550 DR JAMES W. DAWSON ON 



stained by the Bielschowsky method it was possible to recognise where the nerve 

 fibre lost its medullated sheath and continued non-myelinated through the area, and 

 in preparations stained for glia and for cells, the areas were not distinctly marked 

 out from the surrounding tissue. Only occasionally was the impression gained that 

 the large and small spider cells were more abundant in the patches. The changes in 

 the blood-vessels also were not more marked than in the surroundings tissue, and it 

 was found impossible to trace any special relationship between blood-vessels and the 

 areas. From his histological analysis Spielmeyer decided that the changes in the 

 medullated sheath degeneration and the changes in the glia and blood-vessels in the 

 cortex were in no sense proportionate, and in this negative finding he saw an agree- 

 ment with what occurs in the cortical areas in disseminated sclerosis in which all 

 anatomical changes in axis cylinders, cells, and glia fibres are absent. 



In the form, however, of the cortical areas, there appeared in general a distinction 

 between the areas in general paralysis and those in disseminated sclerosis. In the 

 latter disease the areas are usually more extensive, more denned, and spread 

 frequently from the medullary ray into the cortex. In general paralysis, on the 

 other hand, the areas are smaller, indistinctly outlined and often ragged, and rarely 

 spread from white matter to cortex. 



Spielmeyer has also microscopically investigated a case of Nonne's, in which 

 during the last nine months of life there were very marked psychic anomalies. He 

 found numerous sclerotic plaques in the larger ganglia and in the cortex, and traced 

 a complete agreement between clinical data and anatomical findings. 



Siemerling and Raecke (191 1) put forward the suggestive view that underlying 

 disseminated sclerosis there is an inflammatory process, which in its extent keeps to 

 the distribution of the blood-vessels and leads first to the presence of capillary 

 haemorrhages. In all the plaques examined the evidence of the importance of 

 capillary haemorrhages as the first sign of the area was very striking, then followed 

 fibre degeneration, with a subsequent glia proliferation. Such areas, with small 

 haemorrhages, often lay very close together, both in brain and spinal cord, and by 

 their confluence large irregular plaques were formed. The authors investigated seven 

 cases of disseminated sclerosis, and, to ascertain the number and distribution of the 

 areas, made sections through the whole cerebral hemispheres in frontal and sagittal 

 direction. Such large brain sections revealed how varied was the distribution of the 

 sclerotic plaques : in three of the cases only the white matter of the brain was 

 affected, and in two cases, in which psychic affections were marked, the plaques were 

 prevailingly in the cortex. In the cortical areas the wedge-form, with base on the 

 surface of the convolution, was most frequent, and over these areas the pia was 

 thickened and infiltrated with round cells. In all the cortical areas the tangential 

 and supraradial fibres were involved, and in almost all a blood-vessel or blood 

 pigment was the central point of the area. 



FLATAtJ and KoELICHEN (1002-1911) describe a case of disseminated sclerosis 



