688 DR JAMES W. DAWSON ON 



APPENDIX. 



It has already been stated that the foregoing histological study is based on the observations 

 made in nine cases of disseminated sclerosis, and that, as it had been possible to follow one of 

 these cases, clinically and anatomically, that case has been taken, more or less, as the basis 

 on which the study was built up. The other cases, however, were almost as minutely 

 studied, and were freely drawn upon in the descriptions already given. It has, therefore, 

 seemed desirable to give an account of each under the following headings : — 



1. The available clinical notes. 



2. The post-mortem report. 



3. Brief summary of the general characters of the areas. 



4. A more or less detailed description of the topographical distribution of the areas in 

 Weigert sections. In reference to these descriptions it is necessary to note that in some, 

 individual sections were taken, while at other levels such descriptions are given from several 

 successive sections of a series, so that the latter do not completely correspond to individual 

 illustrations. 



Case II. 



Clinical Notes. 



C. S. — This patient was admitted to the late Dr Alexander Brtjce's wards in the Royal 

 Infirmary, Edinburgh, on the 13th of July 1906. At this time she was twenty-two years 

 of age, and complained of weakness in the legs and arms, and difficulty of speaking, of 

 about five years' duration. She had had measles and typhoid fever as a child, and scarlet 

 fever at the age of ten. She had also had two attacks of influenza — the first about six 

 months before the present illness began, and the second about eighteen months previous 

 to admission. She was a total abstainer, and had one child, one year old. Her father 

 and mother were both aged fifty-two, and were alive and healthy. Four brothers and 

 three sisters are all alive and well. One brother died in infancy. 



The present illness began when she was a kitchenmaid five years ago. She noticed 

 then that frequently, especially when she was laughing, her legs gave way under her and 

 she fell to the ground. She also noticed that she let dishes fall and had curious fits of drowsi- 

 ness, especially about midday. This continued for over two years without compelling her 

 to leave work. After this she suddenly got quite well and was married. About six months 

 previous to admission she began to be troubled with giddiness and developed a staggering 

 gait. This grew steadily worse, until she had to remain in bed. The eyesight became poor, 

 and diplopia was present for about eight weeks previous to admission. She noticed that 

 her speech had become more deliberate, and that there was some trouble with the sphincters. 



Condition on Admission. — She could neither walk nor stand, and cannot sit up in bed 

 without help. There is no weakness of the hands or arms, but on making any movement 

 her head always begins to nod. Co-ordination of the upper limbs is slightly interfered with. 

 Sensation is impaired in the legs. The speech is staccato, and coarse nystagmus is seen 

 in looking to the right, left, and upwards. A curious vertical movement of the upper eyelid 

 was also noticed. The knee-jerks were much exaggerated, both plantar reflexes were ex- 

 tensor, and patellar and ankle clonus was well marked. The other organs showed nothing 

 of note, except some involvement of the left apex of the lung. 



The nodding of the head became worse and the speech more slurring. From being 

 happy and contented, she became depressed. She remained for over a year in Dr Brucb's 

 ward, the condition steadily progressing. She became quite unable to feed herself, and 

 slept during a great part of the day. Incontinence of urine developed, and she was re- 



