THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 561 



to protrude to the left side, and slight difficulty in speech was observed, which was 

 followed two days later by difficulty in swallowing. Dr J. S. Fraser, who at this 

 time examined the ears, reported that both vestibular apparatuses were functional, 

 although possibly the activity of the right was slightly diminished. By the 8th of 

 August the weakness in the legs had become very marked and they were painful on 

 attempting any movement. Spasticity in the legs soon developed. On 14th August 

 severe vomiting set in, which was scarcely affected by any treatment. On the 

 evening of 15th August she complained of dimness in seeing, and next morning was 

 found to be blind in both eyes. On examination the discs showed some pallor but no 

 neuritis. Muscular wasting now developed and proceeded rapidly, especially in the 

 legs. The face became more hollow and sunken, diarrhoea and vomiting set in, and 

 a catheter had to be passed every eight hours. From now onwards she went rapidly 

 downhill, sometimes slightly better and sometimes slightly worse. She had an 

 extremely septicsemic look, and died suddenly and unexpectedly on the morning of 

 the 5th of September, after having passed a better night and had a little breakfast. 



Post-mortem Report. 



Body is small, well developed, and fairly well nourished. Rigor passing off in upper 

 limbs and in lower limbs. Slight amount of oedema of lower limbs. Pupils are 

 slightly contracted and equal. 



Sei'ous Sacs. — No adhesions and no fluid in pleural cavities. No excess of fluid 

 in pericardium. 



Heart. — 230 grams. Rather small. Shows a few small milk spots on anterior 

 aspect of ventricles. Tricuspid valve at CO., 12 cm. Appears healthy. Pulmonary 

 valve competent. C.C., 9 cm. No pathological change. No dilatation of either 

 ventricle. No subepicardial fat. No thrombi in cavities. No post-mortem clot. 

 Mitral valve C.C., 11 cm. Healthy in appearance. Heart muscle rather pale but 

 firm. Coronaries healthy. Aorta and aortic valves also healthy. Aortic orifice 

 C.C., 8 cm. 



Lungs. — Lungs are voluminous and pale. General atrophic emphysema, especially 

 along anterior border. Adhesions between upper and lower lobe in left lung. 

 Collapse in lower lobe. On section the lung shows oedema in both upper and 

 lower lobes. Bronchi contain a good deal of frothy mucus. No special change in 

 their walls. Right lung : adhesions between upper and middle lobes. There is a 

 stony, hard nodule in lower part of upper lobe. On section the lung is oedematous 

 and has slight congestion of lower lobe. Left lung, 290 grams. Right lung, 

 400 grams. 



Liver. — 1470 grams. Normal in size. Gall-bladder is very small and contains 

 a small quantity of brownish-red bile. No evidence of gall stones. On section 

 liver substance is pale in colour, rather friable and soft. There is some diffuse 

 fatty change, slight in extent. 



