THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 547 



ganglion cells in the lumbar segments — an alteration en rapport with the muscular 

 atrophy presented by the patient. 



Schlesinger (1909) relates the case of a boy in whom the diagnosis of a typical 

 multiple sclerosis, with subacute course, was made. The patient developed eye 

 symptoms two weeks after an attack of measles and died ten months after the onset 

 of the disease. Microscopical examination revealed the presence of a very large 

 number of larger and smaller sclerosed areas in the brain and spinal cord. 



The author was able to distinguish three types of areas : (l) in a few the nerve 

 substance had in great part perished and only a few naked axis cylinders were left. 

 The glia was markedly proliferated, and in the areas, especially in the walls of the 

 vessels, were numerous fat granule cells. (2) Areas of an older date, typical of the 

 classical picture of disseminated sclerosis, with absence of myelin sheath, marked 

 glia proliferation, and persistence of axis cylinders, but no fat granule cells. (3) 

 Areas described as Markschattenherde, in which the fibre layers are distinctly 

 evident but weakly stained. The fibres have not only a lesser staining capacity, 

 but are frequently abnormal in appearance, being either swollen or atrophied. 

 These areas are also circumscribed, and on each side the fibre layers resume their 

 normal staining and character. These areas were found distributed through the 

 whole central nervous system, but especially in pons and medulla, where they occupy 

 a large part of the transverse section. They were looked upon as transition stages 

 to the development of patches of true disseminated sclerosis. The presence of areas 

 of the second and third types justified the anatomical diagnosis of subacute multiple 

 sclerosis, but the author regarded the areas of the first type as transitional to 

 disseminated encephalo-myelitis. 



Schlesinger also notes the finding of nephrolithiasis at the autopsy, and states 

 that he has found this chiefly in relation to traumatic diseases of the spinal cord, 

 and also in three cases of syringomyelia, and in three cases of encephalo-myelitis. 



Marinesco and Minea (1909) have examined specially the changes in the axis 

 cylinders in the sclerosed areas. They look upon the persistence of the axis cylinders 

 neither as pathognomonic of, nor essential to, the picture of disseminated sclerosis. 

 The persistence does not last indefinitely, and, therefore, there must be some 

 secondary degeneration, but this affects not a tract nor even a bundle of fibres, but 

 only a few groups of fibres. They regard regeneration as a necessary complement 

 of degeneration, and by means of Cajal's and Bielschowsky's methods, they have 

 found distinct evidence of terminal and collateral regeneration. The former is 

 observed at the extremity of rather thick axons, but it is the collateral form which 

 is more manifest in disseminated sclerosis. The thinness and the number of these 

 new axis cylinders distinguish them from pre-existing collaterals of the axon. 



Lejonne and Lhermitte (1909) have examined clinically and anatomically 

 three cases of disseminated sclerosis and give the histological analysis of one case. 

 A young woman, twenty years of age, with the characteristic symptoms of dissemi- 



