YF005066 
 
 1 
 
Memoirs of the American Academy of Arts and Sciences. 
 Vol. XIV, No. II. May, 1918. 
 
 WAVERLEY RESEARCHES IN THE PATHOLOGY 
 OF THE FEEBLEMINDED. 
 
 (Research Series, Cases I to X.) 
 
 WALTER E. FERNALD, M.D., A.M. 
 E. E. SOUTHARD, M.D. Sc.D. 
 ANNIE E. TAFT, M.I). 
 
Memoirs of the American Academy of Arts and Sciences. 
 Vol. XIV, No. II. May, 1918. 
 
 WAVERLEY RESEARCHES IN THE PATHOLOGY OF THE FEEBLE- 
 MINDED. 
 
 (Research Series, Cases I to X.) 
 
 EDITED BY 
 
 WALTER E. FERNALD, M.D., A.M., Superintendent Massachusetts School for the Feeble- 
 Minded, Waverley, City of Waltham, 
 
 AND 
 
 E. E. SOUTHARD, M.D., Sc.D., Pathologist, Massachusetts Commission on Mental Diseases, 
 and Bullard Professor of Neuropathology, Harvard Medical School, 
 
 WITH THE COLLABORATION OF 
 
 ANNIE E. TAFT, M.D., Special Investigator, Massachusetts Commission on Mental Diseases, 
 and Custodian of the Neuropathological Collection, Department of Neuropathology, Harvard 
 Medical School. 
 
 I. General Aspects op the Brain Anatomy in the Feeble-Minded, with partial Bibliography . . 23 
 
 E. E. Southard. 
 
 II. Clinical, Anatomical, and Brief Histological Description op Ten Cases op Feeble-Mindedness, 
 
 with 84 plates (Waverley Research Series, Cases I-X) 59 
 
 E. E. Southard and Annee E. Taft. 
 
 III. Neuropathological Correlations with Clinical and Psychometric Findings in Feeble- 
 mindedness (Waverley Research Series, Cases I-X) 109 
 
 E. E. Southard and Annie E. Taft. 
 
PREFACE. 
 
 We present herein the first-fruits of an orienting study of some of the more funda- 
 mental problems of feeble-mindedness. Rarely has the problem of feeble-mindedness 
 been attacked fundamentally for its own sake. Yet in recent years and in the immediate 
 present the representatives of numerous and varied interests clamor for light upon what 
 appear the limiting problems of their special fields. But what can the workers in feeble- 
 mindedness as such and for its own sake say to 
 
 a) the educators, responsible for "laggards," truants, "terrors," "exceptionals," 
 "ungraded," specially graded, retarded, and backward children; 
 
 b) the court authorities, to whom the educators' problems in part drift and figure 
 as psychopathic cases, defective delinquents, prostitutes, and the like; 
 
 c) the social workers, sometimes over-ready to tar all these cases with the same brush 
 as "mental"; 
 
 d) the eugenists, who either as Galtonians or as Mendelians, often tend to treat as 
 units and thought-counters all sorts of feeble-mindedness and perhaps even epilepsy 
 under a single caption; 
 
 e) the generalizing biologists, with their counsel of perfection in the guise of sterili- 
 zation of the potential parents of more feeble-minded; 
 
 f) the syphilographers and antialcoholists, who need facts for their propagandas 
 and at any rate must not universalize what facts are obtainable; 
 
 g) the legislators and alert guardians of the public purse, who are promised, in lieu 
 of impractical sterilization, a program of segregation — What can the workers in feeble- 
 mindedness offer to all these inquirers? 
 
 Satisfied for the moment with an astonishing and unfamiliar publicity, the special 
 workers in feeble-mindedness shortly turn to fundamentals. Assured in our own minds 
 that not all school "problems" are feeble-minded, that not all delinquents are defective, 
 that not all feeble-minded are institutional subjects, that Pearson and Davenport should 
 not lump and unify so medically obvious a pot-pourri as feeble-mindedness, that sterili- 
 zation is a program whose first physiological lines have not been laid down, that syphilis 
 and alcohol have not had their shares demarcated in the matter of feeble-mindedness, 
 
 i%S63&38 
 
20 FERNALD AND SOUTHARD. 
 
 and that legislators rush in where specialists find no footway, we run to our books. Mier- 
 zejewski, Bourneville, Hammarberg, Wilmarth, Tredgold, Bolton, these and others have 
 done their part, perhaps most notably Bourneville. Even Germany has little to offer 
 in the fundamentals, save perhaps the suggestions of the lamented Alzheimer. The 
 great foundations have neglected feeble-mindedness (there is grim humor in the fact that 
 their proposals will often come to naught through the existence of these very feeble- 
 minded whom the great foundations neglect!). 
 
 Yet it is not merely the present-day neglect of fundamentals in feeble-mindedness 
 that justifies our undertaking. Other sciences have advanced in the meantime. What 
 would not the modern ideas of glandular dysfunction have meant to Bourneville? How 
 Hammarberg would have rejoiced had the modern work of the cortex-topographers 
 enabled him to omit a large part of his monograph and rush on to deeper studies in feeble- 
 mindedness? How Wilmarth would have enjoyed the resources of a modern laboratory! 
 
 These considerations have been set forth more extensively, though still too briefly, 
 in Article I. Here we wish to say that we are minded to present a series of studies of 
 the anatomy, and especially of the brain anatomy, of the feeble-minded (including idiots, 
 imbeciles, and a variety of subnormals under that general term) to which we set the 
 provisional terminus of fifty cases. Until we have presented at least fifty cases from an 
 identical point of view, we feel that we shall hardly be warranted in drawing conclusions. 
 Still, epicritical remarks will be in order with each group of ten cases presented. We 
 plan to present perhaps ten cases a year. The great foundations aforesaid, which have 
 so neglected the topic, might of course speed up the work appreciably; yet it must be 
 granted that every case of feeble-mindedness is so much a unique, not to say Argus-eyed, 
 a problem that speeding-up by funds alone is hardly a practical policy. More living 
 brains are needed to work out the problems of the brains of feeble-minded, whether living 
 or dead — but cadit quaestio, that is the urgent lack of mental hygiene as a whole. 
 
 We must accord due credit and extend our thanks to the various clinical and post 
 mortem observers who have rendered the work possible, especially to the Waverley School 
 workers, to Dr. Myrtelle M. Canavan of the Pathological Service of the Massachusetts 
 Commission on Mental Diseases, who has performed most of the recent autopsies, and to 
 Dr. Annie E. Taft, Custodian of the Neuropathological Collection, Harvard Medical 
 School, who has been charged with much of the brain analysis. We should not omit 
 to call attention to the excellence of the photographic work of Mr. Herbert W. Taylor, 
 Of great importance also is the work of the technicians, among whom we may mention 
 Miss Ellen R. Scott and Miss Mae Cameron. 
 
 Perhaps the most interesting endeavor in the present volume is the attempt to match 
 
WAVERLEY RESEARCHES. 21 
 
 brain complexity with mental capacity. To say nothing of the mind-and-brain problem 
 (the less mind, the less brain, and vice versa, where "less" is taken not too quantitatively), 
 We feel that the whole problem of "mental tests," now sub judice, needs anatomical sup- 
 port and anatomical critique. Various authorities glibly discard all "tests" — mind 
 cannot be measured, that is an a priori certainty! Other persons, chiefly of the bureau- 
 cratizing group, would let fly at the institutions cases "feeble-minded" by a Binet-Simon 
 fraction, particularly if they be antisocial and affected by symptoms never considered by 
 Binet and Simon. The epicritical remarks of the present volume, provisional in char- 
 acter, are therefore levelled at the question of matching testable mind with measurable 
 brain. The situation appears on the whole rather favorable. On the basis of the clinical 
 and anatomical details of Article II, Article III goes on to the more doubtful matter of 
 evaluation. The skeptical may confine their attentions to Articles I and II. 
 
 A second volume, dealing with Cases XI to XX (including also "Mongolians"), 
 is within hail. Therein we hope to deal still further with the major problems herein 
 touched, such as 
 
 a) the correlation of mental and cerebral measurements. 
 
 b) the theoretically preventable group, (e. g. syphilitic, post-poliomyelitic). 
 
 The grant for the investigation and its publication is from a private endowment 
 of the Massachusetts School for the Feeble-minded. A grant for publication of suitable 
 and numerous plates has been received from Dr. W. N. Bullard, whom we would like 
 to thank in fullest measure. 
 
 Walter E. Fernald, 
 E. E. Southard, 
 
 Editors. 
 
I. 
 
 GENERAL ASPECTS OF THE BRAIN ANATOMY OF THE 
 
 FEEBLE-MINDED. 
 
 E. E. SOTJTHABD. 
 
I. 
 
 GENERAL ASPECTS OF THE BRAIN ANATOMY OF THE FEEBLE-MINDED. 
 
 E. E. Southard. 
 
 Abstract. — Small amount of intensive anatomical work available in the literature (Bourneville, 
 Hammarberg, Tredgold, Bolton). Research emphasis on other aspects (heredity, mental tests, social 
 service, education). 
 
 Situation in the biology of feeble-mindedness (Ballantyne). The question whether any feeble- 
 minded persons have normal-looking brains. Relative absence of work on the brains of feeble-minded 
 of higher grades. Modern knowledge of cortex topography. 
 
 Tredgold's distinction of primary and secondary amentia ("germinal blight" versus "arrest"). 
 Classification of W. W. Ireland. Exogenous nature of numerous cases (intrauterine lesions). Tredgold's 
 view that germinal variations are pathological and not spontaneous. The suggestion that germ cells 
 may be poisoned. Brain findings in exogenous cases. 
 
 Anatomical classification, Bourneville, 1889; Bourneville's researches. Hammarberg's report on 
 9 cases (psychic defects connected with defective nerve cells in the cerebral cortex). Idiocy thought 
 to be due to developmental check in later foetal life. Marked weak-mindedness thought to be due to 
 arrest of development in a stage normal for the first years of life. A third group with focal factors of 
 inhibition occurring during the first year of life. 
 
 Most of Hammarberg's work devoted to the microscopy of the normal cortex. Necessity of recog- 
 nizing certain shrinkage processes as artificial. Hammarberg's claim that disorderly arrangement of 
 cortical cells is also found in normal material (undeveloped cells frequently taken for atrophic ones). 
 
 Summary of Hammarberg's work with 4 cases of idiocy, 2 of marked weak-mindedness, 3 of slighter 
 degrees of weak-mindedness. 
 
 Tredgold's conclusion that the essential basis of primary amentia is cellular, due to an imperfect 
 or arrested development of cerebral neurones. Tredgold's belief that irregular arrangement of cells 
 is characteristic of feeble-mindedness material. 
 
 Situation in the anatomy of feeble-mindedness as presented at the Medical Congress in Paris in 1900. 
 
 Work of Mierzejewski (anatomical lesions are developmental deviations). Mierzejewski's special 
 group of cases in which the gray matter is disproportionately large as compared with the white matter. 
 Heterotopia. 
 
 Classification of Shuttleworth and Fletcher-Beach; microcephaly probably not caused by prema- 
 ture synostosis of cranial sutures. Congenital hydrocephalus extends the lateral ventricles lengthwise, 
 acquired vertically and transversely (Meynert); scaphocephaly; Mongolian idiocy; other groups. 
 
 Syphilis not a common cause of feeble-mindedness; juvenile general paresis as first observed by 
 Clouston; traumatic cases; so-called hypertrophy. 
 
 American literature. Wilmarth's study. 25 cases in 100 yielded no brain lesions to gross analysis. 
 Quotations from Wilmarth's conclusions. 
 
 Problems suggested by the literature of the brain anatomy of the feeble-minded. 
 
26 SOUTHARD. 
 
 We present herewith the first section of the Waverley Researches in the Anatomy 
 of the Feeble-Minded begun in 1913 under the auspices of the Massachusetts School for 
 the Feeble-Minded. This first section of Researches contains 
 
 I, a general introduction to the topic of brain anatomy of feeble-mindedness, 
 
 II, a particular description of ten instances of feeble-mindedness of various grades, 
 together with autopsy and microscopic findings, and 
 
 III, attempts at correlating the brain anatomy and histology with clinical and espe- 
 cially with psychometric (mental test) findings. Further studies are under contempla- 
 tion with the object of gradually enlarging the brain series, from which, when it shall 
 have contained say 50 brains, we may be able to draw sound conclusions. 
 
 Let us note at the outset our surprise at the extraordinary neglect into which this 
 topic has fallen. Bourneville, Hammarberg, Wilmarth, are the older names of workers 
 contributing carefully sifted cases studied in the interest of feeble-mindedness. Most 
 authors deal with feeble-mindedness as a stalking-horse in some other scientific pursuit, 
 teratological, embryological, anatomical, histological, etc. We claim for the present work 
 that, despite numerous theoretical and ancillary interests, we have studied feeble-mindedness 
 from the stand-point of feeble-mindedness. In particular we have tried to place our cases 
 in a tentative order of mental strength, correlating brain appearances with mental tests. 
 Our purpose has been at least as much to evaluate the mental tests by throwing their 
 results against the brain pictures as it might have been to evaluate the brain pictures in 
 the light of mental tests. We may anticipate our conclusions so far as to say that, roughly 
 speaking, the architectonic order in which the brains arranged themselves corresponds 
 to the psychometric order indicated by the mental tests. 
 
 Thus, we must emphasize, we are not here studying the brain for the brain's sake, 
 or the mental tests for their sake alone. We have no eugenic, economic or social interests 
 paramount in the present inquiry. 
 
 This first series of ten cases is intended as an orienting and introductory series to a 
 more extended study which at present contemplates the examination by modern methods 
 of 40 more cases, to make up a series of 50, from which series it may be safe to draw pro- 
 visional conclusions. The first series has accordingly been made to include all available 
 material from several sources which was found to comport with certain necessities of 
 modern research in feeble-mindedness. 
 
 One might readily get the impression that the literature would be found to contain 
 enough properly examined material from which to draw conclusions. One would have in 
 mind the Bicetre reports of Bourneville, beginning in 1881 and continued at successive 
 intervals_for 20 years. One would have in mind the masterly work done in Sweden by 
 
WAVERLEY RESEARCHES. I. 
 
 27 
 
 Hammarberg and published after his death at Upsala in 1895. Another source of in- 
 formation would be the work done by Dr. A. F. Tredgold under the London County 
 Council early in this century and published in Mott's Archives of Neurology in 1903, 
 embodied in Tredgold's book on Mental Deficiency, second edition, 1914. 
 
 Then one would find the work of J. S. Bolton "On the Histological Basis of Amentia 
 and Dementia," published in the same volume of Archives of Neurology and later em- 
 bodied in a more popularized form in Bolton's book "On the Brain in Health and Disease," 
 London, 1914. 
 
 In the textbooks on feeble-mindedness, one would find numerous references to Italian 
 work in anatomy. In various textbooks one would find references to considerable work 
 on the anatomy of feeble-mindedness (see for example, the literary references in Ziehen's 
 account of "Diseases of the Brain and Meninges in Childhood," 1912). 
 
 In point of fact, however, the anatomy of feeble-mindedness has not been attacked 
 systematically over a period of years having due regard not only to clinical features, 
 but to anatomical and histological features. 
 
 On the whole, the remarkable developments in education of the feeble-minded fol- 
 lowing the initial work of Seguin have developed almost independently of the anatomical, 
 histological and physiological sides of the topic. With the developments of recent years 
 a tremendous emphasis has begun to be laid upon the hereditary and eugenic aspects of 
 feeble-mindedness, and a large effort has been expended upon certain applications of 
 psychology to the mental testing of the feeble-minded. But neither the hereditariana 
 nor the applied psychologists have particularly concerned themselves with the broader 
 biological aspects of the whole topic. We must confess that on the whole, the broader 
 biological aspects of feeble-mindedness have tended to be concealed in the mass of practi- 
 cal applications which the mental testing methods have unfolded and the web of promises 
 spun by the eugenist. Accordingly we face a situation with the feeble-minded in which 
 their education, their heredity, and the methods of their mental testing have absorbed 
 interest. In the spring of 1915, however, the note of research in this field was struck 
 at the National Conference of Charities and Correction, perhaps somewhat to the as- 
 tonishment of the listeners, who have been far more interested in social service than in 
 the more recondite aspects of research. However, educational research, eugenic research, 
 research in applied psychology, and sociological research, all need effort on the biological 
 basis. It seems as if this basis had been sadly and almost inconceivably neglected in the 
 past. 
 
 What is the present situation, biologically speaking? The biologist, if asked the 
 nature and measure of his interest in feeble-mindedness, would be apt to answer some- 
 
28 SOUTHARD. 
 
 what as follows: The institutions might supply us with a vast deal of material of the 
 greatest interest from such a standpoint, for example, as that of Ballantyne, whose funda- 
 mental collection of material on "Antenatal Pathology and Hygiene" was published in 
 1902 and 1904 respectively. There should be much, the biologist might continue, of 
 great interest from the standpoint of monstrosities, and the teratologist might be able to 
 unravel any number of intricate problems of the mechanics of development from the 
 anatomical material of institutions for the feeble-minded. He would have to consider 
 not merely the immediate pathology of the antenatal period, but also the postponed 
 effects which Ballantyne has emphasized, and not only the postponed effects in the neo- 
 natal period of life, but also its postponed effects upon still later life. 
 
 Ballantyne was able to determine important relations of antenatal pathology to no 
 less than seventeen departments of science (see his figure 3, page 18). Of the considera- 
 tions in TarufR's Storia della teratologia would come an application, and the further 
 development in studies of the idiot types with the methods available to modern research. 
 For example, the microscopy of all types of terata, described in chapters 14-30 of book 3 
 of Ballantyne's volume on the Embryo would get a new importance if proper histological 
 studies were carried out. But withal, the teratologist would be studying this material 
 from the standpoint of teratology and tissue mechanisms, and the fate of the feeble- 
 minded as such would not be visibly altered for the better in a long period of years. 
 
 The pathologist might see not only the importance of antenatal pathology in the 
 direction of monstrosities, but he might be greatly interested in what Ballantyne has 
 termed the intrusion of the antenatal factor in neonatal disease as shown by instances 
 of intracranial traumatism and intranatal infections (ophthalmia neonatorum, etc.). 
 The pathologist would also be interested in the neonatal infections, such as sepsis neo- 
 natorum, as also very particularly in what Ballantyne has called the disturbed antenatal 
 readjustments, such as icterus neonatorum, and the like. Here again the interest in the 
 anatomy of the feeble-minded would be an interest derived ab extra. The pathologist 
 must go to the specialist in feeble-mindedness for his material and carry his interest to 
 that material. Hence from the pathological side it can hardly be hoped that there will 
 be a tremendous flow of new work on this topic. 
 
 Again, the embryologist must be interested in the subject, as is clear throughout both 
 volumes of Ballantyne's work; but the embryologist has so far shown little interest in 
 what has sometimes been termed "late" embryology, confining his attention to the 
 plentiful and unsolved problems of the earlier months. Hence what happens to the hypo- 
 plastic organ in the viable victim of feeble-mindedness is of less immediate interest to the 
 embryologist by reason of the embryologist's comparative ignorance of late embryology 
 
WAVERLEY RESEARCHES. I. 
 
 29 
 
 in general and hence of the appearances in organs sufficiently developed to permit their 
 bearers to live. 
 
 It might be thought that the physiologist would take a tremendous interest in a 
 number of aspects of feeble-mindedness since he would perhaps be able to find the differ- 
 ential effects of imperfect glands of internal secretion and a variety of simplified phenomena 
 of nervous and circulatory reactions. On the whole, however, the physiologist probably 
 feels that his knowledge of these matters in laboratory animals remains too tenuous to 
 permit carrying the standard far afield in feeble-mindedness. 
 
 The zoologist and even the botanist of course have the greatest interest in the germ 
 cells, their development and interferences with their development. In various writers 
 one discovers tendencies to the thought that there is a pathology of the germ plasm which 
 at first sight spoils the simplicity of the Weismannian doctrines about the immortality 
 and comparative immutability of the germ plasm. The interest in eugenics has fortified 
 this interest, and no doubt all the germ cell biologists as well as the eugenists have fully 
 in mind the value of studies in the ancestry and familial traits of the feeble-minded. 
 Nevertheless these interests have not crystallized into a theory or plan of attack as to 
 feeble-mindedness. 
 
 Like the child in Kipling, each science or art above mentioned has mysterious errands 
 of its own; hence it seems likely that the workers in feeble-mindedness themselves must 
 organize then- own researches. Where then should research in feeble-mindedness begin? 
 There is no lack of interest in the education of the feeble-minded. There is no lack of 
 interest in various forms of social service, whether it takes shape as help for the individual, 
 aid to the public purse, or an attempt to safeguard society. There is no lack of interest 
 in heredity and eugenics. There is no lack of interest in the general administrative 
 problem which offers one of the most productive regions for the administrator in the 
 whole field of public service. There is no lack of interest in applied psychology as it has 
 culminated in such mental tests as those of Binet, de Sanctis, Healy, Terman, and Yerkes. 
 Little, however, has ever been said in favor of a consistent attack on the anatomy and 
 physiology . of the feeble-minded. 
 
 The present researches form a comparatively modest introduction to that highly 
 desirable attack upon the physical aspects of feeble-mindedness which have been so in- 
 conceivably neglected in the past. We feel that it is wise to concentrate attention upon 
 brain anatomy for the present, despite the fact that the ultimate value of physiological 
 work, notably in the field of the glands of internal secretion may be immeasurably greater. 
 However, in a number of fields of neuropathological and psychiatric research, we have 
 found that much time can be saved if the physiologist and clinician can have the advantage 
 
30 SOUTHARD. 
 
 of knowing whether they deal on the one hand with entirely abnormal brains or on the 
 other hand with relatively normal ones. This dichotomy of the material is rather apt 
 to leave one with three groups of material, — a) material with gross lesions of an obvious 
 and striking nature; b) material with lesions of a doubtful and questionable character, 
 and c) material without obvious evidence of disease. The worker, whether he deal with 
 insanity, epilepsy, criminal anthropology or any other major field touching the nervous 
 system, finds it convenient to utilize various fundamental studies in the two limiting 
 groups in the series, viz., the group of cases with obvious gross lesions and the group of 
 material with no obvious lesions. He must leave the intermediate or non-interpretable 
 group on one side at the beginning of his research. 
 
 The topic of feeble-mindedness is rendered difficult by the fact that the observer 
 apparently cannot compare abnormal material with normal looking material just by 
 reason of the absence of any normal looking material. At least an observer like Tred- 
 gold remarks that he has never "yet seen the brain of an idiot, a low or even medium 
 grade imbecile which could be regarded as normal upon careful naked-eye examination" 
 (of course it will be noted that Tredgold does not here speak of the imbeciles of higher 
 grade and of the feeble-minded proper). It is safe to say that from the literature one 
 cannot for the present assert whether or not the brains of imbeciles of higher grade, of 
 the feeble-minded proper or so-called morons, or of the dullards or simple-minded per- 
 sons who grade somewhat higher than the former, have normal looking brains. Beyond 
 question, however, most workers distinguish at least roughly between the idiots and 
 imbeciles of lower grade who are virtually bound to show obvious brain lesions, and the 
 higher grades of feeble-minded, who may or may not show such lesions. In either case 
 there is a tendency to the belief that amongst the higher grades will be found persons 
 whose feeble-mindedness tends toward functionality as a limit. There is a tendency to 
 the belief that the higher grades of feeble-minded are persons whose brains are fairly well 
 developed in the sense of having a full complement of cells like their normal brethren, 
 but whose cells do not for some reason work properly or have not, for some reason, devel- 
 oped their full panoply of processes. That there is a group of feeble-minded subjects 
 that in a sense correspond to idiopathic epileptics or to the so-called functional psycho- 
 paths (for example, victims of manic depressive psychosis of modern conception), or like 
 the delinquents whose brains are working, as it were, perversely, without structural basis 
 for the perversity, amounts even to a working hypothesis with many observers. Upon 
 this working hypothesis is founded a number of conceptions as to the educability and 
 comparatively good prognosis of certain feeble-minded subjects "under proper condi- 
 tions" or with an "improved environment." Whether there is an environmental group 
 
WAVERLEY RESEARCHES. I. 31 
 
 of feeble-minded subjects, whether there is, as it were, an idiopathic or functional group 
 of these cases, is an open question. Just as we suspect that there are frank psychoses 
 which have their bases not in structural brain disorder but in exogenous factors working 
 from outside the brain, so we may theoretically conceive that there are feeble-minded 
 subjects in the same logical group. However, in a general way, the concept of "discords 
 played on a good instrument" is not a concept which appears to have a wide scope in 
 feeble-mindedness. 
 
 The literature does not lack work of a systematic and comparative nature upon idiocy. 
 One has only to remember the work of Hammarberg above noted. The literature lacks 
 consistent studies of feeble-mindedness of higher grade from the anatomical and histologi- 
 cal points of view. This task should be one of the major ones of the present undertaking. 
 Hammarberg's work was one of the first pieces of work not only in the anatomy and 
 histology of feeble-mindedness but in the topographical histology of the nervous system. 
 The topographical histology of the nervous system has only been thoroughly staked out 
 within the present century. The idea of the brain's differential topography doubtless 
 lay completely in the minds of such workers as Bevan Lewis, Betz, Meynert, Cajal and 
 Nissl in the nineteenth century. Early in the present century, systematic works like 
 those of Campbell, Brodmann and Cajal began to appear and to have currency. These 
 works on topographical histology were supported by such brain anatomists as Elliot 
 Smith and Ariens Kappers, as well as by the comparative anatomist, Edinger. The 
 idea of cerebral cortex mapping, of a kind of cartography of the brain, has now obtained 
 a firm foothold in neurology and neuropathology. It must, however, be accredited to 
 the science of feeble-mindedness that the lamented Hammarberg was one of the first 
 histologists who saw the importance of such cortex mapping and began his work upon 
 the material of idiocy. To be sure it will be many years before a properly equipped 
 institute carries out the inchoate aims of Hammarberg and the aims which we can all 
 now so clearly see when we associate in conception the material of feeble-mindedness with 
 the modern differential work on cortex structure. 
 
 One of the most fruitful distinctions in feeble-mindedness of the present day is that 
 of Tredgold, who, seeing the inadequacy of the distinction of the feeble-minded into con- 
 genital and acquired cases has replaced this dichotomy with a new and different one, 
 namely, with a division into what he calls primary and secondary amentia. 
 
 The primary aments are victims of what is sometimes termed "germinal blight," 
 whereas the secondary aments are victims of some cause working from outside the brain. 
 The primary ament, according to Tredgold, has cells with an intrinsic vital deficiency, — 
 cells which are unable to develop. The secondary ament is the victim of arrest, due to 
 
32 
 
 SOUTHARD. 
 
 some external cause. One might say that the cells of the ament, if this distinction of 
 Tredgold can be upheld, have "run down" or ceased to develop at a certain point, 
 whereas the cells of the secondary ament have not run down of themselves, but have 
 run counter to some agent; that is, the cells have not ceased to develop, they have been 
 stopped. The distinction reminds one of the simple nomenclature apparently introduced 
 into neurology by Moebius, namely, the distinction between cases of endogenous and 
 cases of exogenous origin. One deals, as it were, with a plastic impotence, an agenesia, 
 in the case of the primary ament; one deals with a sort of plastic arrest or aplasia in the 
 case of the secondary ament. 
 
 The value of this distinction of Tredgold's is that the older heterogeneous anatomical 
 classifications of the feeble-minded, such as were, for example, available to W. W. Ire- 
 land in his book on the "Mental Affections of Children" can be supplanted by a simpler 
 classification with a number of new research possibilities. Ireland, for instance, speaks 
 of genetous idiocy, namely, idiocy in which the disease condition which entails deficiency 
 of mind is complete before birth, and in which accordingly the presumption of the heredi- 
 tary connection is stronger than in other forms. Another chapter deals with micro- 
 cephalics, a third with hydrocephalics, a fourth with eclampsic idiots, a fifth and sixth 
 with epileptic and paralytic idiots, and further chapters with traumatic, inflammatory, 
 sclerotic, syphilitic and cretinistic idiots, and the last chapter with what Ireland terms 
 idiocy by deprivation (namely, that condition of mind in which a child remains who is 
 deprived of two or more of the principal senses). 
 
 According to Tredgold a great number of the intrauterine causes of feeble-mindedness 
 are, as it were, equally exogenous to the feeble-mindedness as would be a cause operating 
 early after birth. The antenatal and neonatal pathology of feeble-mindedness would 
 have to be separated into a congenital and acquired group forthwith, unless we adopt 
 Tredgold's distinction and consider that numerous antenatal causes, such as foetal sepsis, 
 foetal syphilis, and the like are just as secondary in their effects as would be these condi- 
 tions in the neonatal period. Tredgold accordingly distinguishes an intrinsic from an 
 extrinsic group and would probably subscribe to Moebius' terms "endogenous" and 
 "exogenous" as equivalents of his own. In his original discussion of amentia in Mott's 
 Archives in 1903, he had already practically distinguished the intrinsic forms as due to 
 the condition of the germ plasm and the extrinsic forms as due to the environment, which 
 environment he divided into antenatal, intranatal and postnatal. But in his textbook 
 Tredgold states that the real question is as to the respective influences exerted by heredity 
 and by environment and proposes that the terms "congenital" and "acquired" be given 
 up. Tredgold defines extrinsic causes as any factors of the environment which are cap- 
 
WAVERLEY RESEARCHES, t. 38 
 
 able of prejudicially affecting the brain development of the offspring after conception 
 has taken place, whether these factors be intra or extra-uterine. Amentia due to such 
 causes, Tredgold terms extrinsic or secondary amentia. 
 
 Tredgold's employment of the term "hereditary" is possibly somewhat special to 
 him. Primary amentia Tredgold regards as not "due to absence or suppression of some 
 specific germ determinant" such as some Mendelians assert, but "as resulting from a 
 diminished germinal vitality in consequence of which development tends to be incom- 
 plete." Inheritance takes the form of the "neuropathic diathesis or innate predisposi- 
 tion to neurotic imperfection." As to the origin of the germinal impairments that lie 
 at the foundation of the intrinsic or primary group of Tredgold, we have a number of 
 possibilities. The Royal Commission on Feeble-mindedness decided that "both on the 
 ground of fact and of theory, there is the highest degree of probability that feeble-minded- 
 ness is usually spontaneous in origin, that is, not due to influences acting on the parent — 
 and tends strongly to be inherited." Tredgold regards this as a confession of ignorance. 
 He, however, looks upon the hypothesis of Davenport that "feeble-mindedness is not a 
 new variation, but a perpetuation of strains defective from the beginning" as not ten- 
 able. Tredgold regards the germinal variations in the parents of the feeble-minded as 
 pathological variations, as a vitiation and not spontaneous. He regards this vitiation 
 as primarily due to the action of the environment, quoting the work of Paul on lead 
 poisoning, the work of Fere' on the effect of alcohol on incubating eggs, the more recent 
 work of Stockard upon guinea pigs and other similar work. Not only may the germ 
 cells be poisoned, but they may be altered by a variety of physical conditions, such as 
 temperature and non-toxic chemical agents. Whether or not Tredgold's conception of 
 the causes of what he has termed germinal blight are as he thinks environmental, there 
 can be no doubt that it is extremely valuable to separate out all definitely exogenous 
 cases from a residue whose cause may be left undefined. 
 
 What now can we see in the brains of primary as opposed to secondary aments? 
 In the secondary types of feeble-mindedness, we shall often see effects of inflammation, 
 appearances like that of porencephaly, hydrocephalus, and the like, which must appeal 
 to us as flowing from causes operating from without and indicating no essential vital 
 deficiency or vitiation of germ plasm, and we shall be greatly interested to determine 
 the nature of these exogenous processes and the quality and extent of their effects upon 
 the brain map. In the light of these irregularly deficient brains we should, under ideal 
 conditions, be immensely interested to learn whether the mental states of the bearers 
 of these brains also show functional cut-outs and losses to correspond with the irregular 
 defects of the brain lesion. A tremendous number of neurological problems will be settled 
 
34 
 
 SOUTHARD. 
 
 and a deep vista of new problems can be predicted. Moreover, we should learn much 
 by extended study of these secondary cases from the standpoint of what is termed in 
 the German " Korrekturbildung. " We shall namely be interested in discovering what 
 effects may be wrought by the lack of structure A upon the condition of structure B 
 which, under normal conditions, grows in structural and functional relation to A. 
 
 But suppose there be no demonstrable exogenous processes and no basis for sup- 
 posing an exogenous process in a given case. What now will be found in the brain? 
 
 The literary sources of information from which to answer this question are not 
 numerous. We must first resort to Bourneville's volumes on Researches in Epilepsy, 
 Hysteria and Idiocy, published in the form of Reports from the Bicetre, beginning in the 
 year 1881. These reports contain numerous cases reported as fully as the state of sci- 
 ence permitted. The majority of the autopsy reports in the earlier years deal with 
 epileptics. Numerous remarkable cases of tuberous sclerosis (sometimes called Bourne- 
 ville's Disease) are described and photographed. The majority of these cases of tuberous 
 sclerosis were victims of epilepsy or of convulsions in some form. Numerous reports 
 are scattered through the series dealing with myxedematous idiocy. Through the 
 eighties Bourneville's reports contained few instances of case reports in which convul- 
 sions were not prominent. In the nineties began to appear more numerous reports of 
 idiocy and epilepsy without convulsions. Special studies of hydrocephalus, porencephaly 
 and microcephaly appear, and the term "symptomatic idiocy" is frequently used in 
 connection with such cases. 
 
 In 1891 Bourneville presents in his 11th volume an anatomical classification of idiocy 
 (communicated at the International Congress of Mental Medicine in 1889) which classi- 
 fication has 8 chief heads, as follows : — - 
 
 Idiocy symptomatic of hydrocephalus; of microcephalus; of arrest of convolutional 
 development; of congenital malformation of the brain (porencephaly, absence of corpus 
 callosum, etc.); idiocy symptomatic of hypertrophic or tuberous sclerosis; of atrophic 
 sclerosis (A, of one or both hemispheres, B, of one brain lobe, C, of isolated gyri, D, of 
 scl6rose chagrine" du cerveau); idiocy symptomatic of chronic meningitis or meningo- 
 encephalitis; and finally, idiocy with pachy dermic cachexia (myxedematous idiocy con- 
 nected with absence of the thyroid gland). It can readily be seen how much of this 
 classification, which is based upon fifteen years of work at the SalpetriSre and at the 
 Bicetre, has relation to those aments whom Tredgold would readily call secondary aments. 
 Bourneville and his collaborators have published excellent photographs of many of the 
 cases in this series of volumes. From time to time, histological descriptions of a relatively 
 elaborate nature accompany the reports and deal with questions of neuroglia prolifera- 
 
WAVERLEY RESEARCHES. T. 35 
 
 tions and the like in quite the modern manner, which is the more remarkable since much 
 of the work was done before the vogue of neuroglia studies begun by the publication of 
 Weigert's book on Neuroglia in 1895. 
 
 The reports of the nineties are filled especially with accounts of idiocy symptomatic 
 of atrophic sclerosis and of chronic meningitis. Reports upon congenital idiocy are on 
 the whole infrequent in Bourneville's volumes. Such a case published in volume 13, 1893, 
 by Bourneville and Dauriac was, for example, a congenital epileptic idiot, which was 
 almost completely asphyxiated at birth, began to walk at 8 and completed dentition 
 at 10. This idiot had had convulsions at 8 months followed by incomplete paralysis 
 of the right side. Contractures of all limbs with athetotic movements had supervened. 
 Double craniectomy was performed for therapeutic purposes in the thirteenth year. The 
 autopsy showed, besides the effects of the operation, a cerebral atrophy (weight 855 
 grams), or as Bourneville says, the autopsy findings may perhaps better be said to have 
 confirmed the diagnosis "arrest of brain development" made during the patient's life. 
 There were no areas of sclerosis or induration and this fact is taken by Bourneville to 
 corroborate the clinical evidence as to the absence of any severe convulsions. There 
 were, however, certain leathery appearances in some gyri, notably in the left parietal and 
 frontal regions and in the right frontal and temporal sphenoidal regions. 
 
 From such a description and from Bourneville's own remark as to the possible diag- 
 nosis of cerebral atrophy, it can readily be seen that such a case very possibly belongs 
 in the group of secondary aments of Tredgold, although the condition may well have 
 been congenital in the usual acceptance of that term. 
 
 In 1895 Bourneville and LeNoir published an example of so-called complete con- 
 genital idiocy with paraplegia, contracture and deformity of feet. The brain of this case 
 is described by Bourneville as having been reduced to the greatest simplicity, "virtually 
 down to the elementary convolutions." Although these convolutions are in general 
 voluminous, even strikingly voluminous, and the sulci are of a proper depth, annectant 
 convolutions are almost completely lacking. Plates are presented of this case which 
 died at 18. 
 
 In 1896 Bourneville and Ruel present another case of "complete idiocy," probably 
 congenital. The brain showed neither meningitis nor focal lesions. 
 
 In 1897 Bourneville and LeNoir again published a case of congenital idiocy due to 
 arrest of development, and state that the brain reveals no macroscopic lesion. Never- 
 theless its morphology is rudimentary and the arrangement of the convolutions is in 
 many places abnormal. These might serve as examples of the few available reports 
 concerning cases of so-called developmental arrest to be found in Bourneville's series. 
 
36 SOUTHABD. 
 
 Although he terms these cases congenital and speaks of some of them as victims of de- 
 velopmental arrest, they seem on the whole to stand nearest to the cases which Tredgold 
 would be inclined to term primary aments. The number of cases of myxedematous 
 idiocy and of various forms of so-called symptomatic idiocy with atrophic sclerosis and 
 meningitis continue far to outnumber the cases of congenital nature. In passing one 
 can only comment with admiration upon the breadth of Bourneville's general plan of 
 attack on his problem, combining as it does the clinical, therapeutic and anatomical 
 ideals. 
 
 We shall now naturally turn to Hammarberg for evidence as to the essential nature 
 of these two groups of cases, whether on the one hand we adhere to the older distinctions 
 of congenital and acquired cases, or adopt the more modern distinction of primary and 
 secondary amentia proposed by Tredgold. 
 
 Hammarberg's monograph was published in Upsala in 1895, edited by Henschen, 
 after the death of the author from appendicitis. His work appears to have been done 
 a few years after his graduation in medicine and to represent a comparatively brief period 
 of intensive endeavor. His report deals with 9 cases. He believed that he could prove 
 in all cases that the psychic defect could be connected with defective nerve cells in the 
 cortex. The cortical deficiency he considered to be due either to a standstill in devel- 
 opment at some antenatal or early neonatal stage, in consequence of which but a small 
 number of cells were permitted to arrive at high development. He admitted the possi- 
 bility that cells might be destroyed during the process of mal-development. 
 
 In some cases development had been checked in small regions by agents working 
 in a limited and local manner, but in such wise that the total development of the cortex 
 had been unfavorably influenced. If the check in development occurred in the latter 
 stage of foetal life, psychic development in the subject became impossible and these cases 
 are grouped as idiots, "blodsinnig", in group A. Since the inhibiting factor acted unequally 
 in different parts of the developing brain, a variety of disorders in the cranial nerves in 
 locomotor capacity and in sensibility, such as were found in many cases, were explicable. 
 
 In a second group of cases the cortex had not been permitted to arrive at a degree of 
 development more than one normal for the first years of life. These are cases which 
 Hammarberg groups as markedly weak-minded (in hohem grade Schwachsinnige) . Such 
 cases also exhibited the same irregular cranial motor and sensory disorders. 
 
 A third group of cases is a group in which the inhibitory factor is thought to occur 
 during the first year of life and to affect only a small region of the brain. The rest of 
 the brain is regarded as developing properly in all directions, except that the number of 
 cells seems to remain smaller than normal. The psychic result is that the patient is 
 
WAVERLEY RESEARCHES. I. 37 
 
 inactive and less developed than a normal person of the same age. These are cases 
 classified under B 2, as moderately and slightly weakminded {massig und in geringem grade 
 Schwachsinnige) . Similar peripheral disorders are found in these cases also. 
 
