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too inchisive and was applied to a group of cases which had already been described as the "atonic astatic type" (Forster.) At the present time Purchase Cialis Online Cheap three types of infantile cerebral palsy were recognized: a spastic type, an atonic type, and a rare cerebel- lar type. In addition, there were subdivisions characterized by choreiform inovements, athetoid movements, tremiform movements, atactiforni move- ments, epilepsy, and mental defect in various degrees and combination. Consequently, if any classifica- tion was made of this very large and bizarre group of infantile cerebral affections, Purchase Cialis Online Cheap one should adhere strictly to clinical subdivisions, at least for the pres- ent ; and such a term as "cerebrocerebellar" did not tend to clarify the situation, as it would include a group of cases referable to the frontal lobe Purchase Cialis Online Cheap — Fiir- ster type — as well as the cerebellar type. Further- inore in two of Forster's cases of the atonic type, he had demonstrated the existence of a lobar sclerosis of the frontal lobes while the cerebelluin was macro- scopically normal in both the cases ; and while in Doctor Clark's cases there were symptoms which suggested a cerebellar origin, it could not be denied that cerebellar symptoms also arose from frontal lobe lesions, which was another Purchase Cialis Online Cheap objection to the term "cerebrocerebellar." l^octor Hunt desired to call attention to what he would call the ataxic type of cerebral birth palsy, which was in marked contrast to the spastic form and the atonic form, although it resembled in many ways the cerebellar type. Three of these cases had come under his observation. This was a type of cerebral birth palsy characterized by pure ataxia without ]>aralysis or spasticity. There was a his- tory of prolonged or difficult labor, instrumental delivery and injury during the birth, followed by retardation and abnormality in the development of motor coordination. Because of this there was diffi- culty in learning to sit up, walk, talk, and use the hands. All of these acts showed evidences of inco- ordination and ataxia, with a tendency toward grad- ual Purchase Cialis Online Cheap improvement. There was static and locomotor ataxia and an incoordination of the upper and lower extremities which persisted in the recumbent posture. There was a moderate degree of hypo- tonicity and the tendon reflexes were diminished and might be difficult to elicit. The superficial sen- sations were apparently normal and the sjiecial senses were not aficcted. The speech was dysarthric and participated in the ataxic disturbances. There was a inoderate degree of retardation of mental developinent, but no gross intellectual defect and no epilepsy. The symptomatology was bilateral and fairly svmmetrical, although the svnintoms mic:ht predominate on Purchase Cialis Online Cheap one side. The legs were more affected than Purchase Cialis Online Cheap the arms. There was a tendency to gradual improvement. The gross motor f)Ower was well Purchase Cialis Online Cheap preserved and there was no tendency to >pasticity or exaggeration of the tendon or Purchase Cialis Online Cheap i)eriosteal reflexes. The plantar reflex was of the Purchase Cialis Online Cheap physiological type. There was rather a tendency to hypotonicity and diminution of reflex action. There was no nys- tagmus. .Slowing of the rhythmical movements — dysdiadokokinesis— was jjresent. The clinical pic- ture was characterized by motor incoordination which affected in greater or lesser degree the various voluntary movements. fhis clinical picture Doctor Hunt ascribed to a meningeal hemorrhage limited to the parietal lobes. i. e., in the sensory si>liere of the cerebral cortex He believed that during the birth there was throm- bosis or rupture in those parietal veins of the cer- ebral cortex which coursed in the interparietal fis- sure and drained the blood from the parietal lobes .Such a vascular lesion would lie posteriorly to the motor area in the sensory field, and as a result there would be a disturbance — agenesis or dysgenesis — in the development of the cortical centres and com- missural system by which muscle memories were received and transmitted to the motor area. Purchase Cialis Online Cheap It was a sensory equivalent of Little's disease, and was characterized by bilateral cortical ataxia. Little's disease was a cerebral diplegia; this was a cerebral diataxia Dr. 1. Ai!R.\HAMSu.N. of New York, said that he had had two cases similar to those of Doctor Clark. which he had sent to Grossman for reeducation by the Maloney method and improvement in the con dition had been rejjorted. He considered this method sujierior to that of Frenkel. What Doctor Hunt said was perfectly true and only three years ago the speaker had called attention to the difficulty, in these cases, of differentiating between lesions of the parietal lobes and of the cerebelluin : between special orientation and tonus orientation. Some of Doctor Purchase Cialis Online Cheap Clark's cases showed tremors, festination. etc., ])ointing to midbrain disease. Many types could be recognized, de])ending U]xin the sites of involve- ment, and one ought not to speak of a cerebrocer- ebellar disease, the term being entirely too general. Doctor Clark, closing the discussion, said that he had used the term congenital cerebrocerebellar diplegia for two reasons: 1. The association paJsy was either due to an intrauterine lesion, or one at liirth. in which instance the word congenital covered both inborn defect as well as that of an injury at birth. 2. The cerebrum was probably alwavs affected to some degree, as shown in the fits, the mental defect, and the frequent association of injury to the pyramidal tracts, while the type of ataxia present was unmistakably a cerebellar one. .\s was to be ex]iected in so widespread a lesion, embracing both large structures of the cranium, there were many basal ganglia and midbrain symptoms in the syn- drome, such as tremors, dysarthria, nystagmus, and often difficulty in swallowing. It was better to make the syndrome large and all embracing, for the I'KOLEEDINGS OF SOCIETIES. 477 time being, until there was sutiicient clinical material and more was known definitely about the functions of the cerebellar and midbrain structures ; then one might speak of subtypes and specify exactly the structures injured in the different subdivisions of the syndrome.