the lobe at its apex, and had extended inward, nearly reaching the
inferior cornu of the lateral ventricle. The entire inner half of the
occipital lobe was thus destroyed.
Remarks: Jany, _Knapp's Archiv f. Augenheilk._, vol. xi. p. 190,
quoted by Starr, _Am. Journ. Med. Sci._, N. S., lxxxvii., Jan., 1884,
p. 72.
41. Sex and Age: M. 42.
Clinical History: Right hemianopsia. Central vision good. Other
symptoms: aphasia, right complete hemiplegia, with facial paralysis.
Pathology and Location: In left occipital lobe, surrounded by a zone
of softening, reaching inward to and involving the pulvinar of the
left optic thalamus. Optic tracts normal.
Remarks: Hirschberg, _Deut. Zeitsch. f. Prakt. Med._, 1878, No. 4,
quoted by M. Allen Starr, _Am. Journ. Med. Sci._, N. S., lxxxvii.,
Jan., 1884, p. 69.
42. Sex and Age: M. 42.
Clinical History: Right hemianopsia, not quite reaching the point of
fixation. Central vision good in both eyes. Ophthalmoscopic
examination negative. Other symptoms: vertigo, loss of memory,
aphasia, and partial agraphia, with temporary right hemiplegia.
Pathology and Location: Gelatinous sarcoma.
In the left occipital lobe, involving all three of its convolutions,
as well as the præcuncus. Softening extended inward through the white
substance to the posterior cornu of the lateral ventricle. Thalamus
and optic tracts normal.
Remarks: Jastrowitz, _Arch. f. Augenheilk._, 1877, p. 254, quoted by
Starr, _Am. Journ. Med. Sci._, N. S., lxxxvii., Jan., 1884, p. 71.
{1079} 43. Sex and Age: M. 40.
Clinical History: For seven years epileptic seizure, beginning with
spasm of left leg and going on to general convulsions; motions more
violent on left side. An aura consisting of a darkness, coming
gradually over the field of vision from the left side, always preceded
the attack. During the intervals left-sided headache was the chief
symptom. It seems probable that a temporary left hemianopsia preceded
the attack.
Pathology and Location: Cyst filled with serum.
In white matter of the right occipital lobe, surrounded by a zone of
softening which did not involve either the cortex or the wall of the
lateral ventricle.
Remarks: Traube, _Gesammt Beitrage zu Pathologie_, ii. 1083, quoted by
Starr, _Am. Journ. Med. Sci._, N. S., vol. lxxxvii., Jan., 1884, p.
73.
44. Sex and Age: M. 52.
Clinical History: Headache. Numbness down right arm. Later, paroxysms
of headache lasting twenty to forty minutes, generally preceded by
pain and numbness in right hand and arm, ascending to head, and so
intense as to produce profuse perspiration. Delirium (lasting two
days) during these attacks. No paralysis or previous fit, nor
vomiting. Few hours before death had convulsions.
The pain and numbness were in right arm, although tumor was in right
hemisphere.
Pathology and Location: Malignant tumor.
Size of pullet's egg at inferior portion of posterior lobe on right
side in substance of cerebrum, approaching within a few lines of
surface.
Remarks: J. C. Langmore, _Trans. Path. Soc. Lond._, iii. pp. 246-248.
_Temporo-sphenoidal Region._
Temporo-sphenoidal lobe.
45. Sex and Age: M. 33.
Clinical History: History of syphilis. Blows on the head. Headache,
continuous, usually dull, occasionally severe. Occasional vomiting.
Stupidity, want of energy, drowsiness. One general convulsion a few
hours before death. Partial anæsthesia on the right side.
Hyperæsthesia of left side. Sight impaired. No ophthalmoscopic
examination. Hearing defective in right ear. Constipation.
Pathology and Location: Gumma.
One and a quarter inches in diameter, attached to adherent membranes,
and involved the middle portions of the first and second temporal
convolutions of left hemisphere. A layer of brain-substance both
anterior and posterior to the tumor was softened. The tumor grazed the
ascending parietal and inferior parietal convolutions. A large foyer
of greenish-yellow pus was found to the inner side of the tumor.
