1906.] Nervous System in a Case of Chronic Dourine, etc. 



5 



with lymphocytes can be seen and some haemorrhages in the lumbar region. 

 The chronic interstitial inflammation of the anterior roots, in which all the 

 nerve fibres appear to be normal, together with the fact that there is subpial 

 proliferation of the glia tissue of the lumbo-sacral and cervical enlargements 

 in their entire circumference, with extension of the same along the septa, 

 shows that this proliferation of the connective tissue supporting structure, 

 whether of the undamaged roots or of the spinal cord, is not due to atrophy 

 of the nervous elements ; although in the posterior columns where there are 

 three definite bands of sclerosis the neuroglial proliferation is without doubt 

 secondary to neural destruction. (Vide Photomicrograph 3.) Occasional 

 foci of micro-organisms are seen, but do not play any part in the chronic 

 changes above described. They are not found in the blood or inflammatory 

 exudations. In none of the sections could I find any trypanosomes stained 

 by the various methods, which we know will show them, if they are present 

 in any numbers. Since the above description was written I have received 

 from Dr. Lingard the remainder of the central nervous system, including a 

 number of the spinal ganglia, i" was thus enabled when reading the paper at 

 the Royal Society on March 8 to communicate the following additional facts, 

 which have, I consider, an important bearing upon the degeneration of the 

 posterior roots and the sclerosis in the posterior columns. The facts which 

 will be now stated may also explain some of the characteristic symptoms of 

 the disease and afford some further evidence of similarity to Sleeping 

 Sickness in the morbid change occasioned by chronic trypanosome infection. 



Sections of the posterior spinal ganglia and attached roots in the cervical, 

 upper dorsal, mid dorsal, lower dorsal, and lumbo-sacral regions have been 

 examined by the methods previously described and the appearances compared 

 with those observed in Sleeping Sickness. In all these ganglia there was 

 evidence of intense chronic inflammation with marked proliferation of the 

 endothelial nuclei of the capsule and lymphatics, together with lymphocyte 

 infiltration of the interstitial fibrous tissue, and this morbid change can be 

 followed from the nerves to the ganglion and along the posterior roots. This 

 change is most marked in the lower dorsal and lumbo-sacral ganglia, and 

 where the chronic inflammation is most intense, there the posterior spinal 

 ganglion cells are most affected. In all the sections some of the ganglion 

 cells have undergone vacuolar degeneration, and even complete destruction, 

 their place being occupied by inflammatory products (vide Photomicro- 

 graph 4), but the neuronic destruction is most marked in the lumbar region, 

 which is the situation, as before remarked, of extensive posterior root 

 destruction and system-degenerative sclerosis of the posterior columns. 

 ( Vide Photomicrograph 3.) 



