CIHM Microfiche Series (l\Aonograplis) ICIVIH Collection de microfiches (monographies) I Ell Canadian Instituta for Hiatorical Microraproductiona / Inatitut Canadian da microraproductiona hiatoriquaa 1996 Technical and Bibliographic Notes / Notes technique et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming are checl ( i I A ' ( I ROO! i A.tJ THE UNIVEBSITT OP CHICAGO The Decennial Publications A DESCRIPTION OF THE BRAINS ANl) SPINAL CORDS OF TWO JiROTHERS DEAD OF HEREDITARY ATAXIA CASES -^"'J^^ND XX OF THE SEBIE3 IN THE FAMILY DESCRIBED BV DB SA.XOER BROttN. WITH A CLIXICAI, INTRODUCTION BY DR. SANGER BROWN LEWELLYS F. BARKER AND HKAD O* TRH DKPABTMKNT np A PRINTED FROM VOLUIIE X CHICAGO THE UNIVEKSITY OP CHICAGO PRESS 1903 Copyright tsos BT THE UNITXR8ITT OF CHICAQO PWNTED SKPTEHBER 1. IOCS rsPOT A I)ES( RinrON OF THK BRAINS AND SPINAL fORDS OK TWO ItROTHERS DKAI) OF HEKEDI'I AHY ATAXIA CASEH \V\'i AND .XX OF THE SERrKS IX THR FAMILY DFSCHinEI) IIV nil SANOEK SHOWS. WITH A CLINICAL INTlioDltTION DY DR. .SANGER fillUWN LiiriLLii F. Ba«K£» of Pnfl,ol,w .n .I„hn» H„,,kin. t'„iv,.r»ilj, .1,,, kindly turno.! it over to m: I ,.i,l, to o,pr„„, my thnnk, to 1k„1, lhe«. r..,,,!™,. , for th. op,„ri„..i,y they lmv„ Riven „„ of »lu,l,-,nK Iho imlh..loKi,„l -hang™ in . di«.«„. ho rnrely nut n-itl, .^'•"/''"'■"■''"'"'■'''"'"""'omical finding, will l«,,r«,.,l...il,y a Clinical Intro- duction by Dr. Saugir Brown. CLINICAL INTBODtCTION IIV DR. SANtiFK BROWN A« an intro,ln<.>.on to Dr. Lewellya BarkerV Anatomieal Report, and f„r the pnrpore of (acd.tat.ng correct deductiona therefrom, ,» weK «a for the convenience , f tho». ,„tere,ted who either have not read or do not now distinctly rem™,l»rnrv .Mni- cal reiH.rt of the aeriea flrat publiahed in 1M12 in y?„„„ and in the .Vor/A .l™cr,„,» Pr„vl,U■ HeilllI„TV„ \TA.1* / (InnintiHtrnltil. tint in wtiiif lnHtni....... ,. /„m ■ ■ •■ " "•<"• '"" '" » '''» "M'mtln or jfnni piIitiiIh i„ ||ir II .ilizss I mm 'V ilEREDITAKy ATVXV move.enU„f ,„o head, .„d „«e„ „, „. .™„ .cco.pan.liihlS^r 360 LEwiiiiis K. Baoii TOnl. Tli.« lrn.K,,l„, mov..»„.„l. .»-..„r l„ IhH l,n,„l.. I,«., ,„ |,.,„,, ,,,„„,,„, „ ,. .■ffort. M„v,.m,.„l ,...„».. „« .,,„,, Th,. ,,„l«..r„l.. n.Sj l/ ,,„.„.„?,"■"*„ •Uiraii.wl iiiw, „r niiiy k. iiurnmr "" r.ii«.,i t„ 1 1. In u-7«"'ffi~^^^!^::;'Si-^ - - u.. ,..„u„e™.,n,.„... , '„„.,:° , ^t'S^;:^:;:; ^,;:- «^..«.- .i...Vi(.rTn,nmijr.7sf.nr.T-R.-;;„ av^^j^^j:,:! ;"r;i'i wm llu»,l> .,„■,.., Hum., ,l„.->K.rv„„,r„,,h,-i wh..., tl.U la.l.T i, ,.,.,n,,k.„. «, ,„„ -^ ,';,".!;:""""'■"" '■■"--."—>■ !»• -u„,i..,„ „..,.„„„ „„., ,...„„:, „,;j„;2 thrlr j: „g into ,),„ l,r,.,„, ,„,, „„„„i^ ,„||„wi„g i. i„ „„ „„, :,i,„,'„|, :'"'""'° """i' ' > • ^ I 'l'ilm Ua arajligli.to fc"t J^,itiv,.|y, ,(r,v|,..l, ll,i»„nii.toni •P »■«„,« o„ , in „,.,™ e».e, w...... «,„„..n„,„, p,t;.^n tlf,. l,.K«c,.., „, 1 ; Z va^ojlUte u, 1 „j,l,,c ,ju a,,, bm tluT,. .. , n..ried tendency to ^..-Ulion • .l,e« "Tl,cr..i8„ev,.r,H,rnl,tic club-foot, nor any other deformity ,.x.e, „ rnrdv permanent »,».,ie ,,,„,r..,iona of the !.«, in advanced ca... In n„nc of' I. s^ have the paMenl. cvr auffercKi from rbcnnmli.m, »o far „« I can learn I wi»l, to re|»at that tl.e above aummary of the svmpt..n,ntnl„sy of hereditary .taxy .a on y .amended to apply to this ,«rticular ^-riea" ,.f' caae. ; ' ,, J IJ^fZl p.^a.....ed.t,nth..way«, that it might k, the n.ore eaaily compar^.d with oXr Dr Bart!" ""^ ?'"'-° f""" "^ "*''"'' ^^' "" "^^^"^ "o"' "' ""^' "'■««' "P"" '^W.^h Dr. Barker a anatomical re,x,rti, founded, indicating any omiaaiona or addHiona by il«lf, the note, may appear aomewhat unneceaaarily full an,l eirc^umatanlial. In 6 Descsiption of B»ais aku Simnai Oobd in Hebeditabv Ataxia extenuation I beg to Btnerhap8, exploring a new territory and naturally wished to establish the elinical landmarks as firmly as poasible. To this end, with the kind co-operation of the family physician, Dr. R. L. .lames, I presented (happily) the two identical cases now under discussion in person before the Neuro'ogical Section of the American Medical Asstx-iation at the 1SS12 meeting, in Di'troit, where they were seen by some of the test, known represen- tative neurologists of this country and by Dr. James Taylor, of London. clinical notes op case XVIII. made in may. 1891 A business man, thirty, single, of lemperato habits, g,»d family history, except thai his mother became ataxic at nlKrat thirtythiee, the disease preijressing steadily until »he die unsteady when he I. . led against then, that they could not well go on with their work; and ho further distinctly reimmlHirs that on a certain occasion at about this time, when in company with other young men in the country he was quite unable to Mid the large letters of an advertisement at a considerable distance though each of hla companiona could read them with comparative ease. He feels couadenl that this comparative visual defect had not always existed. I should say here that this patient has a good English education, and that his intellectual capacity is above the average, so that, notwithstanding his affliction, he would at the present time be justly regarded as a well-informed man. He feels quite certain, loo-and in this he is corrol».rated by his older relatives who have had an opportunity of observing him closely- thai at the ago of fourteen, when his voice underwent the change incident to puberty, there appe,ared a gradually increasing defect in utterance; his speech was slower and his syllables less deflnite and distinct than formerly. The ataxy has always been much more pronounced if he was fatigued, and ho now remembers that at the ago of eighteen he could not walk in a straight line when very tired. There has been some progressive loss of power in the legs from the flrsl. but this has been insigmficaul throughout in comparison with the ataxy. As already stated, the ataxy was Ural noticed in the legs and has progressed more rapidly in them than in other situations. But it has been distinct in the arms from a very early period. At no time has there been any pain or any other disturbance of sensation; neither has there been any muscular wasting, cramp, or trophic manifestations. The sphincters have not been affi^ctKl, and the patient thinks sexual power has not Ix-u more impaired than can he attnbutsd to the general decline in bodily weight and strength, which has gradually supervened in the past six yeara, the weight having fallen from 136 to 112 pounds in that period. I should have stated that a tendency to choke [strangle] while eating has all along been a troublesome symptom. 11 ht ' '"""™' y<*" P""' ™'0" •»• progressively failed, so that he could Ik-sI read in a dim Lewellts F. Babxeb THE PRESENT CONDITION Patient is considerabljr emaciated, though he eats fairly and sleepii we]]. He a of medium size and well formiKi. The .ensibility is normal ; the iiuee-jerk is gieatly eiaggerated and equal on both sidesi there is a .Ughl anUo-clonusi the skin refleses appear in the main noniial, but the cremasleno and abdominal are not strongly pronounced. There is marked ataxia in noarlv al] voluntary movementsi so that the patient can walk only when supportinl by an alteadani, and can stand only when loaning against some solid support. Closure o( the eyes docs not malenally increase his difficulty. The gait is such as would usually l» dccrilied as C'rebcllar; the patient leans rather backward against his attendant and sways from side to side and al] the time h.l3 an uncomfortable sense of insecurity, as if his head must fall backward to the ground. He elpenencea a distinct loss of power la the legs, which he thinks is even greater than could be accounted for by his general decline in bodily vigor, but the muscles a™ firm and w.ll developed. All the voluntary muscular movements aro slowly performed, and of this the patient is quite conscious. He cannot reach out his hand suddenly to seize any given object. The hand moves slowly and deviates sc^vera] inches in various directions from the direct Une that would normally be taken in such an effort. This tardiness of movement is readily noticed when the patient nuses his eyes; on being addressed, or in winking, the eyelids will rise so slowly as to bo suggestive of tempomry ptosis, but in the end they are raised too high, so that the scle- rotic IS often so much eiposed as to display au expression usually associated with some intense emotion, when in fact the patient is suffering from no emotional disturbance whatever. Though atasy in the muscles that move the tongue would lie difficult of conclusive demonstration, because the normal movements could hardly be definitely described (and the same might be said of the muscles that move the lips), yet a careful observer would see at a glance that the movement of both tougue and lips (especially the former in this case, because a full beard is worn) were far wider in range than usual. There is no difficulty in swallowing, eicepting the tendency to choke already noticed, which might be explaiuid by ataxy and tardiness of the muscOes concerned, because no extraordinary effort has to be made, and there is no tendency for uqmds to pass out through the nose. There is a marked inco-oidination of the various muscles of facial expression, which is easily observed when the changes are going on incident to the discussion of an absorbing topic, the action being more marked now in this group of muscles aud now in that, so that people casually meetmg the patient frequently get the impression that there is some mental defect. There is no spontaneous movement during sleep or waking repose, but a comparatively allphl voluntary movement gives rise to very extensive and peculiar movements in muscles far removed from those required for the execution of the act. For instanc-, when the patient puts out his hand to take a book from a table beside which he may be sitting, the whole upper part of the body goes through a series of irregular movements highly suggestive of chorea. This is particularly the case with the head, which is somewhat inclined forward, moved from side to side, and the chin is protruded; and there is often an associated movement of the other hand. In none of these movements is there ever anything approaching a jerk. oculist's bepobt.' Patient states that tor ten years past he has suffered from some gradual impairment of vision and has had double vision al limes, of not more than a few days' duration, but not for ...LT'il.'l.'"!''^ i""." "'"""J"" »«">tl>o'o»«U» .»d XX) w.