"Osmic acid stains the hyaline material a deep blue black." This change is said to occur in the great majority of cases of general paralysis both acute and chronic. In the central gray matter are spaces or apertures where the vessel walls have dropped out during the process of mounting. These apertures show that the vessels of this region are greatly dilated. In the upper portion of the crossed pyramidal tract there is quite a large focus of complete degeneration— complete loss of tissue. The cause of this degeneration is seen to be a thrombus; the occluded vessel is plainly seen. Thus the degeneration located peripherally to the thrombus is easily accounted for. Section No. III of this region shows a vessel extending nearly across the section, and contains three thrombi. In the vicinity of the thrombi the vessel is undulated in contour. Many of the vessels have greatly thickened walls; peripherally this section presents the appearance of myelitis; as described above, differentiated a little better in this section on account of the osmic acid stain.

Section No. 4 is from the lower cervical region, presenting peripheral myelitis and thrombi. Multipolar cells may be seen in the posterior cornua (sensory cells) as large or larger in the posterior cornua than those in the anterior cornua (motor cells) and more numerous. A few insulated cells may be seen in the same hemisphere, located in the white matter of the cord. Some of the multipolar cells belong to the vesicular column of Clark. The walls of the ves

sels are hypertrophied, and in the portion adjacent to the thrombi are as a rule greatly convoluted, that is they present a marked undulated appearance. The condition is probably caused by the continued force of the blood pressure after the vessel is occluded by the thrombus. This section demonstrates that the myelitis may be at least partially accounted for by the vascular occlusion. Some sections from this region present an occluded central canal.

Section No. 7 is from the upper dorsal region, and using the threefourths objective, no field can be found free from patches of miliary scleroses, both white and gray matter being involved. The vessels of the gray matter are greatly dilated, and a focus of complete degeneration is seen in one of the postero-external columns. With a one-fifth objective the peripheral myelitis appears very distinctly. Other sections from the same region show the lesions of chronic meningitis, peripheral myelilis, and the central canal is occluded by small round cells. Reflected light reveals, miliary sclerosis of the

gray commissure anterior to the cellular proliferation about the central canal. Essentially the same appearances are found in the middle and lower dorsal regions. The pathogenic cellular elements are seen dotting the entire surface of the section, being more numerous as we approach the periphery. By transmitted light the corpuscular elements look very much like pus corpuscles, i. e., as pus corpuscles appear under a one fifth objective. The patches by reflected light present a glassy appearance, especially at the edges. Thus we have the pathological manifestations as found in the third stage of myelitis. There having been what has been described as an "absorption and cicatrization, by softening material being gradually romoved, leaving the reticular appearance," as represented in figure III, the connective tissue trabeculae being thickened and enclosing spaces the contents which-granular debris-have been washed out in the process of mounting. The involved portions finally contract and present the sclerosed patches as observed in figure II. In the central gray matter foci are seen, where there has been disintegration and absorption resulting in cavities varying greatly in size and are quite numerous. In the examination of sections fram the lumbar regions, in addition · to what was found in the cervical and dorsal regions, we find blood corpuscles, many of them being leucocytes. The myelitic process is developed to its greatest extent in the postero-internal columns.

Lungs.-The sections of the lungs present large accumulations of cellular elements, within the pulmonary alveolae. The alveolae are nearly all filled with these small round cells. The condition here found is that of gray hepatization af lobar pneumonia.5

Kindeys.-The microscope reveals no pathological manifestations. Supra renal capsules: These sections present a normal histological appearance.

Remarks.-The meningitis spoken of, we think, stands in an etiological relation to the myelitis; an extension of the inflammatory process from the pia to the cord. Bramwell gives, among the excit ing causes of myelitis, "extension of the inflammatory process from adjacent parts, especially from the adjacent membranes." Some ob. servers claim that the colloid, like exudate-glassy swelling-is an artificial product. Bramwell does not think so. Those who claim it to be an artificial product say, it is due to alcohol used as a hardening fiuid. Others claim the same condition has been found where alcohol has not been used. I have never found this condition, save in cases

giving a clinical history of the disease. Am now using Erlitzki's solution*, a good deal for hardering. It is noticed in this case as in others, the lower the region of the cord the more extensive the disease, and it was only in the lumbar region of the cord that we found extravasated blood corpuscles, and the myelitic process developed to such an extent as to leave no portion uninvolved. Even in a recent work it is said: "It seems that while the results of a transverse myelitis in the middle dorsal cord may remain stationary for two or more years, those of a transverse myelitis at the upper lumbar level do not; on the contrary, the entire cord below appears to be doomed to undergo the same degeneration by contiguity. The explanation can be found in the Lancet of April 2, 1881, pp. 529 and 53, and quoted by Bramwell."

The article in the Lancet is from the Croonian Lectures on the influence of the circulation on the nervous system, by Dr. Moxon.