 The idiots of Hammarberg's series number 4, 
 
 The markedly weakminded, 2, 
 
 The moderately and slightly weakminded, 3. 
 
 Although there are a number of drawings of gross brains in plates 6 and 7 of 
 Hammarberg's monograph, the chief direction of Hammarberg's research is microscopic. 
 Excellent drawings to scale of preparations from various areas of the cortex, stained by 
 methylene blue, are presented in plates 1 to 5. Plates 1, 2 and 3 deal with the normal 
 cortex (since it must be remembered that Hammarberg's work antedated the cerebral topog- 
 raphy of late years) and deal with superior and inferior frontal gyri, with the precentral 
 gyrus, the superior temporal, the superior and inferior parietal and superior occipital gyri, 
 the central lobe, hippocampal gyrus, the fascia dentata, cornu ammonis, fascia cinerea, 
 the gyrus cinguli and the gyrus centralis superior. 
 
 The pathological plates are 4 and 5 and contain 15 drawings to scale of a number 
 of the above mentioned areas. The whole work is but a torso of what Hammarberg 
 would doubtless have accomplished had he lived. 
 
 A number of Hammarberg's observations as to the microscopy of feeble-mindedness 
 exhibit a very modern insight. For example, he dismisses the frequently expressed 
 notion that the pericellular and perivascular spaces are enlarged about the brain cells 
 of idiots, whether in consequence of lymphatic stasis or of cellular atrophy. He regards 
 these features as shrinkage processes, finding them to occur only in material which had 
 at some stage been placed in alcohol of marked concentration, and finding similar changes 
 to occur in normal persons. These findings, then, are dismissed by Hammarberg as arte- 
 facts, and it is probable that all modern workers will agree with him. 
 
 A second statement to be found in the literature preceding Hammarberg and to 
 some extent since his day is that the brain cells of the cortex in idiocy present a disor- 
 derly or imperfect arrangement, so that the apical processes he at right angles to their 
 normal direction or obliquely. Hammarberg discovered that identical appearances 
 might be found in entirely normal material, noting especially that in the inferior frontal 
 gyrus and the hippocampal gyrus such apparent disorder in the orientation of cells is 
 normal. 
 
 A third question of contention in the literature deals with the occurrence of cellular 
 atrophy, vacuole formation and pigmentary degeneration, but such changes as these were 
 found by Hammarberg in but one of his 9 cases, and he notes that undeveloped cells have 
 
38 SOUTHARD. 
 
 frequently been taken for atrophic ones, especially if at the same time an imperfect 
 technique has produced the artefact of dilated pericellular spaces. 
 
 Hammarberg accordingly dismisses the idea that the nerve cells of the idiot and 
 imbecile do not fill enough space in the cerebral cortex in which they are embedded, that 
 they are especially subject to irregular orientation therein, and that they are necessarily 
 subject to atrophy, vacuole formation or pigmentary change. 
 
 Hammarberg' s conclusions then deal with four cases of idiocy, namely, subjects 
 deficient in all the higher psychic functions and incapable of psychic development. In 
 three of these cases the greater part of the cortex was in a stage of development normally 
 found in the last half of intra-uterine life. In a fourth case development had, according 
 to Hammarberg, progressed farther and had reached a stage found normally in the first 
 year of life; but in this case a process had occurred which had reduced development back 
 to the same stage as in the other three cases. 
 
 The second group of cases, two in number, is a group of markedly weak-minded 
 subjects, whose mental life corresponds to that of normal individuals of one to five years 
 of age. Their cortex was found, according to Hammarberg, to be in a stage of develop- 
 ment found in normal individuals during the same years. 
 
 The three cases of the group of moderately or slightly weak-minded are cases in which 
 the mental functions are sluggish and somewhat less developed than in normal individuals 
 of the same age. Such subjects are capable of a certain amount of education. Their 
 degree of development, from a mental standpoint, might readily be compared to any 
 special stage of development in normal individuals. According to Hammarberg, the 
 number of nerve cells in the greater part of the cortex is much less than normal and the 
 remarkable feature of the general brain situation is that in one particular region the cor- 
 tex will be found to be in a stage of development normally appearing in the very first year 
 of life. Here then a number of claims appear which would be well worth substantiating 
 by extensive studies. 
 
 The most elaborate recent statement concerning feeble-mindedness is that by 
 Tredgold in his book on "Mental Deficiency". The ideas are largely based upon special 
 work as published in Mott's Archives of Neurology, Volume 2, 1903, carried out in the 
 Claybury Pathological Laboratory during two years' tenure of the London County 
 Council Research Scholarship in Insanity and Neuropathology. Mention has been made 
 above of Tredgold's conception of primary and secondary aments. He regards the essen- 
 tial basis of primary amentia as cellular. Such gross conditions as porencephaly, hydro- 
 cephalus, microgyria, hemiatrophy, and the like, are of course frequently associated with 
 amentia, but they are, according to Tredgold, accidental associations therewith. "The 
 
WAVERLEY RESEARCHES. I. 39 
 
 essential basis of amentia is an imperfect or arrested development of the cerebral neurones." 
 Tredgold calls attention to numerical deficiency in cells (compare Hammarberg's work), 
 to irregular arrangement of cells and to imperfect development of cells, giving rise to the 
 frequent appearance of certain cells first described by Bevan Lewis, or to some still more 
 ill-developed cells which correspond with early neuroblasts. Tredgold states that the 
 amount of change discoverable by the microscope is directly proportionate to the degree 
 of mental deficiency present during life. Tredgold also ascribes importance to pig- 
 mentation, believing that it is an indication of defective metabolism in which anabolic 
 processes cannot keep pace with the catabolic. 
 
 Hammarberg and Tredgold are accordingly in apparent discord as to the significance 
 of irregular arrangement of nerve cells. Tredgold believes that his own experience as 
 well as that of several others makes it clear that an irregular and haphazard arrangement 
 of cortical cells is very characteristic of the condition. He states that such irregularities 
 are found often where there is no accompanying sclerosis. This problem of the irregular 
 arrangement of nerve cells and its significance accordingly remains a problem in the 
 minds of many workers. Doubtless Tredgold would agree with Hammarberg as to the 
 non-characteristic nature of the pigmentation found. 
 
 As to two points, Hammarberg and Tredgold are then in comparative agreement, 
 namely, that numerical deficiency in nerve cells is a major feature in brains of feeble- 
 mindedness and that the cellular appearances indicate imperfect development. If we 
 consider the problem from the point of view of these two authors, accordingly, we must 
 spend a maximum of attention on the number of cells and on the qualitative appearances 
 therein. 
 
 We cannot pretend at this time to deal with the literature of the anatomy of feeble- 
 mindedness with any completeness, although we have had the advantage of the relatively 
 complete index of the literature of feeble-mindedness possessed by the Waverley School, 
 from which we have abstracted over eight hundred references which deal pretty speci- 
 fically with anatomical problems. We present below a selection from these anatomical 
 references, having chosen those that relate more especially to the types of case considered 
 in the first series of ten cases. The outstanding work of Bourneville and of Hammarberg 
 as above mentioned, and the systematic treatment of Tredgold, do not by any means 
 exhaust the anatomical interests of feeble-mindedness as presented in readily accessible 
 literature. A book of strongly anatomical trend is that of W. W. Ireland called "Mental 
 Affections of Children", wherein are given a number of points of view of permanent value. 
 Ireland's classification has been given in brief above in the discussion of Tredgold's point 
 of view. 
 
40 SOUTHARD. 
 
 Below we shall consider some American work in the field, before which it may be 
 thought desirable to consider the status of the anatomy of feeble-mindedness as presented 
 at the thirteenth international medical congress held in Paris in 1900. The eighth volume 
 of the Comptes Rendus is devoted to psychiatry. There were three special questions 
 proposed to the psychiatrists at this congress, one of which was the question of the patho- 
 logical anatomy of idiocy. Reports by Mierzejewski, of St. Petersburg, of Shuttle- 
 worth and Fletcher-Beach of England, and of Bourneville, were presented, with a special 
 contribution to histopathology by Philippe and Oberthiir. 
 
 Mierzejewski considered that Bourneville's classification based upon coarse changes 
 in the brain might well correspond to practical needs, but that a histological classification 
 based upon special studies and upon exact embryological conceptions was sure to develop 
 in the future. Mierzejewski considered that the basis of every anatomical lesion in the 
 idiot's brain is a developmental deviation in the nerve tissue. Its origin must be sought 
 in embryonic life or in disease occurring in earliest infancy. There could be no question 
 of any true arrest of development without its morphological and histological basis in the 
 entire brain. There could be determined, however, a true arrest of development in 
 certain regions as indicated by the presence of neuroblasts. Mierzejewski went on to 
 describe a particular group of cases, namely: those in which the white substance of the 
 cerebral hemispheres is well developed but the gray matter of the cortex is distinguished 
 by appearing in enormous and disproportionate amount. It was true that such brains 
 belonging to microcephalic or demi-microcephalic subjects as a rule showed small con- 
 volutions (microgyria), but there were cases of this disproportionate development of the 
 cortex in which there was no microgyria. Mierzejewski had published the first case of 
 this nature in the Comptes Rendus of the international congress at Geneva in 1877. 
 
 The Mierzejewski type of idiot brain is characterized by a fairly developed centrum 
 semiovale, an enormous distension of the ventricles, with the cerebral hemispheres trans- 
 formed into a species of thin-walled vessel, 15 or 16 mm. thick. In such extreme examples 
 as this, there is always microcephaly as well as microgyria, but there are other cases in 
 which the white substance of the hemispheres is not so shallow and in which microgyria 
 is absent. In such cases, finer methods will determine a lack or insufficient development 
 of transverse intracortical medullated fibres. In von Monakow's case, there were neither 
 any tangential fibres nor any striations of Vicq-d'Azyr. In other cases these structures 
 were more or less well developed. 
 
 The situation was identical with the short and long subcortical association fibres, 
 absent in certain examples, more or less developed in certain others. The radial bundles 
 also varied in their development in these cases. 
 
WAVEBLEY RESEARCHES. I. 
 
 41 
 
 The gray matter presented at first sight the appearance of making up for the insuf- 
 ficiency of the white, sometimes presenting all its characteristic layers with perfect dis- 
 tinctness; in other cases presenting irregularity of arrangement. 
 
 The distinguishing feature of these hemispheres was the interpolation of a layer 
 between the centrum semiovale and the cortex, of an intermediary strip of the so-called 
 neuroblasts; or in certain cases, a layer of cells resembling those of the lower layers of 
 the cortex, but irregularly arranged. In one case there had been interposed between the 
 new layer and the overlying cortex a separate strip of white matter. This condition of 
 affairs is called heterotopia of the gray matter. Although this particular form of hetero- 
 topia is diffuse, it does not resemble that more frequent form of heterotopia in which 
 there are islets of ganglion cells scattered through the white matter. The microcephalic 
 cases of microgyria show the interpolated layer to be formed of "neuroblasts." The 
 demi-microcephalics have cells in the interpolated layer which resemble the so-called 
 polymorphous cells of the undermost layer of the normal cortex. 
 
 This Mierzejewski type of microcephaly is accordingly distinguished from the ordi- 
 nary microcephalic brain in that the proportions between gray and white matter, more 
 or less well observed in the usual case, are not preserved in the Mierzejewski types. The 
 demi-microcephalics according to Mierzejewski resemble the normal more closely in that 
 the arrest of development on the part of the white matter is of slighter degree and is 
 accompanied by a diffuse subcortical heterotopia of gray matter. But the principle is 
 identical in both types of case. 
 
 Mierzejewski goes on to describe in more detail certain microscopic findings in a 
 fresh case of the disease, and then sums up somewhat as follows : Idiocy may in certain 
 instances accompany a condition in which the gray matter is extremely rich and in which 
 there is an abundance .of nerve cells. In these cases the commissural system of the con- 
 volutions is arrested in development so that there are not a sufficient number of paths of 
 intercommunication and there is a disharmonious development of the different nervous 
 elements. In the central nervous system, quantity alone does not count, but quality 
 of elements and quality in their reciprocal combinations are the things that count. The 
 white matter is nothing but a mass of prolongations of the nerve cells; accordingly rich- 
 ness of the dendritic branchings and of axis-cylinders of cells is the condition which most 
 favors the plentiful development of white matter; and when these ramifications are few 
 in number, the development of the white matter is insufficient. One of the chief condi- 
 tions for irregular processes would then appear to be the multiplication and broad expanse 
 of the connections of the pyramidal cells. Mierzejewski attributes to Dejerine the idea 
 that intellectual supremacy seems to be the result, not so much of the number of cells, 
 
42 SOUTHARD. 
 
 as of the multiplicity and extent of their inter-connections. The idiot may have cells 
 enough though these are deprived of their proper branchings. Mierzejewski throws out 
 the suggestion that some of the neuroblasts lying below the normal-looking cortex may 
 now and then proceed to a further development, and thus explain the occasional notable 
 amelioration of mental faculties found in idiots. 
 
 The report of Shuttleworth and Fletcher Beach presents a classification of the 
 pathological anatomy of idiocy under three main headings: (a) Congenital; (b) De- 
 velopmental; (c) Acquired or accidental. Among the congenital cases Shuttleworth 
 and Beach enumerate eight forms. 
 
 The microcephalic form contains cases with cerebral hemispheres shortened in such 
 wise as to reveal the cerebellum viewed from above, with such hindrance of development 
 during intrauterine life (probably between the third and fourth months of pregnancy) 
 as to disturb the later growth of the hemispheres as well as the detailed development of 
 those parts which had been already formed. It is perhaps the temporo-sphenoidal and 
 occipital regions which suffer most (as to the occipital region, Cunningham and Telford- 
 Smith are quoted). Microcephaly is probably not caused by the premature synostosis 
 of the cranial sutures. On the other hand, the development of the brain is probably 
 the determining factor as to the form of the cranium (H. A. Humphrey). Microscopi- 
 cally one finds simply rounded or oval cells or cells with but few dendrites. 
 
 A second form of congenital disease is hydrocephalus, both that due to antenatal 
 and that due to postnatal conditions. According to Meynert, congenital hydrocephalus 
 extends the lateral ventricles lengthwise, while acquired hydrocephalus stretches the 
 ventricles vertically and transversely. Cases of Bourneville, Beach, and Alexander Hill 
 are quoted. 
 
 A third form of congenital disease is scaphocephaly, a condition possibly due to a pre- 
 mature union of the sagittal suture with an exaggeration in the growth of the coronal and 
 lambdoid sutures in such wise that the head is elongated from before backwards, and 
 may sometimes increase in height. But, on the other hand, this condition may possibly 
 be the result of an original elongation and narrowness of the cranium, such as may be 
 found in the natives of New Caledonia, the New Hebrides, and the Carolines. Sir W. 
 Turner is quoted to the effect that this cranial form is due to intrauterine causes, such 
 as inflammation or injury of the mother during pregnancy. Scaphocephaly does not 
 necessarily produce idiocy, and an approximation of this form of skull may be found in 
 North American tribes due to artificial compression. 
 
 A fourth type of congenital disease is the Mongolian type, with its special bony, 
 cutaneous, mucosal, and cardiac conditions. Brachycephaly, approximately circular 
 
WAVERLEY RESEARCHES. I. 43 
 
 in circumference, with a tendency to parallelism of the parietal and occipital surfaces, is 
 noted. The skull is thin. There is an anomalously short little finger with lateral incurving 
 displacement of the terminal phalanx. The skin is coarse and scaly, the mucous mem- 
 brane irritable, the tongue is long, marked with deep folds, due to hypertrophy of papillae. 
 Cardiac lesions are cited from cases of Garrod and of Thompson. Wilmarth's work is 
 quoted as to the brains, which are said to show a very small pons and medulla, as well 
 as very thin vessels. Shuttleworth thinks that these Mongolian idiots are essentially 
 unfinished children, and that their singular appearance is that of a phase of foetal life. 
 
 The fifth form of congenital case is the so-called genetous or congenital neuropathic 
 form, the offspring of neurotic parents. These cases are said to show very early in life 
 excessive irritability, insomnia, attention disorder, and loss of self control. Such sub- 
 jects are said to show microgyria at autopsy. 
 
 The sixth type is the type of amaurotic family idiocy of Tay and Sachs. 
 
 The seventh form is that of sporadic Cretinism. 
 
 The eighth form is a form presenting partial and local atrophies. Examples are ab- 
 sence of corpus callosum, porencephaly, cerebellar aplasia, and the like. 
 
 In addition to congenital cases Shuttleworth and Beach then consider the develop- 
 mental group, under which they consider eclamptics, epileptics, syphilitics (including 
 juvenile paresis) and paralytics. 
 
 They consider that the lesions found in eclamptic cases associated with the severe 
 convulsions of dentition are local hemorrhages and adherent membranes which are 
 inconsistent with the normal nutrition of the gyri. As for the epileptic group, the work 
 of Bevan Lewis, of Andriezen, and of Echeverria is quoted. 
 
 Syphilis, they consider, is not a common cause of idiocy, but juvenile general paresis 
 they regard as commonly caused by syphilis. They state that since Clouston first de- 
 scribed this latter disease, there have been about 100 observations published. 
 
 The majority of the paralytic group of the developmental cases are of postnatal 
 origin. These cases are attributed to inflammation of the brain or the meninges. 
 
 In the third group of accidental or acquired cases, Shuttleworth and Beach consider 
 three forms: traumatic, postfebrile, and sclerotic. 
 
 The traumatic cases are due to compression of the head during prolonged labor or to 
 the forceps. The lesions are situated as a rule in the Rolandic region. Small hemor- 
 rhages occur which are followed by degeneration and sclerosis. In the cases of cerebral 
 diplegia, the most frequent cause is a meningeal hemorrhage especially affecting the 
 veins between the pia mater and dura mater in the longitudinal sinuses, in such wise that 
 the hemorrhage in finding its way into the great fissure compresses the upper borders 
 
44 SOUTHARD. 
 
 of the two hemispheres. The opinion of Osier and of Jacobi is quoted: that certain of 
 these cases are actually due to foetal meningoencephalitis. Intelligence need not be 
 markedly affected despite the severity of the physical disease. 
 
 Under the heading of the postfebrile cases, Shuttleworth and Beach also take up the 
 cases of so-called hypertrophy. The most frequent acute infections which bring about 
 these postfebrile cases are smallpox, typhoid fever, and scarlet fever. Meningeal, neu- 
 roglia, and nerve cell changes are noted in different degrees. The relatively rare affection 
 known as hypertrophy of the brain shows an increase of neuroglia and of the white matter, 
 but the nutrition of the brain seems also to be affected. The brain looks anaemic on 
 section and strikes one as having been under a certain pressure within the skull, showing 
 flattened and compressed gyri with sulci effaced. The most markedly injured part of 
 the brain is the white matter of the hemispheres. The head does not reach the size of 
 the head in hydrocephalus, nor is the increase so marked in the temples as it is in the 
 superciliary region. The hydrocephalic head is rounded; the skull in hypertrophy tends 
 more to squareness. In hydrocephalus the distance between the eyes is increased; not 
 so in hypertrophy. 
 
 The third type is that of the sclerotic brains, carefully studied by Bourneville. 
 Wilmarth is quoted as finding in 500 autopsies no less than 96 cases. The tuberous form 
 of sclerosis was found in 15 instances. 
 
 Bourneville presented his anatomical point of view under the following ten heads: 
 
 1. Meningitic idiocy. 
 
 2. Meningoencephalitic. 
 
 3. Developmental (simple arrest). 
 
 4. Atrophic sclerosis. 
 
 5. Hypertrophic or tuberous sclerosis. 
 
 6. Porencephalic. 
 
 7. Pseudoporencephalic. 
 
 8. Myxedematous. 
 
 9. Congenitally malformed. 
 10. Microcephalic. 
 
 This account of the general aspects of brain anatomy in the feeble-minded might be 
 concluded by a brief reference to the American literature. Besides the allied but sepa- 
 rate topic of amaurotic family idiocy or Tay-Sachs disease, not here considered, and vari- 
 ous case reports presented largely from the aspect of being interesting as clinical neu- 
 rological phenomena by Mills, Spiller, Pearce, and others, the American literature is 
 
WAVERLEY RESEARCHES. I. 45 
 
 devoid of much systematic work except that of Wilmarth about to be considered. From 
 Massachusetts, a few cases have been published by Bullard and one by Southard. An 
 interesting attempt was made by Orton in his "Pathological Study of a Case of Hydro- 
 cephalus" to parallel the cortex mapping of the topographers (Campbell, Brodmann, 
 and the others) by a similarly conceived study of a markedly hydrocephalic case. He 
 showed how certain portions of the cortex normally sunken below the surface are, as it 
 were, ballooned out to appear on the surface of the dilated brain. The kind of work 
 there initiated by Orton should be continued and performed in a large series of cases, but 
 such work, of both an intensive and extensive nature, requires the resources of a brain 
 institute to execute. 
 
 The largest series of cases of feeble-mindedness as yet studied in America from the 
 anatomical point of view is unquestionably the series reported by A. W. Wilmarth, form- 
 erly of Elwyn, Pa. This work is favorably commented upon in many publications on 
 feeble-mindedness. 
 
 Wilmarth reported in 1890 on the examination of 100 brains of feeble-minded children. 
 The following table shows the classification employed although it is not now possible to 
 learn which cases were entered twice in the table. 
 
 No actual disease or imperfect development of the brain 25 
 
 Non-development in various forms 16 
 
 Degenerative changes in vessels, ganglionic cells, or medullary substance not constituting true 
 
 sclerosis 15 
 
 Sclerosis or atrophy 12 
 
 Diffuse sclerotic change 7 
 
 Tuberous sclerosis . 6 
 
 No actual disease or involved development of brain but hypertrophy of the skull .... 6 
 
 Hydrocephalus 5 
 
 Extensive adhesion of membranes from old meningitis . . . . . . . .3 
 
 General cerebral atrophy 2 
 
 Acute softening, recent 2 
 
 Demi microcephalus ............... 2 
 
 Brain above usual weight but convolutions large and simple 2 
 
 Infantile hemorrhage 1 
 
 Angiomatous condition of cerebral vessels with degenerative changes 1 
 
 Glioma with sclerosis 1 
 
 Porencephaly with non-development 1 
 
 It will be noted from this list that no less than 31 cases, or at any rate 25 cases, were 
 not observed to show any evidence of actual disease of the brain or of imperfect develop- 
 ment therein. These observations are probably the most decisive in the literature upon 
 which to found the idea that the brain of a feeble-minded person may not show in the 
 
46 SOUTHABD. 
 
 gross any evidence of defect. It is well known that in the field of mental disease proper, 
 commonly known as insanity, the opinion long prevailed that there was not necessarily 
 anything grossly abnormal to be found in the brains. Upon the older observations was 
 founded the idea of the functional nature of mental disease so long prevalent. It would 
 have been equally easy to have founded a hypothesis as to the functional nature of feeble- 
 mindedness upon such data as these of Wilmarth. In fact, there are, so far as I know, 
 no more modern data upon which to make a new judgment. In the somewhat allied 
 field of epilepsy, however, Thorn and the writer have recently discovered a somewhat 
 similar percentage of normal-looking brains if we confine attention to the gross appear- 
 ances; namely, about 30 per cent. Our own first series to be presented below (Waverley 
 Research Series Cases I-X) shows at least three cases whose brains might well be con- 
 sidered in the gross as of a normal appearance. Perhaps, then, the generalization which 
 Wilmarth's figures might permit will attain objective value. Wilmarth does not describe 
 further these interesting cases with normal-looking brains. He states that 34 of the 100 
 cases belong to the school department or were employed as aids in the asylum department, 
 and that 66 of the cases were children belonging properly to the asylum department. 
 
 Wilmarth was struck by the comparatively large number of cases of actual cerebral 
 disease in contrast with the relatively small number with imperfect development which 
 seems to be the causative agent. There were, however, 16 cases of so-called non-develop- 
 ment in various forms, which put together with two cases of overweight brain with large 
 and simple convolutions, a case of porencephaly with non-development, and possibly 
 two cases of demi microcephalus, make a fairly large total of cases of arrest of develop- 
 ment. As against these 21 cases of developmental arrest may be placed 42 cases; namely, 
 12 cases of sclerosis and atrophy, 7 of diffuse sclerosis, 15 of degenerative changes not 
 regarded as constituting sclerosis, 2 of cerebral atrophy, 6 of tuberous sclerosis. It ap- 
 pears then that, although it is not safe to say that there is a relatively small number of 
 cases with imperfect development, there is a somewhat larger number of cases of actual 
 sclerosis of the brain substance which may be safely regarded as due in some sense to 
 progressive changes, or at least to changes subsequent to birth. How many of these 
 sclerotic cases are merely complications of developmental arrest was of course not possible 
 for Wilmarth to decide and indeed constitutes a problem of the greatest difficulty. Besides 
 the cases of arrest and the cases of sclerosis with or without arrest, there are a few cases 
 of more obviously acquired nature, namely, one of infantile hemorrhage, three of old 
 meningitis, and two of softening (though these latter may well have been cases of com- 
 plication having nothing to do with feeble-mindedness). 
 
 The case of angiomatous condition of cerebral vessels was one of Mongolian idiocy. 
 
WAVERLEY RESEARCHES. I. 
 
 47 
 
 Wilmarth had five cases of Mongolian idiocy in his series. He regarded the brains as 
 "of good size for imbecile brains." The pons and medulla were very small, weighing 
 about 2 ounce in each instance, whereas the usual weight according to Wilmarth is nearly 
 twice as much. He found the cerebral vessels inclined to be much thinner than in healthy 
 brains, and was led to suspect from the defective nutrition and circulation of these chil- 
 dren that the defective condition of the vessels was a general one. He laid down an 
 interesting hypothesis in the following words: "From the small size of the pons and 
 medulla in every instance, there seems to be a strong probability that the low nutrition, 
 and possibly the other anatomical peculiarities of this group, may be due to the imperfect 
 development or absence of certain cell groups in this region." The following extracts 
 from Wilmarth's paper give further notions as to his conceptions: 
 
 "Probably the most frequent morbid condition met with is sclerosis in its various 
 forms. The most destructive of these to the functional activity of the part involved is 
 the so-called sclerose tuberense. It is usually seen on removing the membrane, as one or 
 more areas of a white color and considerably harder in consistence than the surrounding 
 tissue, slightly elevated above the level of the neighboring convolutions. It may be 
 single but is usually multiple. It seems to be formed by a finely granular exudate, prob- 
 ably albuminous in character. If it occurs in the motor regions of the brain, the resulting 
 paralysis is very complete, and if a large portion of the cortex is implicated, profound 
 idiocy is liable to be the result." 
 
 "Another form of sclerosis, in direct contrast with that just described, is marked 
 by shrunken tissue, the fibrous character of its structure, [sic] is more liable to be found 
 in localized mass than in disseminated nodules, and is apparently less destructive to the 
 function of the parts implicated unless it has reached an advanced stage." 
 
 "Non-development is found in several forms. A portion of the cortical substance 
 may be thin, and instead of following the typical arrangement of the fully developed 
 brain, form a number of irregular folds, which may be so small and numerous as to resem- 
 ble a mass of angle worms. Again, the gyri may be of a normal size and appearance, 
 but show a diminution in number, or absence of ganglionic cells in certain layers. Or, 
 again, the convolutions may begin of normal size and development, but soon diminish 
 and sink beneath the surface of the hemisphere, or perhaps entirely disappear, before 
 acquiring near their normal length." 
 
 From the above all-too-hasty analysis of the literature of brain anatomy in the feeble- 
 minded, we may suggest the following problems as facing us in the present situation. 
 
 1. There should be an attempt all over the world to swell the number of properly 
 reported cases of feeble-mindedness with autopsy. If we speak of cases with suitable 
 
48 SOtFTHAKD. 
 
 histological studies alongside the clinical and anatomical observations, we shall shoot 
 far over the mark if we concede that the literature contains 100 comparable cases — cer- 
 tainly a slender material from which to draw conclusions. Tredgold's interesting book, 
 for example, is founded upon something like a dozen cases, among them epileptic and 
 juvenile paretic cases. Hammarberg's work dealt with but nine cases. Many of Bourne- 
 ville's cases are curiosa. 
 
 2. Systematic external photography and photography of the sectional brain should 
 be freely used and reproduced. For in no other way can what is normal in the gross 
 brain be established. The "normal" anatomists have little or no opportunity as a rule 
 to lay down their own standards, using as they often do prison material, asylum material, 
 and the like, and regarding "brain anomalies" with the same equanimity as anomalies 
 in the liver. 
 
 3. Total brain sections may facilitate the just-mentioned task and are of especial 
 value in marking off "secondary" from "primary" aments, through evidence afforded 
 of special fiber-degenerations. 
 
 4. What may be called the "Mierzejewski effect" is worth particular attention, 
 viz. the problem afforded by certain cases of disharmonious development of gray and white 
 matter (gray in excess), in which the commissural system is thought to be deficient. Rich 
 conscious endowment with poor mobilization might result in mild cases, if we carried the 
 Mierzejewski idea to the limit. 
 
 5. From feeble-mindedness material we may hope to establish the truth or modi- 
 fied truth of the idea attributed by Mierzejewski to Dejerine, viz. that intellectual capacity 
 depends more on cell interconnections than on cell numbers. The Dejerine argument 
 is probably taken for granted by most workers nowadays but certainly needs proof and 
 extension to details. 
 
 6. Hammarberg's idea that he could more or less approximately date the origin 
 of many events of development in his cases requires further work. Such considerations 
 as those of Donaldson re Laura Bridgman's brain are decisive here. Who knows what 
 results bearing upon education would be obtained by exact ideas as to the chronology of 
 normal cerebral development? The route to these observations may in part he through 
 feeble-mindedness material. 
 
 7. An exact definition in cerebral terms of "plastic impotence" (agenesia) and 
 "plastic arrest" (aplasia) would help in many fields, especially perhaps in that of de- 
 mentia praecox. Indeed strong arguments could be brought for the assertion that future 
 psychiatry is to be founded upon a proper knowledge of feeble-mindedness. 
 
 8. The problem of the "normal-looking" brain in feeble-mindedness is intriguing. 
 
WAVERLEY RESEARCHES. I. 
 
 49 
 
 Is there such a thing as "functional feeble-mindedness"? We speak of manic-depressive 
 psychosis perhaps or of certain psychoneuroses as "discords played upon good instru- 
 ments." Can the good instrument simply remain in its case, as it were, with resulting 
 amentia? 
 
 9. A host of special problems in developmental mechanics, glandular dysfunction, 
 disharmonious development of organs, heterotopia, dislocation of cells, reactive gliosis, 
 satellitosis, premature pigmentation of cells, and the like remain, not to mention the 
 problems of alcoholism and syphilis in parents and the operations of heredity working 
 as it were per se. 
 
 BIBLIOGRAPHY. 
 
 Note: — This bibliography is partial. It is based upon the entries in the card catalogue of the 
 Massachusetts School for the Feeble-minded and contains those titles which specifically refer to the ana- 
 tomy of the feeble-minded or articles which are known to contain anatomical material not indicated in 
 their titles. To this fundamental list, which is indicated by Roman numerals and Arabic figures describ- 
 ing the place of articles in the Waverley collection, have been added further references called for by the 
 present work. The bibliography is a working bibliography without pretensions to completeness, and 
 has been arranged by years in such a manner that the history of the development of the subject is clearly 
 shown. Future additions to this bibliography will be made, also by year numbers. 
 
 The word "Assn." refers to the Proceedings of the Association of Medical Officers of American 
 Institutions for Idiotic and Feeble-minded Persons. 
 
 1860 
 
 1. Kind, C. F. De cranio, cerebro, medulla spinali et nervis in idiotia primaria. Lipsise, A. Waldow, 
 1860. 
 
 1863 
 
 1. Bourneville, D. M. Memoire sur la condition de la bouche chez les idiots. Paris, Le Progres 
 med., (1863), p. 28. 
 
 1873 
 
 1. Gairdner. Athetosis. 1873. 
 
 2. Bischoff, T. L. W. von. Anatomische beschreibung eines mikrocephalen 8 jahrigen madchens 
 
 Helene Becker aus Offenbach. 1873. 
 
 1876 
 
 1. Tarbell, G. G. On the height, weight, and relative rate of growth of normal and feeble-minded 
 children. Assn., 1876, p. 188. 
 
 1877 
 
 1. Mierzejewski. Recherches anatomo-pathologiques sur l'idiotie. Compte rendu du Congres 
 
 international de Geneve, 1877, p. 642. 
 
 2. Ireland, W. W. On Idiocy and Imbecility. London, 1877. 
 
50 SOUTHARD. 
 
 1878 
 
 1. Mierzejewski. Sur l'anatomie pathologique de l'idiotie. Compte rendu du Congres international 
 
 de medicine mentale de 1878, tenu a Paris, p. 215. 
 
 2. Heschl. Ueber die vordere quere Schlafenwinding. Festschr. anlasslich des 20 jiihrigen Jubi- 
 
 laeums der Irrenanstalt in Wien, 1878 (quoted by Mierzejewski, 1900). 
 
 1879 
 
 1. Shuttleworth, G. E. Case of microcephalic imbecility. Jour. ment. sci., Oct., 1878, vol. XXIV, 
 
 pp. 438^43, 1 pi. 
 
 2. Knight, H. M. On internal hydrocephalus. Assn., 1878-9, p. 81. 
 
 3. Mierzejewski, J. Researches in idiocy. 1879. Jour. ment. sci., Jan., 1879, n. s. vol. XXIV, 
 
 pp. 562-568. 
 
 4. Mazier. Des arrets de developpement dans l'idiotie. Paris, Emile Martinet, 1879, p. 57. D. 
 
 5. Chiari. Ueber einen Fall von microgyrie bei einem 15 monatlichen Knaben. Jahrbuch fiir kinder- 
 
 heilhunde, 1879. 
 
 1880 
 
 1. Kerlin, I. N., and Mills, C. K. Three cases of progressive muscular degeneration. Phila., 
 Collins, 1880, 15 p., 1 pi. 0. Reprint from Amer. med. assoc. Trans., Phila., 1880, vol. XXXI. 
 
 1881 
 
 1. Bourneville, D. M., and Wuillamie. Idiotie symptomatique de meningo-encephalite. Re- 
 
 cherches. . . .sur l'epilepsie, 1881, vol. II, p. 17. 
 
 2. Bourneville, D. M., and Wuillamie. Note sur deux cas d'imbecillite et d'idiotie due a la micro- 
 
 cephalic. Same, 1881, vol. II, p. 27. 
 
 3. Bourneville, D. M., and Bonnaire. Sclerose tubereuse ou hypertrophique des circonvolutions 
 
 ce're'brales. Recherches. . . .sur l'epilepsie. . . .1881, vol. II, p. 3. 
 
 1882 
 
 1. Bourneville, D. M., and Dauge. Idiotie symptomatique d'une meningo-encephalite chronique 
 
 generalisee chez un enfant de cinq ans. Recherches. . . .sur l'epilepsie, 1882, vol. Ill, p. 98. 
 
 2. Kundrat, H. Die Porencephalic; eine anatomische Studie. Graz, 1882, Leuschner & Lubensky. 
 
 126 p. 8°. 
 
 1883 
 
 1. Albrecht, P. Sur le crane remarquable d'une idiote de21 ans. . . Bruxelles, A. Manceau, 1883, 
 
 p. 58, illus., plates. D. 
 
 2. Shuttleworth, G. E. Physical features of idiocy, in relation to classification and prognosis. 
 
 Liverpool m.-chir. jour., 1883, vol. Ill, pp. 283-3011. 
 
 1884 
 
 1. Shuttleworth, G. E. The health and physical development of idiots as compared with mentally 
 sound children of the same age. London, 1884, W. Clowes & Sons, 12 p., 1 tab. O. Assoc. 
 . . . .Proc, 1876-86, pp. 315-322. 
 
 1885 
 
 1. Wilmarth, A. W. Notes on the anatomy of the idiot brain. Assoc, 1885, p. 323. 
 
 2. Dercum, F. X., and Reel, I. V. Case of arrested development; imbecility with epilepsy. State 
 
 hosp. insane, Norristown, Pa., Report, 1884-5, vol. VI, p. 88. Also Path. dept. . . . State 
 hosp. for the insane , Norristown, Pa., First an. report. . . ., 1885, pp. 28-29. 
 
WAVERLEY RESEARCHES. I. 51 
 
 1886 
 
 1. Mills, C. K. Arrested and aberrant development of fissures and gyres in the brains of paranoiacs, 
 
 criminals, idiots, and negroes. Preliminary study of a Chinese brain. Jour. nerv. and 
 ment. dis., Sept. and Oct., 1886, vol. XIII, nos. 9 and 10. (Reprint, 37 p., 2 pi. D.) 
 
 2. Dercum, F. X. Brief synopsis of the various points involved in the coarse examination of the 
 
 brain and spinal cord. Path. Lab., State Hosp. for the Insane, Norristown, Pa., 1886, 11 p. 
 
 3. Wilmarth, A. W. Notes on the pathology of idiocy. Assoc, 1886., p. 428. 
 
 4. Bourneville, D. M., and Pilliet. Imbecillite et hemiplegie droite. Recherches . . . . sur l'epi- 
 
 lepsie, 1886, vol. VII, p. 129. 
 
 5. Bourneville, D. M., and Pilliet. Idiotie complete symptomatique d'une encephalite avec foyers 
 
 de ramollissement. Recherches. . . .sur l'epilepsie, 1886, vol. VII, p. 178. 
 
 6. Bourneville, D. M., and Pilliet. Idiotie symptomatique de sclerose cerebrale diffuse. Re- 
 
 cherches. . .sur l'epilepsie, 1886, vol. VII, p. 168. 
 
 1887 
 
 1. Sachs, B. On arrested cerebral development, with special reference to its cortical pathology. Jour. 
 
 nerv. and ment. dis., Sept. and Oct., 1887, vol. XIV, pp. 541-553. (Also same, Aug., 1892.) 
 (Also in N. Y. med. jour., May, 1896.) 
 
 2. Bourneville, D. M., and Raoult. Imbecillite. Recherches sur l'epilepsie, 1887, vol. VIII, 
 
 p. 207. 
 
 3. Bourneville, D. M., and Sollier, P. Des anomalies des organes genitaux chez les idiots et les 
 
 epileptiques. Recherches. . . .sur l'epilepsie, 1887, vol. VIII, p. 196. 
 
 4. Bourneville, D. M., and Pilliet. Deux cas d'athetose double avec imbecillite. Recherches.... 
 
 sur l'epilepsie. . . ., 1887, vol. VIII, p. 161. 
 
 1888 
 
 1. Bourneville, D. M. Nouveaux cas d'idiotie avec cachexie pachydermique. Recherches. . . .sur 
 
 l'epilepsie, 1888, vol. IX, p. 3. 
 
 2. Otto. Casuistische Beitrage zur kenntnis der mitrogyrie. Archiv. f. Psychiat. 1, H. 1, XX, 
 
 1888-9. 
 
 1889 
 
 1. Bourneville, D. M. Nouvelle observation d'idiotie myxcedemateuse. Recherches. . . .sur l'epi- 
 
 lepsie, 1889, vol. X, p. 172. 
 
 2. Osler, W. Cerebral palsies of children. Phila., P. Blakiston, Son & Co., 1889, 103 pp., illus. D. 
 
 3. Wulff. Cerebrale kinderlahmung und geistesschwache. Zeits. f. d. Behandlung Schwachsinniger 
 
 u. Epileptischer, Dresden, Oct., 1889, vol. IX, p. 76. 
 
 4. Bruce, A. On a case of absence of the corpus callosum in the human brain. Prof. Roy. Soc. 
 
 Edinb. '1887-88) 1889, xv, 321-341. 12 pi. 
 
 5. Dunn, L. A. A case of complete primary absence of the corpus callosum. Guy's Hosp. Rep., 
 
 London, 1889, 3d s., xxxi, 117-122. 1 pi. 
 