™ mtat.1, ...mlnrf br Dr. r.», Wo«l. P„> mology In th« Woman-* MBdiosl Oollwt... whoso reports I School in thu cltr. •« -"uicw herewith sppand. And two of tholeiie ndvuuHsi eues (XIX 8 Desobiptiok of Bbaik akd Spinal Cobd is Hebeditaby Ataiia urneml yrars past. EsaminatioD ahows marked plonis when Iho paliont ia at rest, but by an i/ITort he am niiso the lids, ahiming scleiolio nlxive the cornea when the ujea are dintteil "in a honzontnl piano. There i» pcrfret co-ordination of the ocukr ninsresent year, all the Bj-mploms originally cunmerated having greatly advanced and no new ones having been added. A son of Case XVI has well-marked symptoms of the disease, which first appeared nl the age of eighteen, five years before I examined him last year. Many thanks are due Dr. R. L. James, of Blue Island, 111. ; the family of b,m™t„„t ifvn.. «xte«l,„K between heBjn.» tm„t„li» ,„p.ri,.r „„d the gyn,. .^ntmli, nnterior. At fte j ,„Tn /'flr»mrffa!i..-A tran,ver«, .ulcu,,2cm. long, .ituated a little anterior to the upper part of the pars superior and parallel to it. It gi.m off a ramus Mgitlali, p^terior. 2en,. long cenlrali.. No part of the .olcn, prajcentrali, reaches the medial margin ot the hemisphere Shlccs racTALls l»rtElo..-Il begins behind in the pars inferior of the sulc,,, pm^-ntm- hs,toB.tendtorw„r,if„radi,tanceof 2.4cm., to ix, intermp.,,1 there by a snperlidal anLtanl gjnrs exlendrng from the par, triangularis of the gjrus fn,„tan, inferior to he gyru., sZlZ inedms. I anastotnoses below with the sulcus in the posterior part of the pars trianKnkn' (fahs, antenor .»e„d,ng ramus of the Sylvian fissure). At its t..mJnation behind the anrt m gyrus , enfoned, it turn, upward to anastomose with one of the segments of the sulcus fronta- lis med,u.s In front ot the anuectanl gyn,» Is a transversal sulcus 2 cm. long, th low^rt of which Insects the pars triangularis. This is pral„bly to 1« regard,^ as the sulcus radiZ, of El«rstaUer. Running sagittally forward from its middle and curving around thrgy us between it and the upper extremity of the ramus horizontalis of the Sylvian Assure is a sulciL which ends m front in another obliquely plac«l transversal siUcus, which is to be regar^^ " tho lateral segment of the sulcus fronlomarglnalis of Wernicke Bumeu as ™ .^"•■";" •■•f"'-" »"':«'"»--n tegins behind in a pars superior, 2.Scm. from the media] margin of the hemispher;-. It passe, forward for 8J)cm., wher. it is cross,,! almost ^^hi angles by a transversal sulcus connect.^ with the complex of the sulcus frontalis melius nie sulcu, here make, a slight jog lateralward and is continued for 2cm. farther forward, n'hen it turns sharply mc^ialward to end 1.4 cm. from the m^nilal margin of the hemisphen,. In Iron" o v±rT ,"'"' "'° °'«"""','"'"" ""'""'"" '™'°™'(>'i"«li».«- l»o Li, oriels. n,ns- versally placed compensatory sulci. At the point where it turns medialward, the sulcus fronta- medT"' ''°*'*°°"^'' "■'"' ° ''^«™"i'' ™l«« "kich is one «,gment of the sulcus frontalis .!,• .'*'^"-™' ™™"'-" ■«:i.n:s.-In»tead of the lypicil sagittal sulcas, so frcjuently met with, this hemisphere shows two transver«.lly placed sulci, a sulcus tmusversus frontalis posterio and a sulcus Iransversus frontalis anterior such as Teuchini and Mingazzini describj^ The former anastomose, above with the sulcus frontalis superior and ends iXv close to the sulcus frontalis mfenor, the latter anastomoses above with the sulcus fixjulalis superior, sends a short antenor .apt a ramus into one of the compensatory sulci in front of the sulcus frontalis upenor, and lateralward b fiu-cates. The supc™ limb of bifurcation runs backward l.eZd he gyn« frontalis mcdio-mferior to anastomos, with the r .- frontalis inferioi, the anterior limb terminating in the gyrus frontalis medias. ante/'' '' "."','"'":7." '' °' ">" "'^•'^"'"O'^" 'jpe, th,, .ng no .subdivision into par, antenor, pa^ intermednis, and pai-s posterior. It begin, in front bi.low the genu corporis calL the gyrus fomicatns intervening, but it d,»s not mich as far as the "carrefour" of Broca It runs more or less paraUel to the corpus «,llosum, and leaves evervwhers between it and that structure a brmd gyrus cinguli. Behind the lobulus parac-ntralis it curve, upward to the margin of the hemisphere and cut, into the fades convexa for a distance of 1.2 cm It gives oil two deep radial rami into the medial surface of the gyrus frontalis superior^ one, a li'tle behmd the level of the sulcus fronto-marginalis, reaches the medial mai^in of the hemisphere and extends for a few mm. upon the fades convexa; the other, 1.5 cm. in front of the level of the pars superior of the sulcus pra«eutralis, just reache, the medial margin of the hemisphere. 367 12 Debobiptki-i of Bbai» and Simsal Coku in Hebeuitabv Ataxia «itiint(Hl in thflparnnperculiLrirtof thegjnu Si-i^cs ni.rAtTOBiin.- It ia nituBled enlirelj upon Uw orbital nurfuco and praKnln no uniuunl fentiinti. St'Lci o»BiT»i.E».~Thommu»lalornll«nn(rtiimu»intennediu«iiret«olonK, dwp furro.™ nmninir nearly parallel to coih other throughout nlmo«t the entire extent of the orliilal .urfai-e. Ihe Biilcua orbitall. tranavemiA i, Inlermph-d i,y them behind. In front of their anioriiir extremitie. 19 a ciirrd trnnsvenuil eomiiennatory wleiis •itiiati'd jii.t at tlio margin of the orbital iurfaee. Tho ramua medUli. is but feeljly develop.Hl. The medial part of the »,ilcu» orbitalia trannrenus la deep. AooEaaoRT si-lci or LOBca kontalis: 1. SitlcU8diagonaUaoperculu—l.H cm. loiiff; (rontalia inferior. It forms no auaatomoaes. i.SHlcmfronto-maroim,li,of We «.•.(,..- It iaentirely K-parat.xl from »..Kmenl. of the ■ulcus frontalis m«lm». and is rppreaente.1 , ,, y-«hap.^ .ulcus complex, tho stem of the * being directed baekwaid into the gyrus frontalis mi^lius. The medial limb of the Y mas almost transversally toward the medial margin of the hemisphen-. and n™r it undergoes tripar- tite .uxliviston The Intend limb of tho V passes Migittally forward and also divid™ Into three parts, the luiddle linnich cutting into the orbital surface. The nimt lateral segment of the aulciia baa bi^-n deacriM along with the sulcus frontalis inferior of tho sulcus radiatus. . Siii<-ii«/,-oi.ta/i».„«(;n(i«.^Thi8«ulcushastnowll-markedsagittal segments. The mote posterior, 1.7 cm. long, ends anteriorly in a transversal piece 1.5 cm. Ion,-. The more antenor ai-gment is 2 cm. in U'ligth, and gives off a short medial and a short latend ramus. In front of It, bettveen it and the sulcus trnnsversus frontalis anterior of tho sulcus frontalis medius, 18 a short compensatory transversal .ulcus. The ramus posterior of the p,irs niedialia of the sulcus prwcentralia is almost in a line with the sagittal «igmenl of the sulcus fionlali. medius. 4. S„;™« mslmm.^A deep, Kellmarked sulcus running for some distance parallel to he anterior part of the sulcus cinguli. It then turns forward and nins to the medial margin of he hemisphere, to an.^stoina«e there with one of the branches of the tripartite aubdivisiona of the medial segment of the sulcus frontomargimilia. There is no sulcus lostralis inferior. lietween the two radiating rami of the sulcus cinituU is a long, deep, sagittal sulcus on the medial surface of the gyms frontalis superior. It gives off a number of short rami into the substance of the gyrus. i?-LCfs PA»ACE.VTaAus.- About the middle of the lobus paracentralis a vertical ramus from the sulcus cinguli cuts into the substance foradistanceof I..'; cm. In front of thia there is a J-shaped depression and behind it a V-shaped depression in the siu-face. SCLCCS INTt IPAKILTALIS: I. Sukm pmlcenlmlts.- This sulcus is divided into three segments : (a) a pars inferior, (i>) a para mtermedms, (c) a pars superior. The jwrs inferior is an oblique segment 2.B cm. long, cutting into the gyrus supramar- ginalis above, and slightly into the gyrus centralis posterior billow. Near its lower extremity it anastomoses with the well-marked sulcus suhcenlralis posterior of Marchand Thepors .nfermerfius 8.3 cm. long, runs almost parallel to the sulcus centralis. It is imitedljelow by a gyrus connecting the gyrus supramarginalis with the gyrus centralis pos- terior. Above, It cuts mto the gyrus centralis posterior, and a little above its middle it anasto- moses with, or gives rise to, the sulcus interpanetalia proprius. The par> superior is curved some .. hat Uke the letter s. Its medial extremity is situnted behind the mcisura sulci cinguli -nd leaches to within 0.7 cm. of the margin of the hemisphere. The sulcus IS markedly convex 'orwaid about its middle. Just low thia convexity, a short LEWEiLva F. Baiiiei ja fritnillii pmlerlor, eoniiw;!. IW inn iiiip,rior with the naglttnl Hulcufl, cutting ncroHn the Kjnw c upper part of the mileiw centnlu. 2. ««(,„. iul,r,Hin,lali. ,,mprii„. It l^-Rin, , little nboTe the raigir™off(n)ar«mu»which runs into the gyrus .upramarginali, to end blindly in that gym. and (6) a ramii. which extend, into the gyru. angularis, p,„«, through it running 'i^^or"™ iutenncdiin. primus, to «na,tomo«, with the sulcu. teml^rZ inten!';rie[l'r''^7'"''''';^''"°'^r''*'-~.'''""'''"'^*''""''^'™™'''°'^^ "' "» -l"^^'" cuttrih r *" ZT^ " ".""""' "■" '"'^'°° "' "'° «»"""' p"*io,x.«pi.„ii, which wHhiro.™ Mr"""T- ."■""■"""'"'"'-ityo' Ibe anterior limb of ,1.,, u reaches ,„ M^^t lli ; T*^" "» •"■ '""""'''''"O- P"'" "-e latter extremity of thi, limb a n„„u, extremity of the sulcu, inlerpanetnlis propriu,." The po,lerior limb of the u bifurcati., a, it approach™ the margm of the hemisphere. It form, no ana,tom.»i, with the sulcu. occi- pitalis tnin^verHUs. Scurs PiaiEWLis srpERioa.-Thi. sulcu, run, nearly tnnsver«dlv on th.- fiici™ convexn being .ituaW W»i«,n the anterior limb of the u of the sulcus pa«,-c'ipit,di, l,.hiiid and the rnmu, m«liah, of the sulcu, interparielali, propriu, in front. It. kteral extremitv i. cum,! a httlc for-vard. Mcd,Ml„„rd it run, to the margin ot the hemiapheie and ana,tom<^» with sulci on the surface of the pra-cuneus. „.„, ^'"^r »"■■*«""■•■»■ -This sulcus i. reprmentcl by two segment.. The anterior seg- ment anas omo«,. m front with the sulcus cingnli and behind turn, up and anastomose, with a lertical .ulcu, pra-cunei. The posterior segment is shallow and im-gular. It i, limited Ixiind by a gym. which connects the posterior part of the pm-cuneu. with the gvru, cinguli SCLCI p».ECf.vEl.