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MULTIPLE NEUROMATA OF THE CENTRAL NERVOUS SYSTEM. 747 
their structure and mode of formation, the disposition and origin of the fibres composing 
them, and their relation to one another and to the tissues around. 
Before passing to this study it is necessary to refer to other pathological processes 
present in the cord. The clinical features were those of disseminated sclerosis, and at 
the post-mortem examination the naked-eye appearances of the cord seemed to confirm 
this diagnosis, for we have noted that on cross-section the characteristic bluish, gelatinous 
patches involved a large part of the sectional area of the cord throughout its whole 
length. Weigert preparations at different levels showed, under low power, areas of 
sclerosis, but under a higher magnification Weigert-fuchsin preparations indicated that 
these were not typical patches of disseminated sclerosis, but were rather areas of marked 
fibrosis. 
Within these fibrosed areas were found evidences of neuroma formation, and it was 
assumed that the fibrosis was an accompaniment or a sequel to the nodule formation. 
Sections of the cord at certain levels showed a more or less normal structure, with the 
exception of the presence of small neuromata, either in the vessel-walls or in the cord 
substance. Such nodules seemed to be the earliest stage of a process which ended in a 
complete disappearance of the nodule and a replacement, not only of the nodule, but of 
the previously healthy surrounding nerve tissue by a fibrosis, whilst in the surrounding 
zone there was a sclerosis comparable to that found in disseminated sclerosis. Between 
this earliest stage of a nodule in the midst of otherwise healthy tissue and the stage of 
complete fibrosis of the area there existed all degrees of transition, from a slight thickening 
of the wall of the vessel, almost invariably present in some relation to every nodule, to 
a further stage which showed an increasing involvement of the intertwining nerve fibres 
of the nodule, so that more and more connective tissue appeared amongst them, 
to a still further stage in which the nerve fibres were compressed and separated by the 
increasing fibrosis, and a yet later stage, when the fibrosis was so intense as to have left 
scarcely any trace of nodule formation and only ghost-tubes of former nerve fibres could 
be recognised. Such interlacing ghost-tubes gave the impression of a fine meshwork 
which, under high power, at first appeared as very fine capillaries but could be definitely 
analysed as nerve fibres with scarcely a trace left of axis-cylinder and myelin sheath 
and peripherally-placed nuclei. 
When such a stage was reached there were added two other elements to the picture, 
the one a very marked infiltration of lymphocyte-like cells accompanying the increased 
condensation of the fibrous tissue, the other, a very intense glia cell proliferation and 
hyperplasia in the immediately surrounding nerve tissue. Still later in a few sections 
a stage was reached in which the fibrosis was not only the most dominant feature, but 
the only one, for Van Gieson and Weigert-fuchsin preparations showed an extensive area 
of dense fibrous tissue with few structural elements recognisable except small round 
cells around the vessels. Hven these were frequently absent, and the vessels themselves 
were completely involved in the fibrosis. 
There were in addition areas of true sclerosis independent of those associated with 
