duced hemiplegia of the opposite side. In two of these the result was instantaneous. One case, he said, occurred under my care in Bellevue, which was performed for malignant disease of the nose in a man about the middle age. The case terminated fatally in seventy-two hours; nearly the whole of the side of the brain corresponding to the side of the ligature was found to be softened.

The second case also occurred in the same institution. The carotid was tied by Dr. Isaac Green. The patient was a middle-aged man. This was also attended with paralysis, which he slowly recovered from, though I think not entirely. The third case was one in which I assisted Dr. Valentine Mott to tie the carotid for malignant disease of the fauces. At the moment the ligature was applied there was hemiplegia of the opposite side. Patient after a while recovered from the paralysis, and the disease showing a disposition to return, the carotid of the other side was tied; paralysis also followed this operation. This second attack of hemiplegia was less severe than on the opposite side, and only lasted a day or two. The patient ultimately recovered, for all I know to the contrary.

Dr. G. F. Shrady next presented a specimen of extensive abscess of the brain. It was removed from the body of one of the victims of the Thirtieth street tragedy, who died at the New York Hospital, on the 14th of November. The history of the case was as follows:

Elizabeth C, aged twenty-three, native of Ireland, was admitted to the New York Hospital, Oct. 26th, during the attendance of Dr. Markoe, with scalp wounds, which were inflicted by a hatchet. Two of these wounds were situated just to the left of the median line, near the vertex, longitudinal in their direction, about half an inch from each other. The third was situated posteriorly on the right side, over the occipital bone, semicircular in form, and caused by a glancing blow of the weapon: they all extended to the bone. The skull itself did not seem to be injured materially. Several small pieces of the external table were chipped off in the posterior wound, and at the bottom of the wound nearest the vertex there was a small groove in the bone about an inch and a half in length, evidently caused by a direct blow upon the part. When first seen she was considerably prostrated, both from the shock of the injuries received and the loss of a considerable amount of blood; though there was no cerebral disturbance present. Reäction soon came on, and every thing progressed favorably. She continued to do well, the wounds granulating nicely until the 3d of November, eight days after the injury, when she complained of severe pain in the side of the head in the region of the wound, attended with a great deal of febrile excitement, dilatation of the pupils, and the occurrence of hemiplegia of the right side. From that time she began to be stupid. Her bowels were freely opened, leeches were applied around the wound, a blister to the back of the neck, but without any good effect. Coma supervened on the third day after, when an operation was attempted for her relief by Dr. Parker, who was at that time attending-surgeon. During the night previous to the day of the operation the patient had four general convulsions, which were quite

severe.

Taking these symptoms into consideration, it was thought possible that

a portion of the internal table of the skull was depressed at the situation of the groove on the outside. Dr. Parker trephined over this spot, removed a button of bone, and found a small spicula of the vitreous table splintered off at a point corresponding with the external injury. The dura mater was diseased at that point, thickened, softened, and was unavoidably wounded by the trephine. A portion of this membrane, about as large as a two-shilling piece, was cut away. The brain substance immediately underneath did not seem to be injured, and presented no marks of any abnormal action, except a considerable discoloration of the part.

The wound was left open, and dressed with cold water. The next day after the operation her mental functions were sufficiently restored to enable her to answer some questions intelligibly, but the appearance of her pupils was unaltered. On the 8th, three days after the operation, a small fungus, about the size of the end of the finger, made its appearance projecting from the centre of the wound; still she kept on improving, complaining only of an occasional pain in the head, which was always alleviated by the application of leeches. The pupils still kept moderately dilated. Her pulse, during all this time, ranged between ninety and one hundred, was moderately full but compressible.

On the morning of the 11th, six days after the operation, she was seized with another general convulsion, making the fifth. It was by no means as severe as the former ones, and lasted but five minutes. She continued in this state with a good deal of intelligence, able to answer questions promptly, pulse quiet and full until the night of the 12th, seven days after the operation, when rather suddenly coma again came on; her pupils became again widely dilated; pulse ninety-two, and thready. Leeches were again applied, and blisters placed on the back of the neck, but no abatement of the symptoms followed their use. During the day the fungus, which had increased none since its formation, was noticed to shrink away into the cavity of the skull, leaving nothing but the thickened scab which formerly covered it.

The coma grew gradually more profound during the following night, the pulse growing more and more feeble until eleven A. M. of the 14th, when she died. Early on the morning of her death, on removing the wet cloth from the wound, it was found to be smeared over with brain matter; this discharge continued until death took place, and amounted in all to a small teacupful.

The post-mortem examination was made four hours after death. The whole superior surface of the dura mater was thickened, and at the situation of the hole in the skull, there was an opening into it nearly as large as a half dollar, nearly circular in shape, with ragged edges. This opening discharged through it a considerable quantity of broken-down brain substance mixed with pus, of a pinkish hue, which formed the contents of an immense abscess of the brain, occupying fully two-thirds of the whole substance of the left hemisphere. The cortical portion of the organ was destroyed for a considerable space around the wound in the dura mater. The cavity of the left ventricle was found to be entirely obliterated, the corpus striatum and optic thalamus were almost entirely destroyed by the diseased action. The septum lucidum was partially

The right

destroyed. The corpus callosum was very much softened. hemisphere was very slightly affected, the softening being very superficial, and limited to the superior margin of the longitudinal fissure. The walls of the right ventricle were somewhat broken down, and the cavity was, to a certain extent, filled with the same material. Besides this, there was a small deposit of flaky pus around the optic chiasm and in the fold of the longitudinal fissure.

