INFLAMMATION. 435 



arterioles is, as a rule, the first to exhibit the waxy change. In the "brain, 

 the capillaries are unquestionably the first invaded formations, as recently 

 proved again by J. Baxter Emerson. The case from which my specimen has 

 come was one for two years under the observation of Dr. E. H. Linnell, of 

 Norwich, Conn.* 



" Mr. T , aged sixty-three, of nervous temperament and thin habit, first 



consulted me," says Dr. Linnell, "for failing vision, in November, 1879. 

 His vocation had been that of a photographer, until ill health obliged him 

 to relinquish it. Inquiry elicited the following facts: For the past eight 

 or nine years he had been subject to frequent attacks of neuralgia, affecting 

 his head and limbs ; he had been habitually constipated ; his urine had been 

 somewhat increased in quantity, light-colored, and passed frequently; and 

 for four years he had had paralysis agitans, affecting his right arm and leg, but 

 more markedly the arm. This tremor developed gradually, and was attended 

 with partial anaesthesia, denoted by numbness and tingling sensations in the 

 affected limbs, and by general debility. In other respects he enjoyed good 

 health until the fall of 1879. During the night of September 27th, of that 

 year, he had a sudden severe attack of pain in the head, extending from 

 vertex to chin, accompanied by total blindness, and followed by vertigo, 

 nausea, and slow pulse. After twenty-four hours the intensity of symptoms 

 was moderated, and his sight began very gradually to be restored, but was 

 never fully recovered. He continued to suffer with neuralgic headache and 

 vertigo, and his gait became halting and uncertain. His mental faculties, 

 however, remained unimpaired, and the paralysis agitans, or the difficulty of 

 locomotion, did not increase. When I first saw him, VOU = fft, refraction 

 Em. He had, however, left-sided binocular hemianopsia. ... In the latter 

 part of April, 1880, he had another sudden attack of complete blindness. 

 This attack was unattended by pain, and was of shorter duration than the 

 first. During the following year his sight seemed to fail gradually, until he 

 could with difficulty distinguish large objects. He complained much of diz- 

 ziness, but suffered less pain ; walking became more fatiguing, the right leg 

 seeming heavy, and as if too long. He retained the use of all his faculties, and 

 could converse intelligently, although his mind seemed to lose some of its 

 natural vigor. In the latter part of June, 1881, he was suddenly seized with 

 a general tremor of the whole body, afterwards becoming more pronounced 

 upon the right side. This was not attended with pain, and he apparently 

 recovered from the effects of it ; but had a similar seizure July 2, accompan- 

 ied with constriction of the post-cervical muscles. The rigidity increased, he 

 soon became unconscious, and was apparently entirely blind. After a few 

 hours he partly regained consciousness, and had perception of light. From 

 July 4 to 8, he seemed to improve somewhat. From this time he gradually 

 failed, both in intellect and strength, until he became comatose, in which con- 

 dition he remained for several days, and died July 19. 



" Autopsy gave the following result : The dura mater was so firmly adher- 

 ent that the calvarium could not be removed without cutting; and in so 

 doing, several ounces of dark fluid blood escaped from the sinuses. Both the 

 dura mater and the arachnoid appeared healthy. The pia mater was much 

 injected, the veins being distended with dark blood. The entire weight of the 

 brain was two pounds, fifteen and one-half ounces. The cortical substance of 

 the cerebrum was of normal consistence ; but upon section of the right hemi- 



* Published in the "Archives of Ophthalmology," vol. x., No. 4, December, 1881. 



