iv] Poxtcciitnd or Sensor}/ Area 95 



The patient was a female, aged 2(1, hemiplegic from childhood. 



The left arm was absolutely paralysed, shortened by one and a half inches, contractured and held across 

 the chest in the flexed position, and the muscles from the shoulder downwards were all profoundly atrophied. 

 The triceps and wrist jerks could not be elicited. Sensation, save the faint and delayed recognition of 

 pain, on the inner side of the arm only, was abolished. 



The left leg was shortened by one inch and the foot fixed in the equino-varus position. Muscle weakness 

 and wasting were pronounced but the paralysis was not complete, and she could walk a short distance without 

 assistance. A knee jerk was obtainable but only just perceptible ; there was no ankle clonus nor phenomenon 

 of llabinski. Tactile sensibility and the muscle sense were in abeyance, but sensations of pain and heat were 

 appreciated, though imperfectly localised. 



The extremities of the right side were normal in every respect. 



At the autopsy a disparity in cerebral weight of 45 grammes, the existence of contra-lateral atrophy of 

 the cerebellum and wasting of the right pyramidal tract and medial lemniscus in the crus, pons, and medulla 

 led one to suspect that the cause of the whole mischief was a central lesion in the right cerebral hemisphere, 

 and on making sections of the brain after fixation in formol this suspicion was found to be correct. The 

 lesion on horizontal section appeared as a slit, about li inches long, between the optic thalanms and claustrum ; 

 it was evidently the remains of an old-standing softening due to embolism. (In the heart signs of preexisting 

 mitral endocarditis were seen.) 



The parts destroyed included the whole internal capsule, the outer half of the optic thalamus and all 

 three segments of the lenticular nucleus. 



Paying further attention to the surface of the brain, after the discovery of this lesion, one noticed a 

 distinct amount of atrophy localised in the Rolandic area, and this was especially noticeable in naked eye 

 transverse sections of the two central gyri. 



Microscopic examination of the crus, pons, and medulla showed among other changes complete sclerosis 

 of the right pyramidal tract, and very obvious atrophy without sclerosis of the medial lemniscus. 



MICROSCOPIC EXAMINATION OF THE CORTEX. 



Sections of the two central convolutions were made at intervals of 1 cm. and stained by the method 

 of Nissl and Wolters-Kulschitzky. The changes in the precentral gyrus I need not describe at length, they 

 consisted essentially of destruction and disappearance of the cells of Betz throughout their area of allocation 

 and a corresponding diminution in the associated fibre wealth. 



In the postcentral gyrus, in which we are particularly interested, important and striking cortical changes 

 were discovered, neatly distributed all along the Rolandic side of the gyrus, not confined to any layer in 

 particular, they consisted for the most part of cell destruction. The general cell lamination was greatly 

 disturbed, and even the position of the stellate lamina was not easy to define, at the same time the 

 cortex altogether was greatly reduced in depth. It seemed that the lower two-thirds of the gyrus had suffered 

 more than the upper third, for in the first position hardly a single cell of normal size and configuration 

 could be made out in any of the laminae, and the elements that remained, numerous though they were, 

 refused to stain deeply, exhibited no internal chromophilic particles, were mostly of rounded or oval form, 

 small in size, and their normal columnar arrangement was entirely lost. In the upper third of the gyrus 

 and on the mesial surface of the hemisphere, behind the fissure of Rolando, the changes in 'regard to columnar 

 disturbance were similar, but here a considerable number of healthy cells was dotted about. 



I wish to emphasize the fact that the affection fell chiefly on the Rolandic side of the gyrus, for as 

 one passed to the crown the cortex began to assume a healthier appearance, and this was maintained on. 

 the parietal side. 



CHANGES IN THE CORTICAL NERVE FIBRES. 



One would have expected, with such a complete destruction of the sensory tract in the capsular region, 

 to have found very distinct changes in the cortical fibres. This, however, was not the case; moreover, the 



