6 inches. The skull was of the usual thickness, symmetrical, and the sutures were normal. The dura mater was easily removed from the bone over the superior portions of the calvaria, but at the anterior extremity of the left middle cerebral fossa, over the right orbital plate of the frontal bone, and over the greater part of the right middle cerebral fossa, the membrane adhered firmly, and a considerable degree of roughening or absorption of the bone had taken place beneath it. On the right side of the crista galli an opening communicated with the ethmoidal cells, and on the right side of the frontal bone a similar opening communicated with the frontal sinus. Into these openings portions of softened cerebral substance had been forced, probably by intracranial pressure. The pia mater had been pressed in with the brain substance, and by its vessels kept the cerebral hernias alive. At the site of the dural adhesions the pia mater and brain cortex were firmly adherent to the inner surface of the dura, so that it was impossible to remove the brain without considerable laceration.

Brain: Weight of left hemisphere, 284 ounces; right hemisphere, 27 ounces; cerebellum, pons, and medulla, 63 ounces. The pia mater was œdematous; veins moderately full of blood; membrane adherent to the dura and cortex at points mentioned above. Arteries at the base normal in arrangement and free from disease. The convolutions were flattened against the skull, especially over the anterior portion of the right hemisphere. The orbital surface of the right frontal lobe was greatly softened, so that hernias of the brain had taken place through the openings in the dura and inner table of the skull. Over the whole adherent surface the brain cortex was torn by removal of the pia mater. The anterior extremity of the left temporal lobe was extensively softened, and cortex, pia, and dura were adherent together.

On the right side, at the entrance of the fissure of Sylvius was a large tumor nearly 2 inches in diameter which had probably originated in the dura mater, as it was firmly adherent to that membrane. It had penetrated the brain deeply, and had encroached upon and pressed aside the third frontal convolution, the lower portion of the ascending frontal, the anterior portions of the three temporal convolutions, and had invaded and pressed upon the island of Reil. The pressure had not appreciably affected the basal ganglia and capsules, as it was mainly in front of these structures.

The tumor was of a reddish-gray color, somewhat rough externally, and seemed to have a complete capsule. On section the growth presented about the same color. It was soft and seemed to be quite vascular. The sections showed that though the growth was adherent to the pia mater over the portions of brain it had invaded, the cortex was still distinguishable in advance of tumor, and even the pia mater could be seen between the tumor and the cortex. In the vicinity of the tumor the brain tissue was very soft, but no destruction of tissue had been caused by the invasion of the tumor.

The brain substance generally was soft, oedematous, and rather pale. There were no gross lesions of the interior of brain, cerebellum, pons, and medulla. The optic nerves and tracts were atrophied and gray in color. The right olfactory nerve had been destroyed by the softenings in the vicinity. The other cranial nerves seemed normal to the naked eye. A portion of the cervical spinal cord removed with the brain seemed normal.

Other organs not examined.

MICROSCOPICAL EXAMINATION.

The tumor consists almost entirely of spindle cells in bands running in every direction, and some whorls, or concentric arrangements of the cells; but these are not so perfect as in some tumors of this class. The arrangement of the cells is much looser than in some similar tumors, and there is a considerable quantity of delicate connective tissue throughout the growth.

A striking feature in this tumor is the large number of huge vessels with thick fibrous walls which in the majority have undergone hyaline degeneration. Vessels with muscular tissue in their walls have not been found, though spindle-cell elements are certainly found in the walls among the fibrous tissue. In many of the vessels nearly the whole wall is converted into a hyaline, glassy material which stains lightly in carmine, and which I have supposed to be hyalin. Another peculiarity in these vessels is the cellular thickening of the inner coat, which much resembles the condition seen in endarteritis. A singular condition is seen in many of the large vessels which is not clearly understood by the writer. The endothelial lining is entirely separated from the vessel wall, and blood intervenes between the loosened endothelial cells and the vessel wall. As the sections were cut by the interstitial imbedding methods and fixed to the slides before removing the infiltrat ing material, it must be concluded that such was the ante-mortem condition of the vessels.

A few large hyaline globes are found in the sections and great numbers of small hyaline, sometimes concentrically striated, round, or oval bodies are found in every part of the growth. They seem to be unusually numerous in the vicinity of the vessels, and they are often found in close proximity to the hyaline material in the vessel walls. In some instances it seemed possible to resolve certain portions of the hyaline change in the vessel walls into these bodies. The similarity in appearance between the large hyaline globes and the small sphèrules suggests that they may be similar in nature and origin.

In this and in other descriptions of similar bodies the term hyaline is used as descriptive of the appearances rather than indicating any definite composition, for, though it is probable, it is not proven that they are the same in composition as the degeneration product, "hyalin," described by Recklinghausen. By the use of iodine and other staining agents I am quite satisfied that the change in the vessels, and the nature of the glassy bodies is not amyloid.

