in] Post-amputation CluoHjex hi the Cerebral Cortex 55 



lowermost cell group, it might have been expected that the degeneratioti in it would have been tailing 

 off; tliis, however, was not the rase, lor it, was as much as or even more affected than the others. After 

 this, there was a very abrupt return to the normal condition, the next group, that lying just above the 

 annectant gyrus, being almost completely untouched, and all the cortex below this normal. 



In finishing oft' the account of this case I would repeat that "reaction a distance," in its most typical 

 form, was unquestionably the predominating cell change, and this change alone we took as our guide, and 

 a certain one too, to the differentiation of the area. It might be pointed out further that a careful search 

 for shrivelled up and pigmented remains of cells in the ultimate stage of dissolution, and also for cells 

 reduced in size, but intensely though homogeneously stained a condition which others have described as 

 one of atrophy proved fruitless. I might also say that as the task of examining into the condition of 

 the giant cells alone was such a time-absorbing and laborious one, and also because the changes found in 

 them were so convincing, particular attention \vas not paid to the condition of other cell layers, and although 

 we think that the large pyramidal cells had suffered a reduction in numerical strength, we cannot attach 

 much importance to the observation because we did not verify it by making careful enumerations and 

 drawings. I can, however, definitely state that the general cell atrophy, the distortion and the loss of the 

 normal columnar arrangement, which figured so prominently in the case of amyotrophic lateral sclerosis, 

 was absent in this, and in fact all the cases of amputation which I have examined. 



CASE No. 2. 



A male, aet. 41, both of whose legs were amputated at a point 6 inches below the knee joint, 2i years 

 prior to death. The left hemisphere was hardened in Orth's mixture of Muller's fluid and formalin and 

 the central convolutions cut seriatim in celloidin. Pairs of sections were taken at intervals of 1 mm., and 

 one set was successfully stained with thionin, to ascertain the condition of the nerve cells, and the other 

 by the method of "Wolters-Kulschitzky, for the display of nerve fibres. 



As to the nerve cells, instances of "reaction k distance," just as beautiful and in every way similar 

 to those found in case No. 1, were again seen, in fact as regards the condition of the giant cells and 

 the general appearances of the cortex these two cases seem to be on all fours. .Slight differences, however, 

 regarding the distribution of the affection must be referred to (text-figure 4). 



As in case No. 1, the group of giant cells on the mesial surface came in for severe affection, in fact- 

 hardly a single cell could be found in this situation which could be described as perfectly healthy. With 

 the two upper groups on the convexity of the hemisphere it was different, for here the affection was not 

 nearly so extensive, and while in nearly all the sections which displayed these groups, the degenerated cells 

 could be seen at some point, the reaction was not so advanced and the major proportion of cells remained 

 intact, and speaking in general terms it may be said that the cells on the free surface of the gyms were 

 least, and those lying on the wall of the fissure of Rolando most, involved. In case No. 1 the cells were 

 equally involved in both situations, and this therefore constitutes an important point of difference and shows 

 a pretty variation in result, according as to whether the leg is amputated above or below the knee. 



Examination of the sections stained for nerve fibres proved entirely negative, for I was unable to detect 

 the slightest difference between these sections and those from a normal brain ; it is clear, therefore, either 

 that nerve fibre changes, if they occiu', are very slow in supervening, or else changes are present for the 

 display of which some other method probably the method of Marchi is needed. 



CASE No. 3. 



A male, aet. 45, with amputations of the right and left legs, at points 14cm. and 21 '5 cm. below the 

 head of the tibia, respectively. 



The exact date of the amputation was not ascertained but it was an old-standing one, because he was 

 an inmate of Rainhill Asylum for li years, and, prior to that, had taken advantage of his disability, to 

 practise the calling of a beggar, on the sands of Blackpool. 



