Nervous and mental diseases . is not markedly blanched,but the fovea centralis presents a clear-cut liver-colored placpie surroundedby a halo of grayish-white which does not obscure the retinal vessels. Nys-tagmus, ocular deviations, and pupillary anomalies are frequentlyencountered. Autopsical findings have shown convolutional sim-plicity and cortical cellular degeneration. Sachs ^ reports degenerativechanges in the gray matter of the entire cerebrospinal axis and even in theroot ganglia. These changes have been attributed to toxic processes, butnone of the alleged toxic factors can be accept
Nervous and mental diseases . is not markedly blanched,but the fovea centralis presents a clear-cut liver-colored placpie surroundedby a halo of grayish-white which does not obscure the retinal vessels. Nys-tagmus, ocular deviations, and pupillary anomalies are frequentlyencountered. Autopsical findings have shown convolutional sim-plicity and cortical cellular degeneration. Sachs ^ reports degenerativechanges in the gray matter of the entire cerebrospinal axis and even in theroot ganglia. These changes have been attributed to toxic processes, butnone of the alleged toxic factors can be accepted as competent in all in-stances. As many as four cases have been observed in a single family,and the inherent anatomical lack in the brain is not explained by inheritedsyphilis, which may, however, produce a veiy similar clinical picture. 1 New York Medical Journal, May 30, 1896. 2 >• Brain, 1899- ^ Dent. Arch. f. klin. Med., Bd. Ixviii. 4 Jonr. Nerv. and Ment. Dis., May, 1900. 5 Jour. Xerv. and Ment. Dis., Jan., 254 DISEASES OF THE BRAIN PROPER. Epileptic Attacks.—One of the most serious features of the cere-bral palsies of children is the marked tendency to the development ofepileptic attacks. These appear in fully one-half of all cases. They aredue to the brain-lesion, and usually are most marked in the paralyticlimbs, but with a tendency to spread and become generalized. TrueJacksonian fits are but rarely encountered. In some cases the initialeclamptic attack is at once followed at regular intervals of weeks ormonths by these seizures. In others they do not appear for a period ofyears and may be preceded by petit mal attacks. They are always to beexpected, and when established constitute a serious menace to the healthand mental state of the patient. The ordinary tendency of epilepsy toinduce dementia is exaggerated in these already defective brains. Diagnosis.—The diagnosis of cerebral palsy when the condition iswell marked should present no difficulty. In
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