558 



DR JAMES W. DAWSON ON 



have been relied upon in the histological analysis of the changes in the several 

 tissue constituents. For the myelin sheath Marchi and Weigert's methods have 

 been employed, supplemented by the iron-hsematoxylin method ; for the axis 

 cylinders Cajal's and Bielschowsky's methods ; for the neuroglia Heidenhain's iron- 

 hsematoxylin supplemented by Van Gieson's stain ; and for the cellular constituents 

 Unna's polychrome methylene blue and the diffuse stains. For use with frozen 

 sections iron-hsematoxylin for the myelin sheath, Bielschowsky's method for axis 

 cylinders, Lhermitte and Guccione's stains, and Ford-Eobertson's methyl-violet for 

 the glia cells and fibrils, Van Gieson and hsematoxylin and eosin for the cell elements, 

 and Scharlach E. for fat granular cells. 



[V. 



HISTOLOGICAL STUDY. 



PAGE 



(1) Introduction : Clinical History of Case I. . 558 



(2) Structure of Different Types of Areas : 



1. An Actual Sclerotic Area : 



(a) Spinal Cord — 



(i) Nerve Fibres cut longitudinally 563 

 (ii) „ „ „ transversely . 565 



(6) Brain — 



(i) „ ,, ,, longitudinally 566 



(ii) ,, „ „ in various 



directions .... 567 



2. An "Early" Area: 



(a) Spinal Cord — 



(i) Nerve Fibres cut transversely . 568 

 (ii) „ „ „ longitudinally 571 



(6) Brain — 



(i) ,, „ „ longitudinally 572 



(ii) „ „ „ in various 



directions .... 573 



3. Evolution of an Actual Sclerotic Area : 



A. Through Stages of increasing Glia 



Hyperplasia 575 



B. Through a Stage of Fat Granule Cell 



Formation : 



(a) Spinal Cord — 



(i) Nerve Fibres cut transversely . 577 

 (ii) ,, „ „ longitudinally 584 



(b) Brain — 



(i) „ „ „ in various 



directions . . . 586 



(ii) Nerve Fibres cut longitudinally 588 



4. Other Types of Areas : 



(a) Areolar Areas .... 



(b) Peri-vascular Sieve-like Areas 



(c) "Markschattenherde" . 



(3) Characteristics in Special Situations ; 



White Matter 

 Grey Matter : 



(a) Central ...... 



(6) Cortical 



Peri-ventricular Sclerosis .... 



Optic Nerve : Cranial and Spinal Nerve 



Boots, etc. ...... 



(4) Changes in the Individual Tissue Elements : 



1. Nerve Fibres — 



(a) Medullated Sheath .... 



(b) Axis Cylinder 



2. Nerve Cells 



3. Neuroglia 



4. Blood - vessels and Lymphatics : Cell 



Elements in the Adventitia 



(5) Other Histological Features : 



1. Form, Symmetry, and Distribution . 



2. Secondary Degeneration .... 



(6) Conclusion : 



1. General Features of the Areas in Case I . 



2. Their Topographical Distribution . 



3. Note on the Pathological Physiology 



589 

 590 

 591 



592 



592 



594 

 598 



601 



604 

 605 

 607 

 609 



612 



618 

 624 



625 

 626 

 633 



(l) Introduction. 



It has already been briefly mentioned that this study is based upon the observa- 

 tions made in the histological investigation of nine cases of disseminated sclerosis. 

 The brain and spinal cord from most of these cases were equally thoroughly 

 examined, but in only one instance was there the possibility of following the case 

 clinically and anatomically. That case, therefore, has been taken, more or less, as 