Remarks: C. K. Mills, _Arch. Med._, vol. viii. No. 1, August, 1882.
46. Sex and Age: M. 42.
Clinical History: At first an attack of vertigo which lasted over
twenty-four hours: some unconsciousness for a time. Continued
headache; loss of memory; giddiness and vomiting, the latter occurring
without connection with the state of the stomach as to food. Partial
bilateral deafness, which the patient stated was of long duration. No
paralysis, but right hand a little weaker than left. Distinct mental
failure during last two weeks of life; incoherence and faulty memory.
Pathology and Location: Epithelioma.
Ovoid tumor about one and a half inches in diameter in the central
portion of the temporo-occipital region. Hippocampal convolution
grazed. Some surrounding softening and meningitis. One corner of tumor
had produced a small spot of softening in the cerebellum.
Remarks: H. C. Wood, “Trans. of Path. Soc. of Philada.,” 1880, _Med.
Times_, vol. xi., Jan. 29, 1881.
47. Sex and Age: F. 40.
Clinical History: Suffered from a light form of epilepsy dating from
tenth year, which resulted, it was believed, from a fall. Rarely bit
her tongue, but usually frothed at the mouth. No history of one-sided
spasms. Always had an aura of a peculiar character. She suddenly
perceived a disagreeable odor, sometimes of smoke, sometimes of a
fetid character, and quite uncomplicated by other sensory warning.
Developed phthisis, her attacks occurring from time to time until her
death.
Pathology and Location: At lower part of right temporo-sphenoidal lobe
a shrinking and induration involving the uncinate gyrus and parts of
the adjacent convolution. The olfactory nerves were not involved. A
form of low-grade hemorrhagic pachymeningitis present.
Remarks: Allan McLane Hamilton, _New York Med. Journ. and Obstet.
Review_, vol. xxxv., June, 1882, p. 575.
{1080} 48. Sex and Age: F. 39.
Clinical History: Attacks of convulsion seven weeks before her death.
In two weeks mind affected; drowsy and stupid; condition of dementia.
Passed into a state of semi-consciousness. No eye symptoms. No
paralysis. Percussion on left side of head painful.
Pathology and Location: Sarcoma.
Occupied the posterior part of the fourth and fifth temporal
convolutions, and the third convolution was atrophied. Did not involve
the lateral ventricle. Under surface flattened and resting partly upon
the left lobe of the cerebellum.
Remarks: W. H. Draper, _New York Hosp. Histories_, N. S. vol. x. p.
445, quoted by M. Allen Starr, _Am. Journ. Med. Sci._, N. S. vol.
lxxxvii., April, 1884, p. 383.
_Basal Ganglia and Adjoining Regions._
49. Sex and Age: M. 59.
Clinical History: Contractures of right arm and leg since childhood.
Death from accident. The arm was atrophied and shortened, flexed at
elbow and wrist; disappearance of some cartilages at wrist and wasting
of joint-surface of radius. Femur flexed at hip; knee-joint flexed;
ankle-joint in position of equinus. Other bone-changes. Right leg
shortened.
Pathology and Location: Osteoma.
Tumor in left corpus striatum on “surface of anterior thick half,”
projecting outward into white substance of brain, and inward into
anterior portion of optic thalamus.
Remarks: A. Bidder, _Arch. f. Path. Anat. und Physiologie, und f.
Klinische Med._ Virchow, 1882, p. 91.
50. Sex and Age: M. 30.
Clinical History: Right frontal and occipital headache. Vertigo.
Paræsthesia of the toes, particularly the right. Face drawn to the
right. Left face paretic. Right eye smaller than left. Weakness and
fatigue of limbs. Convulsions. Vomiting. Slow pulse.
Pathology and Location: Myxo-sarcoma.
In right corpus striatum protruding into right lateral ventricle and
cortex.
Remarks: Schüppel, _Arch. d. Heilk._, p. 357, 1867.
