44 Precentral or Motor Area [CHAP. 



reappeared and looked quite healthy both as regards number and intimate structure. These 

 cells corresponded in position with the very lowest cells found in the normal brain. 



Below this level, no pathological alteration was discovered. 



To complete the description, I would say that the general interference with cell-lamination, 

 and likewise the vascular changes previously referred to, were constant accompaniments of 

 the Betz cell destruction. Furthermore, the area of destruction along with its accompani- 

 ments was sharply circumscribed, that is to say, posteriorly, it did not overstep the floor 

 of the fissure of Rolando, and, anteriorly, it did not extend more than 2 or 3 mm. beyond 

 the normal giant cell limit. 



CASE No. 2. 



CLINICAL HISTORY. 



(From notes kindly supplied by Doctor Guy Wood.) 



E. B., a male, aet, 27. Admitted to Rainhill Asylum September 16th, 1897, died June 2nd, 1898. 



From information given by his mother, it was ascertained that the patient was of temperate habits, 

 and up to 18 months previous to admission had industriously followed the occupation of a worker in a 

 chemical factory. At that time he began to complain of pains and weakness in the legs, as these continued he 

 was obliged to give up work, and six months later he became bedridden. No definite cause could be assigned 

 for the illness. While in bed, signs of mental disease developed, he became childish in his behaviour and 

 at times was so unmanageable, owing to attacks of excitement, that it was deemed advisable to have him 

 removed to this asylum. 



On admission, he was found to be very poorly nourished, weighing only 7 stone 3 Ibs. On account of 

 rigidity and apparent leg weakness, he was unable to walk without support. The lower extremities were 

 thin, but no muscle group seemed specially wasted. The knee jerks were brisk and ankle clonus readily 

 obtainable. 



Inspection of the hands showed obvious flattening of the thenar eminence and wasting of the interossei 

 muscles, also the fore-arms were thin, and the hand grip weak. The wrist and elbow reflexes could be 

 elicited without any difficulty. The upper arm and shoulder muscles were normal in appearance. The neck 

 muscles were healthy, and he could raise and lower himself in bed without trouble. 



There was no facial, ocular or lingual paralysis. Speech also was unimpaired. Sight, smell, hearing 

 and taste were acute, and he was normally sensitive to touch, pain, heat and cold. 



Mentally he seemed childish and made incoherent replies to questions, and he alternately laughed and cried 

 for no obvious reason. 



Three months later, the condition had become aggravated, the hands were fixed in the claw position; 

 the shoulder muscles, particularly the deltoid and pectoralis major, were attacked, and the legs were more 

 wasted but less rigid. Mentally he was dull and listless, and he exercised no control over his bladder 

 and rectum. He went from bad to worse and eventually lay in bed almost completely paralysed. Nine 

 months after admission, and two years and three months after the commencement of the illness, an attack 

 of pneumonia hastened his death. 



AUTOPSY. 



The autopsy was made 15 hours after death, but permission could only be obtained to examine the 

 central nervous system. The marked general emaciation was not associated with any trophic lesions. 