^Theprwcuncu,pn«eutathre. ilci one anterior vertical sulcus and two antero-postenor sulci. The anterior vertical sul. anastomo^., K-low with the anterior segment of the sulcus .ubpanetali, ; it ran. backwar m' upward to the margin of the hemi- sphere to form a superficial ana,tomosi. with the ramus mediall. of the .ulcus interparietali, proprius. fhe two anteroposterior .ulci divide the part of the pr««uneu, behind the vertical anlelre L r '",!!' If' '^."^ '^'' fP""^' aute».po,terior sulca, ana.stomo«,s at it, anlenor extremity with the .ulcus panetali. superior which i, continued upon the medial snr- race oi the nemisphere. with f ''"* ■•"aiETOi^iPi^u.,.- Distance from medial margin of hemisphere to anastomosis wi h fl.,nra oleanna, 3cm.: extent upon facie, convexa, 2.2cm. On the m«lial .surface near its upper part it anastomoses with the upper anterior-posterior surface of the priecuneus This corresponds to an ana.tomoei, »-ith a sulcus on the .uperiicies posterior lobi parietali. of the brother . brain. This brain ha, Ix.™ hardened in MMler', Huid, and the li.sura cinnot be opened so as to permit of the examination of the posterior surface of the parietal lobe. FiSSCRA CALCABINA: Lenffth of truncus 3.5 cm Length of fissura propria 3.3 cm! 3S9 14 Dbiioipviox or B»ai» and Bpikal Co»d in Heieditabv Atama I «iia»lo,nn.,., l,.hin.I with a .uluu. which piu,«-, downward, cultlnK oBf a i^irlioii which othiTww, «„iiM l„ part o( the gvnw llnfc. .all« h..lmt.|i It niiil the puliu ottipitnli«. Sita-t occirETALM mAwvEMcA. - AUivo, It Ix'giiiA 4 iiii,,. l»hlnd tho p<»t.Tiiir lljiili of the •iiloiiA piimre.plUill., but l, coiiipfetely «.i«iratod from It. It pa«™s tnin»v..r™llj dnwuwiird and a littio Imckwiinl to Biia«tiimi»«) witha i.uk-ii» running at right angli.» to It. S,ur ocapiTAiM icpiaioiu. -Thu .urface I, raarkwl by .light deprumlon. : th.T.. nns no donnitf Hulci. SiLii occipiTAi-n LATERALS. - Thpro i» ouo lateral .ulcu«, running from a point jui.! above thi- polu. mxipllalia forwa.,1 and dowuwanl to the Inferior mirfaii, of the h.mi»i>hi.n., IhiTO to form th.- |K«tim.tat.Tal limb of th.. H»haped >ulcua comply. Behind tho 1ow,t part of the sulcus ivc-ipilahs IransversuA a short >ulciw ruiH Imckwanl and downwanl (almoKt at right angles ti, tho coiu^w of the sulcus occipitalis trausversus). Siu;iaTE»po»Ai.»!i-PEMoB.-It begins in front and a little below the polus emporali. and runs backward. The gjrus temporalis suix-rior is very nan„w, aveniging less th.,n 1 cm. In thickni,.. The sulcus curves downward in Its p,wterior part, owing to the ramus posterior descenden, of tho Sylvian assure. Behind this tfgi. u it agiiin runs backward tor a distance of i cm. and then turns sharply upwanl, curve, a little forw ird and ends by a.i-stomo«ing above wi h tho sulcus intorparielalis. In this part of its course, tho sulcus runs alm^ «t parallel to tho sulcus lnt<'rmodius primus of Jensen, and between the two is a transvemally placed gyrus, cut off fmm the anterior portion of the gyrus a-'gularis. Sfuvs TEkpoBALis HEDics. -The bmiu has b.«n a long time in MttUors Juid and h.i« become bnttlo Portions of the surface in the region of the seVus temporalis mediim have been broken off, and the detaiU with 'ogard to tbhi sulcus ate obscun.d. It appears to ran sagiltally iMckward for a distance of about 8 cm. and then to be Interrupted. Tho sulci in the lobidus panelidia Inferior ate well preserved, as are those in tho posterior portion of the |. •unoral lol» The arrangement U peculiar. Behind the terminal part of the sulcus tem|ioraliH aperior and lielow the sulcus interpariolalis and in front of the .ulcus occipitalis transversus is a hirge more or less triangular atea of brain surface. Within it is a Vshaiwl sulcus comtjoi the stem of the V (below) corresponding in all probabUity to a segment of tho sulcus temporalis medras (Elierstaller), i. «., to Wernicke's sulcus occipitalis anterior. The anterior limb of the V corresponds to the continuation of the stem and represents the sulcus about the eitremily of which the gyrus angularis winds. The posterior lunb of the V is tho sulcus about which the lobulns panetahs posterior Inferior Is situated. Cutting into the middle of the area from .ibove IS a short di^ndmg ramus from tho sulcus paroccipitalis. This apiran. to be tho representa- tive of Eberstallor's sulcus intermodius secundus, as it separates the gyrus angularis in front liom the lobulus parictalis posterior inferior behind. Sulcus texporal.s i-ipEEioa.- It begins in front 2.4 cm. behind the polus temporalis, is s shallow sulcus and is interrapted by a gyrus which connects the gyrus temporalis inferior with the gyrus fusiformis. Behind, a segment runs on the inferior surface for a distance of 4 cm ■ opposite, about the middle of this segment, is the incisara formeriv callwl the incisura pne- oocipitaha. It leads into an H-shaped sulcus complex in tho lower part of tho temporal lobe Tlie posterior superior limb of this complei passes upward and anastom .ses with a sagittal' sulcus which runs forward fl«m the lower end of the sulcus occipitalis trans -ersus to cut deep into the gyiustempornlia modius. Fissc»Acoi,LATEBAUs.-It bogius closo behind the flssura rhinic;, which is here only a shallow incisuxo and does not communicate with it. Its greatest convcsily medialward com- spends to tho insertion of the tip of the gyrus lingualis into tho gvrus hippocampi Around its posterior eitiemity an annectant gyrus passes from tho gyms hngualis to tho gyrus fusiformis I ■ I LewilitbP. Baiiei 15 Th« gym. llDgiiali, I. Im«ukrly xroovrf bj lhr«; .ujd. The larp,! !».«!„. „™r ll>., „,«!.. of '.,..clionot.holl,»umc«Icarina»lth II. Iranou. „p,l ni,„ dowimnnl ,m,l lm-k».ml. m»l th, n toemlwanl, l» form th. pcWrior Inf.rior llml, „l it.. H-.hiiM -ulcu. i-eimplc, n^f.™,! lo nt Uio po.t..rior pnrt of Ihe temporal l,il«.. Pu..in» out of Ihi. .ulru., anil iit rlitlit niiKln to It m two .hallow .ulcl which anutomow In front with th» pcterior part of tho Uasura colkteiali.. DEMiaPBAIiril HntlSTBCM iTtn, «. S. 1. 9, 10) FiMr«A CE>n«i LATiuua [Sti.71,]— The ramu. anterior .«»ne In part due to the ve-.jr marked development of ll," .„l,u, diuKoi.uH. whk-h cut. very deep into Ihe par. opereulari. aod the lower part of Ihe lutt. i I. driven deep Into Ihe fo.™ sylvu. SuLccscisTaALU. -The lateral eitremlty ana.lomo«« with a very well mark.»l .ulctia .utwrntrall. anterior. The latter i. 2 cm. long and make, a .uperiiml ana,tomo.i- IxOow with the nH.ure of Sylviiu). Cutting Into Iheopeteulum from lu front lu a direction at right angle, lo Ihe .ulciw .uli- centrali. anterior I. a little .uicn. which .'oe. not appear to have been hithe -to d..«ril«l It l..ltunt.^ jiwl .lelow the in«rtio" of the root of Ihe gym. fioulali. inferior into Ihe gvru. centmll. anterior. The .ulcus centrali. prewnt. about it. middle a knee projectng forward, due lo an imisura into the gyrii. centrali. poaterior from the .ulcu. poetcenlmli.. A «.eaiid .mail knee, due to a .imilar cauae, i» m-n l.r, cm. from the m«linl margin of the hemi.ph jre. The medial extremity of the .ulcu. reaches just to Ihe medial margin of Ihe hemi- .phero and does not pas. over upon the facie, medlali.. Inclination of .ulcus ceL :Bli. lo hHBUra lonaitudinali. cerebri 70- Relative length 7.7 cm. Abralute length 97 j.^ Other than that with the .ulcu. .uboentrnli. anterior, the sulcu. centrali. form, no anaalomowa. Slices PBAicESTBALu. - This present, for eiamiimtlon three portions: a par. inferior a pars superior, and a par. medialis. 1. Para in/«rior. — This form, an X-.hape<,iut 2.3 cm. .u.„.w.^h.twr.rLi':r.rr;:,/rjr.r^iz„r^^^^^^^ th» .ulcuH pMtcentrnli., The ,ulcl» cinmli in it. eoi.r™ Jvlfli . f ""'"■""" "' »M.^.. to™, the „«..„ o, .he he^jiT t JZ nl^'::;\;^ ^^j;- p«=ulf«nr. ""*™"-"-T''« '■ '"--"l ™tW, on the orhifl .urface and present, „„ one ,,„„,h,.r. ,„ ,„ ,„.„„, h„„ i.L <»ntiLuedZ.p .nn^.,Xt;;tT„ ;i'f sT'"'""' '"'■'" of the orl)itiil opereulum > «" nan Qimo«l to the hj Ivian margin ..mporah. The ,„le„, ana..omo«» . Jve wi.hVetLjT™tah:ilTcri„:, '"'"'"'"""' '"""' 362 LlWILLTK F. BaIIEI n V. Sulmn miUnttm.—Vlile tuftm. X Hulrii. frm,l„miirginnlit ( ilVimWirl. II mi»l>t» nf lhm> •rtrimnl'* - m«lliil. mlililli-, and Inl.nil (i( nhirli llio la>t lunHil In iii »lth Ih.. .ulpiw fnii ..!> liiti-rW. rh.i miilliil (/»..) iiml niiilcll.' (/»>,i »«m..iil» r..|,n«iil tl.,. liriilx ..( I«tliir™il.in ..( Ih.. mikiiK fn.iil« h hhkIIim. Tli.. imillul ..wraiil n-.uh..» t.i Ih.. iii.ilii,l iniirKiii ot Ih.. hi.nil«[ihtn-. mid lh<. iiiliMI.. i«Kiii.-nl .-sLiiih l.i wllhln O." c.f lh<. liil.ral Uihit.^l xviiu'iil. i s,flm frmilnU- >u..(/,i/i«. Thin. iin. no ..iiKlllul i«i[nii.nt» wlinli'ViT tu tli.i >ulcu». iDHtfnd, IhiTp .iri. fiv». otillqiit'Iy tmnHViT^nl w>nnpiil». -.. .S»;, ,„ r.«(,n;,-,.-Thl« Ik wll .l,.,..j„,„l. It 1,.^„, l,.hi„,l |„ Bm<.u',. ™m.f,.iir nral [olltm. n ciuir«( iii-nrly poniil..) to Ihn lii;nKlii of Uii. b.iiii»i,l,.,n.. t.-niiluiiliiiK iiluv,. »l (Ir. m.^lluj iiinrKlii. i mm. U'hinil Iho huhIIiiI lliiili i.t Iho mili'iu (niiihimurKlniiUa. Il..l.,»- Ih.. tmiiliil |>iln niii.tl»'r •iilra», n.pn-«.nlli« In oil |in.l«.l>.:itj Ih.. .iilra« fmnt«li« Inferior. l«Kin«. |.xhinillni; for 2 i-m.. it|ioi> 11,.. mi.rwiml uiiil lut..rul»nnl. ii.l In Ih.. iiiilcrlor i..irl o( that Kiirfiu'c. Hiu r« M«»ii»T»ALi»."Thi. LilmliM pmrncnlmli. pnwml. n u .hii|«.il huIi'iik. Thf !»«» of lh» U uii.l lln iint..ri.ir linili un- (l...|ii thi. i»j,terior limii of Ih.. U l» v.TV .hnl]o». HrUT» INTERPARILTALll.: 1. .S«l™«j«M(..|«fra/,«. Thl»con.l,l.oflhnH.«im>.nl. inf.-rlor, mio.lh.. aiM .tiperiop. Thi. infi.nor .«.((meut Uoiily 1.5 cin. 1... , and nlHmt ll« midilh. nnn.torai««.H with III., •illciu n.tt)c«'ntniIiH lniur.v(.n.uH ..f Eli..n.liin.-r. iK-hlnd it. Th.. luldille imrtion i> 4 oni. loiiif and annstoroooi. ncur lt« upper piirt «ilh Iho aulciu mlen«iri..|iin. propriiw. On,, ami n half cm. nl«ivu II. l.„n.r I it kI,i'» oH a ramiw >af{ltlalla nnliTuir which cuU deep into the gjriia ccntmli» |»,«lerior, and mu™.» a kniKj in Iho »ulcu» centralis. The »up tortuous course ImckwnnI and mi.dial,ranl. D.i,ind it foniis n «ui«rilcial anastomosis with the u d..scril„sl l,y the sulcus |Hiroii!ipilalis. Alrait nii.lwav in its course it gives oS a ramus m...lialis which nius mcdUlward ami forward lowanl lh„ nuMlial part of the sulcus poslcenlmlis. The sulcus int,Tmediu» primus of Jeii.s,.n passes lateralward from it l».twisn the gjrus supmmarginalis and the gyms angularis. 3. S,i(|.«« priroecipilalit. -This sulcus forms the usual U alionl the llssura pnrietooccipitalis of the facies convexa. The anterior limb of the U reac'' j, the m.slid martfiu ot the h,™i«phen.; Ihe posterior limb ot the u does not. The post<.rior limb of the u, tog,.