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years under the care or observation of Dr. E. H. Linnell, of Norwich, Conn., and published in the " Archives of Ophthalmology," Vol. X., No. 4, December, 1881.

"Mr. T, aged sixty-three, of nervous temperament and thin habit, first consulted me," says Dr. Linnell, "for failing vision, in November, 1879. His avocation had been that of a photographer until ill health, which he attributed to the constant handling of chemicals, obliged him to relinquish it. Inquiry elicited the following facts: For the past eight or nine years he had been subject to frequent attacks of neuralgia, affecting his head and limbs; he had been habitually constipated; his urine had been somewhat increased in quantity, light-colored, and passed frequently; and for four years he had had paralysis agitans affecting his right arm and leg, but more markedly the arm. This tremor developed gradually, and was attended with partial anæsthesia, denoted by numbness and tingling sensations in the affected limbs, and by general debility. In other respects he enjoyed good health until the fall of 1879. During the night of Sept. 27 of that year, he had a sudden severe attack of pain in the head, extending from vertex to chin, accompanied by total blindness, and followed by vertigo, nausea, and slow pulse. Digitalis was prescribed, and after twenty-four hours the intensity of symptoms was moderated, and his sight began very gradually to be restored, but was never fully recovered. He continued to suffer with neuralgic headache and vertigo, and his gait became halting and uncertain. His mental faculties, however, remained unimpaired, and the paralysis agitans, or the difficulty of locomotion, did not increase. When I first saw him, VOU=33, refraction Em. He had, however, left-sided binocular hemianopsia. ... In the latter part of April, 1880, he had another sudden attack of complete blindness. This attack was unattended by pain, and was of shorter duration than the first." During the following year, Dr. Linnell says, "his sight seemed to fail gradually, until he could with difficulty distinguish large objects. He complained much of dizziness, but suffered less pain; walking became more fatiguing, the right leg seeming heavy, and as if too long. He retained the use of all his faculties, and could converse intelligently, although his mind seemed to lose some of its natural vigor. In the latter part of June, 1881, he was suddenly seized with a general tremor of the whole body, afterwards becoming more pronounced upon the right side. This was not attended with pain, and he apparently recovered from the effects of it; but had a similar seizure, July 2, accompanied with constriction of the post-cervical muscles. The rigidity increased, he soon became unconscious, and was apparently entirely blind. After a few hours he

partly regained consciousness, and had perception of light. From July 4 to 8, he seemed to improve somewhat. From this time he gradually failed both in intellect and strength, until he became comatose, in which condition he remained for several days, and died July 19."

An autopsy was held in the afternoon of the day of his death, with the following result:

"The dura mater was so firmly adherent that the calvarium could not be removed without cutting through it; and in so doing, several ounces of dark fluid blood escaped from the sinuses. Both it and the arachnoid appeared healthy. The pia mater was much injected, the veins being distended with dark blood. The entire weight of the brain was 2 pounds 15 ounces. The cortical substance of the cerebrum was of normal consistence; but upon section of the right hemisphere, a large and firm coagulum was found in the medullary substance. was nearly circular, and measured approximately 4 cm. in diameter and 2 cm. in thickness. It was situated a little anterior to the centre of the hemisphere, and did not anywhere encroach upon the cortical substance. The contiguous brain substance was softened for a thickness of about two lines, but the clot was removed almost entire, and there was no serum, pus, or other indication of inflammation or of extensive degeneration. No pathological changes could be discovered in the left hemisphere. The fluid in the ventricles was not appreciably increased in amount, although there was more serum upon the left than upon the right side. The velum interpositum and choroid plexuses of the ventricles were highly vascular, the veins being turgid and swollen, and this was more marked upon the left side. The tubercula quadrigemina were manifestly degenerated, and presented the appearance described as white softening. This condition was much more evident upon the left side, but it was not limited to these bodies. It also extended laterally and anteriorly, involving the corpora geniculata, the posterior and inferior portions of the optic thalamus on the left side, and also, to some extent, the floor of the fourth ventricle. A portion of the left optic tract and the adjacent under surface of the thalamus was removed for microscopical examination. This was so soft as to require very careful handling to prevent crushing."

Dr. Linnell kindly sent me a portion of the under surface of the left optic thalamus, which came to me a few days after it was removed from the corpse, preserved in alcohol. The specimen exhibited a grayish-yellow discoloration, as if fatty. It was placed in a very dilute (one fifth per cent) solution of chromic acid, and after a few days was sufficiently hard to be sliced with

a razor. The sections were mounted in glycerine, and even those which went through the treatment with alcohol and oil of cloves were again introduced into water and mounted in dilute glycerine. Incidentally, I wish to say that for three years I have been pursuing microscopical studies in the laboratory of Dr. C. Heitzmann, of New York, and by repeated trials have become convinced that the mounting of specimens in glycerine is far superior to mounting in Canada balsam or Damar varnish. Comparative mountings in these liquids, especially for specimens of the nervous centres, have resulted in the conviction that the balsam or varnish mounting ought to be wholly abandoned. Unquestionably one, if not the main reason why our knowledge as to the pathology of the brain and the spinal cord has progressed so slowly for the past twenty years, is the mounting in balsam. By this method, the specimens in a short time clear up to such an extent that the minutest details fade, and the specimens become unfit for research with high amplifications of the microscope (800 to 1,200 diameters), which are the only possible means of revealing the minutest normal as well as pathological features.

