THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 689 



moved to the Longmore Hospital, where she remained four and a half years, death being 

 preceded by a curious state of coma which lasted for about a fortnight. 



Post-mortem Report. 



Post-mortem rigidity present. Marked contracture of the right leg at the hip, the 

 thigh being flexed and drawn across the left thigh. 



Brain. — The dura mater was adherent both to the brain and to the skull. The brain 

 itself felt soft and oedematous. On cutting through the pons, numerous grey gelatinous 

 patches were seen, especially developed round the aqueduct of Sylvius. 



Spinal Cord. — The dura and pia showed no large adhesions. The surface presented 

 an almost uniform flaky appearance. On section very advanced sclerotic areas were found 

 at all levels, in some occupying the whole of the section. At other levels small patches 

 occurred on the surface of the cord. 



Heart. — Small ; considerable epicardial fat. Chambers normal in size, the valves healthy, 

 as were also the muscle fibres. 



Lung. — Left upper lobe was somewhat congested. The lower lobe, with the exception 

 of the extreme base, is completely solidified, at a stage of grey hepatisation. The right lobes 

 were congested and oedematous, but there was no consolidation. 



Liver. — Small ; vessels prominent, and marked cloudy swelling. 



Spleen. — Large, soft and almost diffluent on section. 



Kidneys.— Marked cloudy swelling. Capsule strips freely. 



Skull-cap. — Thick and solid, with some little nodular new bone formation on the inner 

 surface of the frontal bone. 



General Characters of the Areas. 



The extent of the affection, both of the brain and cord, was greater than in that of any 

 of the other cases that came under our observation. The histological changes also, in the 

 affected tissue, presented features which distinguished this case as compared with the 

 others. Not only were those, characteristic of the diseased process in disseminated scler- 

 osis, more marked in degree, but there were also present the maximum of the changes which 

 have been related to the chronicity of the process and to complications. We have, therefore, 

 (1) an extensive demyelination ; (2) a more advanced degree of sclerosis; (3) a more 

 constant persistence of the axis cylinders ; (4) changes in the ganglion cells associated 

 with a chronic process ; and (5) thickening of the cerebral and spinal meninges and a 

 nuclear infiltration of the walls of their blood-vessels and of the peripheral vessels of the 

 nervous tissues. 



The spinal cord, from its highest to its lowest level, showed an almost complete demyelina- 

 tion (figs. 83-88) : at a few levels isolated groups or bands of peripheral fibres were left, 

 which, on closer examination, were found to be related to the marginal tissue through which 

 the anterior and posterior roots passed, and to these nerve roots themselves. Frontal 

 longitudinal sections through the base of the anterior fissure showed on either side the de- 

 myelinated anterior pyramidal tracts, grey matter of anterior horns, and a myelinated 

 peripheral zone, with obliquely-coursing nerve roots (fig. 90) : in Marchi sections those 

 remaining fibres were found to be in an early stage of degeneration. Glia-stained sections 

 showed that an advanced, but not complete, degree of sclerosis was present, and that 

 this was most marked in the more central parts of the posterior and lateral columns. In 

 this sclerosis many still large nuclei were left — nuclei forming the nodal points of radiating 

 fibrils — showing that the tissue had not yet reached its more complete degree of sclerosis. 

 Even in the lateral columns there was no evidence of the sclerosis having developed 

 through stages of an increasing glia hyperplasia. Axis cylinder stains, both Cajal's and 



