714 NERVOUS SYSTEM. 



also discard one case of five small tubercles in one hemisphere of the cerebellum ; one, 

 of a tuberculous mass, the size of a hazel-nut, upon one side ; and one, of a cyst, the size 

 of a hazel-nut, upon one side. These last cases do not present sufficient destruction of 

 the cerebellar substance to lead us to expect any disorder in the movements. 



Thus far we have discarded eighty-five cases, leaving eight to be analyzed. Of these 

 eight cases, in five, it is simply stated that the movements were unaffected, and that 

 " one of the lateral lobes of the cerebellum was the seat of abscess." In view of this 

 bare statement, and of the fact that, in animals, recovery of coordinating power takes place 

 when half of the cerebellum has been removed, we may throw out these cases as incom- 

 plete. It must be remembered that the abscesses were probably of slow development ; 

 and, if they did not destroy a sufficiently large portion of the cerebellum to influence the 

 coordinating power permanently, it is not probable that the functions of this organ would 

 be at all affected, as there would be no shock, such as occurs in the sudden removal of 

 substance by an operation. 



We are thus reduced to three cases ; and, in all of these, the movements were more 

 or less affected. These cases we shall now study as closely as is possible from the details 

 given. 



CASE I. The first case is quoted from Guiot. There was no lesion, except an effu- 

 sion of blood in the median lobe of the cerebellum, and there was probably no pressure 

 upon the peduncles. " The individual who was the subject of this observation had had 

 an attack of apoplexy. Before the attack, he had for some time a staggering gait (une 

 demarche chancelante), and, after the attack, he had remained hemiplegic on the left 

 side." From these meagre details, it seems probable that there was a certain amount of 

 difficulty of coordination, although the description is not as definite as could be desired. 



CASE II. The second case was observed by Andral. A groom, not quite forty years 

 of age, was brought into the Maison royale de sante, having suffered from severe head- 

 ache, vertigo, etc., for fifteen days, which finally became fixed at the occiput. During 

 the first three days in the hospital, " he was in a continual state of agitation ; the move- 

 ments of the members, on the right as well as the left side, were sometimes so brusques 

 and disordered that they resembled convulsive movements." Soon the respiration be- 

 came disturbed, and he died in asphyxia. " Upon post-mortem examination, there was 

 found general injection of the meninges ; nothing particular in the cerebral hemispheres ; 

 a moderate quantity of serum in the ventricles ; reddish softening of the left hemisphere 

 of the cerebellum in its posterior and inferior half; no other lesion." 



The only marked symptom relating to the movements in this case was a certain 

 amount of irregularity and convulsive action of the muscles, while the patient was in 

 bed. The case is not strong in its bearings, either for or against the coordination-theory ; 

 for there must have been a great amount of irritation of the encephalic centres, and it 

 would certainly be difficult to note disturbance of equilibration or of coordination in a 

 patient confined to the bed. 



The third case is quoted by Andral from Lalletnand, and is taken by Lallemand from 

 Delamare. 



CASE III. "M. Gugrin, vicar at Gezeville, forty-six years of age, of a good tempera- 

 ment, strong, and corpulent, with a good appetite, complained of a dull pain, which 

 finally became acute, under the frontal bone. For a year he experienced attacks of ver- 

 tigo and vomiting, without fever. He staggered on his legs, and was often near falling 

 forward. The treatment employed was antiphlogistic and derivative." 



On post-mortem examination, the cerebrum was found entirely healthy, but the en- 

 velop of the cerebellum was collapsed, folded, and only contained about the half of an 

 egg-shell full of a brown and fetid, lymphatico-purulent liquid. 



This case, as far as the description goes, shows marked difficulty in equilibration or 

 coordination. 



If the reader have carefully studied the foregoing analysis of Andral's cases, he will 