 1890 
 
 1. Marchand, F. Beschreibung dreier mikrocephalen-gehirne. 1890. 
 
 2. Sachs, B., and Peterson, F. Study of cerebral palsies of early life. Jour. nerv. and ment. dis., 
 
 N. Y., May, 1890, vol. XVII. 
 
 3. Wilmarth, A. W. Report on the examination of 100 brains of feeble-minded children. Assoc. . . . 
 
 Proa, 1889 and 1890, pp. 56-66 (continuous pp. 138-149). 
 
52 SOUTHARD. 
 
 4. Bullard, W. N. Diffuse cortical sclerosis of the brain in children. 1890. 
 
 5. Bourneville, D. M. Idiotie et epilepsie symptomatiques. Recherches. . . .sur l'epilepsie, 1890, 
 
 vol. XI, p. 21. 
 
 6. Bourneville, D. M. Idiotie symptomatique de meningo-encephalite. Recherches .... sur 
 
 l'epilepsie, 1890, vol. XI, p. 54. 
 
 7. Bourneville, D. M., and Sollier, P. Contribution a l'e"tude de la porencephalic . . . .Recherches 
 
 ... .sur l'epilepsie, 1890, vol. XI, p. 167. 
 
 8. Bourneville, D. M. Nouvelle contribution a l'etude de l'idiotie myxcedemateuse. Recherches — 
 
 sur l'epilepsie, 1890, vol. XI, p. 206. 
 
 9. Keller, Eduard. Ein beitrag zur pathologischen anatomie der idiotie. Berlin, Gustav Schade 
 
 (Otto Francke), 1890, 31 pp. D. 
 
 10. Starr, M. A. Cerebral atrophies of childhood, with special reference to surgical treatment. Jour. 
 
 nerv. and ment. dis., Nov., 1890, pp. 464-470. 
 
 11. Wildermuth, H. A. Ueber nahtverknocherung am schiideldach bei idioten und epileptischen. 
 
 Zeits schwach., 1890, vol. X, p. 81. 
 
 12. Bourneville, D. M., and Camescasse. Nouvelle contribution a l'etude de la microcephalic 
 
 Recherches. . . .sur l'epilepsie. . . .1890, vol. XI, p. 114. 
 
 13. Bourneville, D. M., and Morax. Idiotie symptomatique d'une tumeur cerebrale (hydroceph- 
 
 alic). Recherches. . . .sur l'epilepsie. . . .1890, vol. XI, p. 41. 
 
 14. Bourneville, D. M., and Morax. Idiotie symptomatique de sclerose cerebrale atrophique. 
 
 Recherches. . . .sur l'epilepsie. . . ., 1890, vol. XI, p. 33. 
 
 1891 
 
 1. Bourneville, D. M. Idiotie myxcedemateuse. Recherches .... sur l'epilepsie, 1891, vol. XII, 
 
 p. 34. 
 
 2. Bourneville, D. M., and Raoult. Idiotie complete symptomatique. Recherches. . . .sur l'epi- 
 
 lepsie, 1891, vol. XII, p. 85. 
 
 3. Bourneville, D. M., and Sollier, P. Porencephalic vrai unilaterale. Recherches. . . .sur l'epi- 
 
 lepsie, 1891, vol. XII, p. 96. 
 
 4. Bourneville, D. M. Note a propos de l'obliteration des sutures du crane chez les idiots. Re- 
 
 cherches. . . .sur l'epilepsie, 1891, vol. XII, p. 134. 
 
 5. Parchappe, J.-B. M. de. Idiotie. Bourneville, D. M. Recueil de memoires . . . . sur l'idiotie. 
 
 1891, vol. 1, p. 352. 
 
 6. Wildermuth, H. A. Ueber windungsanomalien am gehirn von epileptischen und idioten. Zeits 
 
 . . . .schwach., Dec, 1891, vol. XI, p. 1. 
 
 7. Bourneville, D. M., and Sollier, P. Idiotie complete symptomatique de sclerose atrophique 
 
 double des circon volutions motrices. . . .Recherches. . . .sur l'epilepsie. . . ., 1891, vol. XII, 
 p. 49. 
 
 8. Arnold, J. Gehirn, riickenmark und schadel eines hemicephalus von dreitagiger lebensdauer. 
 
 Beitr. z. path. Anat. u. a. allg. Path., Jena, 1891-92, xi, 407^40, 2 pi. 
 
 1892 
 
 1. Lloyd, J. H., and Willard, D. Case of porencephalon in which trephining was done. 1892. 
 
 2. Tacquet, E. De l'obliteration des sutures du crane chez les idiots. Paris, 1892, Le Progres med., 
 
 72 p., illus. O. 
 
 3. Barr, M. W. Haematoma auris. Assoc, 1892, p. 293. 
 
 4. Bourneville, D. M., and Noir, J. Idiotie meningitique. Recherches .... sur l'epilepsie, 1892, 
 
 vol. XIII, p. 3. 
 
WAVERLEY RESEARCHES. I. 53 
 
 5. Bourneville, D. M., and Ferrier, P. Idiotie symptomatique d'un ancien foyer du lobe temporal 
 
 gauche. Recherches .... sur l'epilepsie, 1892, vol. XIII, p. 10. 
 
 6. Bourneville, D. M., and Noir, J. Idiotie meningitique. Recherches .... sur l'epilepsie, 1892, 
 
 vol. XIII, p. 66. 
 
 7. Bourneville, D. M., and Dauriac. Idiotie complete symptomatique de double porencephalic 
 
 vrai. Recherches. . .sur l'epilepsie, 1892, vol. XIII, p. 89. 
 
 8. Bourneville, D. M., and Noir, J. Idiotie meningitique. Recherches sur l'epilepsie, 1892, 
 
 vol. XIII, p. 164. 
 
 9. Bourneville, D. M., and Ferrier, P. Idiotie meningitique. Recherches sur l'epilepsie, 
 
 1892, vol. XIII, p. 172. 
 
 10. Bourneville, D. M., and Ferrier, P. Idiotie complete. Recherches. .. .sur l'epilepsie, 1892, 
 
 vol. XIII, p. 201. 
 
 11. Bourneville, D. M., and Dauriac. Idiotie meningitique. Recherches .... sur l'epilepsie, 
 
 1892, vol. XIII, p. 207. 
 
 12. Bourneville, D. M., and Ferrier, P. Idiotie symptomatique. Recherches .... sur l'epilepsie, 
 
 1892, vol. XIII, p. 232. 
 
 13. Bourneville, D. M., and Noir, J. Idiotie congenitale. Recherches sur l'epilepsie, 1892, 
 
 vol. XIII, p. 256. 
 
 14. Bourneville, D. M., and Dauriac. Imbecillite et hemiplegie droite avec athe"tose. Recherches 
 
 ... .sur l'epilepsie, 1892, vol. XIII, p. 38. 
 
 15. Bourneville, D. M., and Noir, J. Idiotie microcephalique. Recherches. . . .sur l'epilepsie. . . ., 
 
 1892, vol. XIII, p. 23. 
 
 16. Bourneville, D. M., and Ferrier, P. Idiotie complete symptomatique de sclerose atrophique. 
 
 Recherches. . . .sur l'epilepsie, 1892, vol. XIII, p. 56. 
 
 17. Bourneville, D. M., and Noir, J. Idiotie symptomatique de sclerose atrophique de l'hemisphere 
 
 cerebral gauche et de meningo-encephalite de l'hemisphere droit. Recherches .... sur l'epi- 
 lepsie, 1892, vol. XIII, p. 132. 
 
 18. Bourneville, D. M., and Dauriac. Idiotie symptomatique de sclerose atrophique. Recherches 
 
 ... .sur l'epilepsie, 1892, vol. XIII, p. 216. 
 
 19. Bourneville, D. M., and Noir, J. Idiotie symptomatique de sclerose cerebrale atrophique. 
 
 Recherches. . . .sur l'epilepsie, 1892, vol. XIII, p. 223. 
 
 1893 
 
 1. Bourneville, D. M., and Noir, J. Idiotie congenitale; atrophie cerebrale. Arch, de neurol., 
 
 1893, vol. XXV, pp. 228-251; also Recherches. . . .sur l'epilepsie, 1892, vol. XIII, pp. 256- 
 282. 
 
 2. Berkhan, O. Eigentiimliche mit einschlafen verbundene anfalle. Zeits. schwach., 1893, pp. 13, 
 
 44, 64. 
 
 3. Bourneville, D. M., and Paul-Boncour, G. Imbecillite. Recherches .... sur l'epilepsie, 1893, 
 
 vol. XIV, p. 91. 
 
 4. Bourneville, D. M., and Sollier, P. Idiotie et epilepsie symptomatiques. Recherches. . . .sur 
 
 l'epilepsie, vol. XIV, p. 164. 
 
 5. Bourneville, D. M.,and Noir, J. De quelques formes de l'hydrocephalie. Recherches. .. .sur 
 
 l'epilepsie, 1893, vol. XIV, p. 175. 
 
 6. Matell. Ein fall von heterotopic der grauen substanz. Archiv. f. Psychiat, pt. 1, XXV, 1893. 
 
 1894 
 1. Barr, M. W. Inchoative paranoia. Assoc, 1894, p. 406. 
 
54 SOUTHARD. 
 
 2. Bourneville, D. M., and Noir, J. Idiotie complete congenitale. Recherches .... sur l'epilepsie 
 
 ...., 1894, vol. XV, p. 81. 
 
 3. Sollier, P. L'idiotie et Timbeeillite au point de vue nosographique. Paris, Le Progres med., 
 
 1894, p. 6. O. Archives d. neurol., Jan., 1894, vol. XXVII, pp. 33-38. 
 
 4. Bourneville, D. M. Contribution a l'etude de la microcephalic. Cong. d. med. alien, et. neurol. 
 
 de France, Proc.-verb., 1894, vol. V, pp. 526-587, 8 pi. 
 
 5. Porter, W. T. The growth of St. Louis children. Trans, of the Acad, of Sc. of St. Louis, 1894, 
 
 vol. VI, No. 12. 
 
 1895 
 
 1. Pearce, F. S. Causes conspiring to produce mental enfeeblement in children. Abstr. Rev. of 
 
 med., Oct., 1895, pp. 716-718. 
 
 2. Pearce, F. S. Causes conspiring to produce mental enfeeblement in children. Amer. medico- 
 
 surgical bulletin, Aug. 1, 1895, pp. 9-14. 
 
 3. Humphrey, Sir G. Notes on the microcephalic or idiot skull, and on the macrocephalic or hydro- 
 
 cephalic skull. Jour. anat. and physiol., Jan., 1895, vol. XXIX, pp. 304-328. 
 
 4. Hammarberg, C. Studien iiber klinik und pathologie der idiotie. .. .Upsala, 1895, E. Berling, 
 
 126 p., plates. O. Leipzig, K. F. Kohler, 1895, 126 p., pi. 
 
 5. Bourneville, D. M. Trois cas d'idiotie myxcedemateuse. Recherches .... sur l'epilepsie, 1895, 
 
 vol. XVI, p. 167. 
 
 6. Bourneville, D. M. Sclerose cerebrale hypertrophique ou tubereuse compliquee de meningite. 
 
 Recherches. . . .sur l'epilepsie. . . ., 1895, vol. XVI, p. 98. 
 
 7. Bourneville, D. M., Lombard, and Pilliet. Idiotie complete symptomatique; microcephalic 
 
 congenitale. . . Recherches. . . .sur l'epilepsie. . . ., 1895, vol. XVI, p. 113. 
 
 8. Oppenheim. Ueber Microgyrie. Neurol Centralbl., 1895. 
 
 1896 
 
 1. Ireland, W. W. Observations on mental affections in children and allied neuroses. Edinb. med. 
 
 jour., 1895-6, vol. XLI, p. 710, etc. (Continued article.) 
 
 2. Bourneville, D. M. Six cas d'idiotie myxcedemateuse. Recherches. .. .sur l'epilepsie, 1896, 
 
 vol. XVII, p. 134. 
 
 3. Bourneville, D. M. Idiotie myxcedemateuse. Recherches .... sur l'epilepsie, 1896, vol. XVII, 
 
 p. 144. 
 
 4. Bourneville, D. M. De Taction de la glande thyroide sur la croissance et l'obe'site' chez les idiots 
 
 myxcedemateuse. Recherches. . . .sur l'epilepsie, 1896, vol. XVII, p. 195. 
 
 5. Gundel, A. Zur klassifizierung der idioten. Zeits. f. d. Behand. Schwachsin. i. Epilep., Dresden, 
 
 Sept., 1896, vol. XVI, p. 73. 
 
 6. Bourneville, D. M. Sclerose cerebrale hemispherique; idiotie, he'miple'gie droite et epilepsie 
 
 consecutives. Recherches .... sur l'epilepsie . . . . , 1896, vol. XVII, p. 82. 
 
 7. Bourneville, D. M. Alcoolisme; hemiplegie gauche et epilepsie consecutives; sclerose atrophique; 
 
 pachymeningite et meningo-encephalite. Recherches .... sur l'epilepsie , 1896, vol. 
 
 XVII, p. 207. (Continued.) 
 
 8. Sachs, B. A family form of idiocy, generally fatal, associated with early blindness (amaurotic 
 
 family idiocy). J. Nerv. & Ment. Dis., New York, 1896, n. s., xxi, 475-479. 
 
 1897 
 
 1. Bourneville, D. M., and Dardel. Idiotie et Epilepsie symptomatiques de sclerose atrophique 
 des deux lobes frontaux. Recherches sur l'epilepsie , 1897, vol. XVIII, p. 96. 
 
WAVERLEY RESEARCHES. I. 
 
 55 
 
 2. Bourneville, D. M. Alcoolisme; hemiplegie gauche et epilepsie consecutives; sclerose atrophique; 
 pachymeningite et meningo-encephalite. Recherches .... sur l'epilepsie, 1897, vol. XVIII, 
 p. 83. (Concluded.) 
 
 1898 
 
 1. Sachs, B. Die amaurotische familiare Idiotic Deutsche med. Wchnschr., Leipzig u. Berlin, 1898, 
 
 xxiv, 63-69. 
 
 2. Spiller, W. G. Contribution to the study of secondary degeneration following cerebral lesions. 
 
 Jour. nerv. and ment. dis., Jan., 1898, vol. XXV, pp. 1-19. 
 
 3. Sailer, J. Hypertrophic nodular gliosis. Jour. nerv. and ment. dis., June, 1898, vol. XXV, pp. 
 
 405-440. 
 
 4. Barr, M. W. Some diseases common to the feeble-minded. Jour, psycho-asthenics, Dec, 1898, 
 
 p. 89. 
 
 5. Telford-Smith, T. Paralytic type of idiocy and imbecility. Pediatrics, 1898, vol. V, pp. 541-549. 
 
 6. Bourneville, D. M., and Chapotin. Athetose double avec mouvements convulsifs chroniques 
 
 de la face simulant, les tics convulsifs. Recherches. . . . sur l'epilepsie . . . ., 1898, vol. XIX, 
 p. 26. 
 
 7. Berkhan, O. Zur entwickelung und deutung der sogenannten Azteken-mikrocephalen. Zeits .... 
 
 schwach. . . April, 1898, vol. XVIII, p. 33. 
 
 8. Bourneville, D. M. Idiotie symptomatique de sclerose tubereuse ou hypertrophique. Re- 
 
 cherches .... sur l'epilepsie ..... 1898, vol. XIX, p. 183. 
 
 9. Hrdlicka, A. F. Anthropological studies. Jour, psycho-asthenics, Dec, 1898, vol. Ill, p. 47. 
 
 (Continued.) 
 
 10. Ireland, W. W. The mental affections of children, idiocy, imbecility and insanity. London, 
 
 1898. 
 
 11. Meine. Ein beitrag sur lehre von der echten heterotopic graun hirnsubstanz. Archiv. f. psychiat., 
 
 XXX, 2 Heft, 1898. 
 
 12. Scarpatetti. Microcephalia vera. ibid. 
 
 13. Bresler. Klinische und pathologisch-anatomische beitrage sur microgyrie. ibid. 
 
 14. Monakow. Ueber einen fall von mikrocephalia, ibid., XXXI, s. 845. 
 
 15. Strumpell, A. Ueber die Westphal'sche pseudosklerose and iiber diffuse hirnsklerose, insbe- 
 
 sondere bei kindern. Deutsche Ztschr. f. Nervenh., Leipzig, 1898, xii, 115-149. 
 
 1899 
 
 1. Barr., M. W. The how, the why, and the wherefore of the training of feeble-minded children. 
 
 Jour, psycho-asthenics, Sept., 1899, p. 204. 
 
 2. Barr, M. W. Adenoma sebaceum. Jour, psycho-asthenics, March, 1899, p. 137. 
 
 3. Collier, J. S. Cerebral diplegia. Brain, part LXXXVII, Autumn, 1899. 
 
 4. Kannegiesser, E. Der schadliche einfluss behinderter nasenatmung auf die korperliche und geistige 
 
 entwickelung der kinder. Zeits. . . .schwach. . . .Sept., 1899, vol. XIX, p. 161. 
 
 5. Hrdlicka, A. F. Anthropological studies. Jour, psycho-asthenics, (Dec, 1898, vol. Ill, p. 47), 
 
 March, 1899, vol. Ill, p. 99; June, 1899, vol. Ill, p. 153. (Concluded.) 
 
 6. Wylie, A. R. T. Contribution to the study of the growth of the feeble-minded in height and weight. 
 
 Faribault, Minn., 1901, 7 p., pi., tables. O. 
 
 7. Bourneville, D. M. Idiotie et epilepsie symptomatique de sclerose tubereuse ou hypertrophique. 
 
 Recherches .... sur l'epilepsie . . . . , 1899, vol. XX, p. 183. 
 
 8. Bourneville, D. M. Inegalite de poids des hemispheres cere"braux et cerebelleux. Recherches .... 
 
 sur l'epilepsie, 1899, vol. XX, p. 107. (Continued.) 
 
56 SOUTHARD. 
 
 1900 
 
 1. Bourneville, D. M. Inegalite de poids des hemispheres cerebraux et cere"belleux. Recherches 
 
 . . . .sur l'epilepsie. . . ., (1899, vol. XX, p. 107); 1900, vol. XXI, p. 130. (Concluded.) 
 
 2. Bourneville, D. M. Thymus et glands thyroide chez les enfants anormaux. Recherches .... 
 
 sur l'epilepsie . . . . , vol. XXI, p. 123. (Continued.) 
 
 3. Bourneville, D. M. Statistique sur la persistance ou l'absence du thymus chez les enfants anor- 
 
 maux. Recherches. . . .sur l'epilepsie. . . ., 1900, vol. XXI, p. 126. (Continued.) 
 
 4. Bourneville, D. M. Statistique sur la persistance de la suture metopique. Recherches. . . .sur 
 
 l'epilepsie,.... 1900, vol. XXI, p. 202. 
 
 5. Bourneville, D. M. Essai de classification anatomo-pathologique de l'idiotie. Recherches .... 
 
 sur l'epilepsie, 1890, vol. XI, p. 112. 
 
 6. Bourneville, D. M. Nouvelle contribution a l'etude de la microcephalic .... Recherches .... 
 
 sur l'epilepsie, 1900, vol. XXI, p. 182. 
 
 7. Bourneville, D. M., and Oberthur. Idiotie microcephalique; agenesie cerebrate; cerveau 
 
 pseudo-kystique. Recherches. . . .sur l'epilepsie,. . . .1900, vol. XXI, p. 81. 
 
 8. Mierzejewski. De l'anatomie pathologique de l'idiotie XIII Congres international de medicine, 
 
 Paris, 1900. Section de Psychiatrie. torn. 8, p. 148. 
 
 9. Shuttleworth and Fletcher-Beach. Idem, ibid., p. 154. 
 
 10. Bourneville. Idem, ibid., p. 167. 
 
 11. Philippe and Oberthur. Contribution a l'etude de l'histologie pathologique de l'idiotie. Ibid., 
 
 p. 207. 
 
 1901 
 
 1. Christopher, W. S. Diagnosis of the backward child. Child study monthly and jour, of adol., 
 
 May, 1901, vol. VII, pp. 417-429. 
 
 2. Bancroft, M. Classification of the mentally deficient. N. C. C. & C, Proa, 1901, p. 191. 
 
 1902 
 
 1. Patrick. Hereditary cerebellar ataxia. Jour. nerv. and ment. dis., Mar., 1902, vol. 29, pp 129- 
 
 152. 
 
 2. Berkhan. Ueber einige besondere gruppen unter den idioten. Zeits .... schwach May, 1902, 
 
 vol. XXII, p. 65. 
 
 3. Ballantyne. Antenatal pathology and hygiene. London, 1902, 1904. 
 
 1903 
 
 1. Bourneville, D. M. Statistique sur la persistance ou l'absence du thymus chez les enfants anor- 
 
 maux. Recherches. . . .sur l'epilepsie,. . . .1903, vol. XXIV, p. 269. 
 
 2. Tredgold, A. F. Mott's Archives of Neurology and Psychiatry, 1903. 
 
 3. Bolton, J. S. On the Histological Basis of Amentia and Dementia. Ibid. 
 
 1904 
 
 1. Bourneville, D. M. Thymus et glande thyroide chez les enfante anormaux. Recherches 
 
 sur l'epilepsie,. . . .1904, vol. XXV, p. 62. (Continued.) 
 
 2. Bourneville, D. M. Statistique sur la persistance ou l'absence du thymus chez les enfants anor- 
 
 maux. Recherches .... sur l'epilepsie , 1904, vol. XXV, p. 58. (Concluded.) 
 
 3. Bourneville, D. M. Statistique sur la persistance de la suture metopique. Recherches 
 
 sur l'epilepsie,. . . . 1904, vol. XXV, p. 53. (Continued.) 
 
 4. U. S. Bureau of Education. Statistics of growth. 1904. 
 
WAVERLEY RESEARCHES. I. 57 
 
 1905 
 
 1. Bourneville, D. M. Thymus et glande thyro'ide chez les enfants anormaux. Recherches . . . . 
 
 sur l'epilepsie, 1905, vol. XXVI, p. 140. (Continued.) 
 
 2. Bourneville, D. M. Statistique sur la persistance de la suture metopique. Recherches .... 
 
 sur l'epilepsie,. . . . 1905, vol. XXVI, p. 133. (Concluded.) 
 
 1906 
 
 1. Bourneville, D. M. Thymus et glande thyroide chez les enfants anormaux. Recherches. . . . 
 sur l'epilepsie, .... 1906, vol. XXVII, p. 60. (Concluded.) 
 
 1907 
 
 1. Clark, L. P., and Atwood, C. E. Longevity of idiots. Med. rec, Aug. 31, 1907. 
 
 2. Mott, Frederick W. Two cases of amaurotic dementia (idiocy) and a correlation of the micro- 
 
 scopic changes in the central nervous system, with the results of a chemical analysis of the 
 brains. Neurol. Path. Lab. Lond. County Asyl., Claybury, London, 1907, iii, 218-245, 4 pi. 
 
 1908 
 
 1. Orton, S. T. Pathological study of a case of hydrocephalus. Amer. Jour. Insan., Oct., 1908, vol. 
 LXV, p. 229. 
 
 1909 
 
 1. Arnold, E. H. Deformities of feeble-minded children. Yale med. jour., Feb., 1909, vol. XV, 
 pp. 281-295. 
 
 1910 
 
 1. Sachs, B. Amaurotic family idiocy (Tay-Sachs Disease). In: Mod. Med. (Osier & McCrae). 
 
 2d ed. Philadelphia, and New York, 1910, v. 863-870. 
 
 2. Shuttleworth, G. E. and Fletcher-Beach. Revised by G. E. Shuttleworth. Idiocy and 
 
 Imbecility. In: Syst. Med. (Allbutt & Rolleston). 8°. London, 1910, viii, 874-891. 
 
 1911 
 
 1. Bullard, W. N. Mongolian idiocy. Boston med. and surg. jour., Jan. 12, 1911, vol. CLXIV, 
 
 pp. 56-57, plates. 
 
 2. Dean, H. R. Idiocy and congenital syphilis. Brit. Jour. Child Dis., 1912, X, p. 385. 
 
 1912 
 
 1. Goddard, H. H. Height and weight of feeble-minded children in American institutions. Jour. 
 
 nerv. and ment. dis., April, 1912, vol. XXXfX, pp. 217-235, charts. 
 
 2. Vogt, H. Die angeborenen defekte und entwickelungsstorungen des gehims. Handb. d. Neurol. 
 
 (Lewandowsky). Berlin, 1912, ii, 1-28. 
 
 1913 
 
 1. Clark, L. P., and Stowell, W. L. Study of mortality in four thousand feeble-minded and idiots. 
 
 N. Y. med. jour., Feb. 22, 1913, pp. 376-378. 
 
 2. Black, D. D. The central nervous system in a case of cyclopia in homo. J. Comp. Neurol. 
 
 Philadelphia, 1913, xxiii, 193-257. 
 
 3. Black, D. D. The study of an atypical cerebral cortex. J. Comp. Neurol. Philadelphia, 1913, 
 
 xxiii, 351-369. 
 
58 
 
 SOUTHARD. 
 
 4. Reuben, M. S., and Cleaver, E. E. Oxycephaly. Arch. Pediatr., New York, 1913, xxx, 820-824. 
 
 5. Coriat, I. H. Amaurotic family idiocy. Arch. Pediatr. New York, 1913, xxx, 404-415. 
 
 1914 
 
 1. Batten, F. E. Family cerebral degeneration with macular change (so-called juvenile form of 
 
 family amaurotic idiocy). Quart. J. M., Oxford, 1914, vii, 444-454. 
 
 2. Hume, W. E. A case of amaurotic family idiocy. Rev. Neurol. & Psychiat., Edinburgh, 1914, 
 
 xii, 281-287. 4 pi. 
 
 3. Ziehen, T. Zur aetiologie und auffassung des soganannten moralischen schwachsinns. Wien. 
 
 med. Wchnschr., 1914, Ixiv, 2242-2245. 
 
 4. Tredgold, A. F. Mental Deficiency. Second Edition, London, 1914. 
 
 5. Bolton, J. S. On the Brain in Health and Disease. London, 1914. 
 
 6. Peters. A microcephalic idiot with malformation of brain. Jour. A. M. A., lxiii, p. 536. 
 
 7. Mott, F. W. Nature and nurture in mental development. London, 1914, J. Murray. 163 p. 8°. 
 
 1915 
 
 1. Davenport, C. B. The feebly inhibited. II. Nomadism or the wandering impulse, with special 
 
 reference to heredity. Proc. Nat'l Acad. Sc, Washington, 1915, i, 120. 
 
 2. Pearson, Karl. Mendelism and the problem of mental defect. III. On the graduated character 
 
 of mental defect and on the need for standardizing judgments as to the grade of social in- 
 » sufficiency which shall involve segregation. (New York), 1915 (G. E. Stechert). 51 p. 
 
 3. Weygandt, W. Idiotie und Imbezileitat. In: Handb. d. Psychiat. (Aschaffenburg). Leipzig und 
 
 Wien, 1915, 95-311. 4°. 
 
 4. Southard, E. E. On the value of the feeble-minded as subjects of research in efficiency. Proc. 
 
 Nat. Conference of Charities and Correction, 1915. 
 
II. 
 
 CLINICAL, ANATOMICAL, AND BRIEF HISTOLOGICAL DESCRIPTION OF 
 
 TEN CASES OF FEEBLE-MINDEDNESS, WITH EIGHTY-FOUR PLATES 
 
 (WAVERLEY RESEARCH SERIES, CASES I-X). 
 
 E. E. Southard and Annie E. Taft. 
 
II. 
 
 CLINICAL, ANATOMICAL, AND BRIEF HISTOLOGICAL DESCRIPTION OF 
 TEN CASES OF FEEBLE-MINDEDNESS. 
 
 With Eighty-four Plates (Waverley Research Series, Cases I-X). 
 E. E. Southard and Annie E. Taft. 
 
 We proceed to a condensed description of the findings in Cases I-X of the Waverley 
 Research Series. For convenience we offer the following table, showing a number of facts 
 about each case, chiefly of a catalogue nature: 
 
 
 Clini- 
 
 
 
 
 
 
 
 
 
 
 Research 
 
 cal 
 
 Local 
 
 Harvard 
 
 Photo- 
 
 
 
 Assigned 
 
 Height 
 
 Brain 
 
 
 Series 
 
 Source 
 
 Autopsy 
 
 Series 
 
 graph 
 
 
 Actual 
 
 Mental 
 
 last 
 
 Weight. 
 
 Brief 
 
 number 
 
 number 
 
 number 
 
 number 
 
 number 
 
 Sex 
 
 Age 
 
 Age 
 
 taken 
 
 grams 
 
 designation 
 
 i 
 
 W. 2268 
 
 Taylor, 65 
 
 14.5 
 
 28 
 
 M 
 
 5 
 
 1— app. 
 
 82 
 
 400? 
 
 Microcephaly 
 
 ii 
 
 W. 1437 
 
 Taylor, 21 
 
 14.6 
 
 26 
 
 M 
 
 20.5 
 
 1— app. 
 
 subn. 
 
 620 
 
 « 
 
 in 
 
 D. 14550 
 
 D. 1279 
 
 12.20 
 
 24 
 
 M 
 
 45 
 
 7 app. 
 
 126 
 
 610 
 
 it 
 
 IV 
 
 D. 16282 
 
 D. 1517 
 
 12.21 
 
 23 
 
 F 
 
 62 
 
 12=*= app. 
 
 143 
 
 1340 
 
 Moron or 
 subnormal 
 
 V 
 
 D. 14779 
 
 D. 1413 
 
 13.13 
 
 1413 
 
 M 
 
 16 
 
 12=*= app. 
 
 168 
 
 1435 
 
 Subnormal, 
 dementia 
 praecox 
 
 VI 
 
 W. 1453 
 
 Canavan, 3 
 
 13.47 
 
 75 
 
 M 
 
 26 
 
 2 Binet 
 
 158 
 
 1130 
 
 Idiot 
 
 VII 
 
 W. 1574, 
 1618 
 
 Canavan, 8 
 
 14.13 
 
 78 
 
 F° 
 
 25 
 
 5(2- )3 
 Binet 
 
 146 
 
 1270 
 
 Imbecile 
 
 VIII 
 
 
 Magrath, 3917 
 
 12.22 
 
 1 
 
 M 
 
 36 
 
 12 ± app. 
 
 179 
 
 1340 
 
 Murderer 
 
 IX 
 
 W. 808 Bur- 
 bank 9760 
 
 S.B.I. 14.22 
 
 14.69 
 
 14.69 
 
 M 
 
 39 
 
 7 Binet 
 
 178 
 
 1620 
 
 Imbecile 
 
 X 
 
 W. 971 
 
 S.B.I. 14.69 
 
 15.2 
 
 15.2 
 
 II 
 
 37 
 
 2.4 Binet 
 
 144 
 
 1450 
 
 Imbecile 
 
 W. = Waverley (Massachusetts School for Feeble-minded). Burbank = Burbank Hospital, Fitchburg. Cana- 
 van = private autopsy series, M. M. Canavan. D. = Danvers State Hospital. Magrath = Medical Examiner's 
 series, G. B. Magrath. S.B.I. = series since establishment of Massachusetts State Board of Insanity, Pathological 
 Service, July 1, 1914. Taylor = private autopsy series, E. W. Taylor. 
 
 The items of our description call for little comment. They are in general: 
 
 a. Clinical Findings 
 
 b. Autopsy Findings 
 
 c. Special Description of Brain 
 
 d. Partial Microscopic Description 
 
 e. Anatomical and Histological Summary. 
 
 As to a. Clinical Findings: These have been arranged so far as possible to follow a 
 scheme employed at the Massachusetts School for the Feeble-minded and originated by 
 Dr. W. E. Fernald. The headings are ten in number, as follows: 
 
62 SOUTHARD AND TAFT. 
 
 1. Physical Examination. 
 
 2. Family History. 
 
 3. Personal and Developmental History. 
 
 4. History of School Progress. 
 
 5. School Examinations. 
 
 6. Practical Knowledge. 
 
 7. Economic Efficiency. 
 
 8. Social History and Reactions. 
 
 9. Moral Reactions. 
 10. Psychological Tests. 
 
 Following the items thus arranged are notes, usually brief, concerning the institutional 
 history, if any, of the patient. 
 
 As to b. Autopsy Findings: These are limited to the gross anatomical findings of the 
 examiner as made on the autopsy table. Their results are more systematically given in 
 table form in Article III. 
 
 As to c. Special Description of Brain: The data are founded upon examination, as a 
 rule, subsequent to the autopsy and to the preservation of the brain, which has been in all 
 cases in 10% formaldehyde solution, in many cases for relatively long periods, which are obvi- 
 ous from the dates included in the descriptions. As a rule, the special brain description has 
 had the advantage of comparison of the brain specimen itself with the photographs, 
 systematically taken, of the brain before and after stripping the pia mater. These descrip- 
 tions are largely the product of Dr. Taft, who has personally stripped each brain of the pia 
 mater, preserving the pia mater in certain cases where there was question of important 
 lesion therein. The nomenclature is, as a rule, self-explanatory and follows largely the 
 nomenclature of Quain's Anatomy. 
 
 As to d. Partial Microscopic Examination: It must be insisted that this is really but 
 partial and has no pretensions to the completeness which the resources of a modern labora- 
 tory will eventually command. Nevertheless, we have resorted in each instance to total 
 brain sections stained by the Weigert myelin sheath method in our estimates of the fibre 
 content of the brain. The resulting estimate is, as a rule, entirely qualitative. But it may 
 be questioned whether it is possible at this time to make more than a qualitative estimate 
 of fibre contents. The total brain sections stained by the Weigert method have been of 
 value in the estimates of the depth of the corpus callosum, as well as for the purpose of 
 discovering special periods of degeneration or faulty development of fibre systems. 
 
 We have, also, employed staining methods for the study of cortical architecture, 
 
WAVERLEY RESEARCHES. II. 63 
 
 employing as a rule cresyl- violet in place of thionin and methylen blue. This sharp nuclear 
 stain has permitted us in most cases to make a profitable study of the cortical lamination, 
 as well as to bring out the exudate about vessels where exudate is present. As will be 
 emphasized in Article III, the existence of exudate in more cases than had been at first 
 suspected is probably of importance from the genetic standpoint, since syphilis or. some 
 kindred chronic inflammatory condition may be suspected in cases with such exudate. 
 Again, we have been able to observe rod cells in certain cases, which cells again tend to 
 indicate a more progressive condition than has been considered typical in cases of feeble- 
 mindedness. In suitable cases, we intend to make special topographical studies of cortical 
 laminations. This we have in hand in chosen instances, and the resulting descriptions 
 are intended to appear in later articles in this series. For the present, as will be evident 
 from Article III, we have limited our microscopy to the question of exudate, rod cells, and 
 the like, on the one hand, and to qualitative estimates of cortex lamination, fibre content, 
 on the other. 
 
 As to e. Anatomical and Histological Summary: We have attempted to bring out the 
 main structural points in each case, with, however, little or no attention to the total genetic 
 picture presented by the case. This total genetic picture is reserved for Article III. 
 
 Further light upon the anatomical situation presented by each brain is offered in the 
 description of the plates. The most inclusive view of each case from all available aspects : 
 clinical, anatomical, histological, and genetic, together with points especially mentioned 
 in the description of the plates, is given in Article III. 
 
 Synopsis op Findings of Case I. 
 
 a) Clinical. 
 
 1. Physical Examination. — P. Cap. was born June 19, 1897, and upon admission, at five years 
 of age, was 32 inches tall and weighed 16 pounds. A photograph shows typical microcephaly, with a head 
 roughly diamond-shaped when viewed from the side, with large ears; spinal caries of the dorsal region, 
 with anterolateral curvature; thighs sharply flexed on abdomen, and legs flexed on thighs; arms slightly 
 flexed and in position of contracture at elbows ; strabismus. The eyes are described as " rather intelligent 
 looking" despite the patient's inability to understand things said. Patient would turn head when 
 spoken to, and follow persons or bright objects with his eyes. Spastic crural paraplegia; slight ability 
 to move hands and arms, and ability to grasp small objects with the hands. Although unable to walk, 
 the patient was able to push himself along the floor, and would come at command. Would stop crying 
 when he heard food being brought in the customary way. Absence of control over bladder or rectum; 
 daily vomiting. Patient is described as having had measles, and is said to have been able to kick up his 
 legs at some time prior to his entrance to the school; but it is possible that this reaction, described by 
 
64 SOUTHARD AND TAFT. 
 
 the parents, was merely the effect of action of the muscles of the back and gluteal region. No history 
 of epilepsy. 
 
 2. Family History. — Sister (born, Nov. 6, 1894) is an inmate of the Massachusetts School at 
 the present time, having been admitted at the same time, at the age of 7. There are two other children, 
 not microcephalic. The father and mother were born in Italy, and were about 33 and 23 years of age 
 respectively at time of birth of patient. There are two other children, one of which was older than the 
 patient's sister. 
 
 Parents are said to have been normal at time of the birth ; birth was normal ; and, although it was 
 stated that the labor in the case of patient's microcephalic elder sister was a tedious labor with slow dila- 
 tation, the delivery was not instrumental in the case of either of the two microcephalic children. 
 
 3. Personal and Developmental History. — Patient seemed to the parents never to have 
 developed mentally. He is described as having been fed but once a day, on bananas only. 
 
 4. History of School Progress. — Nil. 
 
 5. School Examinations. — Nil. 
 
 6 and 7. Practical Knowledge and Economic Efficiency. — Nil except for statements made 
 under Physical Examination (see above). 
 
 8. Social History and Reactions. — Limited to interest in food on the instinctive level; would 
 continue eating indefinitely if food was supplied. Patient wanted to be let alone. 
 
 9. Moral Reactions. — Occasional crying spells, possibly related to appetite. 
 
 10. Psychological Tests. — Quantitative tests not made. The microcephalic elder sister, 
 obviously a little superior to her brother, measures 1.3 years of mental age by Binet scale. It is clear 
 that the present case would have measured one year or less. 
 
 Waverley School History. — Patient's condition was unchanged throughout his stay. Patient 
 was admitted April 12, 1902, when five years old, and died May 21, 1902. 
 
 b) Autopsy. 
 
 Notes not available; findings are limited to Gross anatomical examination: Microcephaly, dorso- 
 spinal caries, with antero-lateral curvature; thighs sharply flexed on abdomen, legs flexed on thighs, 
 arms slightly flexed and contractured at elbows. 
 
 c) Special Anatomical Description of Brain. 
 
 The measurements of the microcephalic brain, after preservation in formaldehyde for 11 years, 
 were as follows: — 
 
 Length of left hemicerebrum LLH, 9 cm. 
 
 right LRH, 8.25 cm. 
 
 Greatest width W 8.75 cm. 
 Greatest height Heit 5 cm. 
 
 W V 100 
 Cerebral index T ,, = 97.22 cm. 
 Length 
 
 Greatest width left hemicerebrum WLH, 4 cm. 
 
 right WRH, 4.75 cm. 
 
 Arc frontal pole to Rolando left LArc FRo 3.08 cm. 
 
 right RArc FRo 3.07 cm. 
 Arc left Rolando to occipital pole LArc RoOc, 5.2 cm. 
 right RArc RoOc, 4.7 cm. 
 
WAVERLEY RESEARCHES. II. 65 
 
 The brain gives the impression of being very simple and slightly developed. There seems to be a 
 moderate degree of generalized thickening of the pia mater over the entire brain. The vessels are 
 prominent but fail to show gross changes. It is noteworthy that the left hemisphere is longer than the 
 right. The olfactory sulcus of the left orbital surface is short and possesses distal extremity deflected 
 to the left. The olfactory sulcus of the right orbital surface is straight and extends almost to the ante- 
 rior pole. The sulci on each orbital surface external to the olfactory sulci are small triradiate sulci 
 whose extremities extend forward and sidewise well toward the margins of the orbital surfaces. Poste- 
 riorly these sulci approach the olfactory trigone. 
 