51. Sex and Age: M. 34.
Clinical History: Walked a mile to an infirmary, and in less than one
hour went into a series of severe epileptic attacks, which continued
for four hours. The spasms were clonic, and chiefly in upper
extremities, with violent contortions of face; the latter most marked
on left side and in zygomatici. Between the fits there was deep coma,
especially three hours before death, when, after another violent fit,
he died, seven hours after first seizure. No paralysis, and report
says nothing about any previous fits.
Pathology and Location: Myxomatous glioma.
It exactly occupied the place of right nucleus caudatus, extending
outward as far as white fibres, but not involving them. Brain-tissue
in proximity normal.
Remarks: Dowson, _Med. S. and Gaz._, London, 1878, p. 333.
52. Sex and Age: ——
Clinical History: Partial anæsthesia of right half of trunk. Hyperæmia
of retina, and capillary hyperæmia of left optic disc. Left pupil
dilated; left ptosis; left diverging strabismus. Paralysis of right
side and extremities. Paralysis of muscles around right corner of
mouth. Incontinence of feces and urine. Redness of face. Variations in
temperature.
Pathology and Location: Tubercle.
In left optic thalamus. Partial destruction of left peduncle of
cerebrum.
Remarks: Fleischmann, _Wien. med. Wochenschrift_, 6, 7, 8, 9, 1871,
quoted by Petrina.
53. Sex and Age: F. 44.
Clinical History: Severe headache on left side. Sensibility lessened
in left extremities, at same time frequent pain. Intelligence
diminished. Speech retarded. Strabismus of left eye. Amblyopia. Left
pupil alternately dilated and contracted. Left lagophthalmos.
Chattering of the teeth. Twitchings on the left paralyzed half of the
face. Tongue and uvula tending toward the left.
Pathology and Location: Sarcoma.
Right optic thalamus. Corpora quadrigemina compressed.
Remarks: Friedreich, quoted by Petrina, _op. cit._
54. Sex and Age: F. 38.
Clinical History: Headache. Creeping sensations in right arm and leg.
Right facial paresis. Paresis of left extremities. Convulsions.
Dimness and confusion of sight. Diplopia. Hardness of hearing. Failure
of memory. Difficulty in speaking and swallowing. Improvement under
iodide of potassium.
Pathology and Location: Glioma.
Left optic thalamus.
Remarks: Bruzelius and Blix, 1870, quoted by Bernhardt, 153.
55. Sex and Age: F. 14.
Clinical History: Headache, vertigo. Epileptic attack. Right
hemiplegia. No anæsthesia. Slight dilatation of pupils.
Pathology and Location: Sarcoma.
In left optic thalamus. The right optic thalamus also affected.
Corpora quadrigemina enlarged and pushed backward.
Remarks: Rusconi, _Gaz. Med. Ital._, 1874, No. 11.
{1081} 56. Sex and Age: M. 30.
Clinical History: Headache. Left ptosis; fixation of left eyeball.
Drowsiness. Retarded speech. Gait unsteady. Paresis of right hand and
foot. Emaciation; incontinence of urine.
Pathology and Location: Serous tumor.
Large as a nut, in posterior half of right optic thalamus.
Remarks: Troschel, _Med. das ver. für Heilk. in Preussen_, xliii.,
1839, quoted by Petrina.
57. Sex and Age: F. 36.
Clinical History: Imbecile. Speech inarticulate. Pupils contracted.
Spasms in arms, but light in limbs.
Pathology and Location: Cancer.
Left optic thalamus and corpus striatum without definite boundary,
extending into brain-mass.
Remarks: Brenner, quoted by Petrina, _op. cit._
58. Sex and Age: F. 33.
Clinical History: Headache and vomiting for three weeks: for one week
had been maniacal. Convulsions. Apoplectiform attack, marked by
unconsciousness, general muscular flaccidity, and stertorous
breathing. Paralysis of left face; twitching of right face.
Pathology and Location: Glioma.