The brain generally shows little of interest. The tissue in the vicinity of the tumor shows some of the effects of pressure. The pericellular spaces are flattened and the cells are compressed. The nerve cells show a moderate degree of yellow granular degeneration of the cell bodies, through the nuclei are always distinct. The blood vessels are somewhat tortuous; pigment, and sometimes a slight increase in the perivascular nuclei, may be seen.

The brain hernias are composed of mechanically disarranged brain tissue, with the products of softening and hemorrhage. The blood vessels carried in with the pia mater still retain their contents, and their walls show evidence of inflammatory changes. Some of the vessels in the brain hernias show glassy change in their walls. Many spider cells, large fatty epithelioid cells, and groups of round cells are found in different parts of the sections.

The cerebellum, pons, and medulla show nothing of special interest.

CASE 805.

T. S. C.; aged 64; widower; late soldier; nativity, United States; mental disease, chronic epileptic mania. This patient had convulsive attacks occasionally which were believed to be epileptic; he was somewhat demented; was feeble, and kept in bed, but showed no distinct paralysis except ptosis of right eyelid. He had occasional attacks of vomiting, and a few days before he died the vomitus contained blood. The eyes were not examined with the ophthalmoscope, but sight was impaired. The duration of his mental trouble was over eighteen years. Death occurred in a convulsion, preceded by great prostration from hemorrhage.

Autopsy thirty hours after death. Body fairly well nourished; marked pallor of skin.

Cranium.-Antero-posterior diameter, 74 inches; transverse, 5 inches. Skull a little thicker than usual, and a few small exostoses were found on the inner surface of the frontal bone. The sutures were partly obliterated and the bone was dense. The right posterior clinoid process and a small portion of the adjoining dura were adherent to a tumor mass in the brain and were brought away with it.

Brain: Weight of right half, 203 ounces; left half, 204 ounces. Pia mater dematous; veins moderately full of blood; arteries at the base atheromatous in patches, especially the vertebrals. Convolutions were moderately atrophied over the whole brain; no effects of pressure could be distinguished.

On the right side at the base a tumor mass was situated on the inner side of the uncinate gyrus and extended from the anterior border of the pons to the posterior border of the orbital convolutions. The tumor was about 1 inches in its longest diameter; it was globular in shape and of firm consistence. The anterior extremity of the temporal lobe was pressed outward, the crus pressed upon and indented slightly, the middle cerebral artery was displaced forward, the posterior communicating artery was pressed inward, and the third nerve was displaced and stretched over the tumor. The anterior extremity of the tentorium was adherent to the capsule of the growth, and the two adhered firmly to the posterior clinoid process. The capsule of the tumor was calcareous and thick, and the accommodation of the parts around to it showed the growth to be of long standing.

Section revealed the true character of the tumor; it proved to be an aneurism which had formed on the middle cerebral artery at a point between the posterior communicating, and the anterior choroid artery. The opening into the vessel was shown to be about one-sixteenth of an inch in diameter and some blood still entered the aneurismal sac, though the cavity was nearly filled by dry, friable laminated clot. (The photograph shows the opening into the vessel and the appearance of the aneurismal contents.)

The brain tissue was very soft in the vicinity of the tumor, so that it was difficult to section it without displacement. The thalamus was encroached upon by the sac and pressed upward; the lenticular nucleus and the anterior portion of the internal capsule were pressed upward. The optic tract was almost completely destroyed at its posterior portion. The situation of the tumor was such that the main fibers of the internal capsule passed over and behind it, and the pressure upon the crus was slight; the absence of distinct paralysis is thus explained. The slow growth of the aneurism and its gradual cure by obliteration of the sac probably account for the absence of more definite symptoms.

The brain tissue in general was reduced in consistence and oedematous, but there were no gross lesions elsewhere in the brain.

Thorax.-Firm pleuritic adhesions on both sides. Lungs: Weight of right, 213 ounces; left, 15 ounces. The left lung showed some hypostasis posteriorly and some chronic scar-like nodules at the apex, possibly the remains of an arrested tuberculosis. On the right side, occupying the position of the lower lobe, was a large cyst-like cavity between the two layers of the pleura which had a capacity of nearly 2 pints. The cyst walls were about one-eighth of an inch in thickness, and were composed of tough, fibrous tissue. The contents of the cyst were yellowish serum, and shreddy, caseous material floating in the serum and adherent to the walls. The lower lobe of the lung was pressed upward and backward by the cyst, and a portion of the tissue may have been destroyed. The parietal pleura and the diaphragm were adherent to the cyst wall and had to be removed with it. The lung was not sectioned, but nothing abnormal could be found in the remaining portions.