 The markings of the convexity are atypical and more markedly atypical on the right side. The 
 frontal lobes consist of but two convolutions, the superior of which are broader than the inferior and 
 marked by a number of short fissures. The inferior frontal convolutions are but slightly indented and 
 fail to cover in the island of Reil. This deficiency of the frontal operculum is more marked on the left 
 side than on the right. 
 
 The central area of the left convexity approaches normal in structure, although the frontal sulci 
 run back to cover the precentral convolution. Upon the right side, the post-central gyrus is folded 
 over the precentral gyrus, forming an atypical operculum therefor. The right postcentral gyrus is situ- 
 ated nearly a centimeter anterior to the left. Like the left central area, the left parietal lobe has an 
 abnormal construction; this is divided atypically by the interparietal fissure; the postcentral and hori- 
 zontal portions of the left interparietal fissure are connected with each other. The anterior third of the 
 left interparietal fissure gives off a short descending branch, which branch separates the submarginal 
 from the angular gyrus. 
 
 The occipital lobes upon both sides are exceedingly small and scarcely marked by fissures or depres- 
 sions. On the left side, the demarcation of the occipital from the parietal lobe is effected by means of 
 the transverse operculum. The general appearance of this area suggests the " Affenspalte " ; on both 
 sides the posterior extremity of the calcarine fissure is found to extend to the external surface of the 
 hemisphere. Upon the left side this extremity terminates in a single cleft, pointing laterally. On the 
 right side, the extremity of the calcarine fissure is a cleft running more frontalwards and finally termi- 
 nating in a T-shape. 
 
 The comparatively large temporal lobes are almost entirely without sulcal markings, if we except 
 the left second temporal gyrus, which is crossed by two transverse fissures in its middle and posterior 
 portions. The pyriform lobule is well developed on both sides, especially on the right. Each pyriform 
 lobule is marked off by a distinct fissura rhinica (Turner). 
 
 The lateral situation of the hippoeampal lobes yields a notable degree of exposure of the crura cerebri 
 and this appearance of an exposure of the crura is increased by the comparatively small number of trans- 
 verse pontine fibers. Upon removal of the pia mater, the transverse pontine fibers are found arranged 
 in bundles which are almost distinct from one another. The optic tracts seem comparatively very large 
 and the olivary and pyramidal eminences upon the ventral surface of the medulla also stand out promi- 
 nently. The cerebellum appears to be not remarkable on gross inspection. 
 
 d) and e) Microscopic Examination and Anatomical and Histological Summary. 
 
 Upon section the lateral ventricles show a moderate degree of dilatation. There is a slight subpial 
 gliosis, involving both an increase of cells and an increase of neuroglia fibrils. Further points so far as 
 important are placed in the general summary below. 
 
 Summary of Anatomical Examination. — The brain as a whole is very small. The cortex averages 
 roughly 3 mm. in thickness. There are only two convolutional divisions in the frontal lobes. The 
 right post-central gyrus forms an operculum which overlies the precentral nearly throughout its entire 
 
66 SOUTHARD AND TAFT. 
 
 length. The sulci of the precentral area are shallow; the individual gyri (especially on the left) are very 
 narrow — some are not separated by sulci — and form thin fingers of white surrounded by grey cortex. 
 The lateral ventricles are moderately large. In the postcentral (parietal) area, the sulci are deeper than 
 precentral (frontal) but the medullary portion of the gyri is narrow. The descending ventricular horns 
 are widened laterally. The structures at the base of the brain, though small, are not otherwise abnormal. 
 The tapetum, optic radiations, and anteroposterior bundles are present. The striae of Lancisi (Indusium) 
 are very noticeable in the anterior plane. The left is much larger than the right but decreases in size 
 posteriorly until in the region of the Splenium, they are scarcely distinguishable. 
 
 The inferior olives stand out prominently from the periphery of the medulla; a distinct cleft exists 
 on their antero-lateral surface, separating them from the surrounding portions, and the anterior arcuate 
 fibers curve in deeply around the depth of this cleft. 
 
 The cortex is of average thickness (3 mm.). The cell supply is scant in all layers, but notably so in 
 the medium sized and large pyramid layers, especially in the frontal and parietal areas. Many of the 
 Betz cells are thin and fusiform. This seems particularly true of the left side. 
 
 The leaflets of the cerebellum are small, but do not lack in normal elements, nor present any anomaly. 
 
 The blood vessels are not remarkable. 
 
 Synopsis of Findings of Case II. 
 a) Clinical. 
 
 1. Physical Examination. — Born September 3, 1876; admitted to the school, April 1, 1893; 
 died March 11, 1897. Characteristic microcephalic with receding forehead; knees stiff and flexed; feet 
 extended; ankles rigid; thighs crossed ; right knee crossed left; legs in contracture; hips can be slightly 
 flexed; spastic paralysis of right arm; locomotion by rolling; patient could feed himself by use of left 
 arm and hand; patient unable to walk or sit; head is described as asymmetrical. The right hemisphere 
 of the brain is described at autopsy as having been one third larger than the left, and the skull flattening 
 is described as having been especially marked in the left frontal region. No evidence of epilepsy. 
 
 2. Family History. — Born in Provincetown, of American parents; father 25 years of age, mother 
 22 years of age at birth of child. The microcephalic child was the first, seven other children following, 
 none of whom is described as showing any deformity. The mother's health during pregnancy is de- 
 scribed as having been good, and no extraordinary circumstances attended the delivery. 
 
 3. Personal Developmental History. — Physician (Dr. Newton) described the patient as having 
 had a paralytic shock, at what time before the age at which first peculiarity was noticed (3 months) 
 cannot now be stated. Another version of the cause is "infantile paralysis," but whether this diagnosis, 
 made in 1876, has reference to epidemic poliomyelitis cannot now be stated. The patient is described 
 as having passed through measles, whooping cough, and chicken pox. 
 
 4 and 6. School Progress and Examinations. — Nil. 
 
 6. Practical Knowledge. — Able to feed himself with left arm and hand. 
 
 7. Economic Efficiency. — Nil. 
 
 8. Social History and Reactions. — Patient appears to understand certain things said to him. 
 Unable to talk. (Is described by family as able to say "Mamma.") Patient could make cackling 
 sounds of a loud and shrill nature. By means of these sounds and by gesticulating with the left hand, 
 patient was able to express clearly: pain, pleasure, displeasure, hunger, and thirst; and was apparently 
 able to make the other boys in the ward able to understand these expressions. Patient took interest in 
 events about him, watching the boys at play, liking to look at pictures and bright colors. Patient's 
 hearing was good. He enjoyed music and was able to hum several tunes correctly. 
 
WAVERLEY RESEARCHES. II. 
 
 67 
 
 9. Moral Reactions. — Patient is described as gluttonous, swallowing food without chewing. 
 He is described by the family as passionate. 
 
 10. Psychological Tests. — No quantitative tests made. Patient would probably measure less 
 than a year. 
 
 Waverley School History. — Is sufficiently described above. Death was due to septicaemia 
 following gangrene of extremities. 
 
 b) Autopsy. 
 
 The description of the autopsy is taken from the report of Dr. Taylor: 
 
 The autopsy was made about twenty-four hours after death, the head only being examined. The 
 body was undersized and markedly deformed. The head was markedly microcephalic in type, the 
 circumference 17J inches; from root of the nose to the occipital protuberance measured 11 inches. The 
 skull was thick, particularly over the parietal regions. Corresponding to two marked depressions in 
 the frontal portion of the brain and easily seen before the removal of the dura were two bony promi- 
 nences on the inner table of the skull. Dura and pia normal. The brain completely filled the cranial 
 cavity, which was asymmetrical. The left hemisphere was markedly smaller than the right, with ab- 
 normal convolutions in both. Very striking at the autopsy was the posterior portion of the brain, 
 including the upper parietal and occipital lobes. The cortex here was so greatly reduced in thickness 
 that fluctuation from the distended ventricle was easily obtained on the left side. The right hemisphere 
 appeared approximately thirty-three and one third percent, larger than the left. 
 
 The brain was hardened in formalin, and after hardening weighed 620 grams. 
 
 Further examination of the brain 16 years after removal yielded the following measurements: — 
 
 Length of left hemicerebrum, LLH, 14.5 cm. 
 
 right LRH, 14.5 cm. 
 
 Greatest width W 11 cm. 
 
 _ . . . . W X 100 na 
 
 Cerebral mdex, -= -r- = 76 cm. 
 
 Length 
 
 Greatest height Heit 5.75 cm. 
 
 Greatest width left hemicerebrum WLH, 5. cm. 
 
 right WRH, 6. cm. 
 
 Arc frontal pole to Rolando LArc FRo 8. Left. 
 
 right RArc FRo 9.5 cm. 
 
 Arc left Rolando to occipital pole, LArc RoOc, 6.5 cm. 
 
 right RArc RoOc, 5. cm. 
 
 Frontal pole to corpus callosum, FCorp Cal. 3.2 cm. 
 
 Right optic commissure 6 cm. 
 
 There is considerable asymmetry in this brain. The hemispheres do not differ materially in length, 
 but the right is considerably broader than the left. This is particularly noticeable at the frontal pole. 
 On the orbital surface the left gyrus rectus is narrower than its opposite, and the convolution which 
 forms the margin is shrunken and shortened. This shortens the distance from the frontal tip to the 
 fronto-temporal angle, and deflects the longitudinal fissure toward the left. 
 
 There is a circumscribed area of microgyria about midway the second frontal gyrus on either side, 
 that on the left is more extensive. The third left frontal is complex and the convolutions are well rounded. 
 
 The central region marks the beginning of an extremely atypical cortex. The precentral gyrus on 
 both sides is of fair width, and well rounded. The postcentral on both sides is much shrunken and 
 narrowed in its upper half. The fissure of Rolando very nearly cuts the margin of the superior longi- 
 tudinal fissure on the left, while on the right, its upper extremity is one centimeter from the margin. 
 
68 
 
 SOUTHARD AND TAFT. 
 
 The entire parietal cortex over the vertex is much shrunken, the convolutions are very narrow and 
 flat, and on the left a small focus has sunken below the surrounding surface. The normal markings are 
 not made out, on account of the alterations in the cortex. At the parieto-temporal juncture, the con- 
 volutions assume a more nearly normal outline. This does not include the upper part of both the supra- 
 marginal and angular gyri on both sides, both of which are severely affected; more particularly the 
 former and the cortical change is more extensive and extreme on the left than the right. 
 
 The temporal lobes are asymmetrical temporo-frontal distance L. 4. cm. Rt. 4.5 cm. 
 
 Both first temporals are very narrow; the right particularly so. The second temporals are broad 
 with transverse markings. The left hippocampal gyrus is completely hidden by the folding over of the 
 third temporal, and only the extreme anterior portion of the pyriform lobule is seen. On the right, the 
 hippocampus and pyriform lobule are not remarkable. 
 
 The occipital lobes are very small and show the same changes on the superior surface as the parietal 
 upper regions; the lateral surfaces are more nearly normal. The posterior extremity of the calcarine 
 fissure extends well on to the outer surface of the occipital tip. On the left, the distortion of the parietal 
 cortex has brought the calcarine fissure for a considerable distance nearly to the upper margin of the 
 hemisphere. 
 
 The pons, medulla, and cerebellum are not notable on gross examination. 
 
 d) Microscopic Examination. 
 
 Nerve fibers have been replaced in many instances by patches of rather dense neuroglia tissue. In 
 the prefrontal sections this condition is marked, especially on the right side; farther back the areas of 
 gliosis show cavitation with numerous glia cells in rather thin encapsulating walls, and a number of large 
 pigment-bearing phagocytes. The major amount of cell loss is in this portion of the frontal region con- 
 fined to the mesial surface. Farther back the frontal cortex shows thinning of all its layers, except the 
 external layer of small pyramids. More posteriorly the total brain sections demonstrate a special loss 
 in size of the two second frontal convolutions; but this loss is more marked on the left than upon the 
 right side. The mesial gyri in this region are also characterized by extreme fiber loss, and the cells which 
 persist are arranged patchily. The sections here indicate that there are more nerve cells than the num- 
 ber of persistent nerve fibers would lead one to expect. More posterior sections exhibit the same higher 
 degree of degeneration upon the left side and this degeneration is shared by both the second and the first 
 frontal gyri. Sections through the plane of the anterior extremity of the lateral ventricles show a marked 
 dilatation upon the left side, with a complete degeneration of the fibers surrounding the ventricle supe- 
 riorly, externally and upon the external half of the inferior border, whereas the fibers on the mesial border 
 and upon the internal half of the inferior border of the ventricle are preserved. The fiber communica- 
 tions of the first and second frontal gyri that underlie portions of the brain are represented by only a 
 narrow band of fibers. 
 
 When the sections begin to cut the corpus callosum, it is found that this body is made up of a very 
 thin bundle with a small number of stained fibers. The white bundle and the third left frontal gyrus 
 are thinned out and in this region there are many large pigmented phagocytes. The first and second 
 frontal gyri in this plane are almost completely degenerated as is also the tissue of the superior mesial 
 surface. The knee of the corpus callosum is also very thin. The lower portions of the hemisphere 
 appear more nearly normal than the upper portions, although the gyri in the lower portions of the hemi- 
 spheres are too narrow and long as compared with normal. Some sections exhibit a multiple cavitation 
 in the degenerated areas with the cavities surrounded by a dense gliosis. In a plane still farther back 
 behind the temporal lobes, a considerable degree of satellitosis is found in both superior frontal gyri. 
 The lateral ventricles are markedly dilated, although the left more so than the right. Small areas of 
 
WAVERLEY RESEARCHES. II. 69 
 
 Betz cells are found in the precentral gyri on each side, although the tissue for the most part above the 
 temporal lobes is markedly degenerated. In view of this marked degeneration, the internal capsule 
 does not appear to be so shrunken a structure as one might expect. The superior temporal gyrus is 
 itself moderately involved in the degeneration, more particularly on the left side. The transverse 
 temporal gyri are markedly shrunken. Planes posterior to the above continue to show extreme degenera- 
 tion of tissues superior to the Sylvian fissure and even including the mesial surface on the left side. Of 
 these gyri the callosal gyri are the least affected. The superior temporal gyri and insulae of both sides 
 show equal degrees of degeneration. On the right side, the inferior parietal lobule shows a certain degree 
 of change, but the alteration of the superior parietal lobule is extreme, if we except the tissue along the 
 longitudinal fissure and upon the mesial surface. Large amyloid granulations are found at the base of 
 the pineal body. 
 
 The thinning of the cortex in sections posterior to the above is extreme except in the temporal lobes. 
 Appearances suggest that the right superior colliculus is smaller than the left. The pyramidal bundles 
 are smaller on the left side than on the right, their magnitude being reduced possibly one third. The 
 tapetum and optic radiations are markedly thinned out on both sides, although more extremely on the 
 left. A section from the extreme tips of the right lobe exhibits a curious appearance of cells in islands 
 separated by fibers. 
 
 e) Anatomical and Histological Summary. 
 
 The interest of this case naturally lodges in the combination of microcephaly, hydrocephalus and 
 posterior-lying focal lesion of the cerebral cortex. It is supposed that this latter lesion may have been 
 due to an old cortical lesion, possibly of the nature of cerebral lesions sometimes occurring in infantile 
 paralysis. The brain is somewhat asymmetrical; in particular the right hemisphere is considerably 
 broader than the left. It is an interesting inquiry what relation may be held between the focal parietal, 
 occipital lesion and the shrunken left frontal region with its circumscribed area of microgyria in the second 
 frontal gyrus. 
 
 When we find that the nerve fiber loss has been replaced by patches of rather dense neuroglia tissue, 
 we are bound to inquire whether this latter condition of gliosis is to be regarded as an acquired reaction 
 following the destruction of tissue which had been properly laid down, or whether this gliosis is to be 
 regarded as gliosis relative to fundamental absence of nerve fibers. The patchy nature of the gliosis 
 rather inclines the examiner to the belief that we are dealing with a lesion in some sense acquired. The 
 fact that large pigment-bearing phagocytes are found in the gliotic walls of the cavities found in some 
 areas of gliosis is perhaps not decisive; but phagocytosis is consistent with the hypothesis of acquired 
 lesion. 
 
 Again the irregular preservation of nerve fibers about the ventricle (mesial and internal fibers of the 
 inferior border preserved) rather suggests acquired lesion. 
 
 What the significance of the multiple cavitation in degenerated areas surrounded by dense gliosis 
 may be is doubtful. We may think of the resemblance of these areas to cavitation in the spinal cord in 
 syringomyelia. Patchy nerve cell and fiber loss, cavitation in areas of gliosis, the occurrence of pigment- 
 bearing phagocytes, to say nothing of the somewhat suggestive history of early brain lesion, may well 
 lead us to regard this case as one of secondary amentia in the sense of Tredgold. Whether we may 
 add to this list of factors the presence of satellitosis in certain areas is questionable. On the whole, 
 however, in the present stage of our knowledge concerning satellitosis, it would appear that the finding 
 is rather indicative of an active or acquired lesion. (One here bears in mind the satellitosis about nerve 
 cells in poliomyelitis and other conditions, which may be repeated experimentally; but one also has to 
 bear in mind the satellitosis in certain cases of atrophy of the brain in the senile period where the satellite 
 cells may be regarded possibly as reactive to the condition of atrophy.) It might be that hypoplastic 
 
70 SOUTHARD AND TAFT. 
 
 nerve cells could be affected by satellitosis in ways identical with those of the condition just mentioned. 
 The presence of large amyloid granulations at the base of the pineal body may have significance in these 
 directions but we must at present omit consideration thereof. 
 
 The greater degree of disease on the left side of the brain is supported by the smaller size of the pyra- 
 midal bundles on the left side above the decussation. 
 
 In our judgment the case then is pretty clearly one of secondary amentia. 
 
 Synopsis of Findings in Case III. 
 a) Clinical. 
 
 Little is known as to Case III although the patient, D. C, born in 1863, was a somewhat well-known 
 figure in Boston and vicinity all his life, which was passed for the most part outside of institutions. When 
 outside of institutions, patient was regarded as a harmless microcephalic, alternately the pet and the 
 butt of the community. He was of a vagrant tendency, unable to support himself but able to curry 
 favor with various kindhearted persons, who would keep him in their houses for a few days or weeks 
 until the vagrant spirit set in once more. He was known as "Peanut head" by the children, and became 
 later known as "Zip," being a namesake of a subject exhibited at circuses and variety shows. In fact, 
 the patient is said to have been exhibited for a time in a nickel theatre in Boston under the name of 
 "Zip, the wild man of the Philippines." The patient entered the hoax with intelligence, wore a buffalo 
 robe, had his hair cut in a peak behind, and rattled a tin cup, saying "Education! Education!" 
 
 The patient, born of Irish-American parents (father alcoholic), is said to have been a seven-months 
 child, born in a fracas between his father and a policeman. The patient's father is said to have been 
 occupied with beating the mother when the policeman interposed. The policeman's club is said to have 
 glanced off onto the head of the mother, who died within twelve hours of giving birth to the patient. 
 
 The patient is said to have learned to walk and talk at the usual time, was unable to get through 
 the primary school, but is said to have picked up reading and writing. He was at first in a Catholic 
 home; later in a home for destitute children; still later in the State Infirmary in Tewksbury, where he 
 was operated upon for rupture; and he was at the Bridgewater State Farm in 1903. The patient had 
 no abnormal sexual tendencies. He was easily susceptible to alcohol. It is said that at the age of 30 
 he had a fit, probably epileptic in nature. 
 
 The history of the patient just before his death makes a somewhat moving story. Upon good 
 authority, it is related that he was in perfect health until September 15, 1908, being six days before he 
 died. Upon September 15, the patient endeavored to steal a quarter from a kind hostess who had kept 
 him in her house for a number of days, as she had done at previous times. He was found out in his 
 design and was upbraided roundly by his hostess for being a liar. The patient became furious, went to 
 his room in his hostess' house, began to mutter to himself and to tear his hair, and then refused to eat or 
 drink. He is said not to have eaten anything until his death. He was admitted to the Danvers State 
 Hospital in extremis, September 20, 1908, and died a few hours later. 
 
WAVEKLEY RESEARCHES. II. 71 
 
 b) Autopsy. 
 
 Head and trunk were examined by E. E. Southard and the cord by M. M. Canavan. 
 
 White male, age 45, 126 cm. long; weight, 88 lbs. Trunk symmetrical; thorax narrow; costal 
 angle acute. Shoulders and hips of equal width. Spinal column straight. Extremities symmetrical 
 and of appropriate length with respect to trunk. Head microcephalic. Skull symmetrical. 
 
 Measurements: Glabello-occipital length, 14.5 
 
 Basi-bregmatic height, 12. 
 
 Vertical index, 81 . 
 
 Minimum frontal diameter, 9.5 
 
 Greatest parietosquamous breadth, 11.5 
 
 Cephalic index, 79. 
 
 Horizontal circumference, 43. 
 
 The glabella is prominent. The general outlines are shown in the accompanying sketch. Extremities 
 rigid. Slight greenish discoloration of abdomen. Pupils: left 5 mm., right 4 mm. 
 
 Peritoneal cavity. — Serosa and contents normal. Appendix infracecal, free, 7 cm. long. Mesen- 
 teric lymph nodes not enlarged. Omentum thinly clad with fat. 
 
 Pleural cavities. — Slightly moister than normal. Adhesions absent. Roughening of pleura at 
 both apices, in areas less than 3 cm. broad. 
 
 Pericardial Cavity. — Not remarkable. 
 
 Mediastinum. — No sign of thymus. 
 
 Heart. — Weight, 210 grams. 
 
 Measurements: T. V. 11. cm. P. V. 5 cm. L. V. 1.5 cm. 
 M.V. 9. cm. A. V. 6 cm. R. V. 0.4 cm. 
 
 Muscle normal. Endocardium shows a slight thickening adjacent to aortic valve. Valves normal. 
 Cavities contain cruor clot. Coronary arteries normal. 
 
 Lungs. — Left 355 gr. ; right 535 gr. Both edematous and congested behind and below. The 
 dependent portions of both lungs, especially right, are coarsely mottled and non-retractile, and contain 
 bronchial plugs of semifluid pus. There is no palpable deposit of fibrin on the pleurae. The larger 
 bronchi are free from pus. The vessels are normal. Bronchial lymph nodes not remarkable. 
 
 Spleen. — Wt. 105 gr. Fir; dark red, without thickening of trabeculae or enlargement of malpighian 
 bodies. Splenculus near hilus below. 
 
 Gastro intestinal tract. — Stomach: Contains little or no fluid. Walls covered with brownish mucus 
 which is tenacious. Duodenum negative, also jejunum. In various parts of the ileum greenish black 
 semi-solid pasty material seen. Walls covered with mucoid exudate. No ulceration or hemorrhage 
 seen. The colon also for some distance after passing ileocecal valve shows black content, but at the sig- 
 moid the content is only cheesy mucoid material. Rectum negative. 
 
 Liver: Wt. 990 gr. Border sharp. Substance of normal consistence and nut-brown in color. Gall 
 bladder not remarkable. 
 
 Pancreas. — Small. 
 
 Adrenals. — Show no lesion. 
 
 Kidneys. — Left weighs 170 gr. Measures 13 X 5 cm., is very red and drips blood on section. The 
 capsule strips with fair ease leaving a smooth surface. The cortex is 1 cm. thick, the pyramids are a 
 large distance from pelvis to capsular surface, being 2.5 cm. The pyramids are uniformly diffusely red, 
 while the cortex, mahogany in color, is markedly injected. Kidney substance bulges on section. Two 
 ureters of usual size connect the kidney with the bladder. The right kidney measures 9 X 2.5 cm. 
 
72 SOUTHARD AND TAFT. 
 
 Two yellow-white pouches 2.5 X 3 cm. in diameter, spring from either pole of the kidney and descend 
 to bladder as independent tubes 1.4 cm.-l cm. in diameter. They are 14-18 cm. in length and above 
 the fundus of the bladder appear to unite and descend on right side of bladder. The bladder is deeply 
 congested and in the upper and right side numerous cysts, closely set, appear in wall. Dissection of the 
 ureters shows fine openings into the bladder, two on the left side corresponding with the two ureters and 
 situated appropriately with relation to the trigonum, two on the right side symmetrically placed with 
 respect to those of the left side but draining only the external of the two right ureters. The internal of 
 the right ureters opens into the bladder by a relatively large orifice situated on the lateral surface near 
 the summit. 
 
 Organs of neck. — Thyroid weighs 15 gr. Normal on section. Under and along upper border of 
 common carotids a glandular bit of tissue held together by adipose and areolar tissue seen. It is yellow 
 in color and contains numerous glistening red bodies. 
 
 Aorta. — Smooth and elastic throughout. 
 
 Genito urinary. — Testes yellow-white, small, edematous, do not thread well. 
 
 Head. — Hair stiff, black, closely cropped. Scalp thick and may be readily gathered into loose 
 folds. Calvarium moderately dense. Dura mater not adherent to calvarium. Sinuses not remarkable. 
 Middle ears normal. Pituitary body normal. Brain wt. 610 gr. Placed in formalin for later description. 
 Brain reweighed after formalin containing 8% NaCl, 615 grams. 
 
 Measurements: Cerebrum, antero-posterior, 
 " dorso-ventrally, 
 
 " laterally, 
 
 Cerebellum, antero-posterior left, 
 " " " right, 
 
 " greatest dorso-ventrally, 
 
 " laterally, 
 
 Width of pons between origins of 5th nerves, 3 cm. 
 
 Antero-posterior basal measurement of pons, 2.5 cm.. 
 
 Pia mater, everywhere clear. Vessels show moderate injection; small pacchionian granulations 
 alongside longitudinal fissure from middle of superior frontal gyri as far back as superior parietal lobules. 
 Sylvian and Rolandic fissures well marked, almost symmetrical. Gyri of fairly even width. Gyri and 
 sulci so disposed as to yield the impression of a normal though small brain. No sign of Affenspalte. 
 Upon superficial examination, besides Rolandic and Sylvian fissures are made out (before stripping pia), 
 ascending ramus of Sylvian, second and third frontal sulci, first frontal sulcus (interrupted), intraparietal 
 sulcus with branches, first and second temporal sulci, parieto-occipital, calcarine, collateral and calloso- 
 marginal sulci. Orbital surfaces normal. Slightly asymmetrical markings. Cerebellae laminae not 
 remarkable possibly in places wider than usual, notably in Amygdala. The inferior vermis is either 
 absent or obscured by close proximity of inner surfaces of the amygdalae. 
 
 Anatomical Diagnosis. 
 Unequal pupils. 
 Chronic pleuritis. 
 Slight chronic endocarditis. 
 Pulmonary congestion. 
 Purulent bronchitis. 
 Acute nephritis. 
 Cystitis, acute. 
 
 Cystic formation in bladder wall. 
 Abnormality of ureters. 
 
 12.5 
 
 cm. 
 
 9. 
 
 cm. 
 
 10.75 
 
 cm. 
 
 4.5 
 
 cm. 
 
 4.5 
 
 cm. 
 
 3.5 
 
 cm. 
 
 8.5 
 
 cm. 
 
WAVERLEY RESEARCHES. II. 73 
 
 Scalp thick. 
 Calvarium dense. 
 Microcephalic brain. 
 Brain weight, 610 grams. 
 
 c) Special Description of Brain. 
 
 Subsequent to examination on the autopsy table, the following notes were made concerning the 
 brain: 
 
 Length left hemicerebrum, LLH, 16 . 9 cm. 
 right LRH, 16.2 cm. 
 
 Width W 12, 10.1. 
 
 Cerebral index 10.1 X 100, over 16.9 cm. 
 Greatest height Heit, 7 cm. 
 
 Arc frontal pole to Rolando, LArc FRo, 9 . 3 cm. 
 right, R Arc FRo, 9.4 cm. 
 
 Arc left Rolando to occipital pole, LArc RoOc, 8.4 cm. 
 right, RArc RoOc, 8.2 cm. 
 
 Angle of Rolando with long, fissure Right = 53° 
 
   " " " " " Left = 53° 
 
 Temporal tip — frontal pole = 3.1 cm. 
 
 " " occipital pole = 10.3 cm. 
 
 Cerebellum. — Bilateral diam. = 8.7 cm. 
 Ant. post, at brachial exit = 5.2 cm. 
 
 Flocculus fairly developed. Lobes uniform in size and outline. 
 
 Fifth nerve leaves the bulb somewhat higher on the right than on left. Cranial nerves otherwise 
 not remarkable. 
 
 Basilar vessels show no alterations except slight diffuse thickening of the vertebrals, especially seen 
 on the right about 2 cm. below the basilar. 
 
 Frontal segment mesial from corpus callosum = 2.5 cm. 
 
 Occipital segment, splenium — occipital pole = 5.7 cm. 
 
 Right Hemisphere. —   The right Sylvian fissure (6.4 cm.) is very simple, its borders closely approxi- 
 mated. The insula is visible only at the base of the ascending ramus; there is no anterior branch. 
 
 Central Rolandic Fissure. — The Fissure of Rolando is 7.6 cm. in length, has no branches and does 
 not cut through the margin of the hemisphere. The genua are represented by two flat curves in the 
 course of the fissure. The superior genu is 1.7 cm. from upper extremity; the inferior, 5.3 cm. 
 
 Occipito-parietal. — Rises where the internal border of the cortex cerebri is in apposition with the 
 ant. corp. quad. It approaches the occipital pole in a comparatively horizontal direction. At the 
 margin it bifurcates, forming a broad Y. The occipito-calcarine stem is short, 1.2 cm. The calcarine 
 fissure forms an acute angle with the parietooccipital and continues posteriorly in an S outline extending 
 downward and backward, then outward and upward. 
 
 The precentral fissure-complex. In the frontal cortex, including and lying in front of the fissure of 
 Rolando, there is one principal fissure, triradiate in form corresponding apparently to the precentral 
 sulcus, frontal from which extends the inferior frontal sulcus. Above the dorsal extremity of the vertical 
 ramus and separated from it by a narrow, plump gyrus, is a short, deep fissure 2.3 cm. in length which 
 cuts the superior margin at right angles. (Sulcus cruciatus?). This sulcal arrangement divides the 
 frontal cortex into two gyri, both of which anastomose with the precentral and anteriorly with each other. 
 The superior frontal convolution is broad and long, and is marked by four short fissurettes which generally 
 
74 SOUTHARD AND TAFT. 
 
 follow an oblique line. The inferior frontal is short and broad, and is marked by three shallow fissur- 
 ettes, and a deep ascending Sylvian fissure. Very far frontal is a T-shaped sulcus, whose stem runs from 
 a point very near the fronto-Sylvian angle and 0.6 cm. from the orbito-frontal margin to a point 0.8 cm. 
 from the superior margin where it opens into a longitudinal sulcus 2.1 cm. in length, slightly concave 
 mesad. 
 
 Temporal and Occipital Fissures. — The parietal lobe presents an anomalous fissure-complex — the 
 postcentral sulcus (1) cuts the margin of the superior longitudinal fissure and extends upon the mesial 
 surface for a short distance. The horizontal interparietal is represented by a very short ramus (2) 
 (1.5 cm.) which springs from the postcentral at the junction of the middle and lower thirds, mesad to this 
 horizontal ramus and 1.4 cm. from the meso-dorsal margin is a deep, curved, horizontal fissure, slightly 
 curved with the convexity mesad. This fissure does not descend vertically into the cortex, but obliquely 
 outward, thus forming a thin operculum which overlies the tips of the horizontal convolutions which 
 form the superior parietal lobule. At its occipital extremity this sulcus opens into a horizontal one 4.3 cm. 
 in length which lies 1.5 on the meso-occipital surface and ends laterad in a forked extremity. The lower 
 lip of this fissure is opercular in character and suggests an Affenspalte. The corresponding sulcus on the 
 left side is quite simple, not at all resembling the one just described. 
 
 The superior parietal lobule is narrow and its gyri vary in width from 1.2 cm. to 0.4 cm. The supra- 
 marginal gyrus is fairly broad — 0.9 cm. in width — but the convolution is short. It anastomoses 
 anteriorly with the postcentral and posteriorly by means of a bridging arm, with the angular gyrus. The 
 latter is made up of three parts which extend horizontally and assume a fan-shaped outline. The gyri 
 are comparatively broad and almost free from ramifications. This gyrus encroaches upon the occipital 
 lobe which is very small. The tips of the occipital lobes of both sides point away from the median line 
 thus exposing a portion of the cortex which is ordinarily found on the approximated mesial surface. 
 
 The Temporal Lobe. — The temporal lobe is divided by two very simple fissures. The gyri are 
 relatively broad, smooth and well-rounded, with short shallow fissures at their bases. The sulci on the 
 basal surface are very simple. A deep fissura rhinica separates the uncus definitely from the tip of 
 the temporal lobe. The inferior temporal sulcus: It is deep with sloping walls, and is interrupted 
 about midway by an arm from the fusiform gyrus which anastomoses with the third temporal convo- 
 lution. 
 
 The Left hemicerebrum. — The configurations of the area anterior to the Rolandic fissure on the left 
 hemisphere are almost identical with those on the right, in every detail. 
 
 The temporal lobe also is uniform with the right. 
 
 The parietal lobe. — The ascending ramus of the interparietal sulcus is separated from the horizontal 
 and descending portions by an anastomosing arm between the postcentral and superior parietal gyri. 
 The posterior extremity of the horizontal limb enters into a roughly star-shaped formation. The poste- 
 rior portion of the second temporal gyrus, representing the area of the angular gyrus, is a separate frag- 
 ment; below this a continuation of the second temporal fissure extends backward to within 3.2 cm. of the 
 longitudinal margin. 
 
 The occipital lobe is noticeably larger than that on the right. Its markings are somewhat complex 
 and may be best studied on the figures and photographs. 
 
 The configuration of the basal surface is uniform with the opposite side. 
 
 The meninges are not particularly remarkable. The pia is slightly thickened and the vessels in- 
 jected. 
 
 There is noticeable occipital asymmetry; the right side is shorter than the left, and points away 
 from the median line. 
 
 The orbital surfaces incline upward to a marked degree both postero-anteriorly and meso-laterally, 
 thus partly exposing them to lateral view. The sulcus pattern here is a very simple tri-radiate one, 
 very similar on both sides. The olfactory bulbs are 3.5 cm. in length, and not notable in development. 
 
WAVERLET RESEARCHES. II. 
 
 75 
 
 Rt. precentral are 9.5 cm. 
 
 " postcentral "8. " 
 
 L. precentral " 10. " 
 
 " postcentral "8. " 
 
 The markings on the hemispheres are very nearly symmetrical. There is lack of development of 
 both frontal and parietal cortex; possibly involving the former to a greater degree. 
 
 The frontal lobes are very pointed at the extreme pole and are made up of only two convolutions. 
 The superior is somewhat narrower than the inferior and is marked with short, oblique fissures, and 
 triangular depressions. The Island of Reil is exposed on both sides: somewhat more on the left than 
 right. At the base of the frontal gyri, and separating them from the precentral convolutions on either 
 side are short, deep, transverse sulci, which resemble the sulcus cruciatus of the dog's brain. In fact this 
 specimen in general contour bears a rather noticeable similarity to the brain of a dog. The convolutional 
 pattern of the central region is very simple. The pre- and post-central gyri on the right are curved only 
 at the genua. The Rolandic fissure on this side points occipitalward at its upper extremity, and nearly 
 cuts the margin of the hemisphere. On the left side the precentral gyrus is interrupted at the point 
 corresponding to the inferior genu; the upper knee is lacking. The Rolandic fissure on this side is formed 
 at its upper extremity by a formation with a convolution of good width between it and the margin of the 
 hemisphere. 
 
 The horizontal portion of the right interparietal sulcus is separated from the postcentral portion 
 by an annectant gyrus, between the superior and inferior parietal lobules. It curves around the supra- 
 marginal and angular gyri, and seems to form an offset to a portion of the superior parietal lobule. The 
 latter is narrow and marked with transverse fissures. On the left side, the inferior postcentral (descend- 
 ing interparietal) fissure is continuous with the horizontal interparietal. 
 
 The superior post central is separated from the former by an annectant gyrus connecting the post 
 central with the superior convolution. A similar opercular formation exists on the left as on the right, 
 but it is made more complex by a reduplication caused by the presence of an additional sulcus which 
 extends with a single interruption, in a curved outline from the posterior extremity of the parieto-occipital 
 fissure to the base of the second temporal from the angular gyrus. 
 
 The occipital lobes are very small, and are marked by a few short fissures. The calcarine fissure 
 extends upon the outer surface, ending in a single upward curve on the right, and in a T formation on the 
 left. 
 
 The temporal lobes are remarkable only for their simplicity. The gyri are nearly straight, and 
 almost entirely without markings. The first and second convolutions are of good width and well rounded. 
 The third is somewhat narrower and flattened. 
 
 The pyriform lobules are well developed, the right apparently more so than the left and are limited 
 anteriorly by a well marked fissura rhinica (Turner) (?). 
 
 The markings on the base of the brain are as singularly symmetrical as they are on the upper and 
 lateral surfaces. 
 
 The mesial surfaces are not described because the hemispheres were not separated. 
 
 d) Microscopic Examination. 
 
 The total brain sections stained by the Weigert myelin sheath method permit the observation of a 
 marked gliosis in the white matter in the frontal region, especially about the vessels. In places the cel- 
 lular gliosis is general and marked and in particular there is an abundance of spider cells in the subpial 
 region. Satellitosis is found in addition to the above mentioned cellular gliosis and in certain areas 
 farther back in the frontal region (sections # 146-151) there appears to be a particular degree of satellitosis 
 about the cells in the lenticular nucleus. Also in this posterior portion of the frontal region, the gyri 
 
76 SOUTHARD AND TAFT. 
 
 begin to show a more marked thinning of their cell layers than is found farther forward. The mesial 
 surface of the uncus of both sides and the basal tissues lying between show a marked subpial gliosis. Large 
 cells were demonstrated in the appropriate region about the ventricle and there was a marked subepen- 
 dymal gliosis with pigmented glia cells and certain la^ge round cells. These findings were especially 
 noted from the mesial angle of the thalamus. 
 
 Practically no areas fail to show general cellular gliosis but thinning of the cell layers is shown in 
 addition to that mentioned above for the frontal areas (sections # 156-186) also in the parietal areas 
 (sections #331 -356). The tapetum, optic radiations and longitudinal bundles are intact. The tissue per- 
 mitted the employment of Van Gieson's stain which demonstrated the subpial gliosis especially well, as 
 also a perivascular gliosis in many places, with lymph spaces apparently containing glia cells (no exudate 
 is present in any area studied). The stem of the olfactory bulb is found infiltrated with amyloid bodies. 
 There was a slight focal thickening of the intima in the basilar artery. 
 
 The blood vessels of the white matter appear numerous and there is a good deal of perivascular 
 gliosis. No abnormality of vessel walls is anywhere shown. 
 
 e) Anatomical and Histological Summary. 
 
 The gyri are everywhere narrow — about 0.8 cm. at their summits — and simple in arrangement. 
 The primary and secondary sulci are of ordinary depth, not complicated by collaterals, and their walls, 
 as a rule, are not approximated at the summits, though the sulcal floor is not exposed. 
 
 The frontal lobes are small, and pointed at the anterior poles; the orbital lobes lie in a more or less 
 vertical plane. The markings are notably uniform on both sides. 
 
 The temporal lobes are comparatively large and are very simply convoluted. 
 
 The parietal lobes present a greater diversity of sulcation than any other part of the brain. The 
 pattern of the two sides varies considerably. This is described in detail in another place. 
 
 The occipital lobes are quite at variance in size, the right being considerably shorter than the left. 
 A deep transverse sulcus about midway between the parieto-occipital fissure and the tip of the occipital 
 lobe forms a relatively large operculum and seems to account for the occipital shortening. This lack of 
 uniformity in the size of the occipital lobes is plainly seen on the basal surface. (See illustration). 
 
 The brain was not divided longitudinally between the hemispheres and consequently a detailed 
 
 examination of the mesial surfaces was not made. 
 
 Angle of Rolando with long fissure, right = 53° 
 « « « u « « i eft = 530 
 
 Temporal tip — frontal pole = 3.1 cm. 
 " " occipital " = 10.3 cm. 
 
