English: Case A. — W. M. Male ; superficial excitable idiot ; aged io}4
years when photograph was taken. Height 3 feet 11^ inches, weight 44 pounds. Head, microbrachycephalic. Head Measurements. Inches, Circumference 15^ Naso-occipital arc 105^ Binauricular arc loYs Antero-posterior diameter 5J^ Greatest transverse diameter 3J^ Binauricular diameter 314 Facial length loj^ Cephalic index yy A mute, with dark hair and gray eyes. Teeth fair ; alveolar arches wider than usual, and palate almost flat. Sight, hearing, taste, and smell apparently normal. Helpless, with marked sialor- rhoea, he is unable to walk or to care for himself ; spends most of the day in the rocking-chair. Is insensitive to pain, extremely nervous, restless, and noisy, never quiet when awake, with pronounced im- perative movements that follow a regular cycle thus : First, throws up head and places left thumb in mouth with fingers resting on left cheek while he rocks to and fro ; bending low, he straightens and turns to right, at the same time placing right hand at nape of neck ; next throws left arm to right shoulder ; crosses wrists, strikes right side of face under ear with right hand and strikes hands together ; then wrings hands with imperative movements of fingers, and places right index finger in left palm ; places left index finger to lips, thumb in mouth ; waves both hands, and crosses feet. This he does con- stantly when awake, with brief intervals between cycles, during which, more quickly than the eye can follow, he pulls and picks at clothing. Organs and functions of body normal, except for occa- sional attacks of gastro-intestinal disturbance. Under treatment for 7 years, learned only to feed himself with a spoon, and became more cleanly in habits, indicating his wants by a peculiar vv'ailing cry. Second child ; born at full term ; labor ordinary ; nourished by mother. Father, a laborer, 26 years, and mother 24, at time of W.'s birth. Two sisters living, both healthy. Parents of " Pennsylvania Dutch " stock. No cause for W.'s condition assigned. Died in twelfth year, of intussusception. At the necropsy the body weighed 45.64 pounds and measured 3 feet 11^ inches. Calvarium thin, measuring at cut portions but one eighth of an inch. Brain not especially edematous, and only a moderate amount of cerebro-spinal fluid escaped. Dura adherent to pia over vifhole cerebral hemispheres, and in some places to the calvarium, so that the latter was removed with great difficulty. Brain weighed 20.64 ounces. The cerebral hemispheres were of equal size — each hemisphere measuring antero-posteriorly 5 inches — and did not cover the cere- bellum, about one inch of each cerebellar lobe being left exposed. The fissure of Rolando on each side was nearly perpendicular. The cerebral convolutions were very imperfectly developed, especially in each parietal lobe. The cerebellum measured transversely 4.14 inches, and was much better developed, proportionately, than the cerebrum. The occipital lobes were separated from one another, and the left superior vermis was exposed. The cranial nerves were normal, and the pons was well developed. The spinal cord was
about as large as is usual in a child of the same size.