THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 711 



and adjoining portions of the optic nerves and tracts show extensive early involvement 

 of both optic nerves on the lower surface. This sclerosis stops short of the chiasma, but 

 as we pass deeper into the chiasma the sclerosis passes as a narrow band along the anterior 

 margin and at the deepest portion of the chiasma cuts it across from side to side. 



Case VII. 



Clinical History. 



J. M'N. — The patient was a cabinetmaker, aged forty-two, born in Edinburgh. He 

 was admitted into Longmore Hospital on 11th October 1905, and died on 30th May 1909. 

 On admission he showed complete paralysis of both legs and of both arms. 



His father died at the age of sixty-three from phthisis ; his mother was still alive and 

 well. He had two brothers and one sister who died in childhood, and five brothers and two 

 sisters living, all of whom are in good health, with the exception of one sister, who has 

 suffered from "nervous troubles " for ten to twelve years. 



The disease was first noticed seventeen years previously, when he says he felt cold in 

 his back after being at an entertainment. This was followed by some shakiness in the limbs 

 on the left side, but this soon passed off, and he was able to continue at work for four years 

 afterwards. About five years ago he finally lost the power of walking ; before this he had 

 gradually required increasing help, first from sticks, then from crutches. 



His hearing had been very defective, especially in his right ear, since he had scarlet 

 fever when six or seven years of age. His eyesight was defective, especially the left eye. 

 There was nystagmus on looking upward or to the left ; the movement to the right was 

 defective. The speech was slurring. There was slight increase of myotatic irritability, 

 and much unsteadiness in attempting to grasp anything. The grasp of the right hand 

 was weak, that of the left hand extremely feeble. The lower limbs were completely 

 paralysed, although sensation appeared to be normal. Both knee-jerks were exagger- 

 ated : there was well-marked ankle clonus on each side, and a double Babinski reflex. 

 The control of the sphincters was retained. The thoracic and abdominal organs appeared 

 normal. 



Progress. — The patient remained in very much the same condition during the whole 

 of his stay in hospital. He had at intervals severe attacks of hiccough lasting from six 

 to nine days. For some weeks before his death he did not appear to be so well, but nothing 

 definite could be made out. He died somewhat unexpectedly. 



Post-mortem Report, 31st May 1909. 



Both arms were atrophied, the fingers were flexed at all the three joints. The ankles 

 were extended and the knees and hips were straight. Slight oedema of both feet ; and 

 the abdomen was slightly green. 



Brain. — The vessels at the base were quite normal. Slight thickening of the fine mem- 

 branes near the left Illrd nerve. Slight milky opacity in membranes at posterior inferior 

 part of the cerebellum. Slight atrophy of convolutions at vertex without material thick- 

 ening of membranes. On section a large patch of sclerosis was found in the optic radiations 

 of the right hemisphere. Other patches with a clearly-defined outline and a greyish-red 

 gelatinous appearance were seen in front of the caudate nucleus. The grey matter round 

 the aqueduct of Sylvius presented a similar gelatinous appearance. On one side there was 

 a patch of the size of a threepenny piece near the red nucleus. The grey matter under the 

 floor of the IVth ventricle in the medulla oblongata presented similar patches of sclerosis, 

 with the same sharp margin. 



