THE HISTOLOGY OF DISSEMINATED SCLEROSIS, 707 



the only area present is an oval one found in front of one superior cerebellar peduncle : 

 this extends forwards to involve trapezoid and middle peduncle fibres. At the upper limit 

 of the pons (fig. 146) this area is still present, but is displaced lateralwards, while another, 

 on the ventral aspect of the pons, extends amongst the superficial transverse fibres for a 

 short distance. As these areas are traced upwards, the latter increases in size for a time, 

 becomes divided into two by a narrow band of dark fibres, and finally both divisions dis- 

 appear : the former becomes smaller and soon disappears, while a further patch develops 

 in the posterior part of the superior cerebellar peduncle. 



At the level of the corpora quadrigemina (fig. 147) a peri-aqueductal sclerosis is present, 

 together with three other oval areas with indistinct outlines. These lie, one in the middle 

 line in front of the decussation of the superior cerebellar peduncles, a second in front of one 

 lateral fillet, and a third on the same side, on the lateral surface of the pons. 



Case VI. 



Clinical Notes. 



C. G. — Patient was a baker's shopwoman, aged twenty-four, and was admitted to 

 Longmore Hospital on 12th October 1910. She died on 28th March 1911. 



No notes of this case could be found previous to her admission to hospital, and even 

 these were very scanty. She looked pale but healthy, although both legs were powerless. 

 On 24th March she suddenly had a convulsion, becoming rigid, cyanosed, and biting her 

 tongue. . The arms and legs twitched and nystagmus developed. She remained in an 

 unconscious condition until death occurred four days later. 



Post-mortem Report, 29th March 1911. 



A large number of small superficial ulcerations of the skin was found on the buttocks 

 and on the lower part of the back. No emaciation nor contractures, and the body was well 

 nourished. 



Spinal Cord. — Some adhesions in pia arachnoid. Lower part congested, but not atro- 

 phied. On section typical patches of disseminated sclerosis could be seen in various places. 



Brain. — Dura mater normal. Surface cedematous. Cortex somewhat congested and 

 post-mortem development of gas below pia. Marked injection of all small vessels over 

 pons and medulla. The pons looked very small. 



Lungs. — Left : lower lobe was deeply congested and there were a number of haemor- 

 rhages both on the surface and in its substance. Upper lobe normal. Right : considerable 

 area of consolidation near the root involving both upper and lower lobes in a condition of 

 grey hepatisation. 



Kidneys. — Both kidneys are small, show cloudy swelling ; the capsules strip freely. 



The spleen is somewhat large, of pale colour, and firm. 



The liver shows marked cloudy swelling, with some wedge-shaped areas paler than the 

 rest — so-called infarcts. 



The heart is small : muscle good colour. Ante-mortem clot on both sides. Valves 

 healthy. 



General Characters of the Areas. 



The outstanding feature in this case was the absence of any marked degree of sclerosis 

 in any of the areas, either spinal or cerebral. The patches, almost without exception, were 

 in a stage of fat granule cell formation (figs. 178-184), and the more advanced showed a 

 moderate amount of glia fibril formation. 



In the cord the extensive and diffuse character of the demyelination is brought out in 



