40 Precentral or Motor Area [CHAP. 



AUTOPSY. 



The autopsy was made 12 hours after death. 



Claw hand existed on both sides, and a rough dissection of the muscular system showed that all the 

 muscles of both hands, fore-arms, and upper arms, including the deltoids, pectorales majores and trapezii, 

 were profoundly atrophied, pale in colour and fibrous ; at the same time, wasted as these muscles were, in 

 none of them was it impossible to detect a few remaining strands of healthy tissue. The intercostal muscles, 

 particularly those of the right side, were also wasted. 



While the spinal, abdominal, hip and leg muscles were all appreciably attenuated, in none was the 

 affection so obvious as in those of the upper extremity, and one was unable to single out any particular 

 muscle on which the atrophy had specially fallen. 



The diaphragm looked normal. 



The encephalon weighed 1370 grammes, but no gross lesion of any kind was discovered, either on the 

 surface or on section, and while the gyri in general were attenuated and the sulci gaped somewhat on that 

 account, no special localised atrophy was noticed. 



The spinal cord was small. 



A great number of peripheral nerves were exposed but none of these showed any alteration, excepting 

 the 6th, 7th, 8th and 9th dorsal of the left side, and the 7th dorsal of the right side, and on the trunks 

 of these, about 4 cm. distal to the posterior root ganglia, were curious oval swellings, from 5 to 15 rum. in 

 length, these swellings were gelatinous in appearance and consistence, and on section did not subside but 

 showed the individual fasciculi of fibres widely dissociated. 



No disease of importance was found in the thoracic and abdominal viscera. 



MICROSCOPIC EXAMINATION. 



Muscles. Portions of the deltoid, pectoralis major, biceps, opponens pollicis, glutens maximus, adductor 

 longus, and tibialis anticus muscles were stained by the method of Marchi for the demonstration of acute 

 degeneration, as well as by ordinary methods. 



The Marchi preparations were very interesting in proving that muscles like the adductor longus and 

 other leg muscles, which did not show pronounced naked-eye changes, were yet extensively affected, although 

 the change was evidently in an early stage. For, in these muscles, any amount of fibres could be seen 

 blurred and swollen, and thickly dotted over with minute black-stained particles, which, on longitudinal section, 

 ran in parallel rows and are typical of acute degeneration. Of course, in addition to these fibres, many 

 others in a condition of extreme atrophy, practically converted into fibro-cellular material, were noticed. 



In the upponens pollicis and some of the arm muscles, the muscular fibre destruction was almost absolute, 

 and even the few fibres which had preserved their shape and volume were in a condition of fatty de- 

 generation. In spite of these very severe changes it was interesting to notice that the muscle spindles, 

 bodies which are supposed to preside over the muscle sense, seemed to be intact. This was particularly 

 noticeable in the sections of the opponens pollicis, wherein at least a dozen of these structures could be 

 counted every time. Of course I am aware that these muscle spindles are more numerous in certain 

 muscles than in others, and that they are particularly frequent in the hand muscles, but I do not think 

 it alters the case concerning their integrity in this condition. 



P,'i-i/il/''i'<il \c/-ces. The most important point gathered from an examination of the ulnar, radial, median, 

 sciatic, popliteal and peroneal nerves was that few or none showed acute degeneration, but practically all 

 gave evidence of atrophy and disappearance of a certain number of fibres, the radial and peroneal being 

 most affected. In the intramuscular fasciculi also, acute degeneration was wanting, but at the same time 

 healthy fibres of any description were hard to find. 



An examination of the bulbous swellings on the dorsal nerves only showed the fasciculi widely separated 

 and the spaces occupied by a few leucocytes. In the original state, apparently, the swelling was due to fluid. 



