694 DR JAMES W. DAWSON ON 



(3) Section above the level of the lateral ventricles (fig. 74). A section through the 

 cerebral hemispheres at this level shows over twenty isolated areas in varying stages of 

 development. These are distributed through the grey and white matter, and more than 

 half of them lie in the frontal lobe and are of very varying shape and size. They are described 

 more fully in the histological study under " cortical and subcortical areas," as most of them 

 involve the medullary rays and adjoining grey matter : a few are limited to the cortex. 



(4) Sections of both hemispheres above this level (fig. 75) show an only slightly less 

 involvement. Their distribution corresponds closely to that just described, but more 

 are limited entirely to the white matter, and one or two are limited to the cortex. Sections 

 still higher show that numerous areas are present up to the extreme vertex of the hemispheres, 

 and that they are slightly more numerous at the frontal end. 



Case III. 



Clinical Notes. 



Mrs G., aged thirty. — Patient was admitted to Professor Greenfield's ward, Royal In- 

 firmary, Edinburgh, on the 13th September 1911, suffering from weakness of both legs and 

 the right arm. Three years previously she had a miscarriage at the seventh month, and 

 three months later began gradually to lose the power of the right arm and leg. This increased, 

 until in three or four months she could use only the left leg and walk by holding on to things. 

 Since that time she has become gradually more helpless and her general health feebler. On 

 12th September 1911 she had a shivering fit during the night, and on trying to get up her 

 legs became rigid, and she fell back on the floor : she has little recollection of anything 

 that has passed till her admission to the Infirmary on the day following. 



Previous Health, etc. — Patient had inflammation of the bladder nine years ago. She 

 has had four children, two of whom are alive and well. Her family history is negative. Her 

 home surroundings are poor. 



Condition on Admission. — Patient looked very ill and was half dazed. There is no oedema 

 of the legs. Nervous system : the pupils react equally to light and accommodation, and 

 the ocular movements are normal. The arms can be moved very slightly, and the grip on 

 both sides is very feeble : there is a tendency to drop-wrist on both sides. Flexion and 

 extension are very feeble. Very slight tendon jerks can be elicited in both arms. The 

 legs can hardly be moved : the right leg cannot be drawn up at all, and the left only to a 

 slight extent, and with great difficulty. Both feet can be flexed to a slight extent. The 

 patellar reflex and the knee-jerks are absent on both sides. There is no ankle clonus, appar- 

 ently from the tendency to a spastic extended condition. The abdominal reflexes are absent. 

 There is no paralysis of the face. The urine had to be drawn off. There is no anaesthesia 

 anywhere, as far as can be made out in the patient's half-dazed condition. There is not 

 much of note in the other systems. Staphylococci and bacillus coli are present in the vaginal 

 discharge. On ophthalmoscopic examination on 16th September the discs appeared normal. 



Progress. — The symptoms varied much : at times the knee-jerks were exaggerated and 

 at times were absent. The plantar reflex was extensor ; ankle clonus was present on 

 the right and occasionally on the left side. Sensation was affected. Pus was present in 

 the urine since admission, with swinging temperature and symptoms of pyelitis. Death 

 occurred on the 24th November from toxaemia and exhaustion. 



Post-mortem Report. 



The body is that of a young, slightly built female. Rigor mortis general. No adhesions 

 or excess of fluid in pleura, pericardium, or peritoneum. 



Brain. — Skull-cap heavy and dense ; somewhat nodular appearance on the inner table. 



