THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 695 



especially in the frontal region ; diplce practically absent. Dura somewhat thickened 

 but not unduly adherent. Pia arachnoid shows slight, patchy thickenings and is cedematous. 

 Convolutions somewhat flattened over both temporal regions, especially the left. Slight 

 thickening of the arachnoid at base. Vessels at base not altered. 



Spinal Cord. — Thickening of dura in the cervical region. In the cervical, upper dorsal, 

 mid-dorsal, and lumbo-sacral regions there are slightly depressed, firm, silver-grey areas 

 varying from 2 cm. to 1 mm. in length. On section these have a grey gelatinous appear- 

 ance, and extend from 1 mm. in diameter to the whole thickness of the cord. The cord 

 has elsewhere a shrivelled appearance and is firm. 



Lungs. — Slight emphysema of upper lobes and margins. On section there is congestion 

 throughout. 



The liver shows engorgement of larger vessels and cloudy swelling. 



The kidneys are both enlarged : both ureters are dilated and slightly tortuous : on 

 section there are found numerous small abscesses along the lines of the vessels in the cortex 

 and in the pyramids ; and the vessels and pelvis are much congested. 



General Histological Characters. 



There were no outstanding features in this case such as were noted in Case II, with the 

 possible exception of the extensive diffuse and faint staining referred to as occurring fre- 

 quently over the whole transverse section of the cord. This affected chiefly the lower dorsal' 

 and the lumbar segments. In marked contrast also to the widespread sclerosis of the cord 

 in the previous case were the numerous isolated areas found, especially in the dorsal cord 

 (fig. 109). Several of these were followed in serial section, and some were found to extend 

 over not more than from twenty to thirty celloidin sections. Such areas were found most 

 frequently around the dorsal portion of the posterior median fissure and in the lateral columns. 

 The sclerosis of the cervical enlargement of the cord was, however, very marked, especially 

 at C6 (fig. 105). Marchi sections proved the existence of very numerous areas in all stages 

 of fat granule cell formation : some of these areas were very minute, corresponding to those 

 cut in serial section ; others extended over the whole antero -lateral column and the adjoin- 

 ing grey matter. Glia sections showed that the sclerosis was again more advanced in the 

 central portions of the posterior and lateral columns. Bielschowsky preparations gave 

 very unsatisfactory pictures in this case, but faintly-staining, swollen axis cylinders could 

 be recognised in large numbers in most of the areas and in one or two of the minute areas 

 in almost normal numbers. The ganglion cells showed changes which could be related to 

 a slow sclerotic process and also to the toxaemia from which the patient suffered : at many 

 levels the ganglion cells were deficient in number, having undergone a slow atrophy and 

 disappearance, and other cells were found with marked condensation of the whole cell 

 structure and deep staining. 



The very numerous central areas showed beautifully the three types of areas met with 

 in Marchi preparations : (1) that giving a negative picture, in which the process had become 

 stationary ; (2) that in which a peripheral zone gave evidence of an advancing process or 

 one not yet exhausted (fig. 311) ; and (3) that in which the fat granule cell formation was at 

 its height (fig. 301). All transitions between these types could be found, and sometimes 

 an old area was found in which fusion with a more recent area had occurred along one margin. 

 The glia stains likewise showed areas in all stages corresponding to the above, but also gave 

 examples of the different degrees of sclerosis which an area may reach after the active process 

 has apparently come to a standstill (figs. 367-369). The degree of peri-ventricular sclerosis 

 is sufficiently indicated in figs. 93-96 : it was found that this sclerosis, to a large extent, 

 showed a peripheral extending zone of fat granule cells. The cortical ganglion cells, not 

 only within the areas but in the adjoining stretches of the convolutions, again were sur- 