|h,.r with a sulcus running Llt,.ralward from its junclion with the foot of the U, makes the sulcus occipilalhi trmnsversus. SiLixs PARIETAMS scpEnioB.— ll anastomoees at the malial margin of Ihe hemisphere with the sulcus pni^cunci. Scixcs siBPABliTALis. — This BulciM IS separated from Ihe sulcus cinguli in front bj a gyms 1.1 cm. wide cxmnecting the prii.cuoeu» with the gyrus cinguli. It curv,« Uwkwnrd and downward but is B<.parat,-<1 behind from the fissura calcarina by a gyrus which connects the pnecuneus with Ih" -'\tus cinguli. Iho .ulru. .uhp.riH.ll.. ■IWl»r.™r,?T.. L "^ ? T""' "'"''"•" '""I"-!- <"•<■"•. of pr-H-m,... .hir;iZ^ w« ,»hTh. *",""*"'" '"'"'"»•' '"•'""■I ''J •«° wtld .„W ™.„f,w,„.,u„. jx:?,^.t„";i:^^„: ■'"""» -•"'•-"'••'""• •»« .•...•»! .o,i.hi„.i„.., , FiuoM calcarina: Longth of truacui .... -, Length of HwuK propria " - i? cm' middle (.ho co'„ii„,„.,™,':Mi,7;r™';j;i"p^",„'"'i' s°:t.5-" ""t""'""" "■• therewith «.ulra.o«lpltnll,lah.n.ll. ^' ■"»'^» '<> ""tonHJM fn,„i^;"^.3r^\rrr^St;'t:;,r::e^^ la.en,l extremity „f the ..Ucu« «,„lpltall. tZ^Z ^' "' ""'™' P"""*"' «» ""> of .he'::;^;,^ iT" "™"»-'f ""^ ■- "■■« ""'"« <«l^ . .^ «„ ,h. ia.en.1 .^,^ pora'i, ,„p.rlor 1. nan^w, beVn^ 0.8 to l" m In^d.h ' ^^^ "■" ^^ "»■ tor, dt^ptiroTihir.:.™:. pj-r ° "■" '^-' '"'-"^ - ""• ■* -> "-' - »""«■ a iuperiidal aulou, connect, the .01™^^? « !^ »nd backward upon the facie, conreia; thl. !^„„. ""' """""^ '"■"P""!'' "■«)i'" -rith the .ulcu, lemporaU. Inferior in b,in/rrWl7»"rmM7a[:a'^°",.'°.:™lt^t^,r/r^^^^ -" P««" backward, THE ' EBEBELLUM (CASB XVIIl) 8M LlWILLTH F. Baiiii 19 UllHtnlnl In Fiif. ». Th. dnwlnir n. klndl; nuih lor me by mj a-ccM,; Dt. D. O. R«i«ll. The llDKuh <«t«Mli Is not «i.|l prwrnsl •od l« Khomiillrallv llliistnilMl. Thu lolxilua cculnilk tlimi«h w..|| .IrnloiKil. u out «ry Inre FI([».aiS and » wllh SliUlnK'" Flu. I a. Kniiu llio n-rttalllrab o( the nrlnr vll» there an eluht ..ir»hool.. corre-pondlnu loSllllInK'"*" tnC- ( Sllllmif . r«(, (.. ,/r(H, Wand ), while (mm the horiiontnl limb ot the arU.r viUu cuui« off the proj.«tloni. con™pondln« to Stilling'. C- to C"(HtillinK'. iiVrle !»< wdiih lla.ii/l. Then. •rould «».ra to be no nurkinl alteration In the numlier and chnnirterol the Jia„rfirti;»(e on th.. dlffennt WAndi; lhou((h iierhnpx the d<'pre«lon> Utwixn them are nilhor .halloner than mimial. The deep ■lit between the culmen nnd the d.Hllre In conllnuoiw lut..nil»»r.l with 1,,.. >ulriia which lepaniln the p,ir» anterior (rom Ibe pnm po«l<.rii>r o( Ih.. UiiiIiih .|ii».lmnKnliirl.. The (ollum termla ixinm ol (mm a terminal off.hool o( the horiiontnl |iortlon o( the arbor titn), bi rvlation to the lowermost portion o( the devlive. The tuber rennl., well developed, l« arrangiHl around one prilulpnl ■leui o( the arbor ilt«., which bKurcatea Into tv o main aubdlrUlona. Tlwpymmw, a. U usual, h« a. Ingle .lemo( arbor ril» which bl(urcale.n«ir the peripherj o( the rermis Inlcrior. «~ i- j The uvula Is large and well developed; It Mema macnwcoplcally quite normal. The nodulus la perhiip. rvlatlveljr a little .mall. Iml otherwlwj pn«nt« normal appearancea. The hemiapherea are well developed; the Individual parts show the normal ohatutxrisllo ■nacrOTCOpic arrangeirent. mcRcscnpioAi examisatics of case iviii All the ti..ue waa hardens ' ii MOIler'. Buid, and the microscopical etamlnallon hna there- Ion been praetlcaUy lim'ted to the study of Welgert pniparalioiu, and carmine specimen.. Paw lombaus (Fig. H): KBDCLLA BPIHAUa DIMmstOITB Antero-posterior diameter Ol7 cm. Tranavenw dismetsr - ■ O.Si cm! iPndtM. atileriorea it poslwiorM.-Theso are small and contain fewer fibers than normal. The connective tissue of the endoneurium is increased in amount. In the anterior roots a very large proportion of the fibers are amall. The number of large fibers appears to 1» diminiahcd. Pm malf r.— This la thickened, as In Ibe other case, measuring a. much as 0.169 mm. in thickness in phices. •^nipftial layer of neuroglia or to-called " glial iheaih." Maximum thickness opposite anterior born - 0.049 mm. Maximum tbicknsfls opposite fueicuius Isteratis • 0.8 mm. Average thickaess over funiculus posterior near medislline 0.061 mm. Average thickness over funiculus posterior near entrsnce of posterior root 0.0e3mm. Maximum thickness over Lissauer's fasciculus - - ai33mm, 366 un,c„l, p».„rio„.,. Hera thei i, toi.ZyT^ZV'^Z'''''T'''rV" ■""' "'"' " "» The defr..„,,r„ti,m i» met marM in tho midVl o nfT^ hjFkch„g an th„ •■ mi,Mlo root vm,." the »ub,ta„,ia Belati„o,H of the two . d^ Ft ttenSl d""" *'±'j'"' "' " '"'■' <•'"»■" "'""■"h root zone „„aff„.t„l, „„ lajter .endiagTwan^r't^"'''";''^' '"" '"'"■'"' ^'"''"'ff'' dor^l •he posterior media,, «,„„„ „„ e,,o^Je y^^^ZlZ '^'V'"'' '•"S^-erat.d areaand sulMtauha fcm,..,,l„,l tie white matt, r of the d^ ll , ,':*''°''™''"" ''''°""''' "'™"»' '<- th» (rreatlydin,mish«l in the liKhtomxl an J iL7 " .'^- ^hoiigh the number of flhera is ;hejl«™ disappeared. The^hteni" ,' d'e foTT''™ '" °"'-' P"*"' '>'''"''"'' '■-e al hted fiber, and to a corresponding nc,S,«l , ,„ j'^P'^''"''" °' " '"'^'™ °' «» ■"«lul- 1. well shown in Fig. U. """ """"^ha. The distribution of the lesion Profe,«,r H. H. Donaldson, who fou, d ibTT^^', , 'J!' °' ^ ^" "" kindly m,«snmi by •he gray matter 2.ISC cm.', Jhe ratio Wngl .4 "'""' ^■^"' ""' '""^ ""> "ea of Secliom sfahifd u-ith Van Gim , ' ' ' eicesslveconnectiro tissue in tLe anterior a„T^7'''"" """ "''■"' "'''""""" «'"-»"ne.-Tl,e nous, while, lib,o,« tissue stailg ?„tL,elvt ^dT'.""" °,"'' '" "" P» ™'- '' «>"»»>- fumculns posterior the ne„r,^lia t Len to 1» diff 1 '°- '."' """ '^'^"'^^■^ ^'-a in the re.1 color, single yellow m.vel,^ sheath, or ..nd,'!,";:'' T™","' "'"^ ""■■""' "' " ^^^^ "' ">- on „cc.ount of their isolation. There is a l^nd LvT";, , "'^' !" "'!;'"'"' "'"-''"^ ™' *aT'r atagd„rso-m.dialwarf from tho d„r onVilsurf^^niT "? °' ''"I'™ '''■'••■■"«"''■ "^^ pos enores. The blo,»l.vcss„l, am largerta th, '^,1 , , '"'""""h- Bri.sea o,' the comna dlsinct fibrous tissue coal, which sW^ in '^ fh%r''.r"''-' °' '''™ *■'"'' "■'''■•''■"'ly crated in tho area in which the ne'Zli" i, „ l^'' '"" "■"■" "'''* """"" "■*(?«- however, that the „„,., f,^.,, „, ,he ^ L Vsnff^lS' „™'' Z "'?: ' '>'^-' '"» ™P"-^on, liisea.s.-proce,s. " """ ""f""™ more than the coarser fil»rs from the ™pioy^ r::v'rt ota„;':;rfac;r':d"'""^ -■■-"■''»' '- -""-^- ^^ -thod, ™ll». The cenlnd canal is oblilLS rp L*S ^ '","'' '°"'""" "'"'P"*'^-' "' ""^ hforale,! ependymal cells. "^ '*"'« '"'"■'' 'V ■"> "rregular aggregation of pio- but the cir,.c.t, of the injm-y c^u ll easitv dTsTi "• ". J"' ^''' "'J"'-' """'""hat on n-moval aotm.1 changes in the li,.,ne, ^ d,st,ngu,shed, so that there is „„ doubt as to Ihe MEAHI-KEMKNT8 Antero-iKwtprior diameter Transverse diameter - - 6 mm, "S::ti:L:ttS^^""» '--- ---The s„bpi„l .::r;„yeri,ingener.l '^'z:^^'^i::z^z^T''r7 ■- "■'" '-' ^™""-."«. -n.e not so markcily a, io the root, of The lumter ner^ '" '■■'"'^^'"""l '" 'hen,, though Lewellts F. Barker 21 There are no degenerattxl areiw risible in the funiculi nnteriores. The funirali Inti-rnl™ prem-nt mnrlied alteraliona. On each side the direel cerclwllar tract of Flechwi- ia almost complotoly dcfjenerated. Only here and there can a tilir of largo cnliljer ho made out in the area corresponding to this fasiiculu«. A good many line filjen, are tisililo in thai portion of tho area immediately adjacent to the main part of the piTamidal tract, but tho»o are doubtless themselves filers of tho pyramidal tract Bliich are norn'ially miswl in with the filxTS of the dirwt cerebellar tract. This marked area of degeneration of the dinrt certW- lar tract is siluatwl as always in tho dorao-lateral portion of the funiculus. The viiitro-lateral region of the funiculus shows no distinct area of lightening, though the largo flliers of that region seem to \nt loss numerous than normal. It is therefoto proljablo that the ventro-luleral coreliellar tract of Cowers has suffered some, though the chief lesion in tho funicidi lateralea is undoubtidly an esteusive degeneration of tho dorso-lateral direct i-ercbellnr Ir.ict of Flechsig. Tho pyramidal tract is not degenerated, nor can I make out nnv alteniliou in tho fasci- culus lateralis proprius. In the funiculi ijosteriotes there are some partial degenerations ttweeQ it and tho substantia grisea of the dorsid horn. In the fa,sciculua gracilis the degenerated atrip is narrow; rather fusiform, and more medially than laterally situated. The atrip is widest and tho degeneration in it most intense about midway U'twwn tho dorsal periphery and the ventral estremitv of tho fa.sciculus. The degenerated area does not extend dorsalward as far as the posterior surface, but growing grailu- ally less distinct, ti'rminates at some distance from this. Ventralward tho strip fuses laterally on each side with the degenerated atrip in the fasciculus cuneatus. It will be noticed that the description of this degeneration corresponds very closely in a negative way to Trepinski's description in a positive way of his third foetal system In th.> thoracic portion of the cord. (Cf. Fig. 290, p. m, of my lx>ok on TAe AVitom SyMem.) It also reminds one forcibly of Fli'chsig's description of tho degeneration in a case of lueipieut tal»>s in the upper portion of the thoracic cord, described by him in the XitumUtgischea Crntralblall for 1890. Lissauer's fascicidi are intact on both aides. Thi'so specimens reveal further im|X)rtant alterations in the white Uliera which enter the gray matter of the cord. Thus, while Waldeyer's nucleua of the dor.sal horn still slnius black aud is rich in fine medullalod libers, the nucleus dorsalia on each aide is almost entirely devoid of them. Tliere is a marked contrast betwren the nucleus dorsalU of this case and that of tho case to be sulm^uently doscrilied, where many of the fine medullated fibers of Clarke nucleua are still relainwl. The Bubatantia gelatinosa is still crossed with many radiating bauds of fine black fillers, and medullated fibers pass forward towanl the anterior horns of gray matter. Sirtloiiit slaiiird trilh fun (litnon'a melhud and nith Schmam's vramiim carmine.— Siiecuiions ataiuMl by these methods demonstrate very beautifully tho pmliferation of tho nou- rogha in the areuaof partial degeneration in the dorsal funicidi. In the place of tho fibers which . ^M.ABx AT AXIA too, a, m the pnr, lumhali,, there " " ™d™o , .T""' """ '" """ f"*™"™ frraoili. Hen Pass cebvicaus (iNTUMEscExm) (Fig. 42): DiMEitgioira Antero-poBterior diameter . Transverse diameter - ' " " " 8-Smm. dec.a»e of "hite'Xr'^fTetrrJr ""'',r''*^^*"'''«''' ""•"■■"-» -™.