 There are varying degrees of satellitosis nowhere marked in the cortex, but rather more extreme in 
 degree in the basal gray matter. 
 
 The cortex averages about 3 cm. in thickness. 
 
 The cortical cell-supply seems somewhat reduced in amount, especially in the frontal and parietal 
 lobes. Betz cells prominent. The lack seems to be mainly in the outer layers of medium sized and 
 large pyramids — possibly at times the inner layer of large pyramids. 
 
 There is considerable subpial gliosis throughout. This is particularly true on the base of the brain 
 between the crura cerebri and the base of the olfactory trigone, especially in the tempero-frontal angle, 
 where the glia network is infiltrated with amyloid granules. 
 
 There is also considerable subependymal gliosis — both cellular and fibrillar with pigment in the 
 glia cells. This is confined mainly to the opposed surfaces of the optic thalamus. 
 
WAVERLEY RESEARCHES. II. 77 
 
 Synopsis of Findings in Case IV. 
 
 a) Clinical. 
 
 Case IV, like Case III, is a Danvers State Hospital case. The patient, M. S., stated to be 62 years 
 of age at death, September 27, 1911, was under hospital observation only from July 26th to her death. 
 The patient was an old almshouse case (Salem and Beverly). 
 
 Physically on admission the patient was 4' 8j" tall, and weighed 111 pounds, with arteriosclerosis, 
 slightly enlarged liver, teeth absent, albuminuria, impairment of vision and hearing, thick speech, and a 
 tic of the right side involving head and shoulder. 
 
 The meagre history of the patient indicates that she was of old American stock. She had been 
 regarded for the twenty-eight years during which she had been under almshouse observation, as feeble- 
 minded. She was not selfsupporting although she would work, receiving a dollar or a dollar and a half, 
 for a week or more, ranging up to two or three months. At the end of her employment, she would leave 
 with her clothes tied up in a bundle covered by a cloth. Whenever the patient appeared upon the street, 
 she attracted much attention and had a crowd of small boys following her. The tic observed at the 
 hospital was apparently of long-standing and it is said that the twitching was more noticeable when the 
 patient was pleased. 
 
 Shortly before admission to Danvers the patient had become untidy. After admission, the patient 
 complained of headaches, was at times restless, was markedly amnesic; did not know the date or her 
 whereabouts, and her attention was hard to obtain. Patient apparently reacted to auditory and visual 
 hallucinations. She said she had seen little women sit on her knees and that they had blue eyes and red 
 hair. 
 
 b) Autopsy. 
 
 Body of a well developed, well nourished, white female 141 cm. in length. Rigor mortis present 
 everywhere. Skin smooth, hair brown, rather thin. Pupils, right 6 mm., left 5 mm. No teeth on 
 either jaw. No glandular enlargements. No decubitus. Tibial crests smooth. Face asymmetrical. 
 
 Ventral Section. — Panniculus over thorax .8 cm., over abdomen near umbilicus 2 cm. Muscle 
 good color. Omentum extends to umbilicus, moderately filled with fat. Lower border of liver extends 
 8 cm. below ensiform, lower border of stomach extends 6 cm. below ensiform. Few adhesions between 
 omentum and right parietal peritoneum. Adhesions about spleen. Appendix retrocedent, lies over 
 brim of pelvis 5 cm. in length, mesentery throughout. Peritoneal mesentery lymph nodes slightly 
 enlarged, no fluid in abdominal or pelvic cavities. Uterus in right side of pelvis. Diaphragm arches 
 to 4th interspace left, to 4th interspace right. Sternal bone marrow well colored. Internal mammary 
 arteries are not sclerosed. 
 
 Thorax. — Left lung adherent along entire posterior region. Adhesions in right lung lie between 
 middle and lower lobes and pericardium, and between the upper, middle and lower lobes. Apex free. 
 No fluid in the pleuric cavity. Anterior edges separated by 2.5 cm. Precordia exposed. Pericardium 
 contains 2.5 cc. of clear straw colored fluid. 
 
 Heart. — Greatest width 10 cm., greatest thickness 8 cm. Epicardium contains a small amount of 
 fat. Over the right ventricle is a milk patch slightly irregular in outline, approximately 2 cm. in diameter. 
 Superficial vessels slightly tortuous. Heart contains fluid blood. Weight 225 grams. 
 
 Measurements: T.V. 12 cm. P.V. 7 cm. M.V. 8.5 cm. 
 A.V. 7 cm. L.V. 1.3 cm. R.V. 5 cm. 
 
 Endocardium grey, thickened, aortic valve shows slight thickening at line of attachment of cusps, 
 
78 SOUTHARD AND TAFT. 
 
 mitral valve thickened along border. Tricuspid slightly thickened, pulmonary lies flat against wall and 
 shows no thickening. Interauriculus septum not intact. Foramen ovale is patent but is functionally 
 closed. Coronaries are free from sclerosis. Arch of the aorta smooth. 
 
 Lungs. — Left lung weight 345, adhesions between upper and lower lobes. Upper lobe air containing 
 throughout, a small fibrous scar at the apex. On section posterior portion darker but crepitant. Lower 
 lobe deep red mottled in lower portion, floats in water. Bronchi in lower lobe congested, upper lobe 
 nothing of note. 
 
 Right lung weight 325, adhesions between upper and middle lobes, air containing throughout. 
 Small scar on anterior surface near apex. Upper lobe pale, lower lobe slightly congested; lungs float in 
 water. Bronchi slightly congested. Bronchial lymph nodes not enlarged. 
 
 Abdomen: Spleen. — Weight 50 grams. Measures 9.5 X 5 X 1.5 cm. Capsule grey, slightly 
 wrinkled. On section soft, mottled. Trabeculae and Malpighian bodies distinct. 
 
 G astro-intestinal Tract: Stomach. — Lesser curvature 20 cm., greater curvature 26 cm. Stomach 
 filled with about 100 cc. of thick yellow mucus. Mucous membrane slightly congested, rugae distinct, no 
 hemorrhages of ulcers. 
 
 Intestines filled with a pale yellow fluid, fecal matter and mucus. Intestines thin walled throughout. 
 Slight congestion of duodenum and jejunum. Peyer's patches not enlarged, no hemorrhages or ulceration. 
 Mucus membrane of colon slightly congested, no hemorrhages or ulcers. 
 
 Liver. — 975 grams, 20 X 20 in quadrate lobe X 13 in left lobe, 5 cm. in thickest portion. Border 
 well rounded, on anterior surface of quadrate lobe near upper border are three furrows 3.5 cm. in length. 
 On section brownish, lobulation distinct not friable. 
 
 Gall Bladder. — Filled with dark, green brown bile. 
 
 Pancreas. — 13 cm. long by 2.5 cm. in width. 
 
 Adrenals. — Right adrenal weighs 4.8 grams, left adrenal weighs 5 grams. On section firm. 
 
 Kidneys. — Right kidney weighs 110 grams, measures 10.5 X 5 X 3 cm. Capsule strips readily, cor- 
 tex pale, .7 cm. Vessels slightly injected. Pyramids slightly more congested than cortex. On section 
 substance bulges slightly beyond capsule. Left kidney weighs 135 grams, measures 11 X 5.5 X 3.5 cm. 
 Pale, otherwise like the right. 
 
 Bladder. — Not unusual. Retroperitoneal lymph glands slightly enlarged and darker than usual. 
 
 Neck Organs: Oesophagus.— Nothing of note. 
 
 Thyroid. — Fairly symmetrical. Weight 12 grams. Left lobe a little more compact than right lobe. 
 
 Larynx, Tongue, and Tonsils. — Nothing of note. 
 
 Pelvic Organs. — External os of uterus was closed, canal filled with mucilaginous secretion. Uterus 
 atrophied, shortening of right broad ligament and is adherent to ovary on this side. 
 
 Ovary is atrophied, left tube apparently normal. 
 
 Rectum, nothing of note. 
 
 Head. — Calvarium dense, measures frontal 1 cm., temporal .3 cm., occipital .8 cm. 
 
 Large amount of diploe. Scalp not unusual. 
 
 Dura mater not adherent to calvarium, slight thickening in frontal portion. 
 
 Few adhesions dura and pia over vertex and along longitudinal sinus. Few adhesions between tip 
 of temporal lobes and dura. Lateral sinus of left side contains liquid blood, right side is filled with a 
 firmly adherent clot. Pituitary soft. 
 
 Right ear drum thickened with one small perforation of the drum. Left slightly thickened. 
 
 Pia Mater slightly thickened notably over vessels over vertex. 
 
 Pons and cerebellum weigh 125. 
 
 Brain firm, with no marked atrophy of convolutions. Slight flattening in parietal region of right 
 side, left hemisphere appears well rounded. Ependyma free and smooth, no sclerosis in basal vessels. 
 
 Brain weight 1215 grams. 
 
WAVERLEY RESEARCHES. II. 
 
 79 
 
 Anatomical Diagnosis. 
 
 Well nourished. 
 
 Rigor mortis. 
 
 Unequal pupils. 
 
 Asymmetry. 
 
 Chronic peritonitis. 
 
 Chronic perisplenitis. 
 
 Enlarged mesenteric lymph nodes. 
 
 Uterus in dextraposition. 
 
 Chronic adhesive pleuritis of left lung. 
 
 Chronic epicarditis. 
 
 Chronic endocarditis. 
 
 Chronic aortic and mitral endocarditis. 
 
 Fibrous scars at apices of both lungs. 
 Acute bronchitis left. 
 Small spleen. 
 Acute gastritis. 
 Acute nephritis. 
 
 Enlarged retroperitoneal lymph nodes. 
 Uterus and ovaries atrophic. 
 Calvarium dense. 
 Perforation of right ear drum. 
 Slight chronic pachymeningitis. 
 Slight chronic leptomeningitis. 
 Brain weight 1215 grams. 
 
 c) Special Anatomical Description of Brain. 
 
 After preservation in formaldehyde, the following further description of brain was made: — 
 
 The brain is dolichocephalic in type. There is slight asymmetry particularly at the poles, the left 
 in each case being more pointed, and the right occipital tip points away from the median line in a slight 
 degree. 
 
 The pia is moderately thickened, and its vessels injected. There are many arachnoid villi along the 
 superior longitudinal fissure. The convolutions throughout are rather narrow, but fairly well rounded, 
 and moderately complex. There is slight opening of the sulci throughout. 
 
 The primary sulci of the frontal lobe are not clearly defined. The first can be traced with some 
 difficulty, the line being broken and irregular. On the left it is interrupted by three annectants; on the 
 right the walls interdigitate in a way to make it unclear. The remainder of both lobes is marked by 
 generally transverse convolutions. 
 
 The precentral gyrus is continuous on the right; on the left it is cut across by the first frontal sulcus. 
 The postcentral sulcus is very narrow. At about midway its length an annectant connects it with the 
 inferior parietal lobule on both sides. The fissure of Rolando on both sides forms little less than a right 
 angle with the superior longitudinal fissure. Their upper extremities cut the superior margin, and extend 
 upon the mesial surface. The lower extremity on the left is separated from the fissure of Sylvius by the 
 convolution forming the operculum; on the left it cuts through the operculum and extends into the 
 Sylvian fissure. 
 
 The convolutions of the parietal lobes are narrow, and complex with very slight separation of their 
 summits. On the right the parts of the interparietal sulcus are continuous; on the left they are inter- 
 rupted by annectants and all three are separate. 
 
 The occipital lobes are not remarkable except for the slight asymmetry already noted. 
 
 (Mesial surfaces are not photographed.) 
 
 The only feature of the base of the brain worthy of note is the asymmetry of the pyriform lobules. 
 The right is larger and considerably more prominent than the left. 
 
 The frontal sections show both lateral ventricles much dilated, except in the descending horns; the 
 optic thalamus and the horizontal portion of the caudate nucleus are considerably flattened. The 
 subiculum gyrus hippocampi also is much flattened and shrunken. 
 
 The cerebellum is notable only for the apparent lack of uniformity between the two dentate nuclei. 
 
80 SOUTHARD AND TAFT. 
 
 d) Microscopic Examination. 
 
 From the notes of a partial microscopic examination, the following is abstracted : — 
 
 The left and right prefrontal areas exhibit a marked gliosis with the appearance of a great numerical 
 increase of cells in all layers. Many of these cells are of a type best described as shadow cells. The 
 plexiform layer shows coarse glia fibers. The remainder of the frontal region exhibits identical changes. 
 
 In the white matter underlying both the left and right precentral gyri, there were many ganglion 
 cells largely of the fusiform type ordinarily found in the undermost layer of the cortex. Although there 
 were numerous corpora amylacea in the white matter, there was no gliosis and there was no alteration 
 in blood vessels. The cortex of this region showed a slight degree of satellitosis with a slight subpial 
 gliosis. There appeared to be a focal loss of nerve cells effected in various places of the laminae, except 
 the layer of small pyramids. It is estimated that many Betz cells are smaller than normal. Their 
 protoplasm is granular and there is marked increase of yellow pigment. There are frequent shrunken 
 cells and shadow cells in all layers. The postcentral regions of the two sides are slightly better off as to 
 cell shrinkage than the precentral gyri. 
 
 The intermediate postcentral regions also show a considerable degree of subpial gliosis and numerous 
 corpora amylacea. Upon the right side there appears to be a thinning in the layer of large pyramidal 
 cells upon the summit of the gyrus examined. There is no such finding upon the left side. There is a 
 suggestion of increase in glia cells throughout the white substance underlying the intermediate post 
 central gyri. 
 
 There is a slight gliosis in the white matter of the calcarine areas. Under the transverse temporal 
 gyri are numerous dislocated ganglion cells in the white substance, resembling those mentioned under 
 the precentral gyri. 
 
 The area of Broca shows cellular gliosis with corpora amylacea, a moderate degree of general nerve 
 cell atrophy and a thinning out of the layer of internal large pyramids from the summits of the gyri 
 examined. In the subpial layer are many coarse neuroglia fibers. 
 
 The hippocampal gyri, cornu ammonis and pyriform lobules show an unusual degree of subpial 
 gliosis and infiltration of corpora amylacea. There is also a gliosis under the ependyma of the ventricles 
 sectioned at this point. There were a number of cells staining palely with colorless spaces about the 
 nucleus, including some shrunken cells with non-staining nuclei and elsewhere were some examples of 
 the shadow cells above mentioned. There is occasional satellitosis but not confined to special laminae. 
 
 The spinal cord and medulla show a marked fibrillar gliosis of the periphery and about the central 
 canal. The posterior columns show a considerable infiltration of corpora amylacea. There appears to 
 be a degree of perivascular infiltration in the posterior fissure. 
 
 e) Anatomical and Histological Summary. 
 
 The brain of this case shows an atrophy or aplasia of the type with flaring sulci suggestive of a condi- 
 tion in which the white matter is relatively better preserved than the grey. The left side appears slightly 
 more hypoplastic or atrophic than the right. The parietal lobes exhibit particularly narrow convolutions 
 and may indicate a certain tendency to microgyria. The left pyriform lobule is smaller than the right. 
 (This appears accordingly not to be a case of cruciate asymmetry in the sense of case V, for example.) 
 
 Employing the microscopic examination for the purpose of determining whether this case is one of 
 acquired lesion, we find a marked gliosis with apparent great numerical increase of cells in many layers. 
 We find a coarse fibrillar gliosis of the plexiform layer in places. We find a considerable variation in 
 degree of gliosis in different places but these findings are consistent enough with the hypothesis of rela- 
 tively recent changes in a subject of 62 years. 
 
WAVERLEY RESEARCHES. II. 
 
 81 
 
 Likewise we may logically dispose of the satellitosis found in certain places as well as the over- 
 pigmentation of certain nerve cells. The shrunken nerve cells, so-called shadow cells, are consistent 
 enough with the hypothesis of relatively recent chronic change. In fact, we should probably be at a 
 loss to determine whether there was any evidence of fundamental change suggestive of long-standing 
 lesion if it were not for the dislocated ganglion cells in the white matter in certain regions. It is important 
 to raise the question whether the slight degree of perivascular infiltration in the posterior fissure of spinal 
 cord in places is to be regarded as a sign of old syphilis. The suspicion must at least be raised in the case, 
 although the data of Wassermann reaction are not available. There are in the body at large no special 
 signs indicative of old syphilis (enlargement of mesenteric and retroperitoneal lymph nodes, valvular 
 and parietal endocarditis, etc.). 
 
 The case is of peculiar value in emphasizing the difficulties which attend a decision as to inborn and 
 acquired lesions in cases of elderly subjects. Of course the majority of the feeble-minded fail to reach the 
 sixties, possibly for reasons inherent in their general make-up. This case then must be used as a limiting 
 instance in our total larger series. 
 
 Synopsis of Findings in Case V. 
 
 a) Clinical. 
 
 Case V has been already published in Southard's monograph on dementia praecox, from which the 
 following condensed history is taken: 
 
 C. B. was a boy of 15 when he was committed to D. S. H., and died there a year and four months 
 later of typhoid fever, ulceration, and peritonitis. The mental diagnosis was eventually considered to be 
 dementia praecox. 
 
 Mother nervous and melancholy during her pregnancy with this boy; hard usage and neglect by 
 husband complicated the pregnancy. From an accident to the boy at seven, is said to date a change of 
 character, with refusal to go to school, fretfulness, and nervousness. At 14 another accident to back 
 and head. An inmate of a truant school for two periods of three and two years respectively. Uncle a 
 patient at state farm. 
 
 Auditory hallucinations, refusal to eat, nervousness, and certain delusions antedated commitment 
 by only a week. (Masturbation had begun four or five months before, but had probably ceased.) In- 
 somnia is said to have lasted four nights after onset. Food poisoned. Passers-by or Indians were to kill 
 him (given to blood-and-thunder stories). "Had never done anything to gladden America," " Traitor," 
 " Going to be shot." < 
 
 Cyanosis of hands; gait staggering (no Romberg) ; right cremasteric reflex not active. 
 
 After eight months' observation it was thought that the patient really belonged in the moron or 
 subnormal group of defectives, and in the quasi-criminal class. A little over 11 months after the delu- 
 sional episode upon which he was committed, patient developed a spell of disturbance which lasted 10 
 days. In this spell, patient was noisy, threatening, profane, denudative, given to disconnected and 
 incoherent talking, lost weight and grew pale. Almost three weeks later typhoid fever developed, and 
 death followed from peritonitis. 
 
 b) Autopsy. 
 
 Summary. — Aside from the typhoid fever lesions, there were bronzing of skin, unusually small 
 adrenals (questionable glycosuria had appeared on entrance but later disappeared), a small thyroid, 
 slight sclerosis of aorta and right auricular endocarditis; cardiac hypertrophy, chronic myocarditis, 
 pleuritis, and pericarditis. 
 
82 SOUTHARD AND TAFT. 
 
 The brain weighed 1435 grams (over weight 90 grams by Tigges' formula). There is nevertheless a 
 tendency to frontal atrophy, perhaps more marked on left side. Striking anomalous folding of convolu- 
 tions in both calloso-marginal regions above the splenium; but on the left side the fissuration suggests 
 acquired lesion rather than congenital anomaly (region above and behind the rostrum). 
 
 c) Special Anatomical Description of Brain. 
 
 After hardening in formaldehyde, the following further description of the brain was made: 
 
 Measurements: Length left hemicerebrum, LLH, 18. cm. 
 
 right LRH, 18. cm. 
 
 Greatest width W-L., 6.5 cm. 
 
 Rt., 7. cm. 
 
 Height, Heit 10 . 75 cm. 
 
 Arc frontal pole to Rolando, left, 10. cm. 
 
 right, 10. cm. 
 Distance temporal to frontal tip, left, 4.5 cm. 
 
 right, 5 . cm. 
 
 The specimen shows the not unusual frontal and occipital cruciate asymmetry, in which the frontal 
 lobe, particularly the most anterior portion, and the contralateral occipital lobe, are narrower than their 
 fellows. In this case it applies to the left frontal and right occipital lobes. 
 
 There is slight general clouding of the pia over the vertex, somewhat more extreme near the margin 
 of the longitudinal fissure. The pial vessels are moderately injected. 
 
 With the pia removed the convolutions appear in general fairly well rounded, but rather narrow; 
 their summits are not closely approximated. There is no remarkable lack of complexity. 
 
 The frontal convolutions are distinctly separated from each other by longitudinal sulci, though an 
 annectant connects the middle of the first with the base of the second on both sides. The third is notice- 
 ably prominent on the left. 
 
 In the central area the Rolandic fissures leave the superior margin of the hemisphere at a right angle. 
 At the superior knee the right points forward more than the left, but the lower extremities both end at a 
 point 7 cm. from the frontal tip. The upper extremity of Rolando extends onto the mesial surface 
 1.5 cm. in a backward direction on the left, 0.5 cm. perpendicularly on the right. The post central 
 convolution is slightly narrowed in its upper extremity. In the parietal lobes the post central sulcus 
 forms a second or double Rolandic fissure. Posterior to this one the usual interparietal sulci, with the 
 horizontal and descending branch. 
 
 The occipital lobes are small; the left side is not otherwise notable, but on the right side the second 
 gyrus is narrowed and shrunken, causing a drawing in of the surface, a part of which is consequently 
 depressed below the surrounding area. On lateral view this forms a slight concavity in the surface of 
 the occipital lobe. 
 
 The basal surface of the brain shows no marked anomalies. The collateral sulcus on the left is 
 interrupted about midway by an annectant between it and the fourth temporal convolution. The 
 typical H-shaped sulcation on the orbital surface is absent; the fissures are mainly sagittal in direction, 
 and near the lateral margin, leaving the middle orbital gyrus unusually wide. The lateral view of the 
 region shows the so-called "keel-formation" of the gyri recti. 
 
 The mesial surfaces of the hemispheres are striking particularly on account of the unusual similarity 
 in their configuration. The cuneate lobule on the left is somewhat smaller than that on the right. 
 
 The corpus callosum is slightly thinned in its posterior half. 
 
 There is no middle commissure. 
 
WAVERLEY RESEARCHES. II. 83 
 
 Gross frontal sections show the cortex of fair and uniform width throughout. 
 
 There is some apparent atrophy at the anterior temporo-insular junction, which leaves the adjacent 
 parts unapproximated. 
 
 The cavity of the right lateral ventricle is larger in all its diameters than that on the left, although 
 the difference is only moderate in degree. 
 
 There is nothing remarkable about the basal nuclei or the subthalamic structures. 
 
 d) Microscopic Examination. 
 
 The Weigert-Myelin sheath preparations show good fiber connections in all areas examined. Com- 
 parisons were made with the drawings in Campbell's "Localization in Cerebral Function." Evidences 
 of gliosis were as follows: — 
 
 The prefrontal tissue shows a moderate increase in the plexiform layer, involving not only an in- 
 crease in a number of cells but in the number of fibrils. There is no gliosis elsewhere. Although there 
 are frequent ganglion cells in the white matter, there is no notable neuroglia increase in this locus. The 
 prefrontal region showed occasional bi-nucleate neuroglia cells supplied with fibrils in the plexiform layer; 
 but there is no marked gliosis elsewhere. 
 
 The same description fits the postcentral tissue, except that there are groups of satellite cells in 
 various layers (right postcentral) as a rule surrounding the small nerve cells. 
 
 The superior and inferior parietal regions show similar glia pictures in the plexiform layer. From 
 the standpoint of gliosis, accordingly, the cerebral cortex of this case exhibits in all areas, so far as ex- 
 amined, a moderate degree of cellular and fibrillar gliosis of the plexiform or subpial layer, but fails to 
 show gliosis in other layers, except in the specimens examined from the right postcentral region. 
 
 As against the neuroglia picture, we may consider the nerve cell pictures. Of course the excellent 
 preservation of the fiber connections as above noted would indicate that there should be no extensive 
 degree of cell loss. What has so far been found may be summed up as follows : 
 
 The prefrontal region (for example, on the right side) shows a suggestion of thinning out of the nerve 
 cells in the supragranular layers; at the summit of the gyrus the cells here are often small and deeply 
 stained. 
 
 The large pyramidal cells of the infragranular region seem also thinned out. Similar slight degrees 
 of thinning out of the cells are found in the supragranular pyramidal layers of the precentral region 
 (upper portion right side) ; identical findings in lesser degree in the postcentral region and in larger degree 
 of the superior parietal and inferior parietal regions. On the whole, the evidence of nerve cell loss or 
 absence is distinct but slight. On the whole the supragranular layers appear to be more involved in 
 this cell loss or absence than the infragranular layers. It is to be noted also that no important degree 
 of satellitosis accompanies this cell loss, if we except the area examined from the right postcentral region. 
 
 A common finding in numerous areas is the presence of dislocated ganglion cells in the white matter. 
 These were noted as frequent in right upper precentral, right postcentral, right inferior parietal, right 
 superior frontal, and right prefrontal areas. 
 
 As for acute changes there was apparently a degree of chromatolysis in the larger cells in the frontal 
 region, but not elsewhere. 
 
 e) Anatomical and Histological Summary. 
 
 Frontal and occipital cruciate asymmetry suggest inborn or very early acquired lesion. This case 
 may well have been one of Dementia Praecox grafted upon a subnormal or moron condition and the 
 microscopy is accordingly of interest. As in the previous case, (IV), so here there are frequent dis- 
 located ganglion cells in the white matter. The gliosis and satellitosis of irregular distribution are con- 
 
84 SOUTHARD AND TAFT. 
 
 sistent enough with the hypothesis of acquired lesion. Nerve cell loss might be interpreted in either 
 direction as due to fundamental absence or to early or late degeneration. In various places, the supra 
 granular layers are subject to thinning out without any important degree of satellitosis (exception right 
 post central region). Our best argument therefore for inborn lesion is the dislocated ganglion cells in 
 the white matter, with the thinning out of cells in the supragranular layers as a not very strong secon- 
 dary argument. Of course it has sometimes been held that satellitosis should be found alongside the cell 
 loss in Dementia Praecox. Special studies in another series of cases, to be published in the Trans- 
 actions of the Association of American Physicians for 1916, indicate, however, that cell loss and satellitosis 
 do not necessarily proceed pari passu and that, in point of fact, in not infrequent instances, the cell loss 
 proceeds independently of reaction. In some instances, it might be argued that the tissues passed through 
 a phase of satellitosis followed by a phase in which nothing but cell loss can be demonstrated. An argu- 
 ment of this nature has been^ submitted in a paper published in the above mentioned Transactions for 1915. 
 At any rate, it would probably be agreed by all that in Senile Dementia there are cases in which nerve 
 cells slowly disappear without neuroglia reaction. The present case must therefore be used as another 
 instance of the fundamental difficulty which attends a decision as to whether a case is one of primary or 
 secondary amentia, even when a comparatively full anatomical and microscopic analysis is available. 
 
 Synopsis in Findings of Case VI. 
 a) Clinical. 
 
 1. Physical Examination. — Born in 1887; died Oct. 19, 1913. Slightly microcephalic; tall and 
 rather slight; death from pulmonary tuberculosis. Further data are given in the description of the 
 autopsy, below, in which the following features are of interest from the point of view of the pathological 
 anatomist. The number of scars of " tissue paper" appearance over extremities, back, and head, suggested 
 syphilis. There were also numerous superficially palpable lymphnodes; mal-formed ears; prominent 
 mastoid processes; high palatine arch; asymmetry of face, especially of nose and jaw; underdeveloped 
 hands and genitalia; redundant prepuce; absence of right vocal cord; hypoplastic aorta, and accessory 
 spleens. No history of epilepsy. 
 
 2. Family History. — Unknown. There is some suspicion of syphilis in the father, but the 
 suspicion has not been well established. Patient had been three years in almshouse at Tewksbury before 
 admission to the Massachusetts School, May 27, 1893. 
 
 3. Personal Developmental History. — Is said to have had measles. At time of application, at 
 6 years of age, he is said to have just begun to talk, and as understanding a good deal of what was said 
 to him. Patient is described as very restless and nervous; is usually rushing around; inclined to be 
 destructive, especially of cloth; soils and wets himself several times a day and every night. He would 
 spend his time destroying shirtsleeves and coatsleeves, unravelling his stockings, and the like. 
 
 4 and 5 and 6. School Progress and Examinations. Practical Knowledge. — Progress at 
 the Massachusetts School was slight. Patient was placed in the training classes but did not advance 
 much. He was able to do simple outdoor manual work. (He could help to clear land, use grubhoe, dig 
 up stones, and the like, and was able to polish floors and carry bundles.) Was able to feed himself with 
 a spoon although he spilled much of the food. Needed to be helped in dressing and undressing. 
 
 7. Economic Efficiency. — Nil. 
 
 8. Social History and Reactions. — Unable to speak words. Made curious squeaking attempts 
 at speech if people that he liked were about him. 
 
 9. Moral Reactions. — If something patient did happened to annoy the caretakers, patient 
 seemed to take pleasure in their annoyance. Patient had the typical idiotic grin when spoken to. 
 
WAVERLEY RESEARCHES. II. 85 
 
 10. Psychological Tests. — Approximately 2. This case, by reason of his aphasia (compare absence 
 of one vocal cord), yielded a poorer impression of his capacity than was perhaps justified. In some 
 respects, patient appears to have been above the rank of idiocy and to fit into the lower grade of imbecility. 
 
 Waverley School History. — Patient's tuberculosis resisted outoor treatment. 
 
 b) Autopsy. 
 
 Body. — That of a slenderly built emaciated white male 158 cm. in length. The skin is bluish gray, 
 and abrasions occur over elbows, hands and shins, irregularly. There are also quantities of "tissue 
 paper" scars over lower legs and back and scalp varying in size from 0.8-1.5 cm. in diameter. Lymph 
 nodes palpable in neck and groins. Rigor mortis absent, no body heat. Decomposition bands in flanks. 
 
 The head is markedly out of proportion, being long and narrow (occipitomental 56 cm.) the ears 
 flare and the measurement from superior portion of helix to lobule inclusive is 5.5 cm. X 4.0 cm. from 
 tragus to lateral side of helix, with a wide and flat antitragus and a minute tragus. Mastoid processes 
 unduly prominent. Palatine arch high, teeth in fair condition. Nose is deflected to right and the angle 
 of the lower jaw on this side is markedly prominent, the line of the left being longer and the angle less 
 noticeable. The hands appear larger than would be proportionate with the arms, and the finger nails 
 are minute, measuring 0.6 cm. in height showing evidences of much nibbling and the eminences below 
 the thumb are absent — giving the palmar surfaces a remarkably undeveloped appearance. Legs not 
 notable. Genitals: The scrotum short and broad, extending in direction of but not reaching anal surface. 
 Penis short and thick. Prepuce long, glands very red. No edema; a decubitus measuring 0.4 cm. over 
 sacrum is fairly superficial. 
 
 Ventral section. — Panniculus nil. Muscles red, peritoneum shows post mortem change. Omeutnm 
 contains no fat, transverse colon extends in a V-shape with apex downward into pelvic cavity. Stomach 
 14 cm., liter 8.0 cm. below costal margin. Spleen free; mesenteric lymph nodes remarkable in size and 
 number, some measuring 3 cm. in length. Appendix 8.0 cm. in length — has a mesentery of its own. 
 Prostate not enlarged, no free fluid in the cavity. Diaphragm arches to the 3d interspace on the right, 
 the 4th on the left. 
 
 Thorax. — Mammary vessels not sclerosed, sternum measures 3.0 cm. on frontal aspect, 5.5 cm. on 
 visceral. Bone marrow of sternum rich red, smears stained show excess of eosinophiles and few giant 
 cells. No nucleated red cells. 
 
 Pleuric cavities obliterated at apices, anterior edges of lungs overlap in median line: pericardium not 
 thickened. 
 
 Heart. — (No weights taken), estimated 250 grams. No fat in epicardium. Myocardium greenish 
 red (p. m.). Coronaries show no change. Section shows right auricle and ventricle filled with cruor 
 clot. Myocardium elastic, not friable. 
 
 Measurements: TV., 13.0 cm. P. V., 6.0 cm. L. V., 1.0 cm. 
 M. V., 10.0 cm. A. V., 6.5 cm. R. V., 0.4 cm. 
 
 Endocardium not remarkable. Some slight thickening in aortic cusps below corpus aurantii. 
 
 Lungs. — Not weighed. Over surface of left there are areas which show as slightly umbilicated 
 centrally, red edges measuring 0.4 cm. Cut section shows a spongy parenchyma, with thickened bronchi 
 in the lower portion and a gush of yellowish puriform material follows knife cut at apex. Stained smear 
 shows tubercle bacilli in countless numbers. 
 
 Same process in right lung, possibly more extensive. Peribronchial lymph nodes not remarkable 
 and showed no areas of infiltration on section. 
 
 Organs of the neck. — The tongue is heavily coated. The epiglottis is thick and yellowish and bathed 
 in pus. The aryteno-epiglottidean folds are ragged on their free edges. From above superior and 
 
86 SOUTHARD AND TAFT. 
 
 inferior vocal cords appear unequal, and on section there are none on the right, being replaced by small 
 white nodes which extend over the whole cavity of the larynx above the cord district. On the left a 
 ventricle is the only mark by which a superior and inferior vocal cord may be inferred. Thyroid not 
 notable. No thymus nor parathyroids seen. Aorta is remarkably narrow (3.5 cm. in circumference) 
 and very elastic. 
 
 Abdomen. — Spleen not weighed. Estimated weight 100 grams. Somewhat autolysed, capsule 
 not thickened. Pulp soft, trabeculae and malpighian bodies not notable. On the inferior edge two small 
 accessory spleens hang, one is 0.2 cm., another 0.8 cm. in diameter. 
 
 Adrenals. — Remarkably small, not over 1.5 cm. at the widest part on cut section. 
 
 Kidneys. — Not weighed — estimated 200 grams. No perirenal fat; capsule stringy and non- 
 adherent, cortex swells slightly over capsule, color of medulla and cortex homogeneous (from p. m. change). 
 Pelves not notable. 
 
 Liver. — Not weighed — estimated 1500 grams. Capsule not thickened. Streaks of yellow occur 
 on surface, organ friable but holds its own weight, inferior edges sharp. No stone in gall-bladder. 
 
 Pancreas. — Not examined. 
 
 G astro-intestinal tract. — Not examined. Were deep greenish red from post-mortem change. 
 
 Genito-urinary tract. — Prostrate not enlarged. Bladder contains some heavy purulent material. 
 Testis threads well. 
 
 Head. — Hair black and short; scalp adherent. Calvarium is well supplied with diploe but has 
 curious inequalities in thickness; frontal measures 0.8-1.0 cm., temporal 0.2-0.8 cm. (in strikingly 
 irregular alternations), occipital 0.9 cm. The dura is not adherent except along the superior longitudinal 
 sinus, and is thickened only along the middle meningeal distribution and the convolutions are plainly 
 seen through it. Pia mater is exceedingly thin and delicate, without edema; the twigs of the arterial 
 capillaries are very brilliantly outlined. There are but two large veins on the vertex, these correspond 
 very nearly to fissure of Rolando and are distended. The hemispheres are apparently equal in size 
 with the exception of a bilobed occipital lobe on the right. There seems to be no cerebrospinal fluid. 
 The brain sags on a board and tends to assume a nearly round mass. The convolutional pattern is 
 simple and the sulci shallow, particularly is this so on the right, involving the motor and parietal lobule, 
 and seeming to limit the frontal pole, the left parietal lobule having a more complex configuration and 
 the frontal pole a greater extension. Smear from this portion shows striking loss of nerve cells; and 
 infiltration of vessel walls with lymphocytes and polynuclear cells. 
 
 At the base. — The 2nd left temporal convolution at the tip has a yellow and denuded look under the 
 pia and is somewhat firmer to the touch. Question of tubercle. Smear from this portion shows cellular 
 detritus. No organisms. 
 
 The denuded area on the right temporal tip is artefact. The basal vessels are slightly hazy but no 
 buds nor abnormal branching of arteries seen. The pia at base binds the 3rd and 4th nerves to the 
 anterior perforated space. Cerebellum slightly softened, the olivary bodies are fairly firm as are the occi- 
 pital tips. Remainder of brain (with exception noted) fairly normal in consistence. Pituitary pigmented 
 on section. Ganglions negative. Petrous portion temporal bone thick. Left ear drum has a hole 
 0.3 cm. in diameter in its center with white and indurated edges, and smear shows tubercle bacilli. Right 
 negative. Optic nerves show brilliant injection of retinal arteries with question of blurred outline of 
 nerve head. There are irregularities in bone in the middle meningeal distribution. Brain weight, 1130 
 grams. 
 
 Cord. — Not notable. 
 
WAVERLEY RESEARCHES. II. 
 
 87 
 
 Anatomical Diagnosis. 
 
 Emaciation. 
 
 Abrasions over extremities. 
 
 ?Syphilitic scars over extremities and back. 
 
 Scars over head. 
 
 Palpable lymphnodes (superficial). 
 
 Dolichocephalic head. 
 
 Malformed ears. 
 
 Prominence of mastoid. 
 
 Palatine arch high. 
 
 Asymmetry face (nose and jaw). 
 
 Nails nibbled below the mid line. 
 
 Hands undeveloped. 
 
 Redundant prepuce. 
 
 Genitals undeveloped. 
 
 Decubitus superficial (sacral). 
 
 Gastroptosis. 
 
 Splanchnoptosis. 
 
 Lymphnodes large and prominent (rever- 
 sion?). 
 
 Chronic fibrous pleuritis. 
 
 Pulmonary tuberculosis. 
 
 Slight chronic fibrous endocarditis (aortic 
 valve). 
 
 Tuberculous epiglottis. 
 Tuberculous aryteno-epiglotidean folds. 
 ?Aplasia vocal cords. 
 ?Tuberculosis of vocal cords. 
 Small aorta. 
 Autolysis of spleen. 
 Accessory spleens. 
 Small adrenals. 
 
 Slight acute parenchymatous nephritis. 
 Cystitis. 
 
 Calvarium unequal in thickness. 
 Calvarium brittle. 
 Focal chronic pachymeningitis. 
 Slight anomaly right occipital tip. 
 ?Hydrocephalus. 
 
 Inequality of convolutional pattern, particu- 
 larly right side. 
 Slight basal leptomeningitis. 
 Tuberculous ulcer left ear drum. 
 Pigmentation of pituitary. 
 ?Choked discs. 
 Brain weight: 1130 grams. 
 
 c) Special Anatomical Description of Brain. 
 
 The brain is symmetrical; the frontal lobes small and pointed; the occipital lobes short, and their 
 tips point away from the median line. 
 
 The pia is generally slightly thickened, with numerous arachnoid villi along the superior longitudinal 
 fissure on both sides. The pial vessels are moderately injected, including the capillaries. 
 
 The convolutions throughout are broad, well-rounded, and there is a noticeable lack of complexity. 
 
 In the right frontal lobe, the first convolution is much narrower than the second or third; the two 
 latter are not clearly defined, and are very scantily fissured. On the left there are apparently four 
 longitudinal divisions, and each is somewhat more complex than on the right. The third left frontal 
 is not remarkable. 
 
 The central convolutions are of good width, and well-rounded. The precentral is connected about 
 midway its length with the base of the second frontal by a recurved annectant. The postcentral con- 
 volution is narrow at its upper extremity on both sides, and again at the junction of the middle and lower 
 thirds on the right. The fissure of Rolando forms little less than a right angle with the superior longi- 
 tudinal fissure. Its upper extremity cuts the superior margin on the left and on the right extends well 
 over on the mesial surface. The lower extremity cuts the operculum on both sides and is lost in the 
 Sylvian fissure. 
 
 The parietal lobes are marked by a very irregular pattern. The sulci are generally arranged in a 
 transverse direction. The superior parietal lobules are broad; the right one somewhat more so than the 
 left, and both present very few secondary fissures. 
 
 The sulcal pattern of the temporal lobes is rather irregular; on the right the superior gyrus is narrow 
 
88 SOUTHARD AND TAFT. 
 
 and loosely convoluted. The superior sulcus is distinct and complete. The second convolution is broad 
 with very few fissures, and these are confined mainly to the posterior part of the gyrus. On the left the 
 limiting sulci are indistinct, but on the whole the fissure-complex is less simple. 
 