Heart: Weight, 10 ounces. Valves of right side, normal; aortic valves thickened, calcareous, and all the contiguous edges of the seg ments were adherent so that the orifice was much narrowed; the aorta showed some atheroma; the mitral valve was slightly thickened at its margins; summits of the muscular papillæ fibrous.

Abdomen.-Spleen: Weight, 4 ounces; capsule wrinkled; pulp pale and fibrous; splenic artery very calcareous.

Kidneys: Weight of left, 33 ounces; right, 2 ounces. The pelvis of the left contained several fragments of calculi, which may have originally been one large calculus broken in removal of the organ. The capsules adhered slightly; surfaces granular; cortical substance extremely thin; several large cysts in each; pelvic fat increased; pyramids atrophied. The calices of the left kidney, its ureter, and the urinary bladder contained some gritty calcareous material and a little muco-pus.

Examination of the abdominal aorta revealed a small aneurism about 13 inches in diameter, which had formed on the vessel at the point where it is crossed by the duodenum. Adhesive inflammation had united the sac to the intestine, and rupture had occurred into the bowel. A coagulum had formed in the interior of the intestine, which extended nearly the whole length of the small intestine from the point of perforation to the ileo-cecal valve.

Other abdominal organs normal to the naked eye.

MICROSCOPICAL EXAMINATION.

Examination of the contents of the aneurism was not considered necessary. The brain-cells showed marked degenerative changes; some of the vessels were tortuous, and pigment was scattered along their walls.

The kidneys showed advanced interstitial nephritis.
Other organs not examined.

CASE 820.

H. F.; aged 57; married; carpenter; late soldier; nativity, United States.

The history previous to admission is imperfect, but shows that the patient was admitted to the National Home for Disabled Volunteer Soldiers, Dayton, Ohio, March 17, 1890, with epilepsy and mental impairment. At the time of his admission to the Government Hos

pital for the Insane, December 31, 1890, he showed some dementia, was harmless, but his mental impairment necessitated restraint. He was neat and tidy; would talk pleasantly, but with some mental effort to collect his thoughts. His habits were temperate, and his family history was good. After remaining in the hospital about four months he was sent to Hampton as "improved," but was returned February 19, 1892, and remained until his death, which occurred April 5, 1894. During his stay in the hospital he had convulsive attacks at intervals of about a week, but no other symptoms of brain tumor were observed. The case was entered on the hospital records as chronic epileptic dementia, duration over five years.

Autopsy, twenty-nine hours after death. Body well nourished; rigor mortis present. Only the brain examined.

Cranium.-Antero posterior diameter, 7 inches; transverse, 5 inches. Skull quite thick and dense; sutures partly united; some prominence of inner surface in the region of the coronal suture; shape of skull at line of section nearly oval and quite symmetrical. On removing the calvaria the dura separated readily from the bone, but was slightly adherent to the pia mater over the left temporal lobe.

Brain: Weight of right half, 23 ounces; left half, 283 ounces. The organ showed the effects of great intracranial pressure; the convolutions were flattened against the dura, and the subdural space was nearly dry. The pia mater was generally normal, but there were some subpial ecchymoses over the lower part of the central convolutions and posterior part of the third frontal convolution of right side, and ecchymoses and superficial softenings over the temporal lobe and lower portion of the central convolutions of left hemisphere. Almost the whole of the surface of the left temporal lobe was very soft, brownish in patches, and blotched with small hemorrhages.

On the left side the lower and anterior portion of the temporal lobe, the Island of Reil, and the anterior half of the basal portion of the hemisphere were dark red in color, swollen, pulpy, and irregular and tuberculated on the surface. The convolutions of the insula were much distorted by the swelling, and the arteries were deeply embedded in the depressions between them. The uncinate gyrus had swollen into a flocculus of pulpy tissue, which projected inward as far as the median line, overhanging the crus, optic tracts, and cerebral vessels. A small portion of the mass projected beneath the posterior communicating artery. A depression made by the wing of the sphenoid bone indented the swollen mass. The optic nerves and tracts were pushed toward the right, the crus was slightly flattened, and the third nerve was stretched somewhat over the tumor mass, and was slightly grayish in color. The posterior cerebral artery was displaced and its branches were deeply embedded in the swollen brain substance. On the median surface of the hemisphere the brain substance was pressed beneath the falx at least half an inch beyond the median line and the projecting portion had embedded itself in the opposite hemisphere.

On dissection of the brain it was found that the changes were more extensive than appeared on the surface. A large tumor mass occupied the interior of the temporal lobe, and apparently infiltration of the brain substance had extended in every direction. The root of the olfactory tract appeared to be affected, the posterior portion of the optic tract showed a reddish appearance unlike the normal, and the third frontal convolution seemed to be slightly infiltrated at its posterior portion. The exact boundaries of the infiltration could not be determined with the naked eye, as the general contour and color of the