-- -The -.ble^ Therearefewerner.ecelUta.h™!;"^"'"^;" ""■ '"'"'^ """'riore, ™ dWiif, Lewellyr F. Basiek 23 Is endenl macroscopically. The length ot the poii» in the ventral middle line i, 2.2 en., tran,- ver!«) distance bet»e..n nervi trigemini of l»o side, 8cm., maximal thickn™» 2.6cm. The depro.,ion between the pyramis and the oliva i» more marM than usual. The lower part of the medulla hn« b.,,n InjunHl on iKmoval of the brain, .so that the nucleus funiculi cmeati and the nucleus funicuhgracUw cannot to examiu«l ccept in their up,K.r parts; ther.', however, they are smaller than nonnal , the bulk of the uppi-r part ot the nuclei funiculi cuneati is cTlainly d.mm„hed. There ,s slight thinning of fib..r, in the stratum interolivare lemnisci and also higher up m the lemniscus mclialis. The pyramids are well developed and stain noriually. The nuclei arcuatl are small. The layer of gray mailer of the nucleus olivaris inferior looks hmnor than normal and the numterotcell, present in it somewhat reduced. The fibrie olivoK.-,.re- belare, are leas prominent than normal, as are also the fibne arcuate, Mlernw. The conms ri-sliformo IS rather smaller than normal, and shows a thinning of fil».rs with nelwork-lik- increase of neuroglia. The nuclei nervi hypoglossi are sm.lller than normal, and conlaiu correspondingly fewer cells. Tbo nucleus on one side c-outains fewer cells than that on the other The Inictu, solitarii are present, and show no recognizable alterations. The tnictus spinalis nervi trigemiai l™ks normal. The lateral region of the formiitio reticularis and the nuclei lalerales are much less develope■ "">'« d.™lop. «-p«raM t™ ,he m.^i„| e.tLily „r LVSm' J T"?,' >«*""'- »■"' 1"™1 mn,;. i, only 0.4 „™, in thk.k„w,, p,„.i 1,„A vard fram .rr.K ™"", ""■■""""• ''^ " "»™'' ^^1* l.r> cm. I, a ,vell-,iinrk,-d brancl. (ramii, ,^M'ii . ?^ «'nlruli» anlerior for a distance of -dcu., ,„„ead „f ,,, „ part of ,he »uie^ pn^J,^^ ''^1° '"' r**"""^ "" " '""■' "' "'" '""<" pne>^„tn,ii., „„K.ri„r a„d ,he „,lc™ fmS^^irfl''."'"'™'"-"'""'" '""""' ',y the. „le„, crucjfonn tvpe " .hfch t„, frc„e„«^^„" j^^S " '"' ■""■-"y *--«' example of the «^^.«.if ™r i:;'„s■;rs^'::^^^x;:^-^ co„.e„ce, „„ ^-t;:5e:^i;'S^-;--;S°:^^^ bitureate, ou the n„^ial mawn of the hemf.„h "^'"'"^ '"■• » dWance of I.4cm., .here il 0..e of ,he„ „,„., f„„,„j „I™^°LXr',;" '°. '°™ ")■<> »«5''".v curved t.™inai fZ^' ht™,lw„rd for the «„me distant, ,o te™ina e in Z^t ? t'"™'" "' '' ™'' "» <>""S^. ""ir:rrt:;!rr''i'^"^^ '"''"""'"" '"'"'" j^». .jn.s 0., cm. b™.d::rh"--'it"vr.Tat*:i^^^^^ --^ » -'»'«*' «-- ^Ith the gjn,, f„„,„|i, ^^^.^ grn« erident]?" ',''° ^^"'' '">"'"''" '-"'"or Tnfrn,n,ulu„g. The!x»teHorp„rlofthe^cnr.„,ltL r. '" ^l^^talW, ^Mer, he gyrus prapcenlndis, extends, lorlnnn.;, u "„ forX ° ^ ^ "^'f "''"■ """ <»" ''"'"ior of .les m a transversal snlou, which cuts a «v , M„ Z"'" I '"7,"'"" '•""n.lwarf.andlermin- the sulcus frontali, ^,^^ „„,, ^ J the «.« tSZ, ^^" "r"""* •" "■'"■'- ''■^■•"■■of antenor hori«,„t„Ii, „t the Sj-lvian (!.„, J ^ '"»-?uh.ns to »«hin O.Scm. of the ramus dir^ted rrh:L'nr a^vt::;:? ™5^tlt'":r;rtn"" r °''''''- '■"' " the gym., franlalis medins. From a WtiL a „v„T '"y^"") "P™"! and mclialwarf into cus run, forward for a distance of cm "^riw',:^!' "i '''r'''''''''' ■>'«*' the main ™^ into the gyrus frontalis medius: it then h™, 1 ^ ^™ ,°' " '■""* ""li"' """U' "hich cut, middle of a sagittally placed ler^il: :u,^^*■*''f„*^i7' Z^ '°"'"""'«'' ^ "" '-'t exactly on the boMer of the orbital surfa™ tI , "*''• ^''» '^"" '' ^"""W almost Mem. in f^nt of the lateral extrem ,"'7;^^ ,^;„:'^™' "'^^^ ,"■« termin,d pieced' that we have here to deal with a fusion of al '" ■""««»«»■ It seems probable with l^he sulcus radiatus of taUer "'°""«"°' '"•"i"- ■>' "■= "ulcus fro„.alis'^taferi„: sulcus p^;sr^-i:;:j3;;;^^^7-'°m«,^ n.»l,al margin of the hemisphere. TheTulcr , IT !!.\'^'"' 2™. distant fmm the anlerior. I ,^„i,i Eb,^,P .^.^ thaUhis p„ w"" n , ^^ '"'o ""> ^^™ """■^i» postenor of the sulcus pr.-ecentrali,) bolon^T™?! . If "'^, '^^ '*"^''" ""> ^mus aagiltalia The main sulcus follow, a tortuou^^lw ^ '"J""" ""''''" '"•■"»"» ^-Peri"'- f^nt about 2.5cm. from the margin ^fT h":rphr1."at„Tt' ,™1- "■^':"™™'-' '" ' ™. ™.. .„ „„_. . „,„. „,„„,„,,_ ^ J^ ■"»"' tte junciron of ,ts posterior 372 Lewellvh F. Barker 27 and middle thirds It given off a rnmuii which cuts lalernlivnrd iind aliKhll; Imckminl d.i'p luto tho ([Tni» fnintnlls mediun. Bt'twiwn thin rnmm and the milcim crulnilla In an Isalnted gynw which, at first siffht, mljfht be thoiiffht to belong to the gynw frontiilln Hitperiiir,)>iit whk-h iniut lie n-gardcd as a part of the medial portion of the Kjnw fiontiilii* niedliiti, Tlie wilcnn fronta- lis superior is nowhere Interrupted by itnneetnnt gyri, nor does It form anostuuiones other than that with the sulcus ptTrcentralls. SuLCi-s raosTALis iiEDius.— This is a pronounced sagittal sulcus, nlmo^t completely divid- ing the gyrus frontalis medius Into two halves, and so estallisbing the "four-c-onvolittions" type of the frontal lobe in this hemisphere. It lieglna behind close to tho inferior jiortion of the sulcus priecentnilis, ns a shallow piece which may, in reality, rt-present a detacheti ramus aniorior of tho inferior prnsterior li:nb of the Y terminates in the pra-ceneus without reaching the margin of the hemisphere. ScLCL-s OLrACTORlus.— Deep; begins 1 cm. from the medial margin, be-hiud. Bifurcates at posterior extnmity. No anastomows. Length, 4.1 cm. Passes forward and medialward. Reaches medial margin and extenda 0.7 cm. ui«n medial siu-face. Sc[,ci-a onatTALis.— This Is of the H tyjw. The sulcus orbitaUs Irmsversus, ramus bleralis, ramus miilialis, and ramus inlermedius are all present. The ramus intormodius forms a superficial anjislomosis with the ranms laleni- lis. Running backward from the sulcus orintaUs transversus into the gyms f.ontalis inferior is a sagittal ramus. Its course Is nearly parallel to that of the medial extremity of the sulcus orbltalis transversus. AccKssoay sulci of tub toavs frontalis: 1. Sulcm diagonalia opei-cuii.— Very dcepi typical direction; extends 2.4cm, on lateral surface and 1 cm. on inferior surface of para opercularia. \o anastomoses. 2. Sitlciis rat/m/»s.— Cannot be dLstiuctly made out. If present at all, it belongs to the Bulcus-complex, composed of that part of the sulcus frontalis inferior which lies along the fiont part of the base of the pars triangularis and anastomoses farther forward with the lateral seg- ment of the sulcus frontomarginalla of Wernicke. 3. Sulcus /rontomarginatia of Wernicke.— The lateral portion (//»,) anastomoses with 373 28 J^!!f^-- ._:^B^^n^^^^^S^^ ^^^^_^ olth, .„k„. fr„,„„ll. „„„„,, ,„„ „,„ J^'J"'™ ' ""' °' ''•'"rn.tlon „f the ,„t,.ri„r p,,™!,*' Tho^yn,, t,„„.ali, .„p..ri„r i, .|ivi,,„l iJi'ZTAn'^^y'"''^"''''''''''"!'"'''- l7'""-""'«"««(n.«li„l f~nt„I.„lJ ',c,„„'r„ll'"r' ">'' ''^ ■«, «""'l.-lop,i .ufc,„ tan»n.r,u«„„,lj„i,o,.i * /• " '»(rl"« ° "■" Wr part o( the .ulcu, n»trall, .-.. fn,„.„n. .,.p,.ri„, al a pou.wSv'^wl^r.'ri'''" ",""" ""'™"' "™""'"'- '» "« bt... furcheiiretehcn Oehinii.,,." """' "'" ""■> "'"■ »» "Wiuaunleii »i„,|„„g,_ 1. ^SulciiH jmHtcfntralin ~Thi» .„i„„_ : c..» interparirfali, p^prfu,. j,, I„,e™l , "J ""I;;''"''""" °°" """' ""' """tomo*, with the ,u|. 2. S,.fc,„ inlerparielali, pm,Ju.^nT^"', ^'"^ "" ""'«'»°' K.vri i" the depth. Wera pcterior limb of the x/wh oh"ut, aol^u" JC "" '"''T'^ »"l«.»complei. The «.t nf the eomplc, by an annectanl J^, i° "^e i„.."'^^""'''"'i"'''' " ""I™"""! »«>". the oom.«pond, t„ the „ai„ co,u«, „, ihfJI^ Lpl.C .h ? .""f' "^ «^'<'"°^ """> "' "o « he lobul,,, parietal,, inferior. The medtaUatTSSnf ^K "'"' ™"'" ""P-™ h"" lateral l.r,cm. The medial poaterior limb ZTi >''"'''' ' •"» 2 cm- in leugth. the ™rd for 2cm., „he„ i. biCate^ S^^lX, "imW r.'"':"''"' "■''' ■"«''"^ "^iS paneta ,, anperior, the other limb communiraHn^^n-rii ^""'■™'""' ™" '"'" »'e lobulua aulc„,m^,janetali.(the„.canedparc«rpi;:r::fe3tS."''^ the p».erior part of the a. iiifcus jjfiroiTcijiiVofis of Wilder Tt; ™"' """OT)' of .hefad«c„„v„.„. ^^anteiritre^^^ir^^^^^^ """""^ P»™'<>-Hpitali, 0.7 m.,n front of the fl,.„ra parietoaceipLu 1,^,1, ."" ""' """*"<" "'e hemi.phere, ^. ■» °' 'he hemisphere where it app..aX.n;.„mLri^.T''''r''^ " '•'"'■"■ '™' '"" but u. examination it i» fou^id to be Tpamtod TromThJ? '" '"''"' ""pitalis transversu,, almo«t to the a, rface. '^"'"' '""" " ^^ «° ""terrupting gjru, which leache, OI'LCL'S PAR r.iLIS SCPEBIOB ■ Thn 1 anlcuapr«H,uneiuponthefacie,conve,a. Tftoa'^te„T„Mr' "["""'^'"n'taualionof the lcm.W. Ildoeanotana.lomo^withthe.ncurr^t^",',-""'^™'';"'"™^ f™"' s™P,„„,ua ,.,„ ,,„„, PaJ»r-!?h^;'™r/''''''''''^^'''«'^i°'«T»'rieWi,. ".th the pa„ posterior of the a,Ucu. cinguli Z«,b^,J"T,^"™' ° '"'•*''*"''' »n««'omo.i, P»tenora„d an inferior tertnim.! ntmua A^tZS ^f '"' ^''•■"- ■'"' bift.rcate, into a Bulcua pnecunei. ^ ""'" ^"bmd ita middle it anastomoaja with the Lbwellyh F. Babikm 29 FiMi'RA PAiiiETOoc('iPiT> *. Dinlance from tuMlinl mnrffin of bmilxpht>n> t<> point of junction with the tniiiciu of the ctttcuriui) llnMiire, S-Kcm. Tbe flnoum oxttmilii l.riciii.OQ tbe fackw conrcxa and th(>n blfiircatii Into two ohort nupirrflrial terminal rnini. Ou o|N'nluK up the flitHure from the mwliiil nurfact), the fiu|M'rficitfi poMtt-rior lo>>i pitrii'tuliii conirn Into vit>w. A t;pii!al gymn cunvl uf Eeker exiHtn. Nmr the medial txmlfrof the nurfoce u det'p tortuouH Hulciu piixwH upwiird and about Irm. from the nMHlial amiK'n of the heminphcre n-achos the facli'H miwliftllK; It then tiirni* piit(fltliil]j forwimt throiiffb the prni-iim-ufi for a iliHtnnco of ;2i-i)), and tbun tumii vprticallj upwanl 1cm. Iwbind tho kuIcuh pru'cunci to termioate nt'iir th«> nuHlial margin of tbe h<>miHpbi-n<. Tb<4 IKtrtlon of the nuperHcli-ii poNterior Inttirnl fmm the tiulcmi junt dewrilMHl U ninrked near the bottom of the fiiwura pnrictonccipitnlis by n trannvcrse Hulctu atxivu wbtch in a V-shnpod mili'Ufl. Tbe hittnal limb of thifi V correKpondt to the anterior liml» of Wfurtation of thf- flsnura imriiitooct-ipitaliM an necn from tbe facies convexa. There Ibui ari»(ii a diminutive lubuluH purietoocripitaliN in the nenHe of Relziufi at the lower end of the fissure. It come*) honertT, in the domain uf the ^ynis arcuatun ]>OHterior of the lobuluii itiirietaliH. FinnrRA caU'arina. — I^'n^'th of tnmciin, l.Hcm. The flsHure extendH S.Hcm. I>e5nnd the truncuM, termlnatinff Ix-bind O.I)cm. from the margin of the bemiaphere, where it undurgoefl a slight bifurcation. Scuts oivipitalis THANnvERsri.