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Related post: the lymphatics and perivascular lymph spaces were very ample.
At the periphery, under the pia mater, the whole external sur-
face of the piece was covered with a connective-tissue layer,
and this sent fibers into the substance of the tissue (the pons).
The ganglionic cells of the pons were pigmented, their processes
stunted, their general outline deformed and surrounded by large
perivascular lymph spaces. The ependyma of the fourth ventri-
cle appeared thickened ; the roof appeared normal, with some
epithelial thickening; with large nuclei and overgrowth of the
capillary vessels. The gray substance on which this granular
substance rested was atrophied ; numerous vacuous places could
be seen and many Actonel 25 Mg large capillary vessels. The cellular substance
of the nerve matter was pigmented, and in some places this
was so extensive as to render the protoplasm opaque. Such
.itrophy could be observed, with a very little difference of de-
gree, principallj in the nuclei of the vagus, the glosso-pharyn-
geal, the facial, and motor oculi. Scattered throughout the
atrophied gray substance, in the floor of the fourth ventricle
and principally around the vessels, were found numerous large
amyloid corpuscles. The restiform bodies appeared normal.
In the medulla the periphery of that body presented similar
changes to those noticed at the periphery of the pons. Large
prolongations of connective tissue went in from the surface to
the medulla and principally into the pyramidal tracts. The
neuroglia appeared everywhere thickened. The vascular changes
were the same as mentioned in the pons, and there was seen
considerable rarefaction of the nervous substance (enlargement
of the perivascular lymph spaces), particularly in the region of
the external arciform fibers and in the region of the inferior
olives. The ganglionic elements of the olives and the inter-
olivary bundles seem normal. In those portions of the medulla
where the rarefaction already spoken of existed there was
to be seen remarkable enlargement of the smaller blood-
vessels and with thick walls. The neuroglia had a sort of
fibrous look, and the amyloid corpuscles were here most
abundant.
In the spinal cord the changes were most noticeable in the
cervical and upper dorsal portion. The periphery of the cord
was encircled by a connective-tissue ring; the neuroglia was
thickened and filled with nuclei : in the gray substance, particu-
larly in the posterior horns, there were numerous greatly en-
larged blood-vessels, and the nerve processes seemed short and
broken. The central canal was encroached upon by numerous
nuclei. The ganglionic cells Actonel 75 Mg Discontinued were fairly well preserved. In the
spinal roots several atrophied fibers existed. The vagus, median,
and external tibial presented prominent alterations, consisting of
atrophy of several of the nerve bundles, with increase of the
connective interstitial tissue and of alterations in the capillary
vessels. In the cervical ganglion examined the atrophy of the
cellular elements was quite well marked ; the blood-vessels
showed marvelous examples of miliary aneurysms : the intersti-
tial connective tissue was abundant. The muscular fibers of the
peronei did not appear much altered, but those taken from the
biceps appeared atrophied and excessively pigmented. The
fibers were thin and broken down, the perimysium thickened
and filled with nuclei and other evidences of degeneration (myo-
sitis).
The histological examination proves, before anything
else, that there were prominent alterations in the central
as well as the peripheral nervous system, and in the sym-
pathetic as well as in the muscles. The most prominent
lesions were those affecting the blood-vessels; but, at the
same time, groups of nervous elements were also altered,
principally in the gray substance around the fourth ventri-
cle and in the gray matter of the spinal cord in its upper
portions. The white substance was not entirely spared, but
it appeared much less affected. The alterations in the
sympathetic system were very conspicuous, while in the
cerebrum and cerebellum the changes were not so conspicu-
ous ; they were intensified in the pons and medulla and de-
creasing as we passed into and down the spinal cord.
From this point the paper is concerned with a justifica-
tion of his interpretation of the lesions found, and the de-
pendence of the symptoms upon them.
He believes that greatest stress should be laid on the
vascular changes.
He says later that he truly believes the pathogenesis of
shaking palsy is the alteration of the capillary vessels and
the small arterioles, and this is followed by secondary
changes of a degenerative nature in surrounding parenchy-
matous cells.
Herterich. — Female, aged sixty-six ; duration, ten years.
Disease followed typhoid ; autopsy not made till thirty-six
hours after death. It was noted that at the time of her death
the temperature gradually rose from 37° to 40"4° 0. She had
some disturbances of speech and dysphagia at this time. Eight
hours after death the temperature was 39° C. There was a
very strong rigor mortis. At the upper end of the cervical
cord there was seen a heteropia (?) of the gray matter; in the
cervical cord there was a yellowish spot of fatty degeneration
in the left anterior horn ; lower down in the cervical swelling
some degeneration of the left lateral column and intermediate
gray matter wiis noticed ; lower down still were slight traces
of sclerosis in the left anterior and right posterior columns. In
the lumbar cord the gray matter at the periphery of the anterior

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