. A treatise on the nervous diseases of children, for physicians and students. , is, as arule, overlooked, and of littlepractical importance. Thrombosis may also be the result ofarterial changes due to hereditary syph-ilis, but I wish distinctly to impress uponthe reader that in these cases of cerebralpalsies syphilis does surely not play asimportant a role as is imputed to it by afew authors, who have generalized fromthe examination of one or two cases.*Gowers has advanced important reasonsfor the supposition that thrombosis andocclusion of the middle cerebral veins areof frequent occurrence
. A treatise on the nervous diseases of children, for physicians and students. , is, as arule, overlooked, and of littlepractical importance. Thrombosis may also be the result ofarterial changes due to hereditary syph-ilis, but I wish distinctly to impress uponthe reader that in these cases of cerebralpalsies syphilis does surely not play asimportant a role as is imputed to it by afew authors, who have generalized fromthe examination of one or two cases.*Gowers has advanced important reasonsfor the supposition that thrombosis andocclusion of the middle cerebral veins areof frequent occurrence in children, andthat some of the cases of infantile hemi-plegia would be more likely to be dueto this condition than to embolism re-sulting from endocarditis. He states,furthermore, that the thrombosis cannotbe distinctly demonstrated post-mortem,because the thrombosis is, as a rule, continued into the sinuses, and a sinus thrombosis would be much more. striking, and would be apt to conceal the venous thrombosis which led to it. * I have had no reason to change these Fig. 113. — Variously DegeneratedCells of the Cortex in the vicinityof the line a b of the preceding fig-ure. Near a, small blood-vessels,walls thickened. Large pyramidalcells are misshapen, and exhibitgranular disintegration. Cells di-minished in number. (Drawn fromspecimen.) INFANTILE CEREBRAL PALSIES. 453 Whatever the initial lesion of an acute cerebral palsymay be, if the patient survive a number of years, secondarychanges may be set up in the brain which will successfullyconceal the initial lesion. Cysts, large areas of softening,atrophy, sclerosis (diffuse and lobar), are a few of thechanges frequently observed. There is no telling in advance of the post-mortem examination, with anydegree of certainty, which secondary lesion will be found in the brain of a
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