Case 4. James Pierce was an almshouse transfer to the Danvers Hospital in his fiftieth year. He died three years later. The accompanying brain pictures demonstrate so extensive a lesion of the left hemisphere that it is of great interest to determine if possible the genesis and course of his disease. It appears that syphilis had been acquired somewhere about the age of 38 or 40, so that the total duration of the process was between 13 and 15 years. In Pierce’s forty-third or forty-fourth year, he had a shock while walking in the streets of his native city, whereupon he was subsequently transferred to the Danvers Hospital, whose data have been summed up as follows (we are obliged to Dr. Charles T. Ryder for these data):
Neurological examination: Neuromuscular condition: Barely able to walk or stand without assistance; hemiplegia of right side; swings foot out and drags toe out and around in attempting to walk. Right hand held by side, flexed at right angle; fingers contracted and thumb thrown across palm. Can lift arm from side; practically no movements of forearms or fingers; atrophy of deltoid, arm, forearm, and hand. Muscular movements of left upper extremities fairly well performed; good strength.
Cranial nerves: Refuses to respond to any tests to determine hearing or vision, but evidently hears what is said to him, and in his movements gives no evidence of deafness. Right corner of mouth droops; tongue protrudes straight.
Reflexes: Pupils dilated; margins irregular; left pupil larger; they vary in size but it is impossible to determine whether the variation is due to light or accommodation reflex. Reflexes of right side extremely exaggerated throughout; there is little ankle clonus; Babinski is not obtained, patient holding his toes in flexed position in resisting attempts to elicit reflexes.
Sensations: Reaction to pain stimuli on either side. Evidently some anesthesia on right side, but pressure is apparently very painful. There is considerable spasticity of limbs on right side on passive motion. Too demented to make accurate tests.
The above examination was made on May 6, 1904. On May 20th the record states:
There is almost complete sensory aphasia with word-deafness; some paraphasic circumlocution. Many of his words are very well enunciated but have no meaning. Is apparently unable to recognize objects or their uses.
Brother stated that he was always supposed not to be over bright. Physician’s certificate states that he is epileptic, averaging two attacks per week. On the 15th of May he had a general convulsion; was unconscious for half an hour, and dull and drowsy for two hours afterwards. On the 19th, he had a similar attack in the afternoon, the convulsion lasting a minute, and he was stuporous for an hour.
On November 8th he had a severe epileptic convulsion. His body was curled up to the right. The convulsive seizure lasted for two minutes and was followed by complete unconsciousness for an hour, when the patient roused and appeared as usual in a few minutes. From that time to December 15th he had five epileptic convulsions; he was much more feeble, and unable to help himself as much as formerly.
Nov. 7, 1905: Patient has had occasional convulsions since last note, but none during the last three months. He is confined to bed, has become very much demented, and shows very marked speech defect, so that he is almost unintelligible. He understands only the simplest directions. Legs are considerably contracted and knees are flexed. Arm and hand on the right are paralyzed and show some atrophic changes; partially flexed. Left elbow jerk is very lively. On May 23, 1906 he was reported as having Achilles on right side only, and Babinski on right side. He died January 5, 1907.