microcephalic idiot with bilateral porencephaly. 497 
the Nissl bodies being dark blue. The pink granules in some 
cells occupy nearly the whole of the cell-substance. In the cells 
of the inferior olive this replacement has reached a further stage 
and in some places nothing remains to shew the position of a cell 
save the aggregate of granules. 
13. The bulb: in the region of the pyramids at the lowest 
part of the inferior olive (Fig. 13). 
The chief feature is the asymmetry of the sections, the right 
pyramid being very much smaller than the left. Similar remarks 
(concerning the presence of abnormal granules or globules in the 
nerve-cells) apply to this as to the preceding section (12). 
Amyloid droplets are seen along the course of blood-vessels, and 
there is a suggestion of inflammatory change in the area imme- 
diately surrounding the central canal. In Weigert preparations 
no definitely degenerated areas are seen. 
14. The internal carotid artery immediately below the circle 
of Willis. 
The section shews that the vessel is thin-walled. It contrasts 
with the control specimen in not being contorted through the 
action of the fixing reagent ; in the control specimen the arterial 
wall is thrown into folds owing to the contraction of the connective 
tissue coating. (As a “control,” the internal carotid of a robust 
adult Hindu convict hanged for murder, was used.) 
In the artery of the microcephalic individual, the endothelial 
lining is indistinct, but the subendothelial layer is dense. The 
fenestrated membrane is distinct, but not thrown into folds, as in 
the “ control.” The tunica media is thin and consists almost 
entirely of circularly-disposed muscle fibres Avith elongated nuclei. 
The tunica adventitia is attenuated. 
Summary and Conclusions. 
The foregoing report contains such observations as I was able 
to make on the microcephalic brain within the time at my disposal. 
A few remarks may be added in concluding this account. The 
specimen exemplifies the conditions of microcephaly and of 
porencephaly combined. Of other examples on record, that 
described by Dr Wigglesworth in Brain 1901, p. 127, very closely 
resembles the present case. In the latter, the clinical evidence 
is necessarily less complete, though it is a matter of good fortune 
that so much clinical evidence was accessible as that which is 
prefixed to this report, and I must repeat my thanks to the 
Superintendent of the Three Counties Asylum for his aid in 
obtaining this. 
In Dr Wigglesworth’s case, the brain Avas microcephalic and 
porencephalic. The hemisphere chiefly affected Avas hoAvever the 
