in] The Cortex in Amyotrophic Lateral Sclerosis 43 



Condition of the Nerve Fibres. 



The nerve Hl>ivs were not examined in serial sections, but some of the blocks which showed 

 the cell alterations to perfection were treated with a chrome salt and stained by the method 

 of Wolters-Kalschitzky. 



The most manifest change was a general lowering of the fibre wealth. The zonal layer, 

 which stands out so distinctly in the normal condition, was only a shadow of what it should 

 have been (atrophy of the zonal layer in this disease has been previously remarked upon 

 by Mott). The supraradiary field was not much changed. The line of Baillarger was given 

 a prominence it does not normally possess, due to the reduction in fibre wealth affecting 

 subjacent parts. In the radiary zone, the fasciculi of Meynert had not only lost an appreciable 

 number of their large fibre constituents, but exhibited a wavy, collapsed appearance. A numerical 

 deficiency in interradiary large " association " fibres was pronounced, but at the same time 

 many healthy elements remained. 



The above changes are interesting concomitants of the nerve cell alterations, and remind 

 me of what I have seen in the cortex of the same area in cases of old-standing capsular 

 lesion, with hemiplegia. 



Distribution of the Affection. 



Taking advantage of my knowledge of the distribution of the giant cells in the 

 healthy brain, I next instituted a comparison between the normal cell grouping and what 

 I discovered in this case. 



Beginning with the small portion of the area found on the mesial surface of tin- 

 hemisphere, that is, the subdivision containing an extensive group of the largest variety of 

 Betz cells, the important fact was discovered that in the case under consideration quite 

 85 / of the cells had been completely swept away, and of the small remainder very few 

 indeed could be described as healthy. It must also be mentioned that the destructive 

 process was equally distributed over the field, and it might here be added that in those 

 sections lying behind the upper limit of the Rolanclic fissure, the large cells which I believe 

 to have no connection with the motor area were present in normal numbers and were 

 perfectly healthy. 



Passing on to the two very large and important groups of cells occupying the upper 

 extremity of the precentral gyrus on the convexity of the hemisphere we found changes 

 entirely on a line with those seen on the mesial surface, and my only noteworthy remark 

 is that while a few cells persisted in the Rolandic wall, the cell destruction on the exposed 

 surface of the gyms was practically complete, section after section showing absolutely no giant 

 cells in this situation, and yet we know that, in the normal brain, hundreds of cells are 

 contained in the same part. 



At the level of the annectant buttress, and immediately above and below it, a like 

 condition held. 



From here down to the lower genu, over a stretch of cortex about 4 cm. in length, 

 block after block was carefully examined and not a single Betz cell found in any of the 

 sections. But a short distance below the inferior genu, at a point about 10 mm. above the 

 lower extremity of Rolando, one suddenly came upon about 4 mm. of cortex where Betz cells 



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