THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 699 



Post-mortem Report, 19th January 1911. 



Spinal Cord. — The cord as a whole is small, especially in the dorsal region. There are 

 one or two calcified plates in the arachnoid. On the surface of the cord a number of irregular, 

 bluish, gelatinous spots could be seen. A particularly large one could be seen in the upper 

 lumbar region. This was removed for experimental purposes. 



On section of the cord there were seen exceedingly well- developed patches of dis- 

 seminated sclerosis. On the surface of the pons one distinct patch was found, but the 

 brain was not cut into. The membranes appeared healthy. 



Heart. — Small ; slight fatty change at aortic and mitral valves. Otherwise healthy. 



Lungs. — Left healthy. Right : externally showed extensive consolidation of the greater 

 part of the lower lobe and posterior parts of upper and middle lobes, a few unconsolidated 

 portions standing out very clearly against the consolidated portions. On section : through- 

 out the consolidated parts were abundant white tubercles, which on microscopic examina- 

 tion were found to be due to a septic staphylococcal broncho-pneumonia. The distri- 

 bution of these patches was apparently bronchial, but the consolidation was so extensive 

 as to be almost lobar. There were no enlarged bronchial glands. 



Liver. — Small, especially the left lobe. Healthy appearance on section. 



The spleen and kidneys were small and very pale : the suprarenals were apparently 

 healthy, and the mesenteric glands not enlarged. 



General Histological Characters. 



The parts most extensively affected in this case are the cervical and dorsal cord : the 

 numerous cranial nuclei and the intra-medullary course of their fibres, especially those of the 

 Hlrd, IVth, Vth, Vllth. and Vlllth nerves ; and the tissues around the lateral walls and roof 

 of the IVth ventricle, especially marked in relation to the dentate nuclei (figs. 121-122). 

 The sclerosis around the walls of the lateral ventricle, with the exception of the walls of 

 the descending horn which .were very strikingly changed, was much less noticeable than 

 in the previous case, but both the genu and splenium of the corpus callosum showed numerous 

 areas (figs. 114-115). The basal ganglia showed a few isolated areas, and numerous areas 

 were present in the convolutions, especially those of the upper levels of the hemispheres. 

 The meninges and cortical vessels showed a considerable degree of cell infiltration. 



The areas in the brain gave the impression of being, as a rule, of older date than those 

 in the spinal cord. No areas in the central white matter were found in which there was 

 not a well-marked central sclerosis, and many were present in which there was no evidence 

 of an existing process. Such areas showed all degrees of sclerosis from a loose neuroglia 

 network to a fairly dense tissue with fine meshes. Many areas, however, showed the presence 

 of fat granule cells both in their peripheral zone and around the vessels in the central denser 

 zone. The peri- ventricular sclerosis was also of an older date than in the previous case, 

 and few fat granule cells were found in the walls of the sub-ependymal veins. The structure 

 of the more recent areas in the cerebral white matter and in the transition zones gave the 

 impression of a slow excentric sclerotic process. One or two of the areas (fig. 286, and cf. 

 figs. 391-392) in the deepest layers of the cortex showed beautifully the typical structure 

 of such areas, composed of a fine network of delicate capillaries, in the meshes of which 

 lie large protoplasmic glia cells with branching processes, many of which are attached to 

 the capillary walls. In the finer meshes formed by the capillary network and the branching 

 processes He numerous fat granule cells and small round cells. 



The areas in the pons, medulla oblongata, and spinal cord all showed numerous fat 

 granule cells, except those in the posterior columns of the cord, which were very densely 

 sclerosed. Bielschowsky preparations demonstrated the persistence of many axis cylinders 