I omitted to state, that at the time of operation a very small quantity of pus was seen to flow from the wound in the skull.

Dr. Detmold, in this connection, referred to a similar case of abscess of brain, which was evacuated by a free incision. When he first saw the case, the patient was comatose, the pulse forty, and breathing stertorous. He removed a portion of bone, and found the dura mater perfectly healthy, but from the nature of the case, being under the firm conviction that an abscess did exist, boldly cut through, and evacuated it. While the pus was flowing, the patient recovered his consciousness. The quantity discharged amounted to five or six ounces. After that, the patient went about for a couple of months, and, with the exception of his memory, which, however, he entirely lost, he did very well. His reasoning powers seemed to be unchanged.

He lived sufficiently long to allow the wound to heal up, with the exception of a small opening through which a probe could be introduced for its whole length into the lateral ventricle. At the end of a couple of months, trouble in the brain again came on, pus formed in the ventricle, and was evacuated, but he died soon after. It was found that the septum lucidum had been ruptured, and discharged some of the contents of the diseased ventricle into the one upon the opposite side.

Dr. W. H. Van Buren next referred to an analogous case of another one of the victims of the tragedy. The wound was about one and a half inches to the left of the median line on the top of the head. It presented a solitary fissure which penetrated the skull, and resembled very much the appearance of a chop into a log by a broad-axe. It was impossible to bring the edges into any correct apposition. A probe being introduced into the wound, went into the substance of the brain. was satisfied that the dura mater was injured, and went no fartber. There was neither concussion nor paralysis present. Under the circumstances, it was thought best to close up the wound, with the hope that the opening in the dura mater might close. Accordingly, sutures were applied.

He

The patient did well for thirteen days, when he was seized with convulsions, after which he was thoroughly paralyzed upon the opposite side. With a pair of cutting forceps, the cranial bones at the seat of the injury were carefully gnawed away. He then discovered that some of the fragments of the internal table were detached by the force of the blow. These spicule were found to be adherent to the dura mater, and when detached, pus was seen to flow. The child looked very much at that time as if he was going to get well, it being fourteen days since the operation. After the operation every thing went on very slowly, and in the meantime he began to be excessively pallid. This state of things has

been noticed by Rokitansky, who supposes it to be owing to a lack of power in the nervous centre to elaborate the blood corpuscles.

He stated that four out of six of these victims were paralyzed on the opposite side of the injury. The other two were not hemiplegic. The eldest son was very severely injured-in fact, he had the most formidable. wound of the six, yet not a bad symptom has showed itself since the injury, and he is now in a fair way to recover.

Dr. Krakowitzer stated that Dr. Isaacs of Brooklyn examined a case of fungus cerebri, where the matter protruded was essentially brain matter, as was proved by microscopical examination.

Dr. Parker referred to an interesting paper, by Dr. Gurdon Buck, published in the New York Journal of Medicine and Surgery, vol. ii., 1840. Thirty-three cases were collected; in all these the fungus was found to be composed of brain-matter.

Dr. Krakowitzer thought that the fungus was a new growth, and that Isaac's case was a very rare exception.

Dr. A. Clark stated that he had examined portions of the fungus in two of Dr. Buck's cases, under the microscope, and was positive that there was not a particle of brain-matter in them.

Selected Papers.

ELIMINATION OF LEAD FROM THE SYSTEM.

By JOHN BACON, M. D.

FOR some years past I have had occasion to make many analyses of the urine in cases of chronic lead-poisoning. Some points, which have attracted my attention, may have a practical interest for the members of the Society.

It is not known in what state of combination absorbed lead is locked up in the tissues. An organic compound of albumen with oxide or chloride of lead may be formed; or a double chloride of lead with chloride of potassium or sodium, as was long since maintained by Mialhe. Various compounds of lead taken into the stomach, except perhaps the sulphide, are decomposed and dissolved by the alkaline chlorides normally present in the alimentary canal; and a recent analysis by Prof. Wurtz shows that a leaden bullet, which had been for many years imbedded in a cyst in the lung, was corroded, much diminished in weight, and surrounded by a crust of chloride, free from sulphate or phosphate. In that case, lead was found in the substance of the lungs and of the diaphragm. The abdominal viscera were accidentally not analyzed. The patient had hemiplegia.

Absorbed lead is diffused generally through the system, but not uniformly. The spleen contains the largest proportion, and next to that the liver. Lead also occurs in the urine, which seems to be the chief channel of elimination. When once deposited in the tissues, the metal is very slowly removed, and the symptoms continue for many months after exposure to the cause of lead-poisoning has ceased. Still, there is no doubt that in time it will be eliminated spontaneously.

In cases of lead-poisoning where I have analyzed the urine previous to treatment, but after removal from the source of the poison, lead has rarely been present, or at least so very little as not to admit of detection in the quantities of urine usually employed for analysis.

Of late years, iodide of potassium has been much used as a means of eliminating absorbed lead, and most of my analyses have been made in cases under this treatment. Melsens, who introduced this remedy, main