Between left optic thalamus and hippocampus minor, extending from the
ventricle to the under surface of the brain. Corpus striatum and optic
thalamus unaffected. Hemorrhage on under surface.
Remarks: Owen, _St. George's Hosp. Rep._, ix., 1877-78, p. 150.
59. Sex and Age: M. 45.
Clinical History: Vertigo, headache, and tinnitus. Five years before
attack had fallen and struck the back of his head. Much exposed to the
sun. One day in August a general feeling of numbness came over him.
This was followed by vertigo, etc., as above. Staggered and stumbled
in walking as if intoxicated. Unable to maintain his balance in the
dark or with his eyes closed. Some numbness in legs and arms, but no
actual loss of sensibility. No neuro-retinitis; no paralysis. When
erect had a constantly increasing tendency to stagger backward.
Divergent squint and diplopia appeared. Potassium, iodide blisters,
and seton were used. Noises and headaches disappeared. During last two
or three weeks some difficulty in swallowing. Involuntary evacuations.
Occasional hallucinations.
Pathology and Location: Glio-sarcoma.
Tumor size of walnut in third ventricle, moulded to the interior.
Extending to base of brain just above corpora albicantia, and forward
as far as anterior commissure. A caudate prolongation completely
blocked up the Sylvian aqueduct. Owing to this obstruction, a large
quantity of serum had been imprisoned, enormously distending the
fourth and lateral ventricle. The growth invaded left optic thalamus.
Superior surface of cerebellum softened from median line to middle of
right hemisphere.
Remarks: F. Woodbury, _Am. Journ. of the Med. Sci._, N. S. lxxvi.,
July 1, 1878.
60. Sex and Age: M. 15.
Clinical History: Epileptic from childhood: had had no fits for last
three years. Had tremors and was dull. Short-sighted, and had a habit
of absurdly frequent winking. Nothing else wrong with eyes. Suddenly,
after a mental disturbance, had intermitting pulse. Cold surface,
dulness, head and face swollen and flushed. Then tonic spasms, loss of
consciousness, involuntary micturition. General tremors, dilated
pupils, stupor. Next diffused dusky-red flush of both cheeks, also
over back of hands and forearms. Temperature depressed to 92° in
axilla. Automatic repetition of words. Taste and smell normal. He
recognized himself in looking-glass on the day he died.
Pathology and Location: Sarcoma.
In third ventricle, lying between corpora striata and optic thalami of
opposite sides. It completely enveloped optic commissure, and
partially involved track of optic nerves issuing from front. The sole
organic connection of tumor was with the commissure. The tuber
cinereum was distinct from its tissue.
Remarks: Russell, _Med. Times and Gaz._, 1873 (1), p. 522.
61. Sex and Age: M. 19.
Clinical History: Periodical headaches. Unsteady gait. Left
hemiparesis. Peculiar swelling of face. Delirium. Convulsions and
sudden death. Bad-smelling discharge of the nose.
Pathology and Location: Echinococcus.
In left lateral ventricle; the whole of the ventricle a sac.
Remarks: Yates, _Med. Times and Gazette_, Aug., 1870.
62. Sex and Age: M. 14.
Clinical History: Convulsions; vomiting; internal strabismus of right
eye; gradually increasing paresis of left leg and arm. Reeling toward
left side. Occipital headache. Pain and numbness in left arm. {1082}
Lateral movements of eyes lost; paralysis of accommodation; nystagmus.
Oscillation of left hand. Left leg ataxic. Patellar reflex
exaggerated, and ankle-clonus present on left side. Superficial
reflexes increased on right side. Partial anæsthesia on left side.
Sight good; double optic neuritis. Left-sided hearing impaired. Taste
and smell normal. Toward end, increasing torpor; left hemiplegia,
except slight power retained in face, with anæsthesia and analgesia.
Tonic fits. Right pupil dilated, and external strabismus in right eye.
Slow respiration. Ankle-clonus and increased knee-jerk in right.
Pathology and Location: Glioma.