— It beginn 0.5 cm. liehind the fifMura parletooccipitalio and Irm. from the mt.-e]ow upward to the niiirRinof the htimiHpbere.and then turuH and nmson themetlial nurfacuof the lubus occipitalist delimiting a |H>ripheral gyniH of the cuneun. Parallel to it, and separating the apical from the middle part of the cuneu« on the medial surface, iti a second short sulcus. Si-Lfi (xciPiTALES LATEPALES.— Opposito the polus Occipitalis and nmning parallel to the mArgin of the hemisphere at a distance of I cm. from it, is a sulcus 3cm. long. Only the mf>4lial one-fourth of this is aliore the level of the flssura ctilcarina of the medial surface. Tbe rest is opposite tbe gyrus lingualis. Anastomosing with this sulcus near its upper (medial) extremity is a sulcus S^cm. long. At the jimction of its medial and anterior thirds it forms a superficial anestomosis nith the sulcus occipitalis transversus, though a det>p occipito-parictal anuectant gyrus prevents fusioa in tbe depth. Sulci tejiporales tbanstebsi.— The sulcus temporalis trnnsvers-is tertius and the sulcus temporalis transversus primus are well markeil, but as the gyms temporalis tranaversus primus and the gyrus temporalis transversus secundus are fused, the sulcus temporalis transversus secundus is a1)sent. Opposite the area of fusion there is a sulcus on the external surface of the gyrus temporalis superior which passes downward on tbe inferior surface of the gyrus and subdivides this as far as the bottom of the sulcus tempondis superior. Sdlccs temporalis scperior. — The sulcus is very di-ep and presents transverse ^yn on both its walls. Its anterior extremity stops short of the frontid polo. It is not bifurcated, nor is there any transversal sulcus in front of it. At the poiut where the sulcus turns upward liehind, it is interrupted by a superficial nnnectant gyrus temporalis medio-superior. Behind this the sulcus passes upward aud a little backward into the gyrus angularis to within 1 cm. of the sulcus interparietalis. The sulcus intermedins primus between the gyrus angularis nod the gyms supramarginalis makes a superficial anastomosis below with the anterior part of the sul- cus temporalis superior. The anterior portion of the gyrus angulons is cut across by a sulcus S7B »lllch oil«ntonxi..»n » gi flrnra ,,™,mn. Tlil. fonn* nn snide of IS' with lh« lonKn.1 nnhTo |,»t.rinr .linm.<.r ot Ih.. h.iiil.ph.n.. Till. (li.lniKv fn.tn llu rnmiM aiil-rior hciriaiutnli.. lo tbi) nuiiiu pclirlMr AwTudra. la -,a cm. Thii niniim |»i»l..rlor n«-<.ruli.ii« k"-» "IT nt iin niiKl- ttl IW iiml !• 1 « <■„, loiiK. llio mmiu |>™tirl.>r .li«.ii.li'U« im.i.im.« 1.6cin. In linxlh. Th.r».iipi».,ir» lo Iwoiilv QUO anlLtlur .ul™., 11.., riuuw anU^rior ii..-..n.l..ii.. Inil „„ cl,«....x„ti,- ..11 , ni,llii„.i,lurT miuu. aiilinor huriroulnlw imIlcatliiK the llrnllii o( Ibe |«ir» trianifiilari. i-u,. Iw maUi. out, iiilliui, ouli a few mm. hilo eliu nnlmil milialuiK'i'. ' 8iL.T. iMTaALi. I Roland.]. The ranllal ..itremllj fall. t„ „.„ch by ll.r, cm. (b.- junction of the f«ta comma „||h lb., tad... mwlkli^ not«llb.l«nrj> - ■ - - ffil' Dlstaacn in a utraliihl line ol Ihe medial end of Ihc muIcum from the frontal polo jj^ ^^^ Ditto from the occipital |Kjle KT mm Dialance in a «tr«i|ihl Iin.. of the lateral end from thi. frontal |»le m mm Ditto from the occipital pole lUmm! SCLCC? Pa.lCE!lall,r).-Thi, i. only ...perfldallT mnm.el,«1 «ilh the para miperiov, an nnu^tant gyrua paaalnR from the naaiial .'«,rli„,i „l the !«.«. of the Kyrua frontali. mcdiua to the gyna centrali, anterior, l«.|nB d,-.,te.«,l lalow the .urfac, by n .hallow .ulcn, only. The lateral extremity of the .ulc.H ia 0.« mn'i. fnnn the mar„in of the Sylvian fiK.ure, there Ix'intf no «,.,«initln(t .ulcus diagonnli. on Ihl. .ide. The nwlial e.lrem.1 y pa™™ in front ol the biternl extremity of the pari superior. Th,.n. 1. n typical anterior Mffittiil mniua (ramu. horizontals of CiumlnKham) paiiatag foi-nuitl and a little m.^lialwartl into the »ul»lance of the Bynu, frontali. mediia. and terminalinK in a lrun»ven«,l .sul.u. 0.8 mm lonir The lateral portion of the foot of the gyrus frontali. melius is ronnect,,! with the foot of the gynia frontalis inferior by an anncctnnt gynia 0.4 cm. in thicknras. The latter pavents tbe amistomosis of the .ulcus frontalis inferior with the .ulcus pnwentnills interior. The posterior Mtn.m.ly of the .ulcus frontali. inferior almost bisects Ibe angle lormid liv the sulcu. nnreen. trails infenor with it. nimua iwgittali. inferior. ' 2. i"or» aiiperior (sa/cii. imrcenlrnlia »u,Hrior of £f.er«/.iH,.r).-This Is an irnimlar miens 3em. in length. It. lateral exl«.mlty has a .hallow sagittal l,.s« 1 cm. in l,.ngth Its medial ..^tr..mity piiss... mwlialwan! and a hltle forward, and, shortly la-foro frminaling, lK.nds .haiply iKickwatd into the gyrus centralis anterior to, and 1 em. from, the mijial mt.rglu ot the hemisph.Te. The sulcus frontalis superior is continuous wilh the m.. «t..|il > rl«hl •nKte .ml ran. wKilUlljr Uckmid for 1cm. to UTmtali!wllhln0.4om.ottl».|»ic«Mll»Tiiir. Slui » rio»TAi.u wrMioi. Tl» .ulcm U mnllnuou. .upfrtlctally. II l« prmralwl Iitmi uiiillw «llh lb» iHir. Inferior o( th. .ulcu. priretotmU. b, n .uperiid.1 aniHitanl ((vru. .•xUMKltaK Ltwiin Ih- piir. op^niilnri. of lh« Kyru. froi. ili. luf.ri.». «ncl Ih. liiLnil pn^lon of 111.' fn<.l of th- gyni, fionl«ll« m..- form.^1 by lh« l»n. miiifrior of Iho .ulciw pnrc..nlmll« wllh it. ranlii> lunfiltiill. .nlrrtor, p«.»mi forward .n.l » llttto lnli.nil«»r ol,llqi«.ly tran.ver«. brniinal mllin. 3cm. ImiK. Tile m.«li«l limb of lhi« ti'rmliuil cron. pl«-« cut« Into the gjni. lr.i[italU iiKili,!.. to within 0.7 cm. of Ihe .ulcu. frontall. nu^liu., while llie hiLrnl limb cut. into lb.' par. trian«ukri» to within 0.11 cm. of the ruilimealarj ramu. ahoml horimnli.li. of the a..un> of Sylvhw. Cutting Into Ihe nrru. fron«ali> m.xliull. from about Ihi. mlchlit. of the ...Kitlal portion of the milnw fmntall. Interior 1. a .hort meaially^lln.cti»l ramu«. EbemtalW. cordf re T>e/en- wiMliiiM In illntlnclly vWlile In Ihe d.plh in front of Ihe latU'r. SLUf. r.o»TALi. .irtaioa. The .uVu. anaalomow. behind wllh Ihe upjKjr part of the nn, .uperior of the .ulcu. pnrcentralla, though they are partially «paral«l by a d«p anneclant gvnw. The .ulcu. at it. pclerlor e.ln,mily 1. only 1.6 cm. from the medial maridn of the heini- .phere. It 1. not piolon|i.«l Uhlnd the .ulcu. pnecenlrall. Into the gym. .■.■nlrall. anterior. It pa.«« forwarrl and a little kUnvlward (in.tead of, a. u.ual, me.llalward) and fonn. in fr..nl a .uperlictal amwlomo-i. with Ihe .ulcu. fiouUiU. mediu., an annectant gyru. making the com- mimication a very .hallow one. The .ulcu. I. not lnt.m.ptcd. It pn-enl. lncl.ur.« into the gyn« frontall- .uperior »l»iTe and the gyru. fionlali. m.-liu. l.low. In front of the ana.tomo. . !rtlh the .ulcu. frontall. mediu. 1. a .hort Waled obbquelj ,-iltal .ulcu , ,....! iu front of IW. again a troa-rerwd .ulcu. 2.6 cm. long on Ihe laelMi conveia, a..d exlendlng for 1 cin. upia. the facie. medkU.. The* two imlatcd .ulcl, although behind the .ulcu, trontomarginab,, may, perhap., be n..(jarded a. Interrapted Mgment. of the anterior eitremity of the .ulcu. frontall. """ Sci.cc. TOSTAU. namc-The .ulcu. on thl. >lde 1. ^ery Irregular. Oiw cm. in front of the anterior termination of Ihe ramu. anU'rior of the Inferior portion of the ..Ucu. pr.ecc_nlmll. i. a lran.ven«l .ulcu. 3 cm. long, .hallow, and unconnected wllh other .ulcl. One and one- half cm. farther forward the .ulcu. frontall. mediu. proper begin, a. a tnui.ver«l l»i™l piece. The nu*al exiremity of thl. form, a .upeiflcial anaatomoai. with the .ulcu. frontall. .up<.™r. Pa..ing forward from the middle of thl. ba»l .ulcu. a .agiltal .ulcu. eitend. 1.6 cm. forward, and then bifurcate. Into the two limlia of the .ulcu. frontomarginali. of \\ emicke. Scwi-s cisocLi.-II con.l»t« of two piece., the par. po.lerior and the par. mtermedm. being continuou,, Ihe par. anterior being »paral«d from the real of the .ulcu.. The par, anterior begiu. In it, u..ml po.illou between the genu corporis callo,! and extend, 'o™""' «nd then upward, cutting through Ihe medial .in^ace of the frontal lol« to reach the margin o the hemUphere about 4 cm. behind the frontal lobe. The par. intermediu, commence, about 1 cm. in front of the anterior extremity of the corpu, callo.um and in the plane of the .upenor .urface of that .truclure. It curvi, backward approximately parallel to the crirpu. callo.um and. Incoming continuou, with the deep par. posterior, pa,«, up behmd the lobulu. paracentrali. to the margin of the hemLphere, and even extend, for a di.lance of 1.3cm. upon the convex "'* Scurr, OLrACTO..c..-0ne cm. deep, 4.1 cm. long. It pa.»» forward and dightly medial- ward, but faU. to reach the mwUal margin by 0.4 cm, So amwtomoK., M8 I.1W1M,T» P. B««I(| .™l";u3ruJVizLr,l:T:'::,rr:r";^^ - ■' Acduo.t ,,u-, UP rat u)ir. rio»i.i,., t^SHiSSS^-f : "■ — Ik. Uepth with tb. lulcu. fmnlall, li,«lm.^ ,h. 1^.1^1' '" ''"""' "■»«'""•"• "■ .lm™i,„,|„lj«:r».th.g,^,. Still mor..nLrJ,rr ■' , "" '"'""""-'l ">"'■' cluing from behind .nd „«,, the 3l.l Z^r^o™^^ ",'.° °',''""'" """" ^'^ ™- W. I«..lni w S:;u:;-s':-ttru.ro':;:rprv'd ;"'™"'T - "■"'•■" "-^ -■ oeiitrali.l,bi(um.ted. • ■«»" wnveia. Tte pclorior e.lrcmit, of Iho ,uku, p,.™- SuLcrs iNTiaPAuruus: lalemlwaM a-d then f„^ a^d ^inci"^ .ulS^llr''''';',"' "" "■""'"'.h-., c.r^ cu. ceDtmli,. The pa™ tafenor U an obnai^rr^n ^ ' T' '«™™'" ■-■'■"w to th„ ,u|. which «,„„„,. ,h„ g^^ „„,^u, I»»t„riorw h ^ w"„ btmnvir ■"" """"T ''^ " «■"" from « deep ,ulcu,.ubce,,lm)i,po.Criorbv as ,. SZr^r"'"""'- " " "•I»"'<«■'■■<«'» 'hsKJ-nu^ntralispctorior ;nferi„';.sr^^tGr:;cr^;risr.h Tbr-" "■■' ""'-- •-""-""^ -uin. parie... ,n,eH.. '• ^-^^^r^r u^rn^ :z::r; ■.rz^;^^^^ 379 n Descr.pt.os o, Bba.k and 9p.s*l Co-d .n He.ed.t*bv^Ataxiu_ ihe ™lcu, p„rocipl.aU. behind, and wiih th. sulou, parietali. »uperior n.^iially. In the dep.h Sci/:l-a »i-BP*»iET»i.is. Il» ant.nor extremity ,,7 It, msterior eitremilv is acparatnl ,ul™, ™bpnrietali», l.i.ect, the pm...uneu,; ,t, "W"*^f ™ ^^^^^^^^ „,peri„r. The anterior its uppT extremity. . , „^„ of the hemisphere to |ioinl F,sseu, at flssnra i. separate.! from *■;«»■-, '"-^^IT^^^^^Vs^^p^pr* ^^^^ a sinuous course to extends tarn the cuueu, to the l?y™""Wd>- ™ "^i^i/cm. upon the tacie, convexa. A the margin ot the hemisphere and extend, tor a d,s^an«, Of l.