DOI: 10.7925/drs1.ucdlib_280676
title: Tubercles in the cerebellum

description: Watercolour medical illustration depicting scrofulous tubercles. It has the alternative reference number 1911, P15A and 5 on the front. The Richmond Hospital Museum reference is D.a.14. The entry for this in P263/1 pg. 16 reads 'Scrofulous tubercles in the Cerebellum. Cath.e McGrane aet 9'. The handwritten note in the bottom left corner reads 'Catherine McGrane aet 9' and the typescript note under the illustration reads 'Tubercles in the Cerebellum'. The typescript note on the back begins '2. Scrofulous Tubercles in the Cerebellum'.
description: Scope and content: The full typescript note on the back reads '2. Scrofulous Tubercles in the Cerebellum- Mr R.W. Smith presented a coloured drawing of the brain of a child nine years of age, admitted into the Richmond Hospital in last May, having been ill for the previous seven months. In September, 1842, it was remarked that this child had become greatly inclined to remain in the recumbent posture; during five months before its admission to the hospital it had suffered severe pain in the forehead which was exacerbated at night; it screamed frequently, and the head required to be supported. At its time of admission the look was vacant, the pupils were dilated like those of an amaurotic patient; they were insensible to light; the hearing remained unimpaired; there was inability to either walk or stand up; of sight all that remained was the power of distinguishing light from complete darkness; the abdomen was tympanitic, and there were frequent vomitings; there were no convulsions, and gradually this patient passed into a comatose condition, from which on 14th of June, there appeared a favourable change; the child became able to stand up and to walk about; the pain in the head ceased; the stomach [?]nger rejected its content, and the patient became lively and intelligent. After this favourable state had continued ten days, the unfavourable symptoms again returned. On the 24th of June there was incessant vomiting, and on 26th death took place, unaccompanied by convulsions. During the last two days there was paralysis of motion, but not of sensation. The results of the examination of the body after death were these: there was effusion of blood into the ventricles of the brain; the brain itself was very large; the foramen commune anterius was dilated. In each lobe of the cerebellum was one scrofulous tubercle as large as a nut. The bones of the head were very thin and diaphanous. Scrofulous tubercles were thickly deposited in the mesentery. The tubercles found in the cerebellum were of a greenish yellow colour, of a firm consistence, and had a laminated structure like that of a calculus. These tubercles are observed generally to have this arrangement. In one of Cruveilhier's plates there is a figure exactly resembling the present specimen. These tubercles often exist of a large size without producing any obvious symptom during life, but frequently there is present some one remarkable symptom, such as strabismus or vomiting; the vomiting is often treated as proceeding from some disease of the stomach. The alteration in the condition of the general health, and its sudden variations, such as were observed in the present case, are known to occur also in many cases of spinal affections, in which also tubercles are not unfrequently met with in the cerebellum. It is extremely difficult, if not impossible, to diagnose these complaints; the symptoms are not modified by either the size or the structure of the tubercles, unless when they irritate or disorganise the cerebral tissue. (Museum, Richmond Hospital).'
description: Numbering/sequence: Original reference number: 1911.