408 INFLAMMATION. 



movements continued with more or less violence till 1.30 P. M., and in the 

 muscles of the neck somewhat longer. 



"At about 6 P. M., I found her lying quiet, rather stupid, but easily 

 aroused. Her vision was evidently good, and she was conscious ; the pupils 

 responded to light, and the direction of the eyes was normal ; pulse 104 ; no 

 cough ; respiration and temperature normal. There was no apparent loss of 

 motion of the muscles of the face, but the right arm and legs were paralyzed, 

 though the palsy was not complete. The great toe flexed on tickling the 

 sole of the foot, but the foot itself showed little or no motion ; but on attempt- 

 ing to flex the leg, which was extended, some rigidity of the muscles was 

 observed. At times, the patient produced slight movement of the thigh upon 

 the trunk. I think, during the two or three days succeeding the convulsions, 

 sensation in the right limbs was not entirely lost, though greatly enfeebled. 

 Subsequently paralysis in the right limbs, both of the nerves of sensation and 

 motion, became nearly or quite complete, and continued so until death. 

 Nevertheless, tickling of the sole of the foot caused some movements of the 

 great toe. On the left side, -sensation and motion were perfect. 



"December 9th. Has vomited to-day for first time ; apparently sees well, 

 and the appearance of the eyes is normal ; has no retraction of the head or 

 rigidity of the muscles of the neck, nor along the spine ; pulse 96 ; tempera- 

 ture normal ; lies quiet with eyes shut ; is stupid and not particularly fretful 

 when aroused ; her bowels moved regularly. 



"December llth. Continued to vomit at intervals; pulse 68. 



" December 16th. Pulse 80, temperature 100; vomited once yesterday, 

 not to-day ; lies in a constant doze. 



" December 18th. Moans at times, as if in pain; pulse 180, temperature 

 100 F. 



"December 19th. Pulse 180, temperature 103; there is convergent 

 strabismus, and her eyes have a wild, almost insane, look ; but she can see, 

 and grasped, hurriedly, a percussion hammer presented towards her. Para- 

 lysis of nerves of motion and sensation in the right extremities nearly com- 

 plete ; slight movement could still be induced in the great toe by titillation ; 

 the vomiting has ceased ; tongue covered with a thick fur ; movements of the 

 bowels pretty regular; has a slight cough, such as is common in cerebral 

 disease. 



" December 22d. Lies quietly on her side in perpetual slumber, with eyes 

 constantly shut ; pulse 118, temperature 101^; the bowels still moved nearly 

 normally. The pupils, when exposed to the light, were seen to oscillate, but 

 are constantly more dilated than in health ; the urine passes freely. Has, at 

 intervals, circumscribed flushing of the features. 



" December 24th. Pulse intermittent ; pupils dilated. 



"December 25th. Died in profound stupor to-day, having lived nineteen 

 days from the commencement of the malady. 



"Autopsy. On removing the calvarium and dura mater, which presented 

 no unusual appearance, the vessels of the pia mater were found rather more 

 injected than common. The cerebro-spinal fluid was scanty, and the surface 

 of the brain rather dry. The vertex of the left hemisphere was unusually 

 prominent, rising perhaps half an inch higher than that of the opposite side. 

 At the highest point, which was about one inch and a half from the median 

 line, was a circular yellowish spot upon the surface of the brain, about one 

 and a half inches in diameter. Pressure upon the spot, made lightly, com- 



