714 DR JAMES W. DAWSON ON 



anterior horn, with the exception of the antero-mesial corner, is involved in an area of sclerosis 

 which surrounds the central canal and ceases at the base of the opposite crescent. 



Medulla Oblongata. — At the lower level of the inferior olive two areas are present : one 

 in the left olivary nucleus itself, the other chiefly in one postero-lateral region. This latter 

 extends from the gracile nucleus on one side towards the central canal, passes into the 

 opposite formatio reticularis, substantia gelatinosa Rolandi, Vth nerve, and the adjoining 

 sensory fibres in the caudate nucleus. At the level of the middle of the inferior olive one 

 large area occurs in the centre and inner portion of one restiform body, and spreads into 

 the adjacent formatio reticularis. A large diffuse area is also present in the ventral half of 

 the inferior olive and adjacent pyramid and fillet. 



Case VIII. 



Clinical History. 



M. R. — The patient was a woman, aged thirty-three, born at Whithorn, a typist. She 

 was admitted to Longmore Hospital on 2nd October 1903, and died 3rd September 1910. 



Her father was alive and well : her mother died from heart disease at the age of sixty- 

 six. She has three brothers all alive and well, and three sisters all in good health. Two 

 sisters died in infancy. 



Patient was always very strong and healthy as a girl. At the age of eighteen, she became 

 weak and was very helpless for about a year. She does not know the nature of this attack, 

 but it was called " a kind of rheumatism." She completely recovered, and learned short- 

 hand and typewriting. She worked at this for about one year, when her health gave way 

 owing to bleeding hsemorrhoids, and she again became very weak. She then went home 

 and kept house and remained in fairly good health, except that she was " always tired," 

 and the bleeding still continued. About six years ago she had an attack of influenza which 

 she attempted to walk off ; her legs again became very weak, and after about a fortnight 

 she was unable to stand and had to remain in bed. She slowly recovered from this condition, 

 until she was able to go about the house holding on to tables, etc., and even managed to go 

 up and down stairs, except in very damp weather, which always made her worse. About 

 three years ago she had a severe and widespread attack of eczema, from which she took 

 nearly a year to recover. The* condition has been liable to recur, especially in spring and 

 autumn. It was about this time that her legs became drawn up. She was also liable to 

 repeated attacks of influenza, which always depressed her. 



On examination both legs were found to be drawn up beyond a right angle at the knee, 

 but some slight passive movement was present. There was complete absence of all volun- 

 tary movement of the lower extremities. There was some dulling of sensibility in both 

 hands and in both legs. All the muscles of the upper limbs were weak, especially on the 

 right side. The knee-jerks could not be elicited, but there was marked ankle clonus and 

 well-marked crossed adductor jerks on both sides. Babinski's sign was positive on both 

 sides. The other systems appeared normal. 



Post-mortem, Report, Uh September 1910. 



Body emaciated. Marked contracture of lower limbs. 



Spinal Cord. — Showed usual appearances of sclerosis in many parts. 



Abdomen. — Descending colon very friable — adherent to wall in left iliac region — with 

 local signs of recent peritonitis. The whole colon, from hepatic flexure to rectum, is 

 ulcerated, in some places down to the peritoneum. The liver and kidney show slight fatty 

 changes, the suprarenals are large, and the pancreas shows no gross lesion. 



