716 NERVOUS SYSTEM. 



CASE VII. Another patient was struck by a piece of wood on the right side of the 

 head. He was found dead a little more than three months after the injury. " The right 

 hemisphere of the cerebellum was entirely disorganized by an abscess which pervaded 

 its whole substance." No disturbances of movement were noted. 



CASE VIII. Another patient had erysipelas following a fall on the side of the head, 

 and abscess. He lived for three or four months. Five or six weeks after the injury, he 

 had severe pains in the occiput, and, " when standing, he could with difficulty only pre- 

 serve his equilibrium." On post-mortem examination, the deep-seated vessels of the cere- 

 brum were found injected. " We found, in the left lobe of the cerebellum, about three 

 table-spoonfuls of pus of a whitish and gelatinous aspect, which had encroached upon, or 

 rather displaced entirely, the hemisphere of the cerebellum ; this purulent substance was 

 enveloped within the pia mater, which had acquired a somewhat firmer consistence, and, 

 as in the subject of the preceding case, assumed a pearly color. The other half of the 

 cerebellum was shrivelled, and the medullary substance forming the arbor-vita was of a 

 grayish color and very dense." 



The first of these cases was found by Larrey to be associated with extinction of sexual 

 appetite and atrophy of the organs of generation. In the first two cases, judging from 

 the results of experiments on animals, there was not enough injury of the cerebellum to 

 necessarily influence the power of coordination. In the last case, there was difficulty in 

 equilibration, but also some paralysis. 



A number of cases, which it is unnecessary to detail fully, are cited by "Wagner, in the 

 Journal de la physiologic, 1861, in which tottering gait and want of equilibration or of 

 muscular coordination were noted, in connection with greater or less disorganization of 

 the cerebellum. In the same journal, is a brief note of a case, reported by Laborde, in 

 which there was a large cyst in the cerebellum, with incomplete paraplegia and " want 

 of coordination of the movements of progression." 



CASE IX. A most remarkable and carefully-observed case of atrophy of the cerebel- 

 lum was reported by Dr. Fiedler, in 1861. The subject of this observation, a man, aged 

 about fifty years, had remarkable peculiarities in his movements for thirty years. ' After 

 the age of twenty years, it is stated that " he could no longer walk with as much cer- 

 tainty as before; the gait was staggering (taumelnd). . . . Not only in the house, but 

 also in the street, the patient often fell, so that he was very frequently taken for a drunk- 

 ard, and was either carried home or taken to the police-station. It is said that he never 

 had drunk spirituous liquors. 



" Sometimes the patient walked backward, but only a few steps. He never had any 

 turning movements; the gait was always tottering (wacklig) and slow." He never fell 

 forward, but always on the back. On post-mortem examination, the cerebrum was found 

 healthy, " but the cerebellum was atrophied, especially at its posterior and inferior portion, 

 and was reduced in size at least one-half." This case presented the phenomena of defec- 

 tive coordination to a marked degree. Nothing is said of vertigo. 



Among the most striking of the cases of disease of the cerebellum, are two observed 

 by Vulpian. 



CASE X. The first was a woman, forty -nine years of age, in the hospital of la Sal- 

 petriere. " All of the movements were preserved, but locomotion was most irregular 

 and difficult ; she could only walk in the most bizarre manner, resting on a chair which 

 she placed before her at every step, and, in spite of her efforts at equilibration, she often 

 fell." This patient, however, retained great muscular power. On post-mortem exami- 

 nation, "the cortical gray substance of the cerebellum was found entirely "atrophied : all 

 the nerve-cells of this layer had disappeared." There was considerable reduction in the 

 size of the cerebellum. The corpora dentata were perfectly preserved, " showing that 

 these parts, at all events, have but a slight office in coordination." 



CASE XL The second case presented an old softening, about the size of a hazel-nut, 

 destroying a corresponding amount of the cerebellar substance of one of the hemi- 



