THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 559 



a standard of comparison, and it is proposed to begin this part of the paper by 

 giving a short account of the clinical history of this patient. In the Appendix will 

 be found the available clinical notes and post-mortem reports in the other cases, as 

 well as an account of the general histological features and topographical distribution 

 of the areas of sclerosis in Weigert-Pal sections. 



Clinical History. 



L. W., aged twenty-eight, a kitchenmaid by occupation, was admitted to the 

 late Dr Alexander Bruce's wards on 4th April 1910, complaining of weakness in 

 both legs, inability to walk, and tremors in both arms and legs, the duration of 

 these symptoms being about two years. 



History of Present Illness. — At the end of March 1908, the patient, who was 

 then employed at one of the baths in Edinburgh, was reaching up to clean the wall 

 with a long brush, when she stepped too far back and fell into the deep end of the 

 bath. She was pulled out immediately, but was, of course, wet through to the skin. 

 This gave her a great fright, and she screamed for about ten minutes. When she 

 had quietened down, she had a hot bath, put on dry clothes and went home. She 

 said also that a menstrual period came on about two hours before she fell into the 

 water ; after this it completely stopped and did not return until a fortnight later. 

 The above accident took place in the forenoon, and by the afternoon she felt so much 

 better that she returned to her work. 



She continued at her work until the end of June, when one morning she found 

 that both her legs had become swollen and tender, that she had shooting pains 

 down her right leg, and that she had great trouble in rising out of bed. She sent 

 for her doctor, who thought the symptoms were due to muscular rheumatism, and 

 treated her accordingly. She was slightly feverish at this time and remained in bed 

 for a week, and at the end of a fortnight returned to work. She noticed, however, 

 that she did not seem to be able to walk so quickly as previously, that she was 

 slightly lame, and that her right knee was stiff. 



She worked steadily at the baths until March 1909, when she began to find her 

 work too heavy, and she, accordingly, took an easier situation as kitchenmaid at a 

 golf club-house. She succeeded so well at this that after a month she became 

 waitress. After four months this post became too heavy for her, and she returned 

 to her old post of kitchenmaid, but two months later had to give this up also, and 

 has done no work since 12th November. Two months before admission her symptoms 

 had become more marked. Both legs became very stiff, and she could only walk 

 with the help of a stick. Her arms became shaky, and one of the reasons why she 

 left the club-house was that if anyone gave her a sudden start her arms became 

 very shaky, and once or twice she dropped a tray full of dishes. Although usually 

 constipated, she was subject to sudden precipitate action of the bowels as well as 

 to incontinence. Her friends had noticed that she had been getting very slow in her 



