. xxv of the Medico-Chirurygical Transactions, remarks: " I have observed 1 case to every 51 in 1324 caes of acute dise in children. When we bear in remembrance that the disae generally proves fatal in early life, by exciting sub-acute inflammation of the brain, ending in serous effusion, and how prone young children are during dentition to haTe such attacks of sub-acute inflammation set up, we may cease to wonder at the rarity of the occurrence of cerebral tuberle in adult life. The local of the tubercular deposit, both physiologically and psychologically, invests such cases with varying degrees of significance and interest." Of this the present case presents an apt illustration, and especially if contrasted with another, which I brought under the notice of the Royal Medical and Chirurgical Society some years ago, and which is published in voL xxv of the Society's Traneactions."* Where the opportunity has been afforded of carefully watching a patient during life, and of noting minutely all the changes in the symptom's, the case becomes invested with an inteest, which nothing short of a knowledge of the pathological conditions can fully satisfy; but how often in private practice we have to forego this satisfaction, the experience of every one can abundantly testify. It was only a few months ago, that I attended a young lady, of delicate constitution, who had suffered from repeated rheumatic attacks, and who had in consequence disease of the mitral alve from endo-carditis. 'Under a severe attack of bronchitis, caught through an accidental exposure, she became suddenly hemiplegic and speechless; she soon recovered consciousness and sensibility, so that she perfectlyr understood whatever was said to her, and noticed all that was doing about her; but she was left hemiplegic, and without the power of utterance. A few days afterwards, and at the time quite unexpectedly and suddenly, she expired. No examination was permitted. But how interesting and instructive it would have been to have seen the actual condition of the cerebral arteries,-the locale of the vupture, and the extent of the extravasation,-the state of