760 DR ALEXANDER BRUCE AND DR JAMES W. DAWSON ON 
obliquely, and transversely, and with almost every vessel there was a radiation inwards 
of fibres and more or less marked nodule formation or indications that such had 
existed. The anterior fissure showed numerous strands of fibres, which were continued 
in the walls of the commissural vessels to the base of the anterior horn, where they 
formed a very large nodule from which several smaller nodules branched off along the 
different vessels. There was frequently, too, a coalescence, at the junction of white 
and grey matter, of fibres of the nodules in relation to central and peripheral vessels. 
In the 2nd sacral segment, the region of the central canal was occupied by a 
large nodule composed of closely-disposed fibres with numerous nuclei (fig. 44), and on 
either side the central vessels showed small nodules in the connective tissue surround- 
ing them. The grey matter of the antero-mesial and antero-lateral groups of cells on 
one side was also occupied by a dense, compact nodule, from which fibres radiated to 
intermingle with fibres formed in relation to the peripheral vessels. The nodule in 
the region of the obliterated central canal passed through the whole of the remaining 
sacral cord; from it fibres radiated in all directions into the grey matter. In the pia 
were numerous strands of very delicate fibres, but no further nodules could be traced. 
(2) FIBROSIS ASSOCIATED WITH THE NODULES. 
The neuroma formation was not the only pathological process present in the cord, 
nor was it the most dominant feature. ‘Throughout the pia it has been noted that 
there was a definite thickening and at numerous levels a marked cell-infiltration, the 
whole suggesting that at one period there had existed meningitic processes. This 
process had spread along the adventitia of nearly all the vessels of the antero-lateral 
cord, and was specially marked at the base of the anterior fissure. The posterior roots 
were similarly involved in the posterior root-entry zone throughout almost the whole 
extent of the cord, and the anterior nerves in the intra-medullary root-emergent zone 
at numerous levels. The upper five cervical and 2nd and 3rd dorsal segments 
were alone free from this change, and even they, in the 5th cervical and the dorsal 
segments, showed the change in the posterior root-entry zone to a slight extent. 
The question of the sequence of the pathological processes naturally at once arises 
in the mind. ScHLESINGER related the neuromata in his cases to a_ proliferative 
process, the result of a long-continued chronic irritation. There is abundant evidence 
of such a chronic irritation in this case, but a prolonged study of individual segments 
confirmed the first impression that the fibrosis was secondary to the nodule formation. 
Every nodule, almost without exception, could, by means of serial sections, be 
definitely related to a vessel. In segments such as the 6th cervical and 1st dorsal, 
where individual isolated nodules were present and the normal structure of the cord 
was otherwise retained, the nodule formation was the only abnormal appearance. Such 
isolated nodules were lying within the adventitia of medium-sized vessels, the walls of 
which were scarcely altered in structure (fig. 6). Other sections showed similar 