 Of the mesial surfaces, the right is more complex; the cuneate lobule is larger and presents more 
 fissures. The right calloso-marginal fissure is complete from its subrostral origin to the marginal ex- 
 tremity, while on the left it is interrupted several times by annectants. The corpus callosum is thin 
 throughout its entire length. 
 
 The most evident peculiarity of the orbital surfaces is the difference in width of the gyri recti. The 
 right is nearly twice as broad as the left, and extends beyond the median line to the extent that its mid- 
 point corresponds in position to that of the optic chiasm. 
 
 The pyriform lobules are nearly uniform in size; the collateral fissure is continuous with the fissura 
 rhinica on the right, but fails to join on the left. Altogether the left temporal lobe presents the appear- 
 ance of better development than the right. 
 
 Frontal sections show no focal lesions. The cortex is of fair width, and the white matter compara- 
 tively small in amount. All the sulci in the temporal lobe are deep, and the gyri narrow, finger-like 
 processes. 
 
 There is no enlargement of the ventricles, nor other anomaly apparent. 
 
 d) Microscopic Examination. 
 
 From the partial microscopic examination, the following is abstracted: 
 
 The findings in numerous areas yield a somewhat general picture. There is, as a rule, an increase 
 of neuroglia cells in the white substance. Even the vessels are lined by an accumulation of neuroglia 
 cells . There is a considerable satellitosis in all layers, including the plexif orm layer, but there is no 
 tendency to an excess of gliosis in the plexiform layer. There is a tendency to decrease of nerve cells 
 so far as qualitative estimate can suffice in the diagnosis in most areas. The frontal areas show a smaller 
 degree of scarcity of cells than numerous other areas. On the whole, the qualitative estimate of neuroglia 
 cell increase rather indicates that the left side is more affected than the right (for example, left insula, 
 left superior parietal, left pyriform lobule, left transverse temporal). 
 
 The findings of particular interest are as follows: — First, rod cells in the cortex of the right upper 
 post central region, a region which also shows a moderate degree of cellular gliosis in the white matter; 
 but this latter gliosis was characterized by the presence of a great many glia nuclei of unusual shape. 
 The area showed very general thinning out of the cells in all layers, particularly at the summit of the 
 gyrus. Frequently cells are found with an appearance of degeneration. Rod cells are also found in 
 the right pyriform lobule. 
 
 Secondly; the finding of one large vessel in the right precentral region surrounded by a relatively 
 heavy collection of lymphocytes; other vessels show numbers of green pigment-laden phagocytes. 
 This area shows considerable satellitosis in all layers; the satellite cells are particularly noteworthy about 
 the large pyramidal cells. There is an increase in neuroglia cells in the plexiform layer with a focal 
 tendency. Of course in connection with a suspicion of brain syphilis, which we may consider proper to 
 raise in connection with the lymphocytosis above noted, especial attention was given to the observa- 
 tion of other foci of lymphocytosis. Several other examples of infiltrated blood vessels were found in 
 the frontal region and with a tendency to accretions in the vertical region. 
 
 e) Anatomical and Histological Summary. 
 
 This brain of simple construction (1130 grams) is comparatively symmetrical. Its corpus callosum 
 is thinned throughout. The white matter of the centrum semi ovale is comparatively small in amount. 
 It does not appear that the ventricles are enlarged. Microscopically once more we discover a marked 
 
WAVERLEY RESEARCHES. II. 
 
 89 
 
 gliosis, with considerable satellitosis corresponding with a certain decrease of nerve cells, if we may judge 
 qualitatively of such loss. On the whole the left side is slightly more affected than the right. We raised 
 the hypothesis in Case IV as to old syphilis, basing our suggestion upon the presence of the effects of 
 perivascular infiltration in posterior fissure of the spinal cord. If we follow the same line of argument 
 in Case VI, we should call attention to the effects of lymphocytosis about a large vessel in the right pre- 
 central region. The presence of rod cells in the cortex of the right upper post central region as well as 
 in the right pyriform lobule may perhaps be regarded as evidence running somewhat in the same direc- 
 tion. These rod cells are characteristic of certain cases of General Paresis, although neuropathologists 
 do not customarily make a diagnosis of brain syphilis upon the presence of rod cells. It may be that 
 both the focal lymphocytosis and the occurrence of rod cells are based upon some other condition than 
 syphilis, but at all events, the lesions are of an acquired nature and go to indicate the presence of at least 
 a slight degree of active chronic, inflammatory processes. It is possible to think of tuberculosis as re- 
 sponsible for the lymphocytosis and it may be for the rod cell deposits, since this case showed widely 
 distributed tuberculosis, pulmonary, epiglottis, vocal cords, left ear drum, etc. A review of the anatomi- 
 cal diagnoses in the case will show the presence of numerous stigmata. 
 
 Synopsis of Findings in Case VII. 
 a) Clinical. 
 
 1. Physical Examination. — At 15 years of age, patient was five feet tall and weighed 97§ pounds. 
 She was born May 5, 1888, and died March 17, 1914. Patient is described as undersized, poorly nourished, 
 anaemic, slightly deaf; as having a small cranium, with circumference of 19f inches, and cephalic index 
 of 84. The face was asymmetrical, the eyes closely set, the teeth irregular, the palate high, and narrow 
 arch. From the autopsy report, given in full below, the following features are culled: Absence of axillary 
 hair, anomalous distribution of pubic hair, rudimentary left nipple, anomaly of toes, deflection of nose 
 to left, dental ridges (mal-nutrition?), ovaries very large, anomaly of kidney; anomaly of sympathetic 
 gangliated cord. 
 
 2. Family History. — Patient's father was born in New York City, of French extraction; the 
 mother was born in England. The father was 37 years old at the birth of the child; the mother was 42, 
 and had had four children before the birth of the present case. Three of the children had died before 
 1893: two girls, described as dying of marasmus, and one boy as dying of croup at the age of 5 years. 
 It is stated that there was no deformity of body or mental deficiency in the other children. The mother 
 is described as never having been very strong, and as subject to fainting fits. She is stated to have been 
 in excellent health until the sudden death of the boy above mentioned, which death took place when she 
 was 7 months pregnant with the present patient. The mother states that she fell off a small box 24 hours 
 before delivery, and that the patient was born at 8 months. An aunt of the patient, the mother's oldest 
 sister, is stated to have become paralyzed at the age of 24 years, and remained in this paralyzed condition 
 until her death, at 42, of consumption. 
 
 3. Personal Developmental History.— The patient was carried on a pillow for a year, as she 
 could not hold her head up. Patient began to walk at 3| years, and became very active. At 5 years, a few 
 words, such as " ma," " pa," " money," " goodbye," " bad boy," were said. The patient is described as 
 having tried very hard to say more words but as being unable to shape them. When desiring to attract 
 attention to something, she would say "Bookit." At the age of 5, she had learned to use a spoon and 
 fork, and kept her person clean. She was restless in sleep. There was a history of middle ear disease on 
 both sides in early childhood. Patient was a mouth-breather, with large tonsils. 
 
 4 and 6. School Progress and Examinations.— Patient upon admission was unable to take the 
 regular school work and was placed in the training classes; although kept in these classes for several 
 
90 SOUTHARD AND TAFT. 
 
 years, she made very little advance. She learned to march in step and could play very simple games. 
 She could not be taught to match color and form. 
 
 6. Practical Knowledge.— When admitted to the school, the patient was untidy, but became 
 thoroughly tidy after training. She was able to feed herself, and to dress and undress herself, although 
 careless with the clothing and inclined to be destructive thereof. Patient learned to do simple work 
 with the hands, such as cutting paper and cloth, but could not cut to a line. 
 
 7. Economic Efficiency.— Nil. Patient was able to do simple domestic work, such as dusting 
 and rubbing the floor, and could make a bed with help. 
 
 8. Social History and Reactions. —   Patient would often walk towards a person as if about to 
 speak, and then draw back, repeating this action several times in succession. When excited, patient 
 would jump up and down and scream, whether pleased or displeased, and would laugh and cry at the 
 same time. 
 
 9. Moral Reactions. — Patient is described as having been of a good temper during her Waverley 
 School life. She was fond of music and liked to look at picturebooks. Was apparently perfectly happy 
 if given a doll or other toy. She was particular about food, liking goodies. She was always rather 
 excitable and noisy, and interpretation of her emotion was difficult on account of the identity of reactions 
 when pleased or displeased. Patient gave the impression of laughing and crying at the same time. 
 Patient masturbated. 
 
 10. Psychological Tests. — Patient's mental age was 5 years. 
 
 Waverley School History. — Patient was admitted to the school, June 20, 1895, and after remaining 
 a few months, was taken home by her mother. She was re-admitted in 1896, at the age of 8 years. She 
 was very seldom sick at the school, dragged her feet, and stood and sat in a roundshouldered attitude. 
 She would march in step if some one put hands on her shoulders in the proper way. Patient is 
 described as running about in a lackadaisical manner, and as having a habit of skipping with one foot. 
 She played relay races well, but was unable to see the point of some of the simple circle games. Patient 
 was addicted to talking, and was more or less troublesome. She showed a number of peculiar move- 
 ments; for example, she would roll and pick the front of her dress with her hands, and finish the process 
 by holding a bunch of clothing in her left hand, passing her right hand in circles over her head. Another 
 characteristic action was pointing her finger downward with arm extended, and repetition of " Yah, 
 mamma, yah." Now and then she would shake her head and squint her eyes. Toward the close of 
 life she had lost much weight and apparently also in height. Tuberculosis was made out in March, 
 1914, just before her death, involving the entire left lung and right apex. 
 
 b) Autopsy. 
 
 Autopsy. — Head, trunk and cord, Dr. M. M. Canavan. 
 
 Body. — That of a somewhat emaciated, slender white female, 146 cm. in length. Skin waxy yellow 
 white in color. There is an abrasion over the right cheek, punctate in character, 2 cm. in diameter. No 
 decubitus scars, edema, nor palpable lymph nodes. Axillary hair absent, pubic hair, yellow, grows in an 
 eliptoid manner 4 cm. above the symphysis, and cylindrically over the labia majora. Left nipple appears 
 rudimentary. 3d and 4th toes on both feet much shorter than 1st or 2nd. 
 
 Abdomen distended and gives hollow note on percussion. 
 
 Pupils equal, 0.3 cm. Nose deflected slightly to left. Upper teeth slightly uneven, (suggestion of 
 early nutrition disease) ridged, but no trace of uneven cutting edge. Orbital arches flattened, forehead 
 measures 8 cm. in height above them and is a straight, not a curved line. 
 
 Ventral section. — Panniculus nil. Muscles in remarkable rigor. Peritoneum shining and grey. 
 Stomach 20 cm., Liver 11 cm. below ensiform. Spleen large and free from adhesions. Appendix 5.5 cm. 
 in length, somewhat injected, has a mesentery of its own. Mesenteric lymph nodes not enlarged. Ad- 
 
WAVERLEY RESEARCHES. II. 91 
 
 hesions exist between lower inferior edge of liver and the transverse and ascending colon. Some free 
 fluid — estimated 150 cc. thin and pale in color exists in peritoneal cavity. 
 
 Pelvis. — The uterus, 5 cm. in length, is in an anterior position; the right ovary measures 5 X 2.5 X 
 1.0 cm.; the left ovary measures 3 X 1.5 X 1.0 cm. 
 
 Diaphragm. — Reaches to the 5th interspace on right, to the 6th rib on left. Ribs are remarkably 
 close together — hardly an intercostal space that was more than 0.5 cm. in width. 
 
 Thorax. — Lungs adhere to chest wall closely showing on the right a yellow puriform open space, 
 and the left is evenly consolidated on palpation with recent fibrin at apex. Lungs not removed but cut 
 in situ with the cavitation of right apex seen: it is extensive. 
 
 Heart. — Assumes circular form — epicardial fat scant — coronaries small — not sclerosed. Myo- 
 cardium grey white. Endocardium not notable. 
 
 Valve measurements: TV, 10.0 cm. P V, 6.0 cm. LV, 1.0 cm. 
 MV, 9.0 " AV, 5.0   RV, 0.5   
 
 The aortic valve is miniature in size of leaflets, and there is some sclerosis of the origins of the coro- 
 naries. The arch of the aorta is smooth — diameter of arch 2.0 cm. 
 
 Organs of neck. — Not removed. 
 
 Abdomen: Spleen. — 13 X 9 X 3 cm. Markedly large; trabeculae distinct — pulp slightly watery 
 and pale. No Malpighian bodies. 
 
 Adrenals. — None seen. 
 
 Kidneys. — Right much smaller than left; contains only three pyramids. Capsule thick, cortex pale 
 and does not show injection. Pelvis very large — somewhat injected. 
 
 Liver. — Somewhat large. Capsule of Glisson is thickened, inferior edges fairly blunt. Color red- 
 brown. Nothing of note on section. Gall-bladder wall white and edematous. No stones. 
 
 Pancreas. — Not examined. 
 
 G astro-intestinal tract. — Stomach large and distended. Rugae not present. Intestines negative 
 throughout. 
 
 Genito-urinary tract. — Ovaries contain pigmented scars — (has not menstruated for a year). 
 
 Retroperitoneal tissues. — Peripheral nerves negative. Sympathetic chain seems vastly broken up 
 into fine threads. 
 
 Head. — Hair fine and abundant if short. Scalp pale, scanty in fat. Temporal muscles fairly well 
 developed. Calvarium 0.3 cm. frontal, 0.1-0.3 cm. temporal, 0.4 cm. occipital; it is very dense and 
 eburnated; no diploe. At the junction of the coronal and sagittal sutures the dura is markedly adherent 
 (the brain herniating through small points of cut dura on forcible removal) and the dura is thickened 
 from this central point to the area of middle meningeal distribution. Vertex is ball shaped and small. 
 Pia mater is thin and delicate except over sulci and vertex where faint hazing appears. 
 
 Hemispheres equal but appear very shortened in the frontal portion as though the whole prefrontal 
 area were missing. Convolutions are simple and shallow, running with no complexity to the longitudinal 
 sinus. Post rolandic gyri simple in pattern. No inequalities on palpation. At the base the temporal 
 lobes are exceedingly plump, and make the distance between their free edges and the frontal pole appear 
 very short. 
 
 Basal arteries clear. 
 
 Optic and 3d nerves negative. 
 
 Gasserian ganglions negative. 
 
 Pituitary softened. Middle ears — left drum ruptured, right not seen. 
 
 Cerebellum, pons and cord negative. 
 
 Brain weight, 1270 gms. 
 
92 
 
 SOUTHARD AND TAFT. 
 
 Anatomical Diagnosis. 
 
 Emaciation. Pulmonary tuberculosis, (advanced). 
 
 Abrasion of right cheek. Cloudy swelling of heart muscles. 
 
 Absence of axillary hair. Right heart hypertrophy. 
 
 Anomaly pubic hair. Aortic stenosis. 
 
 Rudimentary left nipple. Anomalous kidney. 
 
 Anomaly of toes. Chronic perihepatitis. 
 
 Distention of abdomen. Chronic cholecystitis. 
 
 Nose deflected to left. Anomalous sympathetic ganglionated cord. 
 
 Malnutrition ridges on teeth. Calvarium dense. 
 
 Forehead high and flat. Chronic external adhesive pachymeningitis 
 
 Splanchnoptosis. (focal). 
 
 Slight injection of appendix. Chronic fibrous pachymeningitis — (middle 
 
 Chronic peri-colitis. meningeal). 
 
 Slight ascites. Slight chronic leptomeningitis sulcal and 
 
 Ovaries very large. vertex. 
 
 Ribs closely set. Anomalous frontal poles (shortening). 
 
 Chronic adhesive pleuritis. Simplicity of convolutions. 
 
 c) Special Anatomical Description of Brain. 
 
 A more detailed description of the brain is as follows : — The brain is of fair size and suits the dolicho- 
 cephalic type of skull. The dura mater was attached rather more firmly than usual to the pia mater 
 and the brain by means of numerous pial vessels and their investments. There is no evidence of arterio- 
 sclerosis. The pia mater is everywhere slightly thickened and of a dull, cloudy appearance. 
 [^ There is slight asymmetry of the two hemispheres; the right is shorter than the left, and the right 
 occipital lobe points away from the median line. The convolutions are everywhere of fair width and 
 usually well rounded and approximated. 
 
 In the frontal lobe, the dividing sulci are distinct. On both sides the first sulcus cuts across the 
 precentral gyrus. The second frontal gyrus is broader than the first on both sides. 
 
 The central convolutions are quite narrow, the postcentral notably so. 
 
 The pattern of the parietal lobes is in general transverse in direction; the interparietal sulci are 
 interrupted by an annectant between the postcentral gyrus and the superior parietal lobule on both 
 sides. This leaves the ascending postcentral sulcus separate from the descending portion and the 
 horizontal branch. On the right, at the junction of the descending and horizontal interparietal sulci, 
 there is a distinct rosette formation. The size of the two parietal lobules, superior and inferior, is nearly 
 the same on both sides. 
 
 The occipital surfaces are not notable except for the slight asymmetry already remarked upon. 
 
 On the base of the brain the orbital surface presents the usual triradiate sulcal pattern. 
 
 The collateral fissure on both sides is continuous with the fissura rhinica (Turner), thus separating 
 the pyriform lobule entirely from the temporal lobe. The right pyriform lobule appears somewhat larger 
 on the right than on the left. 
 
 The mesial surfaces present no remarkably anomalous cortical pattern. The corpus callosum is nar- 
 row in its horizontal portion as compared with the rostrum and splenium. There is no middle commissure. 
 
 The frontal sections show no pathological lesions. The cortex is everywhere of good width. There 
 appears to be a rather smaller corona radiata than one usually finds. The basal gray matter is present 
 in the usual amount. 
 
WAVERLEY RESEARCHES. II. 
 
 93 
 
 The callosal angles of the lateral ventricles are rounded, but there is no definite enlargement of the 
 ventricle cavity. 
 
 The cerebellum, pons and medulla are negative to gross examination. 
 
 d) Microscopic Examination. 
 
 The results of partial microscopic examination may be stated as follows : — 
 
 The most striking and general characteristic of the tissues is the generalized gliosis involving both 
 anjincrease of cells and increase of fibrils. This gliosis affects the spinal cord as well as encephalic tissues. 
 There is a suggestion of narrowing of the cortex cerebri throughout and a crowding together of the lami- 
 nae. The blood vessels are everywhere prominent; this appearance is partly due to thickening but 
 largely due to the frequency of perivascular gliosis. 
 
 One of the most important findings in the case is that of rod cells such as were found in case VI 
 (although in case VI there are a few foci of perivascular infiltrations). The variations in the different 
 areas examined are quantitative rather than qualitative. The rod cells are found most frequently in the 
 precentral, post central, calcarine and temporal areas. 
 
 One area, the right transverse temporal, shows a canalized thrombus in a small vessel, with a 
 vacuole or approach to a small glia-lined cyst nearby. There is a small acute hemorrhage under the pia 
 mater of the right angular gyrus. The right superior frontal region appears to show a larger degree of 
 cell atrophy (with numerous shadow cells) than is found elsewhere. 
 
 e) Anatomical and Histological Summary. 
 
 This brain of an imbecile weighed 1270 grams, is fairly complex in construction, of fair size, with 
 slight asymmetry and a narrow corpus callosum as to its horizontal part. There is apparently no definite 
 enlargement of the ventricular cavity. Microscopically there is a generalized gliosis which involves not 
 only the encephalic tissues but the spinal cord. The most important finding in the case is that of rod 
 cells, as in Case VI, but the perivascular infiltrations of Case VI are not present in Case VII. The rod 
 cells are more widely distributed in the present case. 
 
 A canalized thrombus in one region may be regarded as another sign of acquired lesion; but as to 
 the date of this lesion nothing can be said. Note is made below of the fact that the mental age of. this 
 patient, set in a general way at 5 years, was regarded in some respects as over-estimated since in a number 
 of directions the patient appeared to verge upon idiocy. 
 
 Synopsis of Findings or Case VIII. 
 a) Clinical. 
 
 This case will probably be reported in extenso elsewhere in collaboration with Dr. G. B. Magrath, 
 Medical Examiner of Suffolk County, who performed the autopsy in pursuance of official duty. We 
 have acted as his deputies in executing our brain studies. 
 
 The case belongs in Dr. Magrath's series of "judicial homicides" having been electrocuted for 
 murder. A number of more or less competent persons regarded the subject as "defective." Further 
 details are reserved for the present. The brain is presented as a foil to the others of the series. If 
 "feeble-mindedness" is a term roughly equivalent to inability of self-support, then this subject should 
 perhaps not be regarded as feeble-minded. If "defect" may be used to include lack of "normal inhibi- 
 tion," then probably this case might classify as defective. 
 
 The subject was physically well developed, had been a "nervous" and "bad" boy, could read and 
 write, had marked practical ability in certain ways, earned a sort of living, was criminalistic, had an 
 
94 SOUTHARD AND TAFT. 
 
 ungovernable temper and was easily overcome by alcohol. There is no means of knowing what his 
 mental "grade" would have been; we have placed it at 12 plus. 
 
 b) Autopsy. 
 Gross findings reserved. 
 
 c) Special Anatomical Description of Brain. 
 
 There is slight asymmetry of the occipital lobes ; the right is thin and points away from the median 
 line, while the left does not. 
 
 The pia is thickened and white over the vertex, and the vessels are considerably injected; particu- 
 larly the larger ones. 
 
 The convolutional pattern is noticeable in that the direction of the gyri is a transverse rather than 
 an antero-posterior one. (This has been noted as a developmental anomaly in mental defectives.) The 
 gyri are well rounded and of fair width, but their summits are not approximated. The markings are of 
 medium complexity in the anterior region, but less so in the part adjacent to the central lobule. 
 
 In the central region the precentral gyrus is unusually wide in its upper third; the postcentral is 
 very narrow in its upper third, but becomes of average width below. The upper extremity of the fissure 
 of Rolando extends barely to the border of the superior longitudinal fissure and approaches it at an acute 
 angle. The lower extremity does not cut the operculum. 
 
 The parietal lobes are well developed with distinct markings. On the right the interparietal sulcus 
 is typical; the postcentral portion is continuous and is intercepted at its middle point by the horizontal 
 limb. On the left the ascending postcentral is separated by a narrow annectant from the descending 
 and horizontal branches, which are continuous. The convolutions of the inferior parietal lobule are 
 broader and less complex than those of the superior parietal. This lobule is marked both by longitudinal 
 and transverse fissures. The entire lobe is characterized by the lack of approximation of the walls of the 
 interparietal fissure and of the convolutions of the superior lobule. 
 
 The occipital lobe is not remarkable; the convolutions are of good width, fairly well rounded, their 
 walls well approximated, and of complex arrangement. 
 
 On the orbital surface the convolutional pattern is not markedly different from that ordinarily seen. 
 
 The pyriform lobules are noticeably asymmetrical; the right is considerably wider than the left, 
 and this is true of the entire hippocampal lobule. The rhinal fissure (Turner) is well marked. The 
 convolutions of the extreme tip of the right occipital lobe are narrow and irregularly arranged. The 
 sulcal pattern over the entire base of the brain is unusually symmetrical. 
 
 The main differences of configuration on the mesial surface are the presence on the left of two sulci 
 parallel with the callosum, while on the right there is but one. On the left, the parietooccipital fissure 
 is wide open, disclosing an otherwise hidden convolution which dips down from the superior surface of 
 the superior parietal lobule and turning back upon itself, joins posteriorly with the superior occipital 
 gyrus. The sulcal complex on the right precuneus is triradiate, while that on the left is made up of four 
 branches. The former has one fissure extending upward toward the superior margin, and two downward 
 and outward; on the left two point upward and outward, and two downward and outward. 
 
 The callosum is of good extent and thickness except in the posterior third of the horizontal portion 
 where there is moderate narrowing. The middle commissure is present. 
 
 The frontal sections illustrate well the lack of complete longitudinal sulci in the frontal lobes; these 
 can be easily identified only in the most anterior portion. 
 
 There is nothing remarkable in the appearance of the cortex, nor of the basal nuclei. 
 
 The ventricles are not dilated. 
 
WAVERLEY RESEARCHES. II. 
 
 d) Microscopic Examination. 
 
 95 
 
 The results of a partial microscopic examination may be abstracted as follows : — 
 
 Gliosis is noted in numerous areas but was rarely of marked degree and often showed a tendency to 
 focalization. Subpial gliosis is noted in the paracentral, postcentral (more marked left), temporal 
 pyriform, cornu ammonis, left prefrontal, right insula, and Broca areas. This subpial gliosis is, as a rule, 
 more marked at the bottoms of the sulci or along their sides than at the tops of the gyri. It is not often 
 of marked degree. 
 
 Perivascular gliosis is especially noted in the right precentral, right middle temporal, superior frontal, 
 middle frontal prefrontal and Broca areas. 
 
 Satellitosis is especially noted in the paracentral, right postcentral, left cornu ammonis, superior 
 frontal, middle frontal, prefrontal and insula regions, and to a lesser extent in several other regions. 
 Gliosis of the white matter is especially noted in the right middle temporal, middle frontal, prefrontal, 
 insula and Broca areas, as well as in areas noted above, showing perivascular gliosis in the white matter. 
 
 Dislocated ganglion cells are noted especially in the white matter of the right precentral area and 
 appear in general to be rare in this case. 
 
 The only instance of exudate consists in infiltration of the space about the small blood vessels in the 
 left prefrontal region, where cells are found highly suggestive of plasma cells. Evidence of recent cell 
 destruction, completed or in process, are few but distinct. The notes show cells with poorly staining 
 nuclei and surrounded at their bases by satellite cells in both paracentral regions. Satellitosis was also 
 found in the postcentral region in considerable degree. 
 
 In the right transverse temporal gyrus, cells are occasionally found of the small pyramidal type, 
 having a clear ring outside the nucleus, suggesting that the chromatic substance had undergone a solvent 
 process in the cell interior. Shadow cells are found in the pyriform lobules and are here associated with 
 cells showing the clear perinuclear rings just mentioned as found in the transverse temporal region. 
 Other areas show occasional cell changes of the same general nature. 
 
 The total brain sections in this case show deep sulci, possibly more so on the left side; the cortex 
 roughly averages 3 mm. in depth at the summits of the gyri and is thinner elsewhere. The white matter 
 appears to preserve a fair proportion to the cortex. There seems to be notably less white matter on the 
 left side of the brain. The larger vessels in the white matter are surrounded by large pigment-laden 
 cells. 
 
 Especially interesting was a slight degree of heterotopia of the gray matter consisting in four small 
 areas below the cortex on the superior surface of the temporal lobe. The blood vessels of the temporal 
 lobe show dilatation of their perivascular spaces with a few large pigmented cells. The ventricles are 
 not dilated; the corpus callosum is of proper thickness, approximately 8 mm. 
 
 It does not appear that there is any evidence of thinning out of the nerve fibers. The suggestion 
 that the left hemisphere has comparatively less white matter than the right is based upon observations 
 both in the anterior and posterior part of the brain. 
 
 e) Anatomical and Histological Summary. 
 
 This brain (1340 grams) in a physically healthy, executed subject, is found to show a number of 
 minor asymmetries, such as the transverse direction of convolutional pattern in many regions. The 
 summits of the gyri are not always approximated. The corpus callosum is of proper size except for a 
 moderate narrowing in the posterior third of the horizontal portion, in which latter connection may be 
 mentioned that the parietal lobules are especially characterized by the lack of approximation of the walls 
 of the gyri. 
 
96 SOUTHARD AND TAFT. 
 
 Microscopically there is a certain tendency to slight gliosis of a focalized nature. This gliosis is more, 
 as a rule, at the bottoms of the sulci where there is normally more fiber-producing tissue. Both the 
 fibrillar gliosis and satellitosis are fairly widespread in cortex and white matter and there is a certain 
 amount of perivascular gliosis. The argument for fundamental hypoplastic changes may perhaps best 
 be based upon dislocated ganglion cells in the white matter of the right precentral area, but the rarity 
 of such cells is conspicuous and it would not seem well to make a diagnosis of hypoplasia or heterotopia 
 upon this single finding. Again, the single focus of perivascular infiltration by cells resembling plasma 
 cells in the left prefrontal region is perhaps but slight evidence on which to ground the hypothesis of brain 
 changes of an important nature in this executed criminal. A vast deal of comparative work in " normal" 
 cases must yet be done before a decision can be rendered on such a point. 
 
 That the case had inborn peculiarities may be argued from the stigma of heterotopia in the temporal 
 lobe and perhaps somewhat upon the deep sulci, possibly deeper on the left side, which the total brain 
 section demonstrated. The suggestion that there is somewhat less white matter on the left side of the 
 brain than on the right may also be entertained as indicative of inborn peculiarity. There is in the case 
 apparently no evidence of thinning out of the nerve fibers. 
 
 An analysis of this case in comparison with others in a series of executed homicides will be profitable. 
 
 Synopsis of Findings of Case IX. 
 a) Clinical. 
 
 1. Physical Examination. — Patient was born August 3, 1875; admitted May 17, 1883; died 
 • August 30, 1914. The patient at autopsy showed an enlarged thyroid and cystic kidneys, but had no 
 
 other anomalies. The stomach was dilated. He is described as having been a strong and healthy 
 subject. 
 
 Voice hoarse, words pronounced in a staccato manner. Patient a little deaf; at all events, later in 
 life. 
 
 2. Family History. — Father and mother are said to have been strong and healthy; the father 30, 
 and the mother 32 years old at the time of the birth of this child. There had been four children before 
 the birth of the patient, and one thereafter. One of the children had died of " summer complaint." It 
 is stated that there are no evidences of deformity or mental deficiency in the other children. The mother 
 died in childbirth, at 37 years. The family was American. 
 
 3. Personal Developmental History. — Patient began to walk at 2 years, and to say a few words 
 at 5 years. His mental deficiency was noticed at 3 years of age, when it appeared that he was not trying 
 to talk. At 8 years, when patient was admitted to the school at South Boston, he could not talk plainly 
 and had untidy habits. He had not learned to read or write. 
 
 4 and 5. School Progress and Examinations. — Patient upon admission was placed in the train- 
 ing classes, and learned a good deal. He learned to do simple outdoor work on the farm, such as grub- 
 hoeing, picking up stones, and the like. In his 25th year, he was transferred to the Colony, where he 
 developed markedly and was regarded as fairly intelligent and industrious. His strength and abundance 
 of health permitted him to help the blacksmith; he could measure and saw off wood, and use a plane 
 and sandpaper. He would keep the blacksmith's tools lined up for him, and assist in shoeing oxen. 
 
 6. Practical Knowledge. — -His practical knowledge is indicated by the remarks under School 
 Progress (see above). Although he could use the plane, saw, and chisel well, his sense of measurement 
 was so deficient that, for instance, he could not tell the difference between 5 and 9 inches. However, 
 if given a piece of board 4 inches wide, patient could go and get another of the same width. If the car- 
 
WAVERLEY RESEARCHES. II. 97 
 
 penter marked with pencil a line to which patient was to plane on a piece of board, he could plane to that 
 mark. Practically speaking, he seemed to be better than his Binet age would indicate. 
 
 7. Economic Efficiency.— See above. 
 
 8. Social History and Reactions. — Patient was much beloved by the caretakers. He was kind- 
 hearted and anxious to please, and after his fashion had a very keen sense of humor, apparently under- 
 standing much more than he was able to express; used nouns, active verbs, and a few descriptive words, 
 but never learning to put sentences together. 
 
 9. Moral Reactions. — Patient belonged in the amiable and " altruistic " group. 
 
 10. Psychological Tests. — Binet tests performed in 1914 show the patient to be of a mental age 
 of 7. 
 
 W averley School History. — The advance of this patient under supervision and the conditions of 
 the school, and later of the colony, was considerable, as above indicated. As the patient grew older, 
 he was given more difficult w r ork, which he was able to perform with fair satisfaction ; this progress was 
 of a degree rather unusual in the feeble-minded. Patient was fond of music and of humming melodies, 
 although he did not pronounce the words. 
 
 The patient was killed by being run down by an automobile while being taken off the grounds with 
 a group of boys on an outing. He had been in general regarded as able to take care of himself and keep 
 out of the way of traffic, although the conditions of state roads may have been more complex than ordi- 
 nary for him. There was a certain error of judgment on the part of the automobile driver. 
 
 b) Autopsy. 
 
 Body of a well built and nourished white male 5 ft., 10 in. in length (177.8 cm.). Skin rosy grey 
 but shows marked number of recent abrasions as follow: 
 
 Right parietal boss is prominent and exhibits a superficial cut 5 cm. in length by 0.5 cm. in width. 
 Hair shaved on this side. Right mid scapular line shows abrasions 3 X 0.5 cm. Right elbow 3 small 
 ones 3X2 cm. in extent. Right lumbar region just above crest of ilium 5.0 cm. X 1 cm. Right popliteal 
 space 5X1 cm. Right knee inner aspect 3 X 0.8 cm. Right mid shin anterior aspect 3X2 cm. Left, 
 below crest of ilium (gleutial side) an abrasion 12 cm. in length X 2 cm. wide. Left thigh lower third 
 outer aspect is another 3X1 cm. Left knee inner aspect 2X2 cm. Bruises, right knee, right shin, 
 right ankle (inner and outer aspects), left ankle slight bruising 7X7 cm. 
 
 Rigor mortis present, in legs — not in arms. No palpable lymph nodes. Pupils 0.5 cm. equal. 
 Slight amount regurgitated material left face and neck. 
 
 Ventral Section. — Fat over abdomen measures 3j cm. Over thorax 5 cm. Muscles red. Peri- 
 toneum is bluish red in lower anterior portion and there is blood between the fascia of the rectii muscles 
 and the peritoneum as high as 10 cm. above the symphysis. There is free blood in the peritoneal cavity, 
 estimated quantity 25-40 cc. The intestines are dilated, the liver is above costal margin and lightly 
 stained with blood. Stomach dilated and 10 cm. in length. Spleen free. Mesenteric lymph nodes not 
 palpable. Hemorrhages exist in the layers of the mesentery. Diaphragm arches to the 4th rib in right 
 to 4th on left. 
 
 Thorax. — Muscles removed from anterior thoracic wall shows much hemorrhage into the muscles 
 between the left clavicle and sternum between 1st and 2nd rib. On the right between clavicle and 
 first and between 1st and 2nd ribs, there is a separation of the clavicle and the sternum on the left 
 by hemorrhagic and edematous muscle and the first rib is broken approximately 1 cm. from the junc- 
 tion of it to sternum. On the right the upper end of the chest wall sinks in a little more than the 
 left and a fracture is present on right first rib 8 cm. from mid sternal line and the 2nd is also 
 fractured somewhat latterly to the first. Anterior portion right chest presents subperiosteal fractures 
 of the 7th, 8th, 9th and 10th ribs with marked hemorrhage into parietal pleura. None on the left. 
 
98 SOUTHARD AND TAFT. 
 
 Upon removal of the lungs, there is also seen marked hemorrhage in posterior surface of right pleura and 
 underneath it the 3rd, 4th, 5th, 6th, 7th, 8th ribs are fractured about 1-3 cm. from vertebrae and 10 cm. 
 from vertebrae the 10th and 11th ribs are also. Marked hemorrhage into posterior mediastinal tissue, 
 on either side, also retroperitoneally in abdomen. Heart weight 12J oz. (354 grams). Epicardial fat 
 scant, muscle somewhat pale but firm. Valves negative. Endocardium smooth. 
 
 Measurements: T.V. 5| in. (14cm.) P.V. 3j in. (8.25cm.) L.V. Jin. (1.2cm.). 
 M.V. 4f in. (12.0 cm.) A.V. 3| in. (8.8 cm.) R.V. § in. (0.3 cm.). 
 
 Lungs. — Right 22J oz. (638 grams). Left 20J oz. (567 grams.). Nothing of note except old adhe- 
 sions left apex and recent congestion of both lungs. 
 
 Organs of the Neck. — Thyroid markedly enlarged and protuberant; weighs 3j oz. (99 gms.). Normal 
 on section except right lobe which is very much congested. Tongue, larynx, trachea, esophagus negative. 
 
 Abdomen. — Spleen 6j oz. (184 gms.). Nothing of note. Capsule not thick, pulp fairly soft, trabe- 
 culae prominent. Adrenals small; otherwise negative. 
 
 Kidneys 9| oz. (269 gms.). One kidney fairly normal; the other, the left, is studded with smooth, 
 firm glistening bodies 0.2 cm. to 0.3 cm. in diameters. Capsule peels with difficulty. Cortex reduced 
 and replaced by these cysts which appear colloidal; the cortex is also injected. Pelves negative. 
 
 Liver 58J oz. (1610 gms.). Nothing of note. No gall stones. 
 
 Pancreas. Very white instead of yellow and a curious softness unlike the usual gland. No hemor- 
 rhages. 
 
 G astro-Intestinal Tract. — Negative throughout. Remains of hastily eaten vegetables in stomach. 
 Well distended, few rugae. 
 
 Genito-Urinary Tract. — Bladder external wall very hemorrhagic; inner wall clear. Clear fluid in 
 bladder. Prostate not examined. Testes thread well. 
 
 Retroperitoneal Tissues. — Aorta and branches smooth and elastic. No lymph nodes seen. Marked 
 hemorrhages into the retroperitoneal tissues. 
 
 Head. — Hair brown, cropped on right. No marks on inner side of scalp. Calvarium thick; frontal 
 \ in. (0.6 cm.); temporal J in. (0.3 cm.); occipital | in. (0.9 cm.). Not much diploe. Dura thickened 
 but not adherent. Pia thin and delicate. Convolutions simple and wide, in every location. General 
 feeling of "normalness" to fingers, slightly putty-like at base. No atrophy nor gliosis. 
 
 At the base, a slight amount of meningitis bends the optics, the circle of Willis and the 3rd nerve 
 together. Tips of olfactory bulbs adherent to skull. Optic nerves slightly edematous but smaller than 
 normal. Ganglions and pituitary negative. Ears and discs not examined. 
 
 Brain wt. 54 oz. (1622 grams.). Cord not removed. 
 
 Anatomical Diagnosis. 
 
 Well nourished. Fractures ribs, left, 1st rib. 
 
 Abrasions, head, trunk, extremities. Slight adhesive pleuritis. 
 
 Bruises, extremities. Pulmonary congestion. 
 
 Subperitoneal hemorrhages. Enlarged thyroid. 
 
 Free blood in peritoneal cavity. Cystic kidneys. 
 
 Mesenteric hemorrhages. Hemorrhagic cystitis (bladder wall). 
 
 Intercostal hemorrhage. Retroperitoneal hemorrhages. 
 
 Fractures ribs, right anterior 2nd, 7th, 8th, Normal brain. 
 
 9th, 10th. Slight edema optic nerves. 
 
 Fractures ribs, right posterior 3rd, 4th, 5th, Brain weight 1622 gms. 
 
 6th, 7th, 8th, 10th, and 11th. (Tigges' formula 1424.) 
 
WAVERLEY RESEARCHES. II. 
 
 c) Special Anatomical Description of Brain. 
 
 99 
 
 The brain of this case is large and suits the dolichocephalic skull. The orbital frontal angle made 
 between the basal and lateral aspects of the frontal lobe is unusually prominent throughout. The occi- 
 pital lobes exhibit a slight degree of asymmetry; the inferior parietal lobules are slightly more prominent 
 than the surrounding tissues. 
 
 The intermediate precentral area has the "coronal" type of construction. The gyri are in general 
 of good width and of fairly simple pattern. The summits of the gyri do not, as a rule, well approximate; 
 in many places the summits do not lie in the same plane; this gives the brain surface a motley, irregular 
 configuration, somewhat suggestive of foothills. 
 
 The corpus callosum is of a good depth except in the posterior third where it is comparatively nar- 
 row. There appears to be no middle commissure. 
 
 The pia mater is slightly thickened and hazy throughout and the arachnoidal villi are moderately 
 well developed along the vertex of the superior longitudinal fissure. There are small pinpoint white 
 nodules in the pia mater, especially over the sulci, chiefly in the region of the superior parietal lobule. 
 
 d) Microscopic Examination. 
 
