542 DR JAMES W. DAWSON ON 



especially in the cervical region, presented very numerous softened and gelatinous 

 foci. These foci presented many of the characteristics of areas of " sclerose en 

 plaques " : the myelin sheaths had disappeared ; the axis cylinders were persistent, 

 though swollen ; the neuroglia was somewhat hyperplastic ; there were numerous 

 fat granule cells in the vessel sheaths, and the vessel walls were infiltrated with 

 numerous small round cells. The vessel alterations were present also in the 

 surrounding normal tissue, and there was a complete absence of secondary 

 degeneration. 



The authors regard these areas as intermediate in position between disseminated 

 myelitis and disseminated sclerosis, and also regard them as a proof of the vascular 

 origin of the sclerotic process. They emphasise the fact that in those cases in which 

 aspergillus infection produced a primary system degeneration, there was no trace of 

 any vascular lesion, a circumstance which proves that alterations of myelin are 

 unable of themselves to produce lesions of an inflammatory character. 



Catola (1905) gives an account of a case in which trembling of the lower limbs 

 developed a few days after the onset of an attack of cholera. Later, the classical 

 symptoms of disseminated sclerosis appeared, and the gait was ataxic-cerebellar and 

 spastic. Histologically there were marked sclerotic areas at various levels in the 

 cord : in the lumbar cord the sclerosis was limited to the pyramidal tracts. In the 

 cerebellum the nucleus dentatus was affected on both sides, but its cells were 

 preserved. One superior cerebellar peduncle was atrophied in its middle portion, 

 but the middle and inferior peduncles stained normally. The vessels both of brain 

 and cord and membranes were thickened and homogeneous both in the sclerotic 

 areas and in the rest of the tissue. The author thinks that the cholera was an 

 etiological factor and that the process was probably of vascular origin. He also 

 notes that although the areas had such an anatomical restriction, the classical 

 symptoms of disseminated sclerosis were nevertheless present. Of special interest 

 is the pronounced sclerosis of the dentate nuclei, in view of the cerebellar ataxia. 



Taylor (1906) states, in evidence of the extraordinary interest which is being 

 taken in disseminated sclerosis, that he has been able to discover eighty papers 

 dealing with this disease in the literature of 1904 and 1905. He has personally 

 examined several hundred specimens from eight cases. He was unable to find any 

 trace of an inflammatory reaction in the areas of sclerosis. The blood-vessels in the 

 various lesions showed no relation to the degenerated areas, nor did the blood-vessel 

 walls show any alteration in the sclerotic areas as contrasted with normal areas. 

 The symmetry, such as it was, appeared to the author to be entirely fortuitous, and 

 both grey and white matter are involved. The peripheral nerves showed no 

 degeneration, but numerous discrete patches were found in one dorsal nerve root 

 with typical myelin degeneration and no other apparent change. " The conviction is 

 strong that the lesions are localised sclerotic areas, characterised by the usual disin- 

 tegration of myelin without either primary or compensatory neuroglial overgrowth." 