Involved right anterior tubercle of corpora quadrigemina; also right
optic thalamus, posterior part of internal capsule, and tegmentum of
crus cerebri. The enlarged optic thalamus pressed back upon right
anterior portion of cerebellum and middle peduncle, and exerted some
transmitted pressure upon medulla oblongata.
Remarks: David Ferrier, _Brain_, vol. v. p. 123.
63. Sex and Age: F. 29.
Clinical History: Cervico-occipital headache. Vertigo. Convulsions.
Right facial paresis. Tendency to fall backward. Uncertain gait. Optic
neuritis. Double amblyopia. Difficulty in moving both eyes toward the
left. Diminished intelligence. Vomiting.
Pathology and Location: Glioma.
In corpora quadrigemina. Cerebellum not involved. Tumor lay upward and
outward from the left cerebellar crus ad pontem.
Remarks: Annuske, _Von Graefe's Arch._, 1873, Bd. xix., quoted by
Bernhardt, 167.
64. Sex and Age: M. 21.
Clinical History: Right temporo-frontal headache. Vertigo. Pains in
right leg. No anæsthesia. Right leg paretic. Tinnitus. Atrophy of the
right optic nerve. Abnormal somnolence. Sexual inclination diminished.
Vomiting. Blindness, first of the right and then of the left. Right
divergent strabismus. Pupils dilated.
Pathology and Location: Lipoma.
Tumor compressed corpora quadrigemina and geniculate bodies.
Remarks: Hirtz, _Bull. de Société Anat._, Mars and April, 1875, quoted
by Bernhardt, 168.
65. Sex and Age: F. 3.
Clinical History: Right hemiparesis. Right-sided tremor. Contraction
of the right elbow. Late, loss of sight in left eye. Ptosis,
dilatation of the left pupil. Stupidity. Peculiar movements when
seated from right backward to the left.
Pathology and Location: Tubercle.
At site of corpora quadrigemina, springing into the third ventricle.
Left cerebral peduncle compressed.
Remarks: Pilz, _Jahrbuch. für Kinderkrankh._, iii., 1870, 2, 133,
quoted by Bernhardt, 168.
66. Sex and Age: M. 25.
Clinical History: Cervico-cephalic pains. Vertigo. Uncertain gait. No
paralysis. Tension of muscles of neck. Optic neuritis. Double
amaurosis. Tinnitus. Diminution of hearing. Intelligence clear until
within fourteen days of death. Insensibility, delirium, coma. Small
irregular pulse.
Pathology and Location: Glioma.
Tumor displaced corpora quadrigemina and pineal gland. Projected into
the third ventricle through aqueduct of Sylvius and into fourth
ventricle.
Remarks: Duffin, _Lancet_, June 17, 1876.
67. Sex and Age: M. 7.
Clinical History: Occipital pains. Staggering gait toward right and
backward. Hydrocephalic cries. Tendency of head forward. Alternating
diverging strabismus. Double optic neuritis. Sudden death in paroxysm
of pain. Paresis of bladder. Vomiting.
Pathology and Location: Tumor took the place of posterior part of
corpora quadrigemina and velum. Cyst in the midst of the cerebellum,
reaching the fourth ventricle.
Remarks: Kohts, _Virch. Arch._, Bd. lxvii., 1876, quoted by Bernhardt,
168.
_Cerebellum._
68. Sex and Age: M. 1.
Clinical History: Frontal headache. Slight control over arms and legs.
Stiff neck. Dilated pupils. Sopor. Vomiting. Duration, one year.
Pathology and Location: Glioma.
Size of an orange in the middle of cerebellum. Chronic hydrocephalus.
Remarks: H. Green, _Trans. Path. Soc._, vol. xx., 1870.
69. Sex and Age: F. 21.
Clinical History: Fall from a swing upon the head, followed by loss of
consciousness for a few minutes. Occasional headache during eleven
years, always located at the occipital region. Eight months before
death severe paroxysmal headaches, increased to one every five or six
days, and lasting three to four days. Great hyperæsthesia of the head.
