in] The Corfi'.r hi Ami/of rojt/tfi- Lat<ral Sclerosis 41 



The vagi nerves seemed healthy. 



Sections of several posterior root ganglia showed integrity ( the intraganglionic cells and sensory fibres, 

 but iiroiuHinecd sclerosis anil lack of film's in the anterior or motor roots. 



H/iinnl <',;/. Kvery alternate spinal segment was examined by three methods, viz. those of Pal, Marchi, 

 and Xissl, for the display of normal fibres, degenerated fibres, and nerve cells, respectively. 



The sections stained by the method of I'al were instructive in showing all the tract-changes typical 

 of this disease. Throughout the cord the field covered by the lateral pyramidal tracts, the anterior root 

 /one and the ventral pyramidal bundles presented a pallid look, due to a wholesale disappearance of fibres, 

 and the sclerosis was most marked (although not complete) in the position of the lateral pyramidal tracts. 

 This vast pale area in the lateral columns was fringed by a belt of healthy fibres corresponding to the 

 ventral and dorsal cerebellar tracts. The fine myelinic plexus, normallv present in the anterior cornua, was 

 almost unrecognisable. 



The anterior root bundles were gravely diseased, their intraspinal course was either obliterated or merely 

 indicated by a line of sclerosis, and the extraspinal fasciculi were almost completely bereft of healthy fibres. 



The posterior columns were quite normal. 



In Marchi specimens the above-mentioned changes were repeated, and, in addition, the existence of a 

 considerable number of acutely degenerated fibres distributed over the entire pallid area, but especially 

 numerous along the outer margin of the posterior cornu, was disclosed. In the same area numbers of 

 blackened compound granular cells were seen accompanying the blood vessels. 



As to cell changes revealed by the method of Nissl, throughout the cord the destruction and disappear- 

 ance of large anterior cornual cells reached an extreme degree, and in the few cells remaining degeneration 

 could be studied in all its phases. 



The cells of the columns of Clarke seemed well-preserved, and also the small group of cells, seen 

 throughout the dorsal region in the lateral projection of the anterior cornu, was intact. 



The foregoing much abbreviated account of the examination of the spinal cord shows how severe and 

 complete the involvement of the motor neurones in their spinal course was. Unfortunately the cranial nerve 

 nuclei were not specially examined, but a pronounced and unmistakeable pallor or partial sclerosis of the 

 pyramidal system of fibres was observed in transverse sections of the cms, pons, and medulla, stained by the 

 method of Pal. 



MICROSCOPIC EXAMINATION OF THE BRAIN'. 



The examination was confined to the central convolutions of the left hemisphere and the method was 

 as follows. 



After prolonged hardening in formalin, 5%, drawings and photographs showing the disposition of con- 

 volutions and sulci on the various surfaces of the hemisphere were made. 



The central convolutions were next carefully cut out and divided into blocks, of a size suitable for 

 section on a freezing microtome, and of a thickness of 3 mm. In slicing the convolutions, an effort was 

 made to carry the plane of section at right angles to the fissure of Rolando, and so free the sections from 

 the spoiling effect of obliquity. 



For purposes of orientation, the exact position from which each block came was most carefully indicated 

 on the outline drawings or photographs of the hemisphere, and further to prevent confusion when the time 

 for examination of the finished specimens arrived, an exact copy of the portion of the block which remained 

 on the disc of the microtome, after section, was made on paper, and the different landmarks in it indicated. 



Eight to ten sections from each block were stained in thionin, j "'/_ , differentiated in alcohol, cleared 

 in origanum oil and mounted in baKam dissolved in chloroform. 



1 For the preparation of most of the cortical sections of this, and also of the next case, I have to express my 

 indebtedness to Doctor H. E. Brown, and I have also to thank Doctor A. C. Wilson for his kindness in making a 

 counter-examination of these sections and so checking the accuracy of my own observations. 



c. G 