 An abstract of the most important findings yet made is as follows : — 
 
 Subpial gliosis is nowhere in evidence. Gliosis of the white matter is found in a number of areas, 
 precentral, postcentral, temporal, occipital, frontal, but is nowhere marked. There is no perivascular 
 gliosis except for a slight amount in the section over the right prefrontal region. Satellitosis is nowhere 
 noted. 
 
 The fiber stains show no notable variation from the normal (as judged by drawings in Campbell's 
 "Localization of Cerebral Function"), except that a section from the right superior temporal gyrus 
 shows some diffuse thinning of radiary fibers; but even this appearance may possibly be regarded as 
 artificial. We have not regarded the presence of knoblike enlargements along the course of the fibers 
 as of pathological significance. 
 
 As might be expected from the nerve fiber and glia appearances, the nerve cell pictures are not far 
 from normal upon qualitative examination. There are, however, a number of stratigraphical appear- 
 ances consistent with the hypothesis of arrest of development. Thus the supragranular layers of the 
 precentral, postcentral and frontal regions are not definitely laminated. 
 
 The evidences of cell loss or numerical hypoplasia in the supragranular layers is, as a rule, confined 
 to the lower portions of these layers. The granular layers are, as a rule, distinct, where they are nor- 
 mally distinct and in general of a normal appearance, unless we regard the cells as slightly thinned out 
 in some places (right upper postcentral, right superior parietal). 
 
 The infragranular layers show apparent scarcity of cells in a number of regions, for example, pre- 
 central, postcentral, occipital, superior parietal. 
 
 The above description suggests a certain irregularity in the distribution of the hypoplasia. The 
 area which more than any other shows architectural disturbance appears to be illustrated by a section 
 from the right superior frontal region. The cortex here shows a narrow plexiform layer but underneath 
 a complete absence of distinct lamination. The granular layer, for example, is nowhere distinct. The 
 scarcity of cells seems to be a definite one and of a convincing degree. The cells that persist show a 
 variety of staining reaction — many of the cells have a pale and finely granular protoplasm. On the 
 other hand a good many cells contain perfectly staining Nissl granulations; there is a moderate degree 
 of phagocytosis in the perivascular spaces in this area and, as above noted, a slight cellular gliosis in the 
 white matter. 
 
100 SOUTHARD AND TAFT. 
 
 The sections stained for the demonstration of neuroglia fibrils fail to show any convincing increase 
 thereof. The Weigert myelin sheath stains are negative as to nerve fiber change. The prefrontal 
 cortex on the right side shows an even more marked scarcity of cells. 
 
 A type of problem is brought up, for example, by a section from the right upper postcentral region. 
 Here there is a number of giant pyramidal cells suggesting that there might have been an error in the 
 labelling of the section and that it had been mistaken for a section of precentral cortex. On the other 
 hand, the supragranular layer in the cortex here sectioned is much more like the postcentral cortex and 
 there seems to be no reason for supposing that in this case there was a mislabelling of sections. 
 
 A section from the right intermediate postcentral gyrus shows an unusual tendency to the grouping 
 or bunching of nerve cells in compact nests containing 2-3-4 cells; sometimes the nerve cells are found 
 overlying each other slightly. 
 
 In a section from the right superior occipital area, a number of dislocated ganglion cells are found a 
 good way into the white matter. One of these dislocated cells was found with two nuclei. On the 
 whole, however, in this case there are not many instances of dislocated ganglion cells in the white matter. 
 
 e) Anatomical and Histological Summary. 
 
 The brain of this imbecile of 39 years weighed 1622 grams, as is perhaps consistent with his belonging 
 to what is sometimes termed, for practical purposes, the able-bodied or colonial type of feeble-minded. 
 The corpus callosum is of good depth except for a narrow place in the posterior third. Microscopically 
 we failed to secure evidence of gliosis in the subpial region nor marked evidence of gliosis in any locus. 
 In particular, there was no evidence of satellitosis. Accordingly we may regard this case as without 
 evidence of active phenomena, whether inflammatory, sclerotic, neuronophagic. There was one region 
 in which there was a moderate degree of phagocytosis in the perivascular spaces. This region, the right 
 superior frontal, was interestingly enough the region in which occurred the most marked architectural 
 disturbance with a complete absence of distinct lamination. 
 
 This brain, accordingly, shows one of the purest examples yet seen of uncomplicated irregular arrest 
 of development with stratigraphical, architectural alterations (right superior frontal, right upper post- 
 central, dislocated ganglion cells, right superior occipital) without complications of acquired disease. 
 
 Synopsis of Findings of Case X. 
 a) Clinical. 
 
 1. Physical Examination.— Patient was born Oct. 3, 1876; admitted Feb. 17, 1887; died of pella- 
 gra, Nov. 17, 1914. Patient was slenderly built, and well nourished up to two years before his death, 
 when pellagra set in. From the autopsy findings, some points concerning the physique of the patient 
 may be taken. The nose was saddleshaped and the head narrow, dolichocephalic, eyes small, ears irreg- 
 ular with adherent lobules, prominent abdomen. The patient was never very strong and had a poor 
 circulation so that he could be kept out of doors only in the warm weather. 
 
 2. Family History. — The father was a native American, 25 years of age at the birth of the child. 
 The mother was born in Canada, and was 20 years of age at the birth of the child. She had had one 
 child before the birth of the patient, and has had two since without evidence of physical deformity or 
 mental deficiency. There is no history of mental disorder in the family. There was nothing unusual 
 about the pregnancy or delivery. 
 
 3. Personal Developmental History. — The patient began to walk at two years; was not able to 
 
WAVERLEY RESEARCHES. II. 101 
 
 talk, and is described as having been of a passionate temper. Late in talking; could say very few words 
 at time of admission. 
 
 4 and 5. School Progress and Examinations.— There was improvement physically when the 
 patient was placed in the outdoor classes. 
 
 6 and 7. Practical Knowledge and Efficiency.— Patient could carry stones, use a grubhoe, carry 
 bundles, and rub floors. 
 
 8. Social History and Reactions. — Patient had a quick temper and would attack people who 
 got in his way. On account of his tendency to cruelty to weaker subjects, he was kept with the older 
 boys. He could say a few words, could not talk in sentences, but used profane and obscene phrases. 
 
 9. Moral Reactions. — Patient was more or less irritable, violent, inclined to be noisy, and as above 
 stated would attack persons. Masturbation. 
 
 10. Psychological Tests. — Binet test made in 1914 showed the patient to be 2.4 years of mental 
 age. 
 
 Waverley School History. — The patient grew more and more troublesome as he grew older, becom- 
 ing noisy and more untidy. In his thirty-seventh year, the patient began to lose weight and became 
 emaciated, and developed a peculiar skin eruption on the back of the neck and extensor surfaces of the 
 hands. The eruption was symmetrical and was regarded as pellagra. This eruption healed with stimu- 
 lating ointments, and the patient grew physically somewhat better. Later the eruption returned and, 
 despite outdoors treatment, a decubitus developed, finally covering a portion as large as a dinner plate, 
 with great destruction of tissue and offensive odor. 
 
 b) Autopsy. 
 
 Body of a slenderly built and poorly developed white male, 144 cm. in length. Skin is yellowish 
 grey except over the face where it is diffusely pigmented (freckles) and over the exposed portions of the 
 head where the hair sparsely grows (frontotemporal region) : here it is a deep brown color with crackled 
 lines alternating with patches of white. This condition is especially marked in the back of the neck 
 extending as far backward as the 7th cervical vertebra where it is abruptly replaced by normal appearing 
 skin. The hands are brown, especially over the knuckles where the skin is scaling, so much that it may 
 be lifted from the pale true skin. This pigment is apparent on the hands up to the wrists and extending 
 in a gauntlet shape 4 cm. above the wrist where it also fades from this diffuse and dense color into iso- 
 lated pigmentation (freckles) that gradually become less until the axillary region is reached. There are 
 some scattered freckles over the chest and abdomen and upper thighs. 
 
 Over the mid-shin region of both legs there are brawny brown areas measuring 8X4 cm. and 12 X 
 6 cm. There is a bruise measuring 3X2 cm. over the anterior surface of the right mid-thigh; another 
 4 cm. above left patella. 
 
 There are gangrenous areas on the skin over the posterior portion of the right shoulder, measuring 
 4X3 cm., over the right trochanter major measuring 12 X 10 cm. This is markedly sloughing and 
 extends deeply into the muscular substance. Probing this muscular substance, a soft, mushy, non- 
 resisting tissue appears in the place of the normal firm resisting muscular tissue. 
 
 A similar area over the left trochanter major measures 8X6 cm. over the left shoulder, another 
 measures 4X5. Also in the inner surface of each knee similar areas vary in size from 3X4 cm. — IX 
 1 cm. and 0.8 X 1 cm. in diameter. 
 
 A few scattered hairs over upper sternal region. Pubic hair more or less triangular in shape, grows 
 in a straight line to the ensiform; hair also grows on inner thighs, also legs and forearms. There is 
 scanty evidence of hair over face. 
 
 Nose slightly saddle shape with broad bridge and small alae. 
 
 The pupik are dilated and unequal; the right measures 0.7 cm., the left 0.6 cm. The lips show 
 
102 SOUTHARD AND TAFT. 
 
 sordes. The teeth are poor and there is a bloody fluid between them. (Some report of sore mouth previ- 
 ous to death). 
 
 Ventral section. — Fat over abdomen 1.0 cm., over thorax, 0.5 cm. Muscles pinkish. Peritoneum 
 is grey. 
 
 Liver. — 6 cm. Stomach 8 cm. Transverse colon 15 cm. below the ensiform. 
 
 The omentum is very rich in fat and covers intestines completely. Intestines are injected and slip- 
 pery to the touch. The appendix measures approximately 4 cm. and is large at its distal end. The 
 bladder is not distended. There is a little free fluid in the abdominal cavity. The mesenteric lymph nodes 
 not enlarged. Spleen exceedingly large. Diaphragm arches to the third rib on the right and to the 5th 
 on the left. 
 
 Thorax. — Lungs adherent to the chest wall in the mid-anterior portion. There is no free fluid in 
 the pleuric cavities. Pericardial sac contains slight traces of fluid. 
 
 Heart. — Assumes a circular shape on being removed. It is very flabby and it would be difficult 
 to tell which were the left side on inspection. The descending branch of the left coronary is smooth and 
 delicate, as is the right coronary. Myocardium is pale and flabby and not friable. Valves are negative 
 except the aortic which shows a sessile red adherent body clinging to the middle of the posterior cusp 
 measuring approximately 0.8 X 0.6 cm. No other vegetations. 
 
 Approximate measurements: TV 8.0 cm. PV 5.0 cm. LV 0.9 cm. 
 
 MV 9.0 cm. AV 8.0cm. RV 0.3 cm. 
 
 The intima of the aorta is very red and firm. 
 
 Lungs. — No weights taken. Right lung has but two lobes. The upper is normal; the lower is 
 injected on lateral surface and on section there is reddening of the lung tissue superficially. Bronchi 
 are covered by reddish thin fluid. Left lung is markedly congested in the posterior portion. Pleura 
 has been torn on removal of lung but there is no raised area around the bronchi at that point. There is 
 a small area not more than 3 cm. in diameter where the bronchi have induration about them in the 
 central portion of the lower lobe. Bronchi reddened throughout. 
 
 Organs of the Neck. — Not removed. 
 
 Abdomen. — Spleen: Markedly large; measures approximately 14 X 10 X 4 cm. Capsule not 
 thickened but dark areas (?). Hemorrhages show through the capsule. On section the pulp is very soft, 
 scrapes heavily and the malpighian bodies faintly descernible. The pulp swells above the cortex on 
 section and there are greyish pink wedge shaped areas with their bases toward the capsule that show red 
 external borders. Trabecidae indistinct. 
 
 Adrenals. — Small. The cortices are both pale yellow edematous and fade into a deeper brown at 
 irregular intervals. The central portion is brown and there is no softening. 
 
 Kidneys. — Fairly well supplied with fat. Capsule strips easily but is opaque. The cortex measures 
 0.6 cm., is brilliantly and uniformly injected and red points dot the intervascular injections. At one 
 point there is a bright yellow-grey wedge shaped body occupying the cortex for a space of 1.5 X 0.6 cm. 
 The pyramids are poorly differentiated, look yellow in their centers. Pelves markedly congested. The 
 other kidney not so injected but swells over capsule on section and on stripping the capsule the kidney 
 surface is pulled away at two points. No cysts seen. 
 
 Liver. — Measures approximately 20 X 18 cm. The surface is mottled yellow and red. Cut 
 surface swells slightly over the capsule. Color of the liver on section is not remarkable; shows lobules 
 well marked but no congestion. The gall bladder very small; contains a few cc. of turbid yellow fluid. 
 
 Pancreas. — Not examined. 
 
 G astro-Intestinal Tract. — Stomach dilated. Swells somewhat; edematous; no rugae. Mucous 
 wall drips grey fluid and the wall has a granular and somewhat injected appearance. The same is true 
 of the lower tract but no ulcers of hemorrhagic state of the intestines seen, with the exception of focal 
 areas of injection in the upper third of the descending colon. The content of the entire intestinal tract 
 and particularly the colon is fluid brown yellow. 
 
WAVERLEY RESEARCHES. II. 
 
 103 
 
 Genito-Urinary Tract. — Bladder negative. Prostate not enlarged. Testes not examined. 
 
 Retro-Peritoneal Tissues. — The lymph nodes are not present. There are (?) hemo-lymph nodes 
 along the aorta. The sympathetic ganglia small. The aorta is small in calibre and thin walled. The 
 peripheral nerves negative. 
 
 Head. — The cranium is narrow, measures 52 cm. in circumference and the hair grows scantily over 
 the entire scalp. The scalp is adherent and inelastic. Caharium is dense and measures, frontal 0.4 cm., 
 temporal, 0.2 cm., 0.4 cm. and occipital, 0.6 cm. Grooving for the middle meningeal arteries very narrow 
 and shallow on the right. The dura is not adherent and in the frontal region one sees the convolutions 
 through it. There is some thickening of the dura in the middle meningeal distribution. The longitudinal 
 sinus free. The dura seems dense and fills the cranium cavity except in the frontal portion where there 
 is a space between the frontal portion and the inner table sufficient to insert three fingers. The pia mater 
 is somewhat injected over the vertex. 
 
 The brain is exceedingly compact and firm. 
 
 At the base of the brain a striking appearance is presented by the depression of the orbital portion of 
 the frontal lobes in their central portions and the marked foreshortening or (?) absence of the prefrontal 
 regions. The olfactory bulbs somewhat softened. The optic nerves slightly thinned but show no atrophy. 
 The pia mater over the cerebellum is markedly thickened and opaque. The floor of the 4th ventricle is 
 clear. Pons and medulla are firm. There is marked pressure pointing over each lobus pyriformis. 
 The 3rd ventricle contains a quantity of clear fluid (specimen taken for gold reaction). 
 
 The superior surface of the brain is uniformly firmer than normal, there being no points of softening 
 or change in consistency with the exception of the posterior portion of the left angular gyrus. The 
 convolutions of the entire surface have a tendency to be less plump on the crowns than is normal; this 
 is seen particularly on the right side. 
 
 The occipital lobes somewhat foreshortened but are flush with the cerebellum. The first temporal on 
 the right is slightly wider than its fellow and there is a difference in the winding of the second convolution. 
 
 The Gasserian ganglia, the pituitary, the optic discs, middle ears, and cord negative on section. 
 
 The brain weight is 1450 grams. 
 
 Anatomical Diagnosis. 
 
 Poorly developed. 
 
 Pellagra. 
 
 Bruises, extremities. 
 
 Decubitus (Shoulder and trochanter major, 
 
 knees.) 
 Saddle shaped nose. 
 Unequal pupils. 
 Sordes on lips. 
 Teeth poor. 
 Induration appendix. 
 Chronic fibrous pleuritis. 
 Acute vegetative endocarditis (aortic valve). 
 Pulmonary congestion; beginning bronchial 
 
 pneumonia. 
 Acute bronchitis. 
 Acute splenitis. 
 Infarct spleen. 
 
 (?) Post mortem change adrenals. 
 Infarct of Kidney. 
 
 Acute parenchymatous nephritis. 
 
 Acute hepatitis. 
 
 Chronic gastritis. 
 
 Head narrow. 
 
 Scalp adherent. 
 
 Calvarium dense. 
 
 thin. 
 Focal thickening of dura. 
 Injection pia. 
 
 Thickening of pia cerebellum. 
 Evidences of brain swelling. 
 General cerebral gliosis. 
 Superficial atrophy convolutions (flattening 
 
 of crowns). 
 Inequalities first temporal convolutions. 
 Brain weight 1450 gms. 
 (Tigges' formula 1152 gms.) 
 Cord not remarkable. 
 
104 
 
 SOUTHARD AND TAFT. 
 
 c) Special Anatomical Description of Brain. 
 
 The brain in general suits the dolichocephalic skull. There is a slight occipital asymmetry such 
 that the right lobe is shorter than the left, deviates somewhat more from the median line and has a groove 
 upon the posterior extremity, whereas the left occipital lobe deviates slightly to the right and even some- 
 what overreaches the median sagittal plane (the posterior extremity of the left occipital lobe, however, 
 deviates again leftwards). 
 
 The gyri of this brain are in general rather narrow, closely approximated except at the borders of 
 the summits. The corpus callosum is of good width except for a somewhat narrow middle third. There 
 is no evidence of the middle commissure. The cerebellum projects farther backward on the right than 
 on the left (compare contralateral asymmetry of occipital lobes). The cerebellum suggests in general 
 a reduction in size and the inferior surface of the cerebellum shows a considerable thickening of the pia 
 mater, especially over the incisure. The pia mater of the brain in general is slightly thickened and hazy. 
 
 d) Microscopic Examination. 
 
 An abstract of important findings is as follows : — 
 
 Subpial gliosis is found in a number of areas, for example, focally in the precentral and postcentral 
 angular gyrus; but in other areas the plexiform layer seems to be normal. The white matter is not, as 
 a rule, affected by gliosis, although the angular gyrus of superior parietel area and frontal regions show a 
 general increase. 
 
 Satellitosis is found in a number of areas (precentral, occipital, temporal angular, superior parietal, 
 prefrontal. 
 
 The Weigert myelin sheath stains show a certain indistinctness in the supraradiary layers, pre- 
 central, postcentral, temporal, angular, superior frontal (here patchy). A good deal of this fiber change 
 might be within the limit of artefact. 
 
 The nerve cells show numerical hypoplasia in a number of areas; the right upper precentral area, 
 for example, shows very few cells in the supragranular region, aside from the outer small pyramids. 
 This condition is less marked in the postcentral area where the distinction of supra and infragranular 
 layers is more evident. The right superior temporal region shows marked cell scarcity and the arrange- 
 ment of the cells is markedly irregular. The supragranular layer of the right angular gyrus is narrow 
 and of a somewhat abnormal development. The infragranular layer here shows marked thinning out 
 of cells. The right superior parietal area shows a more marked architectural disturbance in the infra- 
 granular region. The cells of the second supragranular layer are also much thinned. 
 
 The right superior frontal region shows marked lack of cells in the second and third layers. The 
 prefrontal region, on the other hand, shows fairly well developed supra granular layers with a few foci 
 here and there of thinning out. These foci affect all the layers. The infragranular layer also shows a 
 tendency to patchy cell loss. This case being one of Pellagra shows a rather rich display of acute nerve 
 cell changes, with excellent examples of the axonal reaction in the Betz cells. There was in one region 
 (right, upper postcentral) a focus in which there were a few round cells in the perivascular spaces; it 
 could not be made out that these were definitely lymphocytes and they may perhaps be regarded as 
 neuroglia cells. 
 
 e) Anatomical and Histological Summary. 
 
 The brain of this case in an idiot or low imbecile of 2-4.5 years, Binet age, weighed 1450 grams, and 
 may be regarded as fairly complex in construction. The grey matter, white matter and corpus callosum 
 stand in fair proportion to one another, except that the gyri of the brain fail to approximate along the 
 borders of their summits and that the middle third of the corpus callosum is narrow. 
 
WAVERLEY RESEARCHES. II. 105 
 
 Subpial gliosis and satellitosis are in fairly frequent evidence, but there is little or no affection of the 
 white matter by gliosis. The nerve cell pictures show, to qualitative judgment, frequent instances of 
 cell scarcity affecting both the supra granular and infra granular layers. 
 
 The following is a brief characterization of each of the ten cases in the Waverley 
 Research Series, which may be helpful for quick reference. 
 
 Case I. The brain of this microcephalic idiot, of a mental age estimated less than 
 one year, has somewhat the suggestion of the brain of an ape. A good portion of the cere- 
 bellum is visible from the dorsal aspect of the nervous system. Whatever the cause of 
 microcephaly, the fact that an elder sister of this patient was almost equally deficient and 
 almost identically microcephalic, must be taken into account, as well as the fact that 
 other children before and after the microcephalic pair seem to have been normal, or at all 
 events not microcephalic. The mentality of this case was undoubtedly the lowest of our 
 series. 
 
 Case II. Also microcephalic, this case presents a combination of microcephaly with 
 a high degree of internal hydrocephalus. This hydrocephalus is one doubtless ex vacuo, 
 being very possibly due to an early non-syphilitic (poliomyelitic?) infection at three months 
 of age. The detailed description will show how well preserved was the vision of this case, 
 functionally speaking, despite the remarkable cystic condition and microgyria of the 
 posterior portion of the cerebrum. In point of fact, the visuo-sensory portion of the 
 cortex appears, however, to have been preserved, and the tremendous lesion to be noted 
 on the upper aspect of the parieto-occipital regions did not take effect upon the elementary 
 visual functions of the cortex. The case is evidently one of focal brain lesion, and very 
 probably belongs in what Tredgold would call the group of "secondary amentia." Of 
 course it is possible that the microcephaly was in some sense an example of primary amentia 
 and that the focal posteriorlying lesions with compensatory hydrocephalus were due to 
 intercurrent disorder. It is possible, accordingly, that this case may be one of a combina- 
 tion of primary and secondary amentia. 
 
 Case III. The brain of this microcephalic imbecile was so small (610 grams) that 
 any coarse arrangement of the brains of the present series (Cases I-X) must naturally 
 show "Zip's" brain lower than his actual capacity would have warranted. It is stated 
 that this patient knew how to read and write a little. Although unable to support himself 
 he had lived most of his years outside of institutions, being a harmless, amiable vagrant. 
 With some hesitation, he may perhaps be placed among the imbeciles. Microscopic 
 study indicates a special thinning of cells in the frontal and parietal regions as well as a 
 degree of gliosis in the outermost layer of the cortex and below the appendema of the 
 ventricles. The corpus callosum was well preserved and of a good size in proportion to the 
 
106 SOUTHARD AND TAFT. 
 
 brain. Microscopically the case will form an excellent foil to Case I, a case of far less 
 intelligence, but the microscopy is complicated by gliosis, whose age is difficult to determine. 
 (In this connection, it must be remembered that the patient is said to have had an epileptic 
 attack at one time.) Although the brain at first sight seems a good instance of a brain 
 in miniature, and although the frontal and temporal regions are fairly uniform, the parietal 
 and occipital lobes are quite asymmetric, especially in that the right occipital lobe is 
 considerably shorter than the left; there is a suggestion of an Affenspalte on the right side. 
 
 Case IV. This case is the oldest of the series (62 years), being an old almshouse case, 
 apparently of feeble-mindedness, of unknown grade but apparently far higher than that 
 of any other member of the series (except V, with the question of dementia praecox, and 
 VIII, the executed murderer). It is of course possible that this case is an old dementia 
 praecox (compare hallucinations observed at Dan vers Hospital). The corpus callosum 
 was rather thinner than normal; the brain weighed 1340 grams at death. Throughout the 
 brain, in different places, there were various degrees of gliosis and satellitosis. This was 
 especially marked in the left and right prefrontal regions. The whole brain suggested a 
 slight degree of atrophy (slight sulcal flaring). There was a slight asymmetry, partic- 
 ularly of the poles of the brain; the parietal region shows a tendency to microgyria, and 
 the right pyriform lobule is larger and more prominent than the left. There is a marked 
 dilatation of the lateral ventricles except the descending horns. The gross appearance of 
 the brain must be admitted to be entirely consistent with the hypothesis of dementia 
 praecox; yet the case is a good instance of the so-called old demented imbecile found in 
 almshouses and is of value in this series for comparison with others. 
 
 Case V. Case V falls in a group with Cases IV and VIII as of higher intelligence 
 than any of the others in the present series (Cases I-X). It is possible that the original 
 intelligence of Case V was higher than that in Case VIII, and highly probable that it 
 was higher than that in Case IV. The case is interesting as showing the outcome of a 
 truant high school boy existence. It is probable that the patient was a moron, or at all 
 events a subnormal subject and perhaps belongs in the delinquent group. The unilateral 
 moderate hydrocephalus is not infrequent in dementia praecox. The left frontal and right 
 occipital lobes show contralateral asymmetry, being narrower than their fellows. The 
 right occipital atrophy or aplasia appears to centre in the second gyrus. The corpus 
 callosum in this case is of a good size. The brain weighed 1335 grams. 
 
 Case VI. This case is that of an idiot of two years mental age, who seemed to combine 
 the typical features of idiocy in such a way as to be a case par excellence for clinical demon- 
 stration. The brain, weighing 1130 grams, shows the smallest brain weight of our series 
 outside the group of pronounced microcephalic cases. The brain is of very simple construe- 
 
WAVERLEY RESEARCHES. II. 107 
 
 tion. The histological examination showed in this case, as in Case VII, the occurrence of 
 the so-called "rod cells" in the cortex. These cells, characteristic of general paresis when 
 associated with the exudative and destructive changes found therein, are not to be inter- 
 preted as necessarily indicating syphilis when they occur alone. Perhaps they indicate 
 merely proliferating vascular changes or proliferations of unknown nature of mesenchymal 
 tissue. There is, however, a suspicion of syphilis in the antecedents of this almshouse 
 transfer case, and certain "tissue paper" scars found on the skin at autopsy may add to the 
 suspicion that this may be a case of congenital syphilis of a non-exudative type. It is also 
 possible that good fortune, or a still more minute microscopic examination than we have 
 been able to perform, would reveal exudative changes at some point. Another feature of 
 the greatest interest in Case VI is the virtual absence of one vocal cord as demonstrated 
 at the autopsy. This fact may serve to illustrate the difficulties of proper interpretation 
 in routine cases. In this case, for instance, the aphasia could not be taken to be necessarily 
 of nervous origin. 
 
 Case VII. Like the brain of Case VI, the brain of Case VII showed rod cells. With 
 respect to the possibilities of syphilis in the family, it is important to consider that of five 
 children, three of the children were dead (two of marasmus), and that the mother was 
 subject to fainting fits. A great variety of anomalies in the body is probably entirely 
 consistent with the hypothesis of syphilis. There was a certain irregularity in the mental 
 capacities of the case, which should also be regarded as thoroughly consistent with this 
 hypothesis. Thus the case, classified as an imbecile with a mental age of five, seemed in 
 a number of respects not to reach above the highest grade of idiocy, or a lower grade of 
 imbecility than the mental age would superficially indicate. There was some sensory 
 disorder in the case as well. Accordingly, both VI and VII are cases which bring up the 
 question of congenital syphilis of a character not so destructive or progressive as cases 
 of exudative syphilis (of the group, for example, of juvenile paresis) would be. To be 
 sure, the rod cells indicate a certain activity and progressiveness on the part of the disease. 
 Theoretically and academically, at any rate, these cells may indicate that conditions are not 
 so entirely stationary in the nervous system as we are led theoretically to suppose should 
 be the case in the brains of the feeble-minded. 
 
 Case VIII. This belongs with Cases IV and V, amongst those of highest intelligence 
 in the present series (Cases I-X). The case was that of an executed murderer. The 
 brain was viewed on anatomical grounds to be that of a defective before there was any 
 clinical confirmation or knowledge of the fact. The gyri were noted to be of a generally 
 transverse direction. There was a lack of complete longitudinal sulci in the frontal lobes. 
 A blunting of the frontal lobes was possibly the most convincing suggestion of the probable 
 
108 SOUTHARD AND TAFT. . 
 
 clinical deficiency on the part of the subject. The parietal region was relatively and 
 absolutely well developed. There was an asymmetry of the pyriform lobules, to some 
 extent of the entire hippocampal lobule. The corpus callosum was of good size though 
 there was a question whether it might not be regarded as somewhat thinned out posteriorly. 
 It seems safe to regard this case as either in the moron group or as at any rate to some 
 degree subnormal. 
 
 Case IX. Case IX illustrates the "ablebodied" type of imbecile (mental age, 7). 
 The weight of the brain in this case was even in excess of what it should have been by 
 Tigges' formula; namely: 1622 grams, as against 1424 by Tigges' formula. (It is true 
 that the violent death of this patient may have led to a certain congestion of the brain 
 which artificially increased its weight.) The brain of Case IX, quantitatively adequate 
 as it would seem, was a brain which must strike the anatomist as of exceedingly poor 
 mould. 
 
 Case X. The brain weight in Case X was also high, being 1450 grams, and in point 
 of fact 298 grams in excess if we should trust Tigges' formula. He is described as of a 
 very excitable nature. The brain shows a very considerable degree of hydrocephalus. 
 Attention may be called to some theoretical points concerning hydrocephalus in these 
 cases in a special section devoted to this topic. Case X, like Case VII, was of the excitable 
 group, and the brain of Case VII also showed hydrocephalus, which likewise does not 
 seem to be explicable on the basis of a compensatory condition (ex vacuo, as illustrated by 
 Case IV), or an anomaly of the dementia praecox group (as illustrated by Case V). 
 
III. 
 
 NEUROPATHOLOGICAL CORRELATIONS WITH CLINICAL AND 
 
 PSYCHOMETRIC FINDINGS IN FEEBLE-MINDEDNESS 
 
 (WAVERLEY RESEARCH SERIES, CASES I-X). 
 
 E. E. Southard and Annie E. Taft. 
 
III. 
 
 NEUROPATHOLOGICAL CORRELATIONS WITH CLINICAL AND 
 
 PSYCHOMETRIC FINDINGS IN FEEBLE-MINDEDNESS 
 
 (WAVERLEY RESEARCH SERIES, CASES I-X.) 
 
 E. E. Southard and Annie E. Taft. 
 
 The province of the present article is limited. We intend to make a provisional 
 epicritical review of the problems presented by the first ten cases (I-X) of the Waverley 
 Research Series of cases of feeble-mindedness. This term we use to include, not only 
 feeble-mindedness proper (i. e., the so-called morons of recent American nomenclature), 
 but also the subnormal persons above the grade of morons, which modern research is 
 bringing into the field of feeble-mindedness, and also the imbeciles and idiots which lie 
 below the grade of moron or of the feeble-minded proper. It is the plan of the present 
 series of anatomical examinations, therefore, to work up successively a series of all types 
 and grades of feeble-mindedness and subnormality without undue regard to their clinical 
 classification or intelligence grading. Already, however, the data of our first ten cases 
 have suggested certain lines of correlation which it seems worth while to set down here in 
 the guise of provisional hypotheses. 
 
 Among all the problems sketched above (problems of the schools, the courts, the social 
 agencies, the eugenics record offices, the biological laboratories, and the like), perhaps no 
 problem is more acute than that of the significance and possible future of mental tests after 
 the manner of Binet. We must leave to the psychologists the evaluation of the details 
 of these tests and the construction and choice of new variants. We must leave to those 
 versed in the statistics of mental measurement the decision how far the age level of the 
 Binet tests and the percentage level of the Yerkes tests apply to actual conditions. We 
 must concede forthwith that Binet left but a torso of what the future has in store in the 
 shape of mental tests, and we may concede that these tests, for the most part, yield little 
 information as to those emotional and volitional impulses, instincts, and sentiments which 
 are so important in social life. On the whole, however, it is generally admitted that progress 
 is being made to a more and more accurate measurement of mental capacities of certain sorts. 
 This bit of progress is enough to brighten the path of the anatomist. The anatomist feels 
 that he must follow far in the rear of the psychologist and physiologist in his analysis; par- 
 ticularly in his analysis of deviations and perversions which are of a qualitative nature or 
 cannot readily be reduced to quantitative values. When, however, the anatomist learns 
 
112 SOUTHARD AND TAFT. 
 
 that psychometry is not merely an idle dream, but that distinct losses, — when, at any 
 rate, these losses are of large degree, — are demonstrable and to a certain extent measura- 
 ble, his hope is kindled that the brain itself may unexpectedly at least yield up a set of 
 useful correlations. 
 
 What is the relation of mind to brain? Speculation halts shortly before the intricacies 
 of this problem when it is taken as a problem of the relation of the full-blown, healthy mind 
 with the entirely normal, richly active brain. Important light is thrown upon the topic, 
 of course, by the anatomo-clinical method which yielded such rich data in the last half 
 of the nineteenth century; for by this method definite losses of brain substance were often 
 found to be associated with equally definite losses of mental power. The limitations of 
 this method are numerous and need not detain us. The method has not been exhausted; 
 but its future fruits depend upon elaborate tissue analyses which the ordinary laboratory 
 and the ordinary scientific leisure available under our present institutional system do not 
 permit. Almost equally rich results have accrued from work in comparative anatomy, 
 latterly supplemented by behavioristic studies. 
 
 What we at present need is to supplement the methods of normal neurology and 
 psychology, the methods of anatomo-clinical research, and the methods of comparative 
 anatomy with a method which has alliances with each of these but seems to us to contain 
 certain elements of novelty. It would be strange if the field of anatomy in feebleminded- 
 ness were not full of novelty since it had been so poorly tilled heretofore. The novelty in 
 the anatomic situation with respect to feeble-mindedness seems to us to lie in the fact 
 that we deal with all grades of defect, from an equality with brutes up to subnormality, 
 hardly removed from ourselves, and thereby gain a number of steps upon what the com- 
 parative anatomist can ever take. It is conceded that the higher mental operations have 
 much to do with speech, — its storage and its expression. Now, among animals few traces 
 of speech exist. But among the feeble-minded all degrees of speech loss may in the course 
 of years be studied. The missing links and intergrading transitions between the primates 
 in general and man in particular may be found in feeble-mindedness. By proper sifting of 
 cases, future investigation will discover by an accumulation of instances the minimum 
 mechanism with which speech can be effected. 
 
 It is this principle of the minimum apparatus, the minimum machinery with which 
 a function may be performed, that we regard as the most important and promising 
 aspect of feeble-mindedness from the standpoint of research into mental function. As we 
 have elsewhere sketched, fundamental researches in the psychology of efficiency may well 
 be made with the feeble-minded, since among them we shall be able to discover what can 
 be done with the least apparatus. For the purpose of the present argument we need not 
 
WAVERLEY RESEARCHES. III. 113 
 
 develop the collateral fact, that in brain disease of the normal adult and in brain disease 
 of epileptics we often deal with far more complicated problems since the destruction of a 
 few bits of brain apparatus in one region may lead to functional disuse of great masses of 
 mechanisms that are structurally quite intact. Diaschisis and shock are instances in 
 point. There is no method of determining, at least in the majority of nerve cells, whether 
 they are performing vegetative or conductive functions, or no functions whatever. Con- 
 sequently the principle of discovering the minimum machinery with which a given act 
 may be performed cannot be applied as a rule in the field of the neuropathology of destruc- 
 tive lesions. 
 
 Mill's method of study by means of concomitant variations is a method much more 
 readily applied to material in feeble-mindedness than to the ordinary anatomo-clinical 
 material of the neurological clinic. 
 
 Now, it must be conceded forthwith that, if the authorities in mental tests are in doubt 
 as to their ultimacy, the brain anatomists are equally modest in their claims. As we looked 
 over the claims of the workers in mental tests, we concluded that these mental tests could 
 at least lay claim to a certain orderliness, such that a patient stated to have a mental age, of 
 six, was at all events of less mental capacity than one having a mental age of seven or eight. 
 In short, the dicta of the mental tests might have an ordinal value if they did not possess 
 cardinal value. Very possibly, also, this point might apply to the point-scale data of the 
 Yerkes tests, although this perhaps was less likely on account of the fact that a given per- 
 centage in the Yerkes tests might be made up of exceedingly heterogeneous successes in 
 puzzle-solving, the doing of sums, and the answering of questions. Conceding for the 
 moment that the mental tests are now so good as to have approximately an ordinal value, 
 such that a patient of eight years mental age has higher intelligence than a patient having 
 a mental age of seven years, we can see that it might be well to compare our brains of 
 feeble-minded subjects together so that we might learn whether here also there was an 
 ordinal value to attach to the brains. We are, doubtless, far from the achievement of 
 cardinal values, indicating definite increment of mental capacity to correspond with definite 
 increment of brain mass, even should our studies be so minute as to permit us to evaluate 
 the dendrite supply and synaptic surface area of the brain cells instead of their mere pro- 
 portionate numbers. But might we not be able to arrange our brains in an ordinal series 
 which would be convincing because of the derivation of the principles of arrangement from 
 a number of sources: say, brain weight, proportionate brain weight to body length, com- 
 plication of sulci, size of corpus callosum, etc., etc.? 
 
 And suppose this order of brains to be obtained, would it fit at all with the order of 
 brains obtainable by mental tests? If the two series were largely identical, then might 
 
114 
 
 SOUTHARD AND TAFT. 
 
 not some progress be thought to have been made in the problem of the relation of intelli- 
 gence to brain? We are, of course, entirely aware that this principle is applicable to a 
 large series only, and the present tables are offered chiefly to lay down a few principles as 
 to the proper lines of future correlation on the basis of more cases. We have placed at the 
 head of Article II a statistical table of the ten cases in which some data for identification are 
 given. In the following table, we again arrange the brains in their order of acquisition by 
 the laboratory. In separate columns we place the age, mental age, brain weight (whether 
 less or more than average according to our view), together with certain anatomical and 
 histological data. 
 
 TABLE II. 
 
 Table Displaying Mainly Histopathological Findings, Cases I-X. 
 
 
 
 
 Brain 
 
 Focal 
 
 
 Exudative 
 
 Nerve 
 
 
 
 
 Dislocated 
 
 
 
 
 Weight 
 
 Destructive 
 
 Hydro- 
 
 Lesion of 
 
 Cell 
 
 Fiber 
 
 
 Satelli- 
 
 Ganglion 
 
 Numbei 
 
 Age 
 
 Mental Age 
 
 probably 
 
 Lesion 
 
 cephalus 
 
 Rod Cells 
 
 Aplasia 
 
 Loss 
 
 Gliosis 
 
 tosis 
 
 Cells 
 
 i 
 
 5 
 
 1-, est. 
 
 minus 
 
 
 
 moderate 
 
 
 
 marked 
 
 marked 
 
 slight 
 
 
 
 
 
 ii 
 
 20 
 
 1-, est. 
 
 minus 
 
 + 
 
 marked 
 
 
 
 marked 
 
 marked 
 
 marked, 
 patchy 
 
 + 
 
 
 
 in 
 
 45 
 
 7, est. 
 
 minus 
 
 
 
 
 
 
 
 + 
 
 ? 
 
 + 
 
 + 
 
 
 
 IV 
 
 62 
 
 moron or 
 subnormal 
 
 plus 
 
 
 
 + 
 
 + 
 
 + 
 
 + 
 
 + 
 
 focal 
 
 + 
 
 V 
 
 16 
 
 subnormal 
 
 normal 
 
 
 
 slight 
 
 
 
 + 
 
 
 
 + 
 
 0(d) 
 focal 
 
 + 
 
 VI 
 
 26 
 
 2, est. 
 
 minus 
 
 
 
 
 
 + 
 
 rod cells 
 
 slight 
 
 ? 
 
 + 
 
 + 
 
 
 
 VII 
 
 25 
 
 5, Binet 
 
 normal 
 
 thrombus 
 (Hist.) 
 
 
 
 rod cells 
 
 slight 
 
 ? 
 