^c I» „„„,„ „„„i„g sulcus aap.talis interior cturei (Retzm. pas«>s throngh tte ^°-' P;^^,^,^^^„ „, ,.i ,^. „p„„ approximately paiaUel to the fissura calcanna. It extends also the tacies convexa. , „„ti„iy separated above from the SeLces OCC.F.TAUS T»Av»vE«s.».-Th,s .s a *«-P ™''^'^^ ,,„! ^^, 0.6 cm. broad. The :-rr.t:i:JaX'rrprx'?iL"a'-:tr^terior extremity of the lob. parietaliB. There is only one such sulcus. It is 2 cm. long, begins 0.5 cm..rr:==--^ii-:;rrr"t 880 Lewellyh F, Babkeb 85 Sulci TE«poRiLEs tbassvebsi of Hcsciir _TI,n ..,i„. . h"»"»- turn, „pwaM U a„a,.„,„„,« f^J^S-. J: et £ ™TJ, 1":^^ mcta with the ral™, te3™7, infX A f'"™'" '''''*"°' "■'»'«""' ^"'■»'<'- SSSiaSilgi ward £^5 crTinb™"™;L'T''°' '™- '"'"'"' '"^ '»'"' '■^^''' "-=' ™- "act- il 1 the top piece to n ,-.h«ped terminal .ulcu. complei. Between it. posterior eitremlty nnd the lower Mtremity of the milciis oocipitali» lran.ver.iiB a third gyrus connect, the gym. temporalM interior with the gyms tuaiforrai.. ,.,.,. ,^ ■ t„„. r~,m FissfBA coLLiTEBALis. This Is shallower than on the nght side, is separated in front from the gyms hippocampi b, a long, narrow gyrus which run. from the incuricl i«lu. t..nip..rali8 to the middle of the gyrus hippocampi. Behind, it end, near the posterior cxtn..m.ty<,f he hemisphen., in an oWlquely transversal cross-piece, the medial limb of which goes l"'"«-" '^= two vertical piece, of the ^shaped sulcus complex at the posterior enlremily of the .ulcus temporalis inferior. The gyrus lingunli. is .ulxlivided by a Mgittal sulcus which anastomow, in front with the flssura collaterali, lielow the anni.ctant gyrus rhiuencphalo-lmgiuvlis. ScLci iv-,CL...-Quldberg's central sulcus of the island separates the postenor lobe with its two gyri from the anterior lobe with its four gyii. THE CF.REBELLCH (FiKs. 21, 22, 2.1, 24, and 2S) The eerebellum look, a' little small. It has, however, been distorted in the hardening process. The actual measurement, are a. follows: Length (anteroposterior), in the middle H *""' Rifiht side (maximal) - . . - ti,i cm. Lilt side (maximal) 6.6cm, Greatest transverse diameter 42 cm Greatest height or thick-. ss - 4.* . The distortion has Batt'-ned tl>.. verticil and increa«!d the anteroposterior diameter. The incisura cerebelli posterior is deep. , l>™.i«.-The lingula cerebelli has been torn in reparaling the cereU-llum from the rest ol the brain stem. It is weU developed, i, not atrophic or rudimentary, and is a hngula simplex, not duplex. The vincula linguto cerebelli are symmetrical and not separated from tho lingiUa by notches The two sides of the posterior free surface of the lingula are symmetrical. Ihe anterior surface is firmly fusixl posteriorly with the velum medullareanterm,. Lob„lm cen(ro;i».-Thi, is well developed. It Ue, almost entirely on the anterior free surface of the cerebellum, but it, most superior portion is visible from (ho facie, superior and thus enter, to a slight extent into the formation of this surface. On it, anterior smrface eight Hamlu.-,me are present, separated from one another by depressions The«. Jio„rf,,.^(.,(c run m general pamll.l to one another and vary only slightly in thickne,,. The upper hree ««"<"■«»» are marked off from the ala lobuU centraHs on each side by deep indentalionsi below these throe, however, the junction i, grooved, but there i. no incisure. The delimitation is more sharply marked off on the left than on tho right side. Tho posterior surface of the lobulu, centralis is slightly concave. It present, seven BanduilhtTot approxim,atelj equal width. There are no incisure, between the BamluyaUle of the central lobule and it, alie. The apex of the central lobule is rather blunt. The dimension, of the lobulu, centralis are as follow,: A. CM lacies anterior: 1. From above downward (apex to lia,e)-in the middle ■ ■ n mm. (Stilling's normal measurements vary Ijetween 10 and Ji) mm.) S. From right to left— _ g ^^ Alwve , ', ,n ,' " (Stilling's normal, 4- lU mm.) Middle '•°°"°' (Stilling', normal, 6-10 nun.) J B. Thlcknciis: Just beneath apex In the middle At the base Lewellvs F. Babxeb 37 i Dim, anterior free surface of eac.Ltor,ubdMdvT.f™""' ""'' ""> '"■'"^'■ium p„„ti». Tl... "Pp..Tt™ar.,tho,horte^ iLe:! d„'"Tr., r, 'n ""'"'"'"'■'' ■"'■""■"■" '■>"'"■! '^" Tlifre ta no fusion with ILe bmchhl '''•.""' "'•''"1 all the way to the poKt,.rolat™l n.arrin The l..ft al» also pn-l'l^l^^tZZT'TZT l7 Y"" T""''"'"' "' ""> "'" "•^"■ the .u ri from „„,,„r »i,„a,ed uoar tC html at^ ■» « Weuey to a radial arra,„,,„o„, of -far this a,«x. Tho ,«,terior fr," ./Xl " .1 ', '' "'"'* " ■»' ""iHUvid, J exi,t, «ulci, „„ the left .ide hi,, ,r ai7» Z^Zl ,'" 1: >■"■:■"" »""-«»A»i '!«>,.l,n„.te au.l anterior ,„fae„ of the ala lobreeu.r^^^a™ 1' fow" '"''"■"^'"- '^'^ '^"■•*"» °' "■» From above downward: o) Next the lobulus centralis, riuiit wide leftside - 0) In the middle, right wide - . . . ' left Bide - . . . _ „, I, L. , .,.. 'Stillintis averaffo, 7-8 mm.) c) Behind imddle of brachium j^ntia. right Hide - left side (Stilling's average, 4-") mm i Width: ") t'pper margin, right side - . . , . left side . , T (Stilling's average, lG-22 mm 1 6) Lower marBin, right side --.... left wide -...__ (Stilling's average. 14-20 mm.) 12 mm 11 mm 10 mm, 10 mm. 7 mm, 10 mm, 18 E 22t] 16 mm, 18 mm. .od.he\?;zi;*t'4h:'„t;"nLit:' '"" """""^ ™'"'"" »»•' "^ »"» »"•-" "-'°p«< lir,. porliou of the cuta™ *Lt~. t™™rb™ "° ""■, '°.'"'"" "■"'™''" "■"• ""' superior. Thogeneralconfimra taStl, I ' uT' """''' """ ""'''■' "' ""> ™"nw .pond, very clcSTly to^wfdT^rU^'sXTrm^ the mgittal section (FiR. 26) ha, in Ihi. re^ a ■ . . ™'"" " »''«' '^P^''. ""^"bI" that the posterior pati oMhTsiu; p^lX^tX I ""Tn"",' '""" """ °'"""° •■'"""'» tho ix>.terior part of the wonT ^ *■ °' ""' '"^^■°i»P''ere and not through 383 ,:^l \'^4i&^sB^BSM 88 Dercbiption or Bbain and Spinal Cord in Uebbuitaby Ataxia Upper Burface: Right Bide ' - 1. Near vermin 21 (StilliDK'B noriual, 17-19) 2. Near pons 1* (Stillior a Dormal, 12-14) 3. In middle, between vermiB and ponB ^ (Stilling's normal, 22-26) Left Hide— 1. Near vermis ... 14 (Stilling.) 2. Near pon» ^^ .1. I.i middle, between vermis and pons 23 The six wnllH {Wande) correspond to the nix Wfintle of the montic Jus. The first wall is doubled on the left side; the swuud. on the right side. The fourth wall iff but slightly devel- oped, being represented by a projection in the depth, between the third and fifth walla. The (UmeuBions of the lobulus qmidrangiduria are as follows ou the Jpper surface: 1. In sagittal direction next to monticulus, left - - - 43 cm. right - - - 4.6 cm. (StillinK..13 40 mm.) Ne«t to brachium pontis, left 2.3 cm. I'rljt - 2.4 cm. (citillinK, 18-20 mm.) 2, In transversal direction on anterior margin, left - - - - g.Oom. right - - - 2.1 cm. (Stilling, 28-35 mm.) oHterior margin, left ^-^ **'"• right 5.7 cm. (Stilling, U5-72 mm.) Lobulua gemilunaris auperior.— On the right side the number of RandwUMe on the sur- face near the incisura cerebelli posterior i-s five; on the left ^ide, seven. On the right side, on the surface in the middle, there are tliirteen iJanditnWa^c; on the left side, fourteen. The maximal sagittal measurement o* 'he upper surface ou the right side is 1.2cm.; on the left sidr^, 1.8 cm. The cur\-ud meiisuremrnt transversally along the posterior margin is on the right side 1.5 cm.; ou the left side, 6.5cm. Lobulua semilunarin inferior: Num r of Randw&Ute near vermis, right 8 left 10 " " " lateral margin, right - - - - 4 left - - - . 3 " " " in middle, njht 8 left 9 Maximal sagittal measurement, right 1.7 cm. left 2.2 cm. Maximallength of posterior margin, right 7.4 cm. left 7.0 cm. 8M ^Lkwellys F. Ba»eb i'Otntliitigrarilit: Number of «„„rf„«.,e„,„„,^^,.^^j .. .. I»'t ■ . . lateral margin, right Majimal Mgiital meanurement, r.iht - .'"". ' Maiin,.U.Bittal„ea.urem™t (curved), right - " . " Number ol «„„<,«,„„ i„ „m„^. „, .„,,,.__^ ^^^j__^^^ ^.^^^ S^jittal measurement, in middle, right - . ''" Lcncth or iioBterior margin, right Flocculun: ' ' ' • ''""''»^' ■"*'""«""»'« on inferior .urtace, right - Dimension, of interior .urfaee, right . '"" " left - 6 3 i 3 1.1 cm. OBcm. 01) em. tl.U em. 1.T 12 (injured) 1 3X0.7 cm. 1.2X0.9 cm. iia„dMfe,e on the ".cdial .urface of U,rm^a] „"?. .T' '"™"^°»-"- The™ are „m. face of the kteml musa. ™**' °"'"'' '""' ""^ ™™ ""mber on the lateral aur- The^rXK^rrtle™^^^^ 't-edia, ^ .he aa.o. surface of the lateral mas«. *^^ *'*^ "'^'^^ ^'»«''; «"•! seven oa the lateral MICBOSCOPrCAL EXAMINaTIOK op case XX MEDDLLA SPINALIS Pr^ (FiK3.45,«*nd35) DLOOD-VESSELS OF THE SPIN*r rnon Tl , vea^ej, ,„„„<, „„,. oo„p„^": h Z'iS.^iol'IfT'r' " '^'™ "-'y- ^ke blood- d.atnbutioo of the larger vessel, i,„„ral The t^.i^"'"™"' ^^''- '""' R<«'- The posterior, posterolateralia e. M.r.^^'^^.^Zt""' '?'°'"'-"-"''"nle,olatemli», ^.,S-:rirs:t:rtaLtf tr5i5^^^^^^^ -" - ~ - harfening.area. folio,.,, °°' °' ""' """* "' ""o «■« ''^bar aegmeol, after formol Anterior posterior diameter Transverse diameter ' • - - 0.7 cm. followlf"""""'"^'''-''^^™''-'-'''.^ level, o.ea;u,edb;P.,e«ort::;^„ are as White matter .... Gray matter --..."''"" 