314 MR. J. L. CLARKE ON THE INTIMATE STRUCTURE OF THE BRAIN. 
All the central parts of the pons Varolii were very much softened. The softening 
involved a large portion of the prolongations of the anterior pyramids, and extended 
backward to within a sixth of an inch of the fourth ventricle. 
(79) The second case was a gentleman, who, having recovered, in a great degree, from 
an attack of left hemiplegia, with some difficulty of articulation, suddenly found that he 
had altogether lost the power of speech, and then became insensible for a few hours. 
He had total paralysis of the tongue on both sides. He was unable to cough, and had 
very great difficulty in swallowing. Sensation was unimpaired. On laryngoscopic ex- 
amination by Dr. Morell Mackenzie, there did not appear to be any paralysis of the 
vocal cords. The patient was under the care of Dr. Hughlings Jackson, with whom I 
saw him, from time to time, to the period of his death. The post-mortem examination 
was made by Dr. Hughlings Jackson, who sent me the brain, medulla oblongata, and 
spinal cord. 
I found many of the principal arteries of the brain, particularly the basilar, the pos- 
terior, middle, and anterior cerebral, and the right carotid loaded, and in some places 
nearly choked up, with atheromatous deposit. I shall not give a detailed description of 
the numerous lesions which, as might be expected from such a condition of the arteries, 
I found in different parts of the brain, but shall only state that the convolutions of the 
middle and anterior lobes, especially those along the front of the middle lobes, bordering 
the fissure of Sylvius, and those of the insula , were much softer and paler than natural. 
The anterior perforated space, and the orbital and adjacent convolutions, were particu- 
larly soft. Both thalami optici were soft. On the surface of the left corpus striatum 
was a dark brown and softened depression about the size of a pea. Over the posterior 
half of the right corpus striatum and outer and fore part of the thalamus opticus, there 
was a chocolate-coloured and softened mass about the size of a hazel-nut. Beneath 
this the substance of both these bodies was very soft, and about a third of an inch from 
their surface were the remains of an old clot. 
Many parts of the cerebellum were exceedingly soft. The corpus dentatum on the 
left side was almost wholly destroyed by a round cyst containing turbid fluid. 
The surface of the fourth ventricle was softer than natural, and of a pale-yellow or 
cream-colour. In the medulla oblongata, on the left side, a small rust-coloured spot was 
observed at the origin of the vagus nerve ; and in the same section there was a dark 
rust-coloured streak on the inner side of the right anterior pyramid. A third of an inch 
below the pons Yarolii another rust-coloured spot, about the size of an ordinary pin’s 
head, was found in the substance of the posterior convolutions of the olivary body. 
This was proved by microscopic examination to be the remains of an old clot. It 
descended the medulla about the third of an inch, gradually diminishing and at length 
occupying the part immediately behind the convolutions of the olivary lamina, amongst 
the deep arciform fibres. 
(80) Valuable as these cases are in many respects, they by no means prove that the 
loss of articulate speech was due to the lesions in the olivary bodies ; since it is impos- 