 + 
 
 
 
 
 
 VIII 
 
 36 
 
 subnormal 
 
 normal 
 
 
 
 
 
 + 
 
 + 
 
 
 
 + 
 
 + 
 
 + 
 
 IX 
 
 39 
 
 7, Binet 
 
 plus 
 
 
 
 
 
 
 
 + 
 
 
 
 
 
 
 
 +, slight 
 
 X 
 
 37 
 
 24, Binet 
 
 plus 
 
 
 
 
 
 ? 
 
 + 
 
 f 
 
 + 
 
 + 
 
 
 
 It will be seen that one case (II) is apparently the result of a focal destructive brain 
 lesion of great size. This case was probably one of encephalitis, — possibly due to poli- 
 omyelitis, — and yielded a marked degree of hydrocephalus. This fact, however, did not 
 complicate the estimation of its proper place in the anatomical or psychological series, 
 since the brain was clearly upon the score of weight and simplicity not of so low grade as 
 Case I, but lower than any other brain. Cases I and II, then, appear to be the lowest 
 brains in point of anatomy and the lowest cases in point of intelligence. The comparison 
 may be made even finer, since beyond question the brain of Case I was the least complex 
 of the entire series, and the mentality of this case, whose actual age was but five years, was 
 also minimal. 
 
 There are, however, three cases of pronounced microcephaly, namely; cases I, II, 
 and III. The instance of Case III is the most disquieting in the analysis so far from the 
 
WAVERLEY RESEARCHES. III. 
 
 115 
 
 standpoint of aligning the brains with estimated mental capacity. Case III, it may be 
 remembered, was that of Little Zip, a microcephalic, who lived for forty-five years a vagrant 
 life, which was almost self-supporting in the hobo sense of the term. With the brains 
 superficially suggestive of a dog, the patient himself exhibited a number of doglike features 
 in his vagrant, happy-go-lucky life, journeying from the barn or house of one friend to that 
 of another. Arranging the brains in the order of their complexity, the brain of Little Zip 
 must be placed third, after the microcephalic case I and the microhydrocephalic case (post- 
 encephalitic) II, and yet the mental age of Little Zip may be safely estimated as about 
 seven years. The mental age is, at all events, much higher than that of the other micro- 
 cephalics. Thus, if the brains are arranged in order of their estimated age, the brain of 
 Little Zip comes in sixth or seventh place, instead of in the third place. 
 
 Another case (IX) may be chosen as well illustrating the possibility of wrongly 
 estimating the mental capacity of a patient from his brain appearances; for this brain 
 was placed upon the score of its complexity, largely in the gross, in the fifth place. Its 
 mental age was seven. Yet two brains that are regarded as still more complex, namely; 
 those of Cases X and VII, yielded Binet ages of 2£ and 5 respectively. The microscopy 
 of Case IX, however, should that be taken into account, would insure a somewhat lower 
 place for the brain of this able-bodied imbecile, of great stature and large, poorly-molded 
 brain (1620 grams; more than 200 grams in excess of an estimated norm). The examples 
 of Little Zip (Case III) and of the able-bodied imbecile (Case IX) suffice to indicate the 
 difficulties of these analyses. 
 
 The following table (Table III) shows the brains arranged in the order of their estimated 
 complexity, and the figures in the intelligence column will readily demonstrate the facts 
 just mentioned, concerning the dislocation of cases III and IX from their proper places in 
 the series if we estimated the brains on their gross complexity alone. 
 
 TABLE III. 
 
 Comparison of Brain Complexity, Brain Weight, and Order of Intelligence in Cases I-X. 
 
 
 
 Brain 
 
 Brain 
 
 
 Number 
 
 Age 
 
 Complexity 
 
 Weight 
 
 Intelligence 
 
 i 
 
 5 
 
 a) 
 
 
 400-, est. 
 
 1-, est. 
 
 ii 
 
 20 
 
 b) 
 
 
 620 
 
 1-, est. 
 
 in 
 
 45 
 
 c) 
 
 
 610 
 
 7, est. 
 
 VI 
 
 26 
 
 d) 
 
 
 1130 
 
 2, est. 
 
 IX 
 
 39 
 
 e) 
 
 
 1620 
 
 7, Binet 
 
 X 
 
 37 
 
 f) or 
 
 g) 
 
 1450 
 
 2.4, Binet 
 
 VII 
 
 25 
 
 f) or 
 
 g) 
 
 1270 
 
 5, Binet 
 
 IV 
 
 62 
 
 h) 
 
 
 1340 
 
 Moron or subnormal 
 
 v 
 
 16 
 
 i) or 
 
 i) 
 
 1435 
 
 Subnormal 
 
 VIII 
 
 36 
 
 i) or 
 
 i) 
 
 1340 
 
 Subnormal 
 
116 
 
 SOUTHARD AND TAFT. 
 
 Table IV arranges the brains in the order of actual brain weight, but gives also the 
 brain weights estimated by Tigges's formula (eight times the body length in centimeters = 
 brain weight in grams). The brain weight for the normal age and sex of the individual 
 taken from Vierordt's tables is also given. 
 
 TABLE IV. 
 
 Comparison of Brain Weight, Corrected Brain Weights, and Order of Intelligence in Cases I-X. 
 
 (Arranged in order of actual brain weight). 
 
 Number, 
 
 
 
 
 
 
 Age, 
 
 Brain Weight 
 
 Brain Weight 
 
 Brain Weight 
 
 
 Height (cm.) 
 
 Tigges 
 
 Age normal (Sex) 
 
 Actual 
 
 Intelligence 
 
 I, 5, 81 
 
 648 
 
 1282, 
 
 M 
 
 400-, est. 
 
 1-, est. 
 
 III, 45, 126 
 
 1008 
 
 1348-66, 
 
 M 
 
 610 
 
 7, est. 
 
 II, 20, subn. 
 
 ? 
 
 1358-96, 
 
 M 
 
 620 
 
 1-, est. 
 
 VI, 26, 158 
 
 1264 
 
 1358-96, 
 
 M 
 
 1130 
 
 2, est. 
 
 VII, 25, 146 
 
 1168 
 
 1234-39, 
 
 F 
 
 1270 
 
 5, Binet 
 
 IV, 62, 141 
 
 1128 
 
 1178-1210 
 
 ,F 
 
 1340 
 
 Moron or subnormal 
 
 VIII, 36, 179 
 
 1432 
 
 1365-6, 
 
 M 
 
 1340 
 
 Subnormal 
 
 V, 16, 168 
 
 1344 
 
 1358-96, 
 
 M 
 
 1435 
 
 Subnormal 
 
 X, 37, 144 
 
 1152 
 
 1365-6, 
 
 M 
 
 1450 
 
 2.4, Binet 
 
 IX, 39, 178 
 
 1424 
 
 1365-6, 
 
 M 
 
 1620 
 
 7, Binet 
 
 Table V presents the cases in the order of their estimated intelligence. 
 
 TABLE v. 
 
 Comparison of Order of Intelligence with Complexity of Brain in Cases I-X. 
 
 
 
 
 Brain 
 
 
 Number 
 
 Actual Age 
 
 Intelligence 
 
 Complexity 
 
 Remarks 
 
 i 
 
 5 
 
 1-, est. 
 
 a) 
 
 
 ii 
 
 20 
 
 1-, est. 
 
 b) 
 
 
 VI 
 
 26 
 
 2, est. 
 
 d) 
 
 Vocal cord absent 
 
 X 
 
 37 
 
 2.4, Binet 
 
 f) or g) 
 
 
 VII 
 
 25 
 
 5, Binet 
 
 f) or g) 
 
 
 IX 
 
 39 
 
 7, Binet 
 
 e) 
 
 Out of place 
 
 III 
 
 45 
 
 7, est. 
 
 c) 
 
 "Zip," out of place! 
 
 IV 
 
 62 
 
 Moron or subnormal 
 
 h) 
 
 Almshouse transfer 
 
 V 
 
 16 
 
 Subnormal 
 
 i) or j) 
 
 Dementia praecox 
 
 VIII 
 
 36 
 
 Subnormal 
 
 i) or j) 
 
 Murderer 
 
 It seems safe to conclude from these tables that at least the brains of least complexity 
 are correlated with the minds of least range, and that the brains of greater complexity are 
 in a general way correlated with minds of greater range. By microscopic correction of 
 the anatomical decisions, we may even cause our figures to look still more satisfactory 
 from the standpoint of identical ordering of anatomical and psychological data. Whether 
 
WAVERLEY RESEARCHES. III. 117 
 
 the future may show how to account for the apparent too-great simplicity of the brain of 
 Little Zip, remains to be seen. 
 
 The second point in our epicritical review may be presented briefly, partly on the basis 
 of Table II, in which the findings of exudative lesion or rod cells are entered, and also by 
 means of Table VI, in which are displayed the majority of the anatomical findings in the 
 series. How many of our cases may be regarded as essentially preventable by the means 
 theoretically available to the mental or psychiatric hygiene of the individual, leaving out, 
 that is to say, the eugenic line of attack? Let us, perhaps, grant that Case II, with its 
 focal destructive lesion, — possibly of postencephalitic origin, — its marked hydrocephalus, 
 marked nerve cell and fibre loss, and marked patchy gliosis, with its focal microgyria in 
 other regions than the most marked post-encephalitic lesion, is a case that is preventable, — 
 that is by social and scientific devices which shall exclude this presumably infectious 
 disease from occurring. 
 
 If we take at their face value the slight mononucleosis of cases IV, VI, VIII, and X, 
 we may perhaps consider them as either syphilitic or as suffering from progressive exudative 
 disease of a mild nature, also theoretically preventable. Now, in point of fact, we are far 
 from proving that these four cases are cases of syphilis; or that Case VII, a case which fails 
 to demonstrate lymphocytosis but does demonstrate rod cells, is a case of syphilis. It is, 
 however, of importance to consider that in a series of ten cases of numerous grades of feeble- 
 mindedness, no less than six show processes of a suspiciously progressive nature or suggestive 
 of infection. Here is a problem that is well worth working out in the utmost detail, whether 
 we lay down the problem as a problem of the frequency and distribution of syphilis in the 
 feeble-minded, or whether we seek to establish the part played in feeble-mindedness by 
 acquired disease. 
 
 Let us sum up these considerations by saying that the number of cases in which the 
 hypothesis of infection must be more or less firmly entertained is much larger than has been 
 supposed. By consequence, the scales tip much farther for the group of the so-called 
 secondary amentias than was the supposition with most workers. 
 
 In addition to these main points in our epicritical review, namely; the point concerning 
 the relation of the complexity of brain to capacity of mind, and the point concerning the 
 theoretical preventability of certain cases, we should not dismiss our review without 
 slightly indicating the richness of the field in points of interest to neurology. The teratolo- 
 gist and embryologist are sufficiently aware of these values, so that we need not make 
 special point of the Affenspalte question (for instance, Case I and Case III) ; the question of 
 cruciate asymmetry (Case V), the question of the absence of the middle commissure (Cases 
 V, VII, IX, and X) , the question of presence of dislocated ganglion cells in the white matter 
 
118 
 
 SOUTHARD AND TAFT. 
 TABLE VI. 
 
 Case 
 Num- 
 ber 
 
 Calvarium 
 
 Dura Mater 
 
 Pia Mater 
 
 Vessels 
 
 Brain 
 Weight 
 Grams 
 
 Gyri 
 
 Diffuse 
 Atrophy 
 or Aplasia 
 
 Focal 
 Atrophy 
 or Aplasia 
 
 Corpus 
 Callosum 
 
 I 
 
 
 
 slight general 
 thickening 
 
 negative 
 
 400, est. 
 
 Microcephaly 
 
 marked 
 
 variations; 
 "affenspalte" 
 left 
 
 proportionate 
 
 
 
 II 
 
 thick frontal ; 
 depressions 
 
 normal 
 
 normal 
 
 negative 
 
 620 
 
 Microcephaly 
 
 marked 
 
 microgyria, 
 2nd frontal, 
 etc. 
 
 thin 
 
 III 
 
 moderately 
 
 normal 
 
 normal 
 
 negative; 
 
 except 
 
 vertebrals 
 
 610 
 
 Microcephaly 
 
 marked 
 
 minor anom- 
 alies 
 
 proportionate 
 
 IV 
 
 dense 
 
 slight thick, 
 frontal 
 
 slight thick, 
 vertex 
 
 negative 
 
 1340 
 
 Focal micro- 
 gyria and 
 asymmetry 
 
 no 
 
 minor anom- 
 alies 
 
 rather thin 
 
 V 
 
 negative 
 
 negative 
 
 slight general 
 clouding ver- 
 tex 
 
 negative 
 
 1435 
 
 Cruciate 
 asymmetry 
 
 absent 
 
 frontal; oper- 
 cular 
 
 slightly thin, 
 posterior third 
 
 VI 
 
 inequalities of 
 
 thickness, 
 
 brittle 
 
 thick along 
 
 middle 
 
 meningeals 
 
 slight general 
 thickening 
 
 negative 
 
 1130 
 
 simple, sym- 
 metrical 
 
 absent 
 
 Frontal 
 
 thin through- 
 out 
 
 VII 
 
 dense 
 
 adherent at 
 corono-sag- 
 ittal suture 
 line 
 
 faintly hazy, 
 vertex and 
 sulci 
 
 negative 
 
 1270 
 
 slight asym- 
 metry; simple 
 construction 
 
 absent 
 
 Frontal 
 
 thin, horizon- 
 tal portion 
 
 VIII 
 
 
 
 thickened 
 
 negative 
 
 1340 
 
 slight asym- 
 metry; trans- 
 verse gyri 
 
 absent 
 
 left parietal 
 
 moderate thin- 
 ing, posterior 
 third 
 
 
 
 IX 
 
 thick, some- 
 what dense 
 
 thick 
 
 focal basal 
 leptomeningi- 
 tis 
 
 negative 
 
 1620 
 
 slight asym- 
 metry; "poor- 
 ly moulded " 
 
 absent 
 
 absent 
 
 narrow, poste- 
 rior third 
 
 X 
 
 dense 
 
 focal thick- 
 ening 
 
 cerebellar pia 
 thickened; 
 pia in general 
 thick 
 
 negative 
 
 1450 
 
 slight asym- 
 metry 
 
 general 
 superficial 
 
 Frontal 
 
 slight thinning, 
 posterior third 
 
WAVERLEY RESEARCHES. III. 
 TABLE VI (continued). 
 
 119 
 
 Middle 
 Commissure 
 
 Consistence 
 
 Sclerotic Foci 
 
 Other 
 Foci Destructive 
 
 Ventricles 
 
 Hydro- 
 cephalus 
 
 Cerebellum Spinal Cord 
 
 Remarks 
 
 absent 
 
 absent 
 
 absent 
 
 present 
 
 absent 
 
 absent 
 
 not remarkable 
 
 not remarkable 
 
 not remarkable 
 
 normal 
 
 normal in general 
 
 normal 
 
 normal; putty- 
 like at base 
 
 unusually firm; 
 " brain swelling ' 
 
 absent 
 
 absent 
 
 absent 
 
 left 2nd tem- 
 poral firm, yel- 
 low 
 
 absent 
 
 absent 
 
 absent 
 
 absent 
 
 left parietal 
 
 absent 
 
 absent 
 
 acquired? slight 
 lesion, left callo- 
 so-marginal 
 
 absent 
 
 canalized 
 thrombus 
 (histologically) 
 
 absent 
 
 absent 
 
 absent 
 
 moderate 
 
 marked 
 
 present 
 
 slight 
 
 0? 
 
 negative 
 
 negative 
 
 inferior 
 vermis ab- 
 sent? 
 
 dentate 
 
 nuclei 
 
 unequal 
 
 negative 
 
 negative 
 
 negative 
 
 negative 
 
 negative 
 
 small 
 
 negative 
 
 negative 
 
 early focal encephalitis, 
 (poliomyelitic?) 
 
 mononucleosis, posterior 
 septum, spinal cord 
 
 negative 
 
 negative 
 
 negative 
 
 rod cells; lymphocytes in 
 smear, frontal 
 
 rod cells 
 
 plasmocytosis, focal, left 
 prefrontal 
 
 negative 
 
 ?mononucleosis, focal, right 
 postcentral (dead of pel- 
 lagra; tuberculous) 
 
120 SOUTHARD AND TAFT. 
 
 (Cases IV and V, and to a slight degree, Case IX), the problem of the time relations of 
 satellitosis (as shown in cases II, III, VI, VIII, and X; and focally, in IV and V), and the 
 question of defective cortex lamina (as shown characteristically in Case IX). We choose 
 for exposition a somewhat more recondite point, namely; the significance of hydrocephalus 
 in some of these cases. 
 
 The significance of hydrocephalus in Cases I and II with microcephalic brains is hard 
 to judge. Whether the microcephaly is due to hypoplasia or to agenesia, it would naturally 
 not be unlikely that there should be an absence of neurones, both on the exterior and in the 
 interior, or both in the outer and inner portions of the brain substance. Accordingly 
 the hydrocephalus exhibited in the brains of Cases I and II is not necessarily to be associated 
 with increase of intracranial pressure at any time in the lives of the patients. The hydro- 
 cephalus in Case II is very possibly to be related with an early focal acquired lesion of the 
 nervous system (paralytic shock stated to have occurred at three months of age by attending 
 physician). The hydrocephalus in Case III is possibly to be explained similarly, and does 
 not require the hypothesis of heightened intracranial pressure at any time in the life of the 
 patient. 
 
 Aside from hydrocephalus associated with microcephaly, and possibly due to the 
 operation of identical causes, we must consider on another basis the hydrocephalus of four 
 other cases: IV, V, VII, and X. 
 
 The hydrocephalus of Case IV is voluminous and is associated with a corpus callosum 
 rather thinner than normal, and in fact very thin posteriorly opposite the region of greatest 
 ventricular dilatation. The motor restlessness of this case may or may not be correlated 
 with the ventricular dilatation, as has been contended by Southard in his work on dementia 
 praecox in 1915, and in a later analysis of hydrocephalus in the so-called functional psy- 
 choses, as yet unpublished. However, it may well seem to the anatomist that the hydro- 
 cephalus would best be regarded as one due to tissue atrophy of a gradual nature, not in 
 any wise necessarily related to alterations of intracranial pressure. The external features 
 of the brain do not show recent effects of ventricular swelling. Accordingly, we should 
 not lay particular stress on the occurrence of ventricular dilatation associated with motor 
 restlessness in Case IV. 
 
 Case V shows dilatation of the right lateral ventricle without dilatation of the left 
 (in fact, there may have been a slight degree of internal brain swelling which has caused the 
 surfaces of the left ventricle to come into apposition). This finding of unilateral hydro- 
 cephalus has not been infrequent in Southard's dementia praecox series of 1915; has been 
 there referred to at length, and also in the later, as yet unpublished, analysis. In cases 
 VII and X, we are dealing neither with pronounced microcephaly (the brain weights 
 
WAVEKLET RESEARCHES. III. 121 
 
 respectively are 1270 and 1450 grams, accordingly over weight according to Tigges' formula 
 of brain weight in grams equal to eight times the body length in centimeters) , nor with the 
 special conditions of a possibly atrophic brain in an imbecile of 62 years, Case IV, and the 
 special features of the case of dementia praecox, Case V. Cases VII and X, curiously 
 enough from our present standpoint, are examples of such an imbecile as is rather apt to be 
 termed by the laymen insane, or "crazy", imbecile. The point of the attendant's or 
 layman's remark is not that such an imbecile belongs in the group of the psychoses as the 
 physician views them, but that the patient is insane or "crazy" from the nonmedical 
 standpoint; showing spells of marked irritability. Thus, Case VII is described as having 
 had tantrums, as being "hysterical" on examination, laughing one minute and crying the 
 next, rushing about, jumping up and down, and screaming on occasion, and was regarded 
 as a very troublesome case. 
 
 Case X is described as having been somewhat feeble on admission to the school at the 
 age of 10 years, but as later becoming very troublesome, with quick temper and noisiness. 
 
 This problem of the relation of hydrocephalus to hyperkinesis, as first developed 
 from Southard's dementia praecox work of 1915, can hardly be settled in its relation to 
 feeble-mindedness from this series, for if we exclude the three markedly microcephalic 
 cases (Cases I, II, and III), the old demented imbecile (Case IV), the case of dementia 
 praecox (CaseV), and the executed murderer (Case VIII), we are left with but four cases: 
 VI, VII, IX, and X, of which VII and X were hydrocephalic and had been as sketched 
 above as to their tendencies to over-activity. If we consider in contrast to these VI and 
 IX, (the cases we have termed "typical idiot" and "peculiar imbecile" with some capacities 
 above the imbecile grade), we find ourselves dealing with brains of simple construction 
 and of poor moulding respectively, in which brains there is no evidence of hydrocephalus 
 despite the fact that the brains show the corpus callosum in both instances to be thinned 
 out posteriorly. (In fact, the corpus callosum of Case VI is everywhere rather thinner 
 than usual.) Case VI was a very restless and nervous idiot, described as "always looking 
 around," and as "inclined to be destructive". It appears that these tendencies were 
 constant and not more marked at one time than another. The case seemed to be one of 
 slight microcephaly (brain weight, 1130, is 134 grams under Tigges' formula for the patient's 
 height, 158 cm.). "Constant nervousness" or hyperkinesis can hardly be supposed to be 
 associated with hydrocephalus except accidentally and independently of any casual inter- 
 relation. The point of the coexistence of overactivity and hydrocephalus in the micro- 
 cephalic would lodge rather in the simplicity of the neuronic system in the microcephalic 
 case. It is clear that, if the microcephalic brain is also hydrocephalic, the neuronic systems 
 of the brain in question must be still simpler in make-up. If the brain in question is 
 
122 SOUTHARD AND TAFT. 
 
 taking in anything like the normal number of ingoing stimuli, and the capacity of the 
 brain to dampen or inhibit the stimuli and divert them from taking effect in motion, is 
 a diminishing capacity, then over-activity becomes the most natural result of the simplicity 
 of the brain and one quite to be expected. 
 
 Accordingly, although the typical idiot ( Case VI) yielded a brain without hydrocephalus 
 and yet was over-active, it is clear that the over-activity is not of the type of the occasional 
 hysterical outburst; thus, whereas Cases VII and X are described as excitable, Case VI 
 would best be described as restless or "nervous". 
 
 Case IX showed no restlessness or excitability at any time, having a good disposition 
 and in general a rather cooperative nature. 
 
 Our problem, accordingly, as based on the analysis of this group of cases from the 
 standpoint of hydrocephalus, may be summed up as follows : 
 
 The association of internal hydrocephalus with microcephaly may well be incident 
 to the mal-development, that is to say, merely a part of the result of the factors which have 
 retarded or stopped the growth of the brain. Accordingly, under these circumstances, 
 alterations of intracranial pressure are neither necessary nor in fact very likely to occur. 
 Moreover, dilatation of the ventricles in old age and in dementia praecox must be considered 
 separately. If there is any relation between occasional outbursts of excitability and altera- 
 tions of intracranial pressure which have to do with the production of hydrocephalus, 
 many more cases will be necessary to make the point certain. We have one good instance 
 to show that constant restlessness is not necessarily associated with hydrocephalus. A 
 further physiological and psychological analysis of the difference between excitability 
 and restlessness would be very desirable, both for its intrinsic interest and for the light it 
 may throw upon these structural conditions, which are difficult, if not impossible to interpret 
 when considered entirely by themselves. 
 
 Summary. 
 
 The entirely provisional conclusions of the epicritical review may be briefly stated as 
 follows : 
 
 First, it is not impossible that the problem of matching brain complexity with mental 
 capacity may be solved by a much larger series of instances than is here available; but 
 the instances of such matching as has been undertaken are somewhat convincing as to the 
 correlations of low orders of intelligence with simple brains and of higher orders of intelli- 
 gence with more complex brains. Occasional exceptions to the rule may be explained by 
 
WAVERLEY RESEARCHES. III. 123 
 
 the finer anatomy of certain cases (Case IX) ; others remain less easy to explain away (Case 
 III). 
 
 Secondly, the partial orienting and microscopic examination yielded more instances 
 of slight exudative lesions (including in some instances rod cells) than might have been d 
 priori expected from a relatively stable institutional material like that here largely drawn 
 upon. What the share of syphilis in this group of cases may really be is doubtful. There 
 was one instance of feeble-mindedness very possibly due to an early focal encephalitis en- 
 tailing mal-development of brain. 
 
 Thirdly, as an example of special neurological interest attaching to this study, some 
 considerations about hydrocephalus offered bring up the question of the relation between 
 occasional bursts of excitability and alterations of intracranial pressure with the production 
 of hydrocephalus. 
 
124 southard and taft. 
 
 Description of Photographs. 
 Views of Case I. 
 
 The gross photographs of the stripped brain alone are presented since, although there 
 was a slight general thickening of the pia mater, the microscopy of the tissue has so far 
 shown no evidence of exudate. 
 
 Note in photographs I-a, I-c, and I-d the striking projection of the cerebellum behind 
 the occipital poles. Note the suggestion of Affenspalte (I-a). 
 
 Note in I-b the large exposure of the crura cerebri, as well as the comparatively small 
 number of transverse pontine fibres arranged in almost distinct bundles. Note, also, 
 in I-b the comparative size of the optic tracts and olivary eminences. 
 
 Note in I-a, I-c, and I-d the bi-convolute construction of the frontal lobe; the su- 
 perior frontal convolution, broader than the inferior, may represent superior and middle 
 frontal convolutions of more highly developed brains. Note the excellent development of 
 the pyrif orm lobule on each side, especially the right (I-b) . 
 
 We present in I-e, I-f, and I-g, three views of the brain in total section as stained 
 by the Weigert myelin sheath method. (Note that the stains are relatively successful 
 despite the preservation of the brain for eleven years in formaldehyde solution.) A moderate 
 degree of hydrocephalus is notable in I-f. The small size of the leaflets of the cerebellum 
 is to be noted in I-g. The comparatively greater depth of the sulci than those found 
 in more normal brains is obvious in each of the total brain section views. 
 
 This case is thought to have possessed the lowest mental age in the entire series. An 
 older sister of the patient was almost equally defective and almost identically micro- 
 cephalic; other children, before and after, were not microcephalic. 
 
 Views of Case II. 
 
 The gross photographs of the stripped brain alone are presented since the membranes 
 were normal and there were no microscopic evidences of exudative disease. 
 
 Photograph Il-a demonstrates the focal posterior-lying areas, especially marked 
 on the left side with microgyria. This case of microcephaly exhibits a higher degree of 
 hydrocephalus than did Case I, as is demonstrable from the total brain sections II— f, 
 Il-g, and Il-h. Il-a also shows frontal depressions corresponding with depressions in the 
 skull. Note in Il-a, II-c, and Il-d the distinct projection of the cerebellum behind the 
 occipital poles; a projection less marked than in Case I. 
 
WAVERLEY RESEARCHES. III. 
 
 125 
 
 Note in II-c an area of microgyria in the second frontal gyrus; a similar area is less 
 marked in Il-d. Il-a demonstrates that the area of microgyria begins almost abruptly 
 with the postcentral gyrus; whereas the precentral gyrus on each side is of fair width and 
 well rounded. Photographs II-c and Il-d demonstrate that the microgyria is far less 
 marked on the flanks and inferiorly than superiorly; and this contrast is strongly brought 
 out in the total brain section view, Il-g and Il-h. 
 
 The mental age of this case was, also, one year or less, but the intelligence of the patient 
 was greater than that of Case I. Clinical observation of the patient's general behavior 
 indicated that he was in the habit of attending to bright colors, looking at pictures, 
 watching boys at play, and taking interest in events about him. The question arises, 
 whether these functions are largely related so far as they are of visual origin with the 
 inferior rather than the superior tissues of the occipital lobe. It may be noted that the 
 Weigert myelin sheath stains are relatively successful with this brain although it was 
 preserved in formaldehyde for 13 years. 
 
 Views of Case III. 
 
 The views of this case are, also, limited to the stripped brain for the same reasons 
 as in Cases I and II. Note the general symmetry of this brain. The views do not include 
 the cerebellum, which, however, did not project beyond the plane of the occipital poles. 
 Note in Ill-a the suggestion of Affenspalte on the right side. 
 
 Note that the gyri are everywhere narrow and simple in arrangement, and that the 
 secondary sulci are rarely complicated by collaterals. A special description in the text 
 is made of the parietal regions, which in Ill-a are quite unlike. 
 
 III-c and Ill-d show at the base of the frontal gyri, separating them from the 
 precentral convolutions, short, deep, transverse sulci, somewhat suggesting the sulcus 
 cruciatus of the brain of a dog. Note, in fact, the somewhat general superficial resemblance 
 of the brain of this case to that of a dog. 
 
 Views of Case IV. 
 
 Views IV-a and IV-b are presented of the unstripped brain viewed from above and 
 below, partly because there is a slight thickening of the pia mater at the vertex, and partly 
 because microscopic examination showed a mononucleosis of the posterior septum of the 
 spinal cord, which naturally gives rise to the suspicion of former syphilis, although it 
 
126 SOUTHARD AND TAFT. 
 
 fails to prove the existence of syphilis. IV-c and IV-d show the same aspects with the 
 pia mater stripped. 
 
 IV-c, IV-e, IV-f show a lack of division of the primary sulci of the frontal lobe on 
 account of the interruption of annectants. The parietal convolutions are also narrow: 
 IV-c, IV-e, IV-f. 
 
 IV-d shows a right pyriform lobule larger and more prominent than the left. Now, 
 the left side of the brain in general appears slightly more hypoplastic (or atrophic?) than 
 the right, so that Case IV exhibits a diminution of the crossed and uncrossed systems on the 
 same side of the brain. (We here proceed upon the basis that the connections of the left 
 pyriform lobule are largely with the left olfactory zone, whereas the connections of the 
 neopalium are largely crossed.) Compare, accordingly, the cruciate asymmetry which 
 appears in Case V. We might argue that the conditions in Case IV are of more recent 
 origin than those of Case V. At least, if we desire to attribute the cruciate asymmetry 
 of Case V to the operation of a single agent at or before the beginning of decussation, of 
 course this case, — the oldest in the series, — was microscopically found subject to gliosis, 
 and the whole brain shows a tendency to atrophy with slightly flaring sulci. It may be 
 that the condition is one of atrophy and not of aplasia, and that the atrophy has little or 
 nothing to do with the feeble-mindedness of the case. 
 
 The gross sections are presented with some completeness (four views, IV-g to IV-j) 
 for the reason of the somewhat surprising degree of hydrocephalus which the external 
 views would hardly give one cause for suspecting. 
 
 The best argument for feeble-mindedness in this case is microscopic, namely; the 
 presence of dislocated ganglion cells in the white matter. 
 
 Views of Case V. 
 
 The unstripped views of Case V are omitted, as in several previous cases, because of 
 the lack of acute or progressive exudative process. 
 
 V-a presents the not unusual frontal and occipital cruciate asymmetry. In this 
 instance, the loft frontal and left occipital lobes are smaller than their fellows. The mesial 
 views V-g and V-h show a slight amount of thinning out in the posterior third of the corpus 
 callosum. 
 
 As in Case IV, the best argument for feeble-mindedness in this case is microscopic, 
 namely; the presence of dislocated ganglion cells in the white matter. Naturally, this 
 argument may not be convincing. In general, the gross findings in the case resemble 
 
WAVERLEY RESEARCHES. III. 127 
 
 those of dementia praecox in their mildness and unilaterality. These appearances are 
 borne out in a cross section (V-d). 
 
 Views of Case VI. 
 
 Unstripped appearances from above and below are 'presented in Vl-a and Vl-b, 
 because there was not only a general thickening of slight degree of the pia mater, but 
 lymphocytes were found in a smear from the frontal region as well as a few rod cells in 
 certain areas. These appearances may well suggest syphilis. But one focus of perivascular 
 lymphocytosis has been found in the microscopic study, which was in this instance chiefly 
 limited to the stripped brain. Despite the indication of syphilis, this case was a rather 
 typical instance of a "grinning idiot", who was perhaps classed too low under the Binet 
 test because of his aphasia, which aphasia may have been in part due to the absence of one 
 vocal cord. There were certain other suspicions of syphilis in the case. The corpus 
 callosum was thin throughout (see especially Vl-g and Vl-h). 
 
 Views of Case VII. 
 
 The unstripped appearances in Case VII, viewed from above and from below, are 
 likewise shown, although the pia mater was but faintly hazy throughout. The microscopic 
 examination, however, demonstrated rod cells, from which may perhaps be suspected a 
 more progressive condition than is assumed to be typical of feeble-mindedness. The 
 mental age of this case, though set at five, seemed too high in a number of respects. The 
 case also showed some sensory disorder. As in Case VI, there was apparently a suspicion 
 of syphilis. 
 
 The views of the stripped brain exhibit a fairly complex construction. The cross 
 sections, Vll-g and Vll-h, show a narrow corpus callosum. 
 
 Views of Case VIII. 
 
 On account of the focal plasmocytosis of the left prefrontal area, the unstripped views 
 of the vertex (VHI-a), the left flank (VHI-b), and the left mesial surface (VIII-c) are 
 presented. There was no suspicion of syphilis in this case clinically, and it may be that 
 the condition found is due to some other intercurrent condition, which may possibly have 
 set in even after the crime for which the patient was executed. The stripped appearances 
 show a number of transversely directed gyri and a failure to approximate on the part of the 
 summits of numerous gyri. This is especially shown in the view of the left flank (VHI-b). 
 
128 
 
 WAVERLEY RESEARCHES. III. 
 
 Perhaps the strongest argument for feeble-mindedness in the case is the dislocated 
 ganglion cells in the white matter of certain areas (very few). The narrowing of the 
 posterior third of the corpus callosum is best shown in the mesial views VIII-c, VHI-e; 
 less well in VHI-f, VHI-g, VHI-h, and VHI-i. 
 
 Views of Case IX. 
 
 The unstripped appearances in Case IX are presented from above and below (IX-a 
 and IX-b) and mesially (IX-c and IX-d) to exhibit a focal leptomeningitis, especially 
 at the base. But there was no evidence of acute or chronic inflammation microscopically. 
 
 The stripped appearances (IX-e to IX-j) show slight asymmetry and a brain in general 
 of great size but poor molding. The mesial views (IX-i and IX-j) show a narrowing of 
 the posterior third of the corpus callosum. 
 
 Views of the brain in cross section are shown with comparative fulness on account of 
 the irregularity in the distribution of hypoplasia as suggested by the microscopic examina- 
 tion. Especially the right superior frontal region (IX-k) exhibited the most marked 
 architectural disturbance microscopically. A cyst-like area in the right hemisphere of 
 IX-1 is due to artifact. 
 
 Views of Case X. 
 
 Photograph X-a illustrates the unstripped appearances, to which are added X-b 
 and X-c to illustrate the thickening of the cerebellar pia mater. The case exhibited a 
 somewhat questionable focal mononucleosis about the vessels of one region. 
 
 Microscopic examination showed numerical hyperplasia of cells in a number of places. 
 The brain is fairly complex in construction, but the corpus callosum (X-h and X-i) shows 
 a slight thinning in the posterior third. 
 
I-c i-d 
 
 CASE 1 — MICROCEPHALY. LOW IDIOT 
 
 Memoirs American Academy of Arts and Sciences. Vol. XIV.- Waverley Researches. 
 
I-e, 1-f, 1-g 
 
 CASE I — MICROCEPHALY. LOW IDIOT 
 
 Memoirs American Academy of Arts and Sciences. Vol. XIV.- Waverley Researches. 
 
Il-a 
 
 Il-b 
 
 II-c Il-d 
 
 CASE II — MICROCEPHALY. ENCEPHALITIC. LOW IDIOT 
 
 Memoirs American Academy of Arts and Sciences. Vol, XIV. — Waverley Researches. 
 
o 
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 o 
 
 -j 
 
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 I 
 
 D_ 
 UJ 
 
 O 
 
 LU 
 
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 I 
 
 o 
 o 
 
 E 
 
 o 
 
 < 
 o 
 
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 X 
 
Ill-a 
 
 Ill-b 
 
 III-c Ill-d 
 
 CASE III — MICROCEPHALY. IMBECILE " LITTLE ZIP" 
 
 Memoifs American Academy of Arts and Sciences. Vol. X I V. — Waverley Researches. 
 
IV-a 
 
 IV-b 
 
 IV-c 
 
 CASE IV — OLD ALMSHOUSE MORON 
 Memoirs American Academy of Arts and Sciences. Vol. XIV. — Waverley Researches. 
 
 IV-d 
 
IV-e 
 
 IV-f 
 
 IV-g 
 
 IV-h 
 
 IV-i IV-j 
 
 CASE IV — ALMSHOUSE MORON. NOTE HYDROCEPHALUS 
 
 Memoirs American Academy of Arts and Sciences. Vol. XIV. — Waverley Researches. 
 
V-a 
 
 V-b 
 
 V-c V-d 
 
 CASE V — MORON. TRUANT. DEMENTIA PRAECOX (?) 
 
 Memoirs American Academy of Arts and Sciences. Vol. XIV.- Waverley Researches. 
 
V-g V-h 
 
 CASE V— MORON. TRUANT. DEMENTIA PRAECOX (?) 
 
 Memoirs American Academy of Arts and Sciences. Vol. XIV. — Waverley Researches. 
 
Vl-b 
 
 VI-c VI-d 
 
 CASE VI —IDIOT (APHASIA. VOCAL CORD ABSENT). SYPHILITIC (?) 
 Memoirs American Academy of Arts ano Sciences. Vol. X I V. — Waverley Researches. 
 
Vl-e 
 
 Vl-f 
 
 Vl-g Vl-h 
 
 CASE VI — IDIOT. SYPHILITICA) CORPUS CALLOSUM THIN 
 
 Memoirs American Academy of Arts and Sciences. Vol. XIV. — Waverley Researches. 
 
VII-c 
 
 CASE VII — IMBECILE. SYPHILITIC (??) 
 
 Memoirs American Academy of Arts ano Sciences. Vol. XIV.- Waverley Researches. 
 
 Vll-d 
 
Vll-e 
 
 VH-f 
 
 VH-g VH-h 
 
 CASE VI I — IMBECILE. SYPHILITIC (?) 
 
 Memoirs American Academy of Arts and Sciences. Vol. XIV. — Waverlev Researches. 
 
VII I-a 
 
 VHI-b 
 
 VIII-c VHI-d 
 
 CASE VIII — MORON OR SUBNORMAL. EXECUTED MURDERER 
 
 Memoirs American Academy of Arts and Sciences. Vol. X I V. - Waverley Researches. 
 
VHI-e 
 
 VHI-f 
 
 VHI-g 
 
 VHI-h VHI-i 
 
 CASE VIII — MORON OR SUBNORMAL. EXECUTED MURDERER 
 
 Memoirs American Academy of Arts and Sciences. Vol. XIV.- Waverley Researches. 
 
lX-a 
 
 IX-b 
 
 IX-c IX-d 
 
 CASE IX — "ABLE BODIED" IMBECILE. BRAIN WEIGHT 1622 GRAMS 
 
 Memoirs American Academy of Arts and Sciences. Vol. XIV.- Waverlev Researches. 
 
IX-e 
 
 IX-f 
 
 IX-g IX-h 
 
 CASE IX — "ABLE BODIED" IMBECILE BRAIN WEIGHT 1622 GRAMS 
 
 Memoirs American Academy of Arts and Science?. Vol. XIV. — Waverley Researches. 
 
IX-] 
 
 IX-j 
 
 IX-k 
 
 IX-1 
 
 CASE IX — "ABLE BODIED" IMBECILE. BRAIN WEIGHT 1622 GRAMS 
 Memoirs American Academy of Arts and Sciences. Vol. XIV. — Waverley Researches. 
 
X-a 
 
 X-b 
 
 X-d X-e 
 
 CASE X — LOW IMBECILE (BINET 2.4) 
 Memoirs American Academy of Arts and Sciences. Vol. XIV. — Waverley Researches. 
 
 X-c 
 
X-f 
 
 X-h 
 
 CASE X — LOW IMBECILE (BINET 2.4) 
 Memoirs Amer.can Academy of Arts and Sc.ences. Vol. X I V-Waverley Researches. 
 
 X-i