"The spinal cord is suspended within the spinal canal, is subarachnoid fluid, which entirely insulates it." Thus suspended, "the spinal cord is out of reach of any blood supply except such as can come to it from the brain above or along the nerve roots at the side. The blood is carried out by slender vessels which come from the vertebral arteries within the cranium. There are three of these arteries, one on the front and two on the back of the cord; they are very slender, and yet have to run along its whole length. No arteries so small as these run so great a length elsewhere in the body, and pressure falls rapidly in minute arteries as the length of pipe increases, so that it becomes necessary to reinforce these slender vessels wherever possible; and advantage is taken of the nerve roots to send up little reinforcing arteries along these. In the part of the cord corresponding to the neck, upper extremities and trunk, where the nerve roots are short, the reinforcing arteries are also short, and they reach and join and furnish blood to the spinal arteries, so that in this part of the cord every segment of it is supplied with blood from two directions, the anterior spinal artery bringing blood from above and the reinforcing artery from below. But where you reach the tip of the cord the supply from below becomes exceedingly precarious, and even apt to fail entirely, because upon the long strands of the cauda equina the small arteries are too narrow and too long to reinforce the cord with any certainty. But at the same time, the supply from above has *Bichromate of potash 2.5, sulphate of copper 5, distilled water 100.00.

to be furnished with greater difficulty than in the upper regions of the cord, because the original spinal artery is very far away, and the reinforcing arteries, even in the lumbar region, have to run considerably longer courses than they had in the cervical region. Thus the tip of the cord has its blood supply only from above, and deficiently even there, whilst the upper parts of the cord have a better sustained supply from above and below. Hence we see that the tip of the spinal cord corresponding to the lower limbs and sphincters, is much more weakly organized as to its circulation than are the upper parts of the cord." Thus we see why it is that the disease progresses so much more rapidly when located in the lower cord, and for anatomical reasons, when it is located here, we should give a grave prognosis.

The microscopical examination of the supra renal capsules is of interest on account of the absence of any pathological manifestations. The patient presented the appearance of having Addison's disease. The discoloration of the skin was so marked that it was noticeable so far as the patient could be recognized. This is one of those very rare cases that have led some authors to believe that the disease is the result of some affection of the sympathetic nerve fibres, which pass to and from these organs, and attention has been drawn to the solar plexus in which the following changes have been noticed; connective tissue proliferation, fatty degeneration, pigment degeneration of the ganglion cells, atrophy of the gangion cells and nerve fibres, and nuclear proliferation of the sheaths of the fibres. In other cases, however, the solar plexus and sympathetic have been found intact. Some claim that Addison's disease is the result of a functional disturbance of sympathetic nerve tracts. Disease of the supra-renal capsules is not always followed by Addison's disease; the latter does not develop unless the sympathetic is affected. The connection between the sympathetic and the pigmentation of the skin is obscure. Finally, similar tegumentary changes are found in other chronic diseases associated with cachexis, and to this class we ascribe the case here observed (7).

BIBLIOGRAPHY.

1. Disease of Spinal Cord-Bramwell, p. 200, Fig. 138; 2. p. 213; 3. p. 190; 4. p. 202.

5.

Cornil and Ranvier-Pathological Histology. Fig. 230.

6. Pepper's System of Medicine (1886), Vol. v.

7. Eichorst-Wood's Library Standard Medical Authors, June, 1886.

CHRONIC MANIA.

Case 1105 is that of a male patient, aet 58. Married. Farmer, and a native of Virginia. He was admitted April 1, 1868. The first indications of the disorder were manifested in the autumn of 1865. The disease is increasing. There are no rational intervals. The first symptoms of the present attack were manifested two weeks ago. He is deranged on all subjects, and is growing worse continually. He has been violent; has threatened to kill his wife and family. The principal cause seems to be domestic trouble.*

ABSTRACT OF HISTORY AFTER ADMISSION.

Mr. A. was very much excited after admission and disposed to violence; was noisy and entertained fears that his life was in danger; was inclined to resist being undressed at night. His appetite was poor. His bowels were constipated, and the expression of his countenance was that of a maniacal person. In a few days under the usual medical treatment and careful nursing the excitement subsided. He became quiet and tractable. We learn from a neighbor that he attempted to kill two persons with an ax. He also endeavored to strangle an officer who had him in charge. By the first of July he had improved to such an extent as to be allowed the privilege of going out at pleasure, and was apparently contented. During the latter part of July and first of August he assisted the barn man, but ran away on the seventh of August, returning to his home.

READMITTED SEPTEMBER 26, 1883.

Mr. A. has been sleepless for four or five weeks. About two weeks ago he began to act strangely; riding over the country to see if he owes any one, and conversing with every one he met on the subject of temperance. Disease appears to be increasing, not variable. Derangement is manifested on the subject of temperance, in trying to set the world afire so that he can burn up the drunkards and saloons. He has been inclined to fight when opposed, not otherwise. He has called for a razor and motioned at his throat, but has not spoken of violence. He broke out of the house when confined, burned a pillow *In many of these cases, the "domestic troume" is the result of the disease.

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