iv] Postcaktral or Sensory Area 89 



CASE No. 2. 

 CLINICAL HISTORY. 



M. A., aged 35. Admitted to Rainhill Asylum, October 25th, 1895, died December llth, 1897. 



The following particulars were supplied by his brother. There was nothing in the family history which 

 bad any bearing on this, his first attack of insanity. He entered the Navy at the age of 18, and after 

 serving for a period of eleven years received his discharge as an invalid. At that time six years before 

 admission to Hainhill difficulty in walking appeared, and gradually increased. He had frequently complained 

 of attacks of sudden shooting pain in the legs, especially on sitting down. There was no history of injury 

 to account for the disease, but infection with syphilis was admitted by the patient, who also stated that he 

 had lost all sexual power. 



STATE ON ADMISSION. 



There was definite brachial ataxy, so marked that he was quite unable to touch his nose with his finger 

 tips when the eyes were closed, his gait was also decidedly ataxic and he swayed and was in danger of falling 

 when placed in the erect posture with shut eyes. The knee jei-ks were entirely abolished, but many of the 

 superficial reflexes could be elicited. The right pupil was larger than the left, each reacted slightly to accom- 

 modation, and the light reflex was abolished. The tongue was protruded straight and was free from tremor. 

 Mentally, no obvious delusions or hallucinations were discovered, his answers to questions were coherent and 

 he was quiet and orderly in his behaviour. 



PROGRESS. 



For two or three months after admission his condition remained more or less stationary. At the end 

 of this period he began to develop signs of general paralysis, and six months later he was described as 

 undoubtedly suffering from that disease, but it is interesting to mention that there was an entire absence 

 of grandiose delusions. It is unnecessary to add more details concerning the case ; the physical signs of 

 general paralysis associated with those of Tabes gradually advanced, and he died 8 years after the onset 

 of the first indications of the latter disease and 17 months after the physical and mental signs of general 

 paralysis declared themselves, and throughout there was not the slightest doubt concerning the correctness 

 of the diagnosis. 



EXAMINATION OF THE SPINAL CORD. 



Even to the naked eye the signs of Tabes were evident, the cord was small and flattened from before 

 backwards owing to contraction of the posterior columns, the pia-arachnoid membrane on the dorsal aspect 

 was thickened, opaque, and adherent in places to the dura, and all the posterior roots presented a more or 

 less withered appearance. 



A series of microscopic sections made at the level of each spinal segment clearly demonstrated the 

 severity and extensive nature of the posterior root and column affection. Without entering into details, it 

 may be said that in specimens stained by a modification of the method of Weigert-Pal applied to formol 

 hardened tissues, which I formerly adopted, the posterior columns exhibited pronounced sclerosis and shrinkage 

 throughout the whole length of the cord ; in the lower cervical and upper dorsal and in the lower lumbar 

 and sacral regions, where the stress of this affection usually falls heaviest, the destruction of posterior root 

 fibres was virtually total and absolute, and even in the remaining upper cervical and upper lumbar regions the 

 affection had not descended lightly. From the negative point of view the only fibres remaining healthy in 

 the posterior columns were a few pertaining to posterior roots in the upper cervical and upper lumbar 

 regions, along with certain small endogenous, descending and internuncial systems which seem to escape even 

 in the most advanced cases of this disease'. 



In the nuclei of Goll and Burdach there was an obvious thinning of the myelinic plexus ; but specimens 

 of the medulla showed no obvious change in the internal arciform fibres and fillet. 



c. 12 