[graphic][merged small][subsumed][subsumed]


V. Capillary blood-vessel, containing a granular mass, compressed at its upper portion, surrounded by a layer of the waxy mass.

G. Gray substance, the meshes of the bioplasson enlarged by the waxy material, which collects into branching, irregularly contoured, shining fields, W1, W2.

N. Nucleus of the gray substance; a part of the periphery, surrounded by a waxy mass.

All the specimens obtained exhibited a peculiar change of the gray substance. This consisted in the presence of homogeneous,

grayish fields of greatly varying size and configuration, mostly with fluted outlines, scattered throughout the gray substance. With lower powers of the microscope, I was satisfied that these shining fields either accompanied capillary blood-vessels, or were distributed without any regularity in the gray substance, or lastly, represented more or less straight tracts in closely lying parallel or in diverging fan-shaped courses, in the direction of the axis cylinders. The latter feature was especially pronounced in the neighborhood of the optic tract.

The shining fields are doubtless in close relation to the capillary blood-vessels, inasmuch as they appeared by the side of the capillaries, as if in the perivascular space, without at first invading the endothelial coat itself. With advancing degeneration in the neighborhood of the blood-vessels, they, also, became destroyed to such an extent that the direction of the glistening tracts was the only indication of the course of the former capillaries; though also in such tracts, occasionally, a small portion of the original capillary was found embedded. The numerous straight tracts following the course of the axis cylinders were evidently due to a degeneration upon a large scale.

Owing to the tolerably high degree of refraction of these fields, my first impression was that a fatty degeneration of the gray substance had taken place. The treatment of the specimens, however, with strong alcohol and oil of cloves, at once revealed the fact that these formations could not be fat, for they were not perceptibly altered by those reagents. A second full proof of their not being fat was the treatment with a one per cent solution of osmic acid, which we know to be the most trustworthy reagent for fat, and which should in a few moments stain the fat black. No such thing occurred in my specimens.

The next question was, Could the waxy nature of these fields be proved by the application of different reagents? To answer this question I applied the following reagents: Carmine, iodine, hæmatoxylon, fuchsine, violet methyl-aniline, picro-indigo, and chloride of gold. Among those, picro-indigo was the only one which, in Emerson's case, yielded a positive result, where the waxy blood-vessels and globules were rendered by it a bright green. In my case no one of these reagents, not even the picro-indigo, yielded positive results, as all the hyaline fields remained unchanged in their color.

Nevertheless, I am satisfied that this change is materially a form of waxy degeneration; somewhat different from the degeneration in Emerson's case, but kindred to the waxy degeneration which, two years ago, J. B. Greene ("American Journal of Obstetrics and Diseases of Women and Children," Vol. XIII., No. 2, April, 1880) described in the placenta as the most common cause of abortion and premature birth.

This certainty as to the nature of this degeneration could be obtained by a study with high amplifications of the microscope, such as 1,000 to 1,200 diameters. The best specimens for the study with such high powers I obtained by the treatment with a one half per cent solution of chloride of gold, in which solution the specimens were placed for one hour and twenty minutes, after having been thoroughly soaked in distilled water. By this, the blood-vessels were rendered dark blue violet, and the gray substance, with its nuclei, purple, while the shining fields remained unaffected. Here I could see the first change into the shining, homogeneous mass before mentioned, at the periphery of the capillary blood-vessels, and in the mesh spaces of the bioplasson reticulum. By the transformation of the liquid contents of a mesh space into a semi-solid shining mass, the space became enlarged and the neighboring reticulum was pushed apart. By coalescence of neighboring shining formations, larger clusters with fluting outlines originated, in the middle of which often a faint trace of biaplasson was recognizable in the shape of a few delicate granules and their connecting filaments. Whether or not the reticulum of the bioplasson within the homogeneous masses was destroyed, I am unable to say. Not quite infrequently I met with small clusters of the homogeneous mass around nuclei of the gray substance, as if ensheathing them. In the further progress of the degeneration, a great many capillaries became destroyed; probably first by pressure, and later by transformation. These blood-vessels, free of the change just described, looked, especially in their transverse sections, as if compressed and engorged with blood corpuscles.

The result of my researches perhaps is a very small one, if it simply proves that there are waxy degenerations going on in the brain tissue kindred to the waxy degeneration in other organs, such as the spleen, the liver, the kidneys, and the placenta. The intimate reason of this degeneration is not known, nor do we understand its intimate chemical construction. One thing is certainly of interest in the case examined; namely, that the blood-vessels being destroyed to great extent by waxy degeneration, the circulation of the blood in the brain is interfered with, and an encephalitic process may in consequence ensue; or the walls of the blood-vessels, being rendered brittle by the waxy degeneration, may give way the same as in fatty degeneration, and give rise to cerebral hemorrhage.

IN the "Medical Bulletin" for January, a brief article, translated from a German periodical, recommends as an infallible cure for sea-sickness, painting the epigastric region with several coats of collodion. It is said to act here, as in acute peritonitis, as an anti-emetic,

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