548 DR JAMES W. DAWSON ON 



nated sclerosis of five years' duration, died in hospital from typhoid fever. Plaques 

 of sclerosis in every stage of development were found, from small inflammatory foci 

 to old areas of neuroglial sclerosis. 



In the cord the patches were quite typical : in some the vessels were apparently 

 normal, in others they were surrounded by a proliferation of embryonic cells invading 

 the lymphatic sheath and the vessel wall itself. In the brain, however, the picture 

 was very variable, but in the centre of each plaque a blood-vessel was found, with 

 embryonic cells and fat granule cells in its walls, or showing hyaline degeneration. 

 In the areas, old and new, there was proliferation of the neuroglia with preserva- 

 tion of the axis cylinders. The axis cylinders were more or less hypertrophic or 

 atrophic, but no secondary degeneration was found anywhere. 



The recent areas showed typical inflammatory appearances, and all transitions 

 could be traced to the old patches. The vessel changes are the more pronounced 

 the younger the areas, and the authors consider it highly probable that the plaques 

 owe their origin to an irritative agent brought by means of the blood-vessels. 

 Nowhere was there any evidence of thrombosis or narrowing of the lumen. They 

 exclude the possibility of a terminal infection, pointing out that the characteristic 

 features of the latter are not present. They believe that there is no essential and 

 fundamental difference between disseminated sclerosis and disseminated myelitis : it 

 is a dirference in degree rather than in kind. 



Lhermitte and Guccione (1909), in the histological investigation of three 

 typical cases of disseminated sclerosis, found identical lesions affecting the blood- 

 vessels, the neuroglia, and the axis cylinders. In the wall of the blood-vessels in 

 recent areas there was a marked infiltration of lymphocytes and plasma cells, and 

 in older plaques the vessel wall was thickened and hyaline. In their opinion, the 

 plasma cells in the vessel walls of the early areas develop into connective-tissue cells 

 and give rise to the fibrous thickening of the older areas. The neuroglia was 

 studied by means of their new staining methods for glia cells and fibrils (p. 556). 

 The axis cylinders persisted in very diminished numbers, and there were marked 

 alterations in those persisting. 



In a later paper (1910) the authors review the psychic symptoms occurring in 

 disseminated sclerosis, and relate them to anatomical alterations in the cortex. 



In a further paper (1910) the authors describe specially the peri-ventricular 

 changes found in two cases. In addition to numerous plaques in spinal cord and 

 brain, there was marked neuroglia sclerosis of the peri-ventricular white substance. 

 The ventricles were not dilated and the walls were of their normal smoothness. The 

 sclerosed tissue was dense and poor in nuclei : the fibrils followed the lines of the 

 nerve fibres, surrounding them completely. As a result, the latter were tortuous, 

 rarefied, and moniliform ; some were reduced to irregular spiral threads. The 

 ependymal epithelium was normal, and dilated tortuous vessels, surrounded by small 

 round-cell and plasma-cell infiltration, ramified through the glial tissue. A circular 



