microcephalic idiot with bilateral porencephaly. 479 
1898. 
1899. 
1900. 
1901. 
1902. 
1903. 
January, 1904. 
October 17, 1904. 
» 25 „ 
November 4 „ 
No change. 
Confined to bed with hernia, in other respects no change. 
No mental or bodily change, destructive and dirty in 
habits. 
No change as above, never speaks nor takes any ap- 
parent interest in anything except his food. 
Again confined to bed with hernia. No mental change. 
Unclean and destructive. 
Frequently confined to bed with hernia. 
No mental change, confined to bed with hernia for some 
months, habits faulty and destructive. 
Ordered to bed, weak and very unclean in habits. 
Very much weaker, still confined to bed, losing flesh 
and unclean. 
Patient died this morning. 
Powers of Sight— Indifferent. 
„ Hearing — Indifferent. 
Taste and Habits — Ravenous in eating, would eat grass or rubbish, appeared 
timid and frightened, would stand in a corner for hours 
if not encouraged to sit down or walk about. 
Speech — Never carried on conversation, but could mutter a few words 
unintelligibly. 
The calvaria measures 154 mm. in extreme length, and its 
extreme breadth is 120 mm. The corresponding endocranial 
dimensions are 137 mm. and 103 mm. The several cranial 
components are completely fused endocranially, though externally 
the coronal and lambdoid sutures are quite distinct. The sagittal 
suture has disappeared from both aspects of the skull-cap. 
The cranial vault is thick, but there is comparatively little 
variation in thickness in the different regions. Thus though 
somewhat reduced in thickness above the pterion, the usual 
marked contrast in this respect, between this region and the 
parietal area, is not found here. 
The calvaria is asymmetrical, and as the inspection of the 
cerebrum suggests, the left half is more capacious than the right. 
The capacity of the right half is further reduced by a thickened 
endocranial ridge, corresponding in position to the external occipital 
protuberance ; this ridge, although formerly median in position, 
has encroached very considerably on the right side. J ust behind 
the vertex, the internal aspect of the calvaria is characterised by 
a scarred and roughened surface. Behind this area again and 
to the right of the superior longitudinal sinus, a depression is 
seen and this corresponds to and is probably the result of a large 
haemorrhagic tumour which has destroyed most of the right 
occipital lobe of the cerebrum. 
The foregoing characters are the most striking features of the 
calvaria. 
