704 DR JAMES W. DAWSON ON 



Case V. 



Clinical Notes. 



S. S. — The patient was a trained nurse, aged forty-four, born at Kirkwall. Her father 

 died at sixty-four from " dropsy," and her mother at fifty from decline. She had two brothers, 

 sailors, who have been lost sight of, and two sisters alive and well, while a third died at 

 twenty-six from psoas abscess, and a fourth at thirty from typhoid. She had always been 

 healthy. When she was thirty-four years of age, she suddenly became blind for a week 

 in the left eye, with acute pain on movement. Three months later the right eye was similarly 

 affected. Shortly after, when nursing in Perthshire, " something came into the muscles 

 of the legs nearly making her fall," and something of this kind occurred periodically. She 

 was able to continue at work nursing for the next four years, when she gave it up and took 

 a house and kept boarders. She was last able to walk about one year ago, but she fell down 

 a stair and injured her knees, and has never been able to walk since. Sensation in the lower 

 limbs is fairly good, except to heat and cold. Both legs are quite helpless, being flexed 

 on the thighs, and the thighs on the abdomen, and quite immobile. Babinski's sign is present 

 on both sides. The upper limbs were only affected very late. Pain and weakness de- 

 veloped in the right upper arm, but no inco-ordination could be detected. Nystagmus 

 was absent. Admitted to Longmore Hospital, 28th March 1906; died 8th March 1910. 



Post-mortem Report, 10th March 1910. 



Great contracture of lower extremities, the hips and knees being flexed at an acute angle. 

 Numerous small ulcers over the right buttock from -J in. to J in. in diameter. A large abscess 

 containing about one pint of pus was found in the left buttock. 



Brain. — Great oedema of pia arachnoid : the substance was soft. The under surface 

 of the pons and medulla oblongata showed patches of sclerosis. The left optic nerve was 

 grey and gelatinous as far as the chiasma, the right optic nerve was only partially degener- 

 ated. The chiasma was of a cream colour, and the right optic tract of a mixed colour. 



Cord. — The spinal cord showed no thickening of the dura mater or other membranes. 

 Greyish-red gelatinous-looking patches were seen in the cervical and dorsal regions. 



Lungs. — Pleura free from adhesions. Both lungs oedematous. Caseous mass at root 

 of left lung about the size of a large walnut and firmly encapsulated. Lower lobe of left 

 lung partly collapsed. 



Heart. — Contained pale yellow thrombus in the right side extending into the pulmonary 

 artery. Muscular walls somewhat flabby, valves normal. 



Liver. — Large, engorged with fluid blood and considerable fatty infiltration. 



Spleen. — Diffluent ; not much increased in size. 



Kidney. — Right : capsule thickened and slightly adherent, leaving a finely granular 

 surface on stripping. Cortex slightly reduced in size. Some calcareous deposits in tubules. 

 Left : as in right, with addition of a few small abscesses in cortex and medulla. Several 

 small capillary haemorrhages in pelvis. Condition is one of " commencing surgical kidney." 



General Characters of the Areas. 



Only a few features call for reference here. The most extensive affection was present 

 in the cervical, dorsal, and upper lumbar cord, and at several levels, especially in the cervical 

 cord, there was a marked symmetry in the position and form of the areas — a symmetry 

 which was continued throughout several segments and gave the appearance of an ascending 

 and descending secondary degeneration (figs. 148-149). The areas found were, again, in 