Choked discs in both eyes. Complete blindness. Slight paresis of left
side of body; twitching of muscles of left side of face. Staggering
gait; sometimes complained of a momentary swinging or rotary
sensation. Intellect clear. During last few days of life loss of power
of deglutition, and also of taste, smell, and hearing.
Pathology and Location: Tubercle.
In left and middle lobe of cerebellum, involving the pia mater. Over
the tumefaction leptomeningitis.
Remarks: H. F. Formad, _Tr. of Philada. Path. Soc._, 1879-81, vol. x.
p. 178.
{1083} 70. Sex and Age: F. 27.
Clinical History: History of syphilis. Headache, with paroxysmal
exacerbations. Vomiting, frequently recurring; for four weeks before
death vomited almost incessantly. Vertigo; impossible to sit or stand
because of vertigo late in illness. Slowness of mind and hebetude.
General muscular weakness. Right partial hemiplegia and
hemianæsthesia. Trigeminal neuralgia. No ophthalmoscopic examination,
but sight impaired. Marked slowness of respiration; respirations ran
down as low as four and five per minute two weeks before death.
Pathology and Location: A nodulated mass involved the right middle
cerebellar peduncle and the adjacent region of the right cerebellar
hemisphere. The right upper half of the floor of the fourth ventricle
superficially softened. A small area of softening was also found
involving the under outer surface of the left optic thalamus, the
breadth of the internal capsule, and a small segment of the lenticular
nucleus.
Remarks: C. K. Mills, _Arch. Med._, vol. viii. No. 1, August, 1882.
71. Sex and Age: F. 13.
Clinical History: Tubercular history. Headache, with severe paroxysms;
most marked in frontal and occipital regions. Vomiting; vertigo;
attacks of reeling and falling. Mental dulness. Weakness of limbs, but
no distinct paralysis. Hyperæsthesia; severe pains in limbs. Gradually
went blind, first in left eye, and then in right. Descending neuritis
determined nearly a year before death; marked optic atrophy observed a
month before death. Constipation.
Pathology and Location: Tubercle.
A large nodulated mass occupied the lower two-thirds of the right
cerebellar hemisphere; one small nodule extended across the posterior
extremity of the superior vermiform process, destroying altogether
about one-third to one-half of a cubic inch of its substance. Internal
hydrocephalus.
Remarks: C. K. Mills, _Arch. Med._, vol. viii. No. 1, Aug., 1882.
72. Sex and Age: F. 20.
Clinical History: Headache. Occasional vomiting, but only upon a full
stomach and at the beginning of a paroxysm of headache. No impairment
of intellect; no paralysis; no convulsion; no inco-ordination. During
last few days, when in paroxysms of headache, her face would be drawn
toward left side, accompanied by a rigid drawing backward of the head,
by pain in left shoulder and arm, and by a marked diminution of
sensation in the same shoulder and arm. Head-pain excruciating, at
first involving the whole cranium, afterward only the forehead and
temples, but finally only the back of the head and nape of the neck.
Died of sheer exhaustion. Symptoms and physical signs of phthisis.
Pathology and Location: Tubercle.
In right lobe of cerebellum. Tubercular disease of both lungs with
pleuritic adhesion. Fatty liver.
Remarks: L. S. Clark for A. S. Gerhardt, _Tr. of Philada. Path. Soc._,
1878-79, vol. ix. p. 144.
73. Sex and Age: M. 45.
Clinical History: Occipital headache. Movements weak; gait staggering.
Inability to fix eyes; sight retained. Pupils unequal. Partial
deafness in both ears. Vomiting. Sopor. Sudden death. History of fall
upon head at twenty years of age, since which time much headache.
Pathology and Location: Tumor size of nut, compressing cerebellum and
pons, situated between pons, middle peduncle of cerebellum, the
cerebellum, and brain. Corpora quadrigemina atrophied.
Remarks: Luys, _Gaz. des Hôp._, 1867, 105, quoted by Bernhardt, p.
225.
74. Sex and Age: F. 52.