m] The Cortc.i- hi Aiiii/(ttro]>lii<- Lateral Sclerosis 4.i 



Surface inspection of the muscles left no doubt on the question of wasting, but it was noted that tin- 

 leg inuseles were more invohed (ban those of the ami, anil that the extensor muscles on the front and 

 side of the lower leg, and the extensor museles of the knee were particularly attaeked. In each hand 

 the thenar eminence was markedly flattened, prominence of the buses of the first metaearpal bones was 

 pronounced and there was a, distinct derive of clawing. Then, although wasting of the fore-arm and shoulder 

 inu.-eles was obvious, the biceps and triceps were fairly well represented. 



The cerebro-spinal fluid was increased in quantity. Distinct thickening and oedema of the pia-arachnoid 

 was evident, but it was free from undue opacity. 



The encephalon weighed 117S gran s, the right hemisphere, unstripped, 49.") grammes, the same hemi- 

 sphere, stripped, 4.Vi grammes, the left hemisphere, unstripped, 493 grammes, the cerebellum, along with the 

 pons and medulla, ]~r2 grammes. 



These weights are obviously not up to standard, and in accordance with this it was further noticed 

 that the convolutions in general were wasted and that the cortex was pale and thin, but, at the autopsy, 

 no special atrophy localised to the precentral gyrus was recorded. 



MICROSCOPIC EXAMINATION. 



Sections of the spinal cord taken from a number of different levels, and stained by the method of Pal, 

 showed partial but not complete sclerosis of the direct and lateral pyramidal tracts in the whole of their 

 course, but the extension of the sclerosis to the anterior root zones was not so marked as in case No. 1. 



The anterior cornual myelinic plexus was reduced iu density. An examination of the anterior cornual 

 cells, in carmine preparations, revealed a pronounced numerical deficiency. Marchi preparations disclosed 

 the existence of a few acutely diseased fibres in the pyramidal tracts, of many in the anterior root zone, 

 and of a few in the issuing anterior roots. 



The posterior columns and sensory roots were normal. 



A similar sclerosis of the motor tract was observed in the cms, pons and medulla, but there was less 

 ai-ure degeneration. 



Judging from the appearances of the spinal cord, it might be said that, in this case, the morbid process 

 generally was in a less advanced condition. 



Microscopic Examination of the Brain. 



The method of examination was identical with that adopted in case No. 1, and as the 

 changes discovered are on all fours with those previously observed, we can proceed at once 

 with the feature of most importance, namely, the topographic distribution of the Betz cell 

 destruction. Commencing again with the small area on the mesial surface of the hemisphere, 

 we found an almost complete absence of giant cells and it was obvious that the destruction 

 was even greater than it was in case No. 1. 



On the free surface of the convexity of the hemisphere, it was again noticed that 

 absolutely no cells remained, but on the wall of the Rolandic fissure, especially in that part 

 lying immediately above the buttress, a few cells were discovered three or four per section 

 of which some were healthy and others diseased. 



Some of the small Betz cells peculiar to the buttress remained, and also, in three blocks 

 in imediately below the buttress (9 mm. of cortex), a fair proportion of giant cells could be 

 seen, but the majority were distinctly degenerated. 



Then followed several blocks in which there were no giant cells whatever, but on arrival 

 at the level of the lower genu they reappeared and resumed their normal slate. 



