INFLAMMA TION. 431 



subjects ; emotions not under control ; sense of decency lost ; using the most 

 obscene language; responding to calls of nature regardless of surrounding 

 circumstances ; dementia very marked, at times so violent as to necessitate 

 restraint; insomnia. 



On November 14, 1876, he had an attack, with the following symptoms : 

 Complete left hemiplegia and hemianaesthesia ; complete aphasia ; congestion 

 of head and neck ; extremities cold, especially the left ; head drawn to the 

 right, and fixed ; both eyeballs drawn to the right ; left pupil widely dilated ; 

 conscious, with sense of sight and hearing intact ; facial muscles slightly par- 

 alyzed on the right side ; those of deglutition interfered with ; respiration 

 irregular and sighing in character; pulse 84, irregular and intermittent; 

 temperature 100. Soon after, the muscles of the paralyzed side began to 

 twitch, first in the extremities, gradually extending to the trunk, until, 

 finally, all the muscles of the left side were in a constant state of spasmodic 

 contraction. The next morning the symptoms were all gone, except slight 

 paralysis and aphasia, and the patient apparently better than before the 

 attack. These attacks, of varying intensity, occurred about once a month 

 during the remainder of the patient's life. Dementia became more marked. 

 He persisted in keeping up the movements of his right fore-arm and the 

 grinding of his teeth to the last ; consequently, their muscles retained the 

 normal size, while all others underwent atrophy from disuse ; but to the day 

 of his death he was able to walk with assistance. His urine was normal to 

 the last, but he had retention for five days previous to his death, which 

 occurred May 13, 1879, from exhaustion. 



A post-mortem examination gave the following results : Body much ema- 

 ciated ; ulcer, the size of a dime, on sacrum. Dura mater much thickened 

 throughout its whole extent, adherent to the pia mater in spots, and firmly 

 adherent along sup. long, sinus and in the temporal regions, much more so on 

 the left side than on the right. The pia mater was much thickened and con- 

 gested, and had numerous haemorrhages, from the size of a pin's head to that 

 of a split pea, imbedded in its structure. These were principally on the left 

 side, all confined to the upper surface. The pia mater was adherent to the 

 base of the skull and the brain, in spots. The brain was much congested, 

 weight 40 oz. The convolutions on the right side seemed deeper, and the 

 gray matter thicker than on the left. The white substance was slightly 

 darker than normal, and much congested. The consistency of the whole 

 normal, and all other parts negative. 



A large portion of both hemispheres was removed and placed in Mutter's 

 fluid, then in a weak solution of chromic acid, until it was sufficiently hard 

 for section, after which it was kept in dilute alcohol. 



The pia mater was composed principally of bundles of decussating fibers 

 of connective tissue, coarser than normal, traversed by dilated and enlarged 

 blood-vessels, distended with blood, and around many of them were bundles 

 of spindles and inflammatory elements. This condition of connective tissue 

 is characteristic of an inflammatory process of chronic nature, which process 

 led to the formation of new connective tissue, while an acute recurrence of 

 the same process has given rise to a new formatibn of inflammatory ele- 

 ments. The dura mater was found structurally in the same condition as the 

 pia mater, but had no haemorrhages in it. 



A vertical section through either hemisphere of the cerebellum with a low 

 power of the microscope gave the following appearance : The blood-vessels 