8.870 sq. cm. Ratio - . . ' ' " ■ • 3.583 mi, cm. 1:2,3 886 ^ i 40 Description op Bbain and Spinal Oubd in Hbbeditabt Ataxia The nDtt'rior am\ jxwtf rior rootn of the Bpiniil ntrvea show no altt-ratiou, except jioHHlbly a Blight iui-ri'HM) in tlie emloneuriiiin. Tlie piu mater is a little tbickenod. ThicknPHH of pia ovnr funiculuu latt^raliii Thickn^MH of [lia over funiculus puHterior Thickneba of pia over funiculus anterior 0.076 to 0.155 mm. 0.m8toO.U81 mm. O.UI7toU,OH7miii. The subpial layer of neuroglia (GUahnllf. of the Germans) is much thicker in the lumbar region than norinal. The avenifft? tbickutjtw ovi-r the fuuieuluB anterior i^ 0.4H mm. Thuro un- t»To triauf,nilar indentations in the anterior part of the cord where this glial layer measures 0^1 mm. and 0.243 mm. in depth. Thicknpfw of Kubiiial Inyi-r of ^lia over faHciculus Liiuaucri 0.iri2 mm. Tliifkm'W) of subpial Injft uf ylia ovvr funiculuM potiterior (lateral part) 0.017 mm. Thickness of subpial layer of glia over tuniculut) putjteriur (Doar median wptum) O.OM mm. Stitdy of sections stained with Weiyert'H myeUn $heath stain or tvith iron hnmatoxylin fttain of chromicized tissues. — The fasciculi stain, on the whole, ' annally. There are nodefjen- erated areas. An exception is to be made for the middle root zone (FIech«i{f) of the funiculus posterior, which is lighter than the n>st of the funiculus, and the glia is more abundant than normal in this lightened area. In view of the fact that the nucleus dorsidis and the direct cere- b(;llar tract higher up are degenerated, it is interesting to note that it is this middle root zone of Flechsig in the lumbar cord which contains those posterior root fibers which nm in to end in the gray matter of the nucleus dusaiis at a higher level. Aside from the alteration in this middle root zone, the doi'sal funiculi show no change. Lissauer's f\sciculus is well developed. The pyramidal tracts and fasciculi propiii of the funiculus lateralis look normal. No alteration Clin bj niiido out in the funiculus anterior. The fine medullatod fibers (tenninals and collat- erals) which pass through the substantia gelatinosa appear normal in numlwr and distribvition. The anterior and posterior white commissures show no change. Sectio7is stained by Nissl's methodt in thionin, and in toluidin blue. — The anterior horn cells are pR-sent in nearly normal number, though they may be slightly reduced. No change in size, shape, or distribution is discoverable. The internal morphology of these cells appears to be quite normal. The nuclei are centrally placed, and the nucleoli stain intensely. The stichochrome arrangement of the tigroid masses is well preserved in the dendrites and also in the perikaryons. Abundant masses of lipochrome can be seen in many of the anterior horn cells, Pabs thoracalih. — The cord has been a little flattened on rnmoval. The dimensions are: Anterior posterior diameter . . - 0.5 mm. Transver.Ht> diameter . , . _ o.9 mm. Average diameter in the two directions 0.7 mm. Professor Donaldson's measurements of a cross-section nhow an area of white matter of 6.955 sq. cm. and an area of gray matter of 0.t)73 sq. cm. This is a ratio of 1 : 13," which is clearly abnormal. The anterior and posterior roots of the spinal nerves show no changes. The subpial layer of neurologia measures as follows: '•Cf. Dnnaldson, H. H. and D.O. Davis. Adeserlptionof chart showing the anasoftbfloross-Mctioas of the huBftD spinal eunl ut Iha canter of each dvinal aetve, J. Comp. yevrol., UraoTiUe, Vol. XIII (1900), pp. 1^-38. L'WEi .Lrs F. Babkeii iQtcKnriw over riinr>.i>i.. ^ . " ■■ - ■ 0,35 mtn. O.tiQium. or, mm. 0.22 aim. . — .-"-""r i.unicmua gracilis) n^., ""• Aeo((on« stained u^ith ii- ■ .. " ' O.ZJaim. Bfi7 4 2 D.gQ.iPT.oii or B.Ais and Sfikal Oo»d -k H.;..piTA.t At>«i* The cell, of the column, po-tfrlor include (1) the cell, of the nucleu. domlll. (Ctark.'. coluB^rS the ell. ot the .r.an.l» «cl«.l„n» RolaudJ, (3) the c-U. o ">« -°» '""" ~Zfc. limUanlc). and (4) the cell- of the columua po-terior ,.ropm (W aldejer . nud™. of the i°-";^»)- ^, ^,_,^,^,,, „,„^„ ,„^^, „ ,, ,.„ ,h.y ,^„ «""<-» ™';-'yf|, .ppeaaKl IhmuKhout the .hole length of the nucleu.. In "-" Y^'^rtahSn™ ^ visible- where any cell- are Mt at all, the »uml»T doe« not eic-d tmm one lo thr.» in a i«c Znlw The te« cU, remaining pre«.ut no chamclert-tio .lt,.n,tU,n» when con,par,^ ^Uh t henomal ell. of control pre,»mtio„,. The tigroid n,a«e. are irregular In -.le and di.- rrlhu.rn°«™»ionally they are ^ripher^lly di,po«d. The nuclei ,„n, be eccentncall, placed, "'"' ' AuTltaui o"f''r:!^c.ll«l Gierke, cell, of the ,„b..an.ia gela.in«a ha, ^. made. On comparimu with control preparation,, they appear to 1» normal. The marginal cell, of the ronal layer are uornml u, numl>er and «p|».anmoo. I cannot detect any alteration in the lriang.dar cell, of Waldeyef, nucleu, ot the dor«.l horn. Pars CERVICALIH AND TBASalTIOM INTO MKDCLLAt „- , _,. l S.c"'o« .to.rf by Weigerf. m,tko,i. and ,nth .mn »„.»a(o.-Bl,-..-The degencrat..! „r«. ,W1 co^plnd. to the .Ltion of the dir.^t ce«,l-llar tract. The area u larger than n JhTlh l™cic^rn of the corf, and U«i„. nearer the dormd horn. In -c-tion, tb""*^ *« unc«rof the -pinal c.rrl with the medulla oblongata the deg,.nerat«.l area ., "V"».«^y marl^ Hi out. It i, appmximntely triangular in ,h„pe, the apex of the Inanglo l,eiug on the Tla V l^h nd oppiite the dor^l horn, the 1„« in front. The two , d« o the '™.»gle »« Zmj by he J!rip^,erv of the cord and the lateral .urtace o the lateral pynmudal tract Z^tivdy On one .ide ot the cord a large bundle of pyramidal tract fil».r, plunge, te Ij ZTXlho degluemtcd area, iu.t after dcca^alion: lhe« Hbenin™ »„rr„und«l on all ..de^ b,Mhe pale yellow glia ot .hat part ot the cord from which fiber, of the duect cereWlar trac lave „l,*t'ent°rel^ dl«>ppea,ed (ride Fig. 41). The di.lauce from the "I«-'° '>;=>»« °' he tri, nde i. 2 128 mm., the width of the ba« i. Om mm. A few .cattenxl healthy hber, emltain the degfnrratrf arcs a, wa. th. ca«, in the «.tion. thjough the par, thoracah^ T3a™chieflj fi^r,of very large caliber. The .ubpial neurologia layer over the degenerated area measure, 0.113 mm. in tbickne... i r ,„„ i„ fm„t of the There i. .light dillur« lightening of the area eitendmg tor 1 to 1.B mm. m front ol the mainSeo degeneration and with the high power it i, ««n that the nerve hber, do no Z,d To cTc«.ry tolSher here a. they do normally. Either a tew fll».r. of the direct cer^be la tact have uJnpSnt in tbi. area, or we have to deal with a .light lo.. ot m»r, in the ventral "•"TThrdo^uI^LdUhr™ i, a long, narrow, -■^•'"^,'tr';"'.f ^''^'r-he^^ral margin of the ta^iculu. gracili,, and a .till more di«u«, .lightly l.ghten..l ^-.^ °!''/^° J'''"^ middle portion of the fa«;iculu, cuoe«tu.. There ha. be,-a an actual te. of hber. from the«> "'^''The fa^icuUcerebroepinale, contain no lightened a.ea. in the cr«.*.lion.^Thi,i^^^^^^ al«., of the variou. faociculi proprii. Helweg'. ^ath i, not di.tmgm.hable by any color d.Ber- ences from the .urrounding while matter. -.i ,„■„«,.. i,;,„ —The Seclinm riaimd b) Kissr, mctlwd, with Ihionin, and with ioluuim '""-The ceU. of the ventraThor^. are preeenl in normal number and di.tributton. The tigroid ^talatce i! abldant, and a large number of the.e cell, are richly provided with ma.«, o UphZe So alteraiio- in any of the nerv«iell. in thi. portion of the nervou, .J.tem U discernible. HDCLLA OBLOMOATA T-„, „ (P'««- ■^ ». «i «nd «) of the m«lulJa. B„.„..„; ?W .T.^'.hh 'r'.""""?. °' '"""■• '•"'««l«'-l. to the periph™^ he „.r, p..riph„, of .h. .nedulla'h ' .C of tZZ^' ""I''' ""," «"•"■ ""■■"•-"■ <>° Bbra nrcuata. eitenrn.. lep'uenition h Uiunded by «„„,„ niedulhited .h.«.lt::"-sszxr.LrhL:;;x™^^^^^ tri«eini„„| „,.rve l,x,k. normal "*' <»«•'""''■• tn.it. The .pi^l ,„„.., „, n„ a..' normal on each .ide. The fibm, arcuatointernMrT-'; '"'' "'""'™ '""-'o"™ro l™nl«l The tmelu, ,pi„„n, „. Mg,u,M ami the ?lei °M T n ™ "''''""" """"» "PP"" ""™al. '""'• "PP-'-nlly having ,„r„.^ ^nto Ihe^^.f ™?,r "^""I'"^' ''""l'-«PP^">«l a. thU appear, to bo evenly dark and the Do.ll „„ ^T. .'*"'''°"°''- The latter .truelu,,, however root flW» of the n/rvu, h;^lt:,!^^r„l '," ZT"' f"'" '' °°' "--'"'-"l"- Th' chao«e. No e,te„.ive al.e'^on, ha 'X: ™1 J^^ ".".'T" °l™'«'«-"«re-. .ho» noobvlou, Ih.a level -miceua nervi hvuoi,lr„i „„ i , ■ ""■ ™™"' """"aes of irrav matter >1 aj-ee»»ni,m.eie„,,„„i,:;;^j:::t;a7i';-^-^^ o the ohvo in probably .mailer thi n noma inS '.. ""'">«■',"' "'"" '" ""= ^^ "">"er what diminished (f/. Fig. .M) ' """• """ '"" o' "U the .IruetimM seem, wme- ,c„,™"r "' """"^ ■""="'" - "^ — " ".-o», „ .^,o» or .»^.,e„ „, , nervettrS"'" '" "■''«-''""^-««""..- Xo alteration, a« vUible i„ the vestibular PONS rABOLII centmli, (c,nlr„,e //«..6,„6o°^M. Tf ™ ° '' '-"""•"^ l^teml"- The ta»i™l„s lefc-,„euti and the .ran,ver«, fil.r. of the ^„ ."llirnZLr "?!"""' "'■"■ '^^ '""'■■"'"''"'" '"--o ■n the par. dor^li. p„,,„, „„j S;™^™^'^jn«jrray matter of the fonnatioretieukri, hi amount and distribution. ' '"°"' "' """ P"" ""tn^" appear to be normal CERKBEtL01I WRtDKlT PSKFAEATIOKB .)Co^»..„„„e.-The,.miim^£;Zroir^SinWei.r.pre^.iou.. ,n nud.™ ill llio m.-diilk nml tho n«ion of tha iiaclovw o! tho ruof a.-e o proimuii. »ctiQi»; lb..}- u« l.ro«"l 111 ii|.p.iroiillj Domiiil oumWr.. _ ,, OTBciliH, tlio ByraaiU, und the toDHlUii. „)SM :(mc..r(i(-ali..-Nooll«alioii»ani;;; .•jl'.tt^^X;: Mi! T T e .ha.thever.icaldiame.eri,l«evor,.ma.o^ng^^...cr.^^^^^^^ ;:tT:fnrr3S' meliXlu l^. ^rber, o, ganglion e..,U are present i. the """'Tj^nol.u.nenla.,,. -Only three .mall Ulanda o! ganglion cell, are present; iLe« are obvio '1*^:^ «^:rorthrongb l m»t -*\ r«x°yiS» nr:t;s'':;™. »,» .en ,) -for,^ „,■ '«Kare.-The amina, ■T^""™ ^;j^„t"^l^^?A iq" Lly c.U ^ develop.Hlaiidtu» inlhtboc-nln,Uhlte,uh.lanoo J^» '™r""^'J,°k „,„ J,. Vhe filx.ra c„r«.^ndin« to tho anU-rior and posterior d»"»'''°"J°""^»"^'^;^^;^'^;,„,„„, ,„ok a ot the brachium conjunctivum (Stilling". proceMUa oeiehelll ad corpora qua ge little thinner and the bloodveMek in it am dilated. ^^ , of the bnichium pontia. . , , , , muvoluted. Tb«5 cells In LlwiLLTi P. Baku 411 n« III iHirniiil pnimnillon.. .\„ nlfcrnlto tlj hi , l' -"■"lioinulnr.-, I,.„ ,i|.,i„rt diimTiiilil... "■■ni.ioii. Mm Ibnri IW (pmriil •lliniiiutl.m In volnmi. nro STi_nt „r r„„T»L .n-iio»i TH«oi-mi . i..-!- i-xenmity „f th.. „„cl,,,. ,l..„i„„,,. Tl„. m„.. „f m..^„ J i '"' '""""" "' "'" »"•••"'" n.t Mn,„,l, or .1,,.,,,^ .t..h,i,« «U.r„( „ "l . r Th TT; """""' " '," '"— ' ''7 "I'l"!''-!? ™bollf„„„|. i„ ,hi, ph,„,.. airil i,Tr ™ «r„' 7';i 'V"'"'"' "^•"' " "'" ""= " -.. ji... „ie.ih„ ,™„T,. A., .h"r,i.,T:z" r,' "'Ti; ;r '-i-r' "r" " -"" -^"^ ""■ """l""" '""liBil 1« n minute mii». of imv mnll-r „ .i J-' "' ""'' "•P"'«'nt»t'vo of The „hi,., m„„„ „,.hi„ .he n,ic rir, ; ,ik,th?'^'w' "'"r "' '"" "■"■"■"■ blo,xi-v««.|» are dn.l.,1. Thi, ,»,|lor i, „„, T,"''^',,r ""'^ Pn'Panitio,,., „„d Ih, Welgert pi<.p„n,lioi„. corami»,„ii, l» .ell H,.n.|„,»,l „„,l ,,„i,„ |„,„„„|j, ^^ „,^ In the cm„« „,e.l,„l„„. Seetta , thZlTh^^^'r 7"."' "'" ?""'"' '"""» '""--W"! NiMfc PurAiATtona that the Purkinje cell, i„The he^lspi™ 1^^ 'T, 't '"» «"^-™uld .»■ l„„,l„„„.,e,„p, near the bn«, than at the .ummr„,The iT ^ °'"- '" ""'''"""■ " " 'W"'" .er,™':riX.hr;d:::rT:h^ttoro/rh:iitr ^! "■' ""-''" ■"•"• " -'■— . The«, mea„uen,e„,» „„. -malle than hi l^^/^'^.'^''^"^^^ "f- "^ ^ » ••■.■ 0.1 „„! whan, .hemo,ee,d„r and granular ky'ra^ of 3Th Li. ?' ''''"'^'' """"''°* *" d,.plh. VonK(illiker,however,(rive,o»thenomnMM 1, T.' ''""'' """^"""^ "l-mu. in Dnoatr*to> or Bttix amd Humi, Ouii' i" n««iniTA .t Ataxia •WolwnucWl. Tl».,ne.llon."Ar.,th..P«rklnJ..».ll.|.r.-nl In n..r,,„,l ...m.l.n.' .»dUB Tl"« K',l'r„,,,l l."r,W.. ,M 06„„M. Slllllw'. ..nl...n..ut .i.b r.««nl ... th.- dl..««:» lifl«f.-ii II... liKlivliliu.1 riirkli.j.. .-.ll" 1« 1." f.illuw. : 0.1.-rmlna",,^»..nHtr-.-