712 DR JAMES W. DAWSON ON 



Cord. — The spinal cord showed clearly-defined islands of sclerosis throughout its whole 

 length. These were mostly separate from each other. 



Lungs. — Both lungs were adherent to the chest wall, especially in the upper lobes. They 

 were studded with broncho-pneumonic tubercles. The lower lobes of the right lung were in 

 a state of grey hepatisation and very friable. The lower lobe of the other lung was 

 congested, but not consolidated. 



Heart. — There was some thickening and fusion of several chordae tendinese, but no 

 narrowing of the orifice of the mitral valve. The cardiac muscle was fairly normal. 



General Characters. 



The areas in the spinal cord and those in the brain were here in marked contrast to one 

 another. The former throughout the whole extent of the cord showed a more advanced 

 and uniform degree of sclerosis than in any of the other cases — no " early " areas were 

 found. In the brain, on the other hand, the areas showed all stages of a commencing and 

 advancing sclerosis. 



In the cord the sclerosis conformed closely to the typical anatomical picture given by 

 Charcot : the areas (1) were, as a rule, insular ; (2) had clearly-defined outline ; (3) pre- 

 sented an advanced and in many cases complete degree of sclerosis ; (4) showed a marked 

 persistence of the axis cylinders ; (5) atrophic changes in the ganglion cells ; (6) chronic 

 changes in the blood-vessels ; and (7) the glia marginal zone throughout the whole cord 

 was very widened. Marchi sections, both transverse and longitudinal, however, showed 

 that at numerous levels a few fat granule cells were still present in the walls of the blood- 

 vessels, and such areas had a peripheral zone of sclerosis, less dense than the central zone. 

 In the still myelinated tissue there was no evidence of an increasing glia hyperplasia, and 

 the impression was left that all the areas had arisen on the basis of a fat granule cell stage. 

 Several patches were cut in serial section, and they were found to retain, throughout, their 

 clearly-defined outline. The nerve roots were normal, and showed no rarefaction : the 

 posterior root ganglia, examined at numerous levels, were entirely normal, and the mem- 

 branes were not materially altered. 



In the brain " early " areas were found in several medullary rays, and patches were 

 present in the central white matter above the ventricles. The peri-ventricular sclerosis 

 around all the horns of the lateral ventricles was very marked, especially around the descend- 

 ing horn on both sides. The tissue of the medulla oblongata, pons, and cerebral hemispheres, 

 with the exception of a few levels, was removed for mounting (figs. 200-201). The ven- 

 tricles were not dilated, and their walls showed zones of greyish-blue staining, which outlined 

 the sub-ependymal veins (fig. 201). 



Topographical Distribution of Areas. 



Spinal Cord. — Cervical Cord (figs. 185-188). — In its upper segments the clerosis is limited 

 to a narrow band along the outer half of the posterior median fissure and to a broad band 

 which passes obliquely across the cord in the region of the central canal. Diffuse changes 

 are also present in each crossed pyramidal tract. In C3 only one area is present : this is 

 very irregular in outline and occupies one antero-lateral column with the whole of the cor- 

 responding anterior and posterior horns of grey matter. It then passes into the opposite 

 anterior horn and also sends a broad band along the posterior median fissure. At C6 the 

 sclerosis affects chiefly the posterior columns : this is a triangular area with its blunted apex 

 at the posterior commissure and its base at the periphery of the cord : the lateral outlines 

 are clearly defined and leave a considerable portion of the columns of Burdach, adjoining 

 the posterior horns, unaffected. Several small dense areas are also present in the lateral 

 column on one side. The glia border zone around the whole circumference of the cord is 



