92 The Postcentral Gyrus in Tabes DorsaJis [CHAP. 



CASE No. 3. 



J. M., aged 36. Admitted to Eainhill Asylum, March 16th, 1899. Died March 26th, 1899. 



HISTORY. 



He was married, and his wife informed us that he had followed the occupation of a railway porter all 

 his lite, and had always been an energetic worker, and of temperate habits. She knew of no illness or 

 injury which could account for the present attack and could supply no information concerning infection 

 with syphilis. She had a family of two, both young and apparently healthy, but one other child had been 

 born dead and she had had four miscarriages. Up to within 14 months of admission she stated that her 

 husband had enjoyed good health, then difficulty in walking and in handling goods, and also an affection 

 of the eye, gradually leading to closure of the left lid occurred, and he was obliged to abandon his occupation. 

 No seizure of any description was noticed. Finally the onset of dulness, restlessness, and other signs of mental 

 disorder compelled her to have him certified for removal to Rainhill Asylum. 



STATE ON ADMISSION AND PROGRESS. 



There was bilateral ophthalnioplegia externa and left-sided ptosis ; the left superior oblique muscle was 

 intact on both sides. The pupils were equal but did not react to light. The knee jerks were absent and 

 the gait feeble and unmistakeably ataxic. The tongue was protruded straight and was free from tremor. 

 His general appearance was one of great feebleness, he was much emaciated, and had trophic sores over the 

 sacrum. Mentally his replies to simple questions were coherent but his memory was very defective ; he 

 seemed to be indifferent to his surroundings, was restless and exhibited distinct signs of dementia. His speech 

 was thick and suggested palatal paralysis, he had difficulty in .swallowing and was wet and dirty in his habits. 

 He showed not the slightest sign of improvement and died from exhaustion ten days after admission. 



AUTOPSY. 



It is important to mention that the brain did not exhibit marked signs of general paralysis ; true it 

 is that the pia-arachnoid membrane was somewhat opaque, thick and tough, and its removal occasioned 

 some decortication, but wasting had not occurred to any great extent, as evidenced by the fact that the 

 encephalon weighed no less than 1560 grammes. The ventricles also were not dilated and the ependyma only 

 slightly granular. The oculo-motor nerves were attenuated and grey in colour (microscopic examination 

 revealed serious changes in the nuclei of these nerves). 



To the naked eye the spinal cord showed sclerosis of the posterior columns and withering of many posterior 

 nerve roots. 



The only other point of interest to be mentioned is that a suspicious scar was seen on the penis, and 

 the discovery of arterial changes in the subsequent microscopic examination is almost convincing proof that 

 he must have suffered from syphilis. 



MICROSCOPIC EXAMINATION OF THE BRAIN. 



The brain was hardened in formol 5 / . Blocks were taken from both central convolutions at intervals 

 of 1 cm. and cut and stained by the method of Nissl for nerve cells and by a special process for nerve fibres, 

 also a number of blocks from other regions were examined for purposes of comparison. 



It may be at once stated that the classical signs of general paralysis although present, were not advanced, 

 and that the postcentral gyms was singled out for specific affection. The changes therein I shall now describe. 



In the first layer there was no alteration of special importance, only glial proliferation and some thickening 

 of vessels indicative of general paralysis were noticed. 



The small pyramidal cells appeared orderly and well formed, but were not so numerous as they should 

 have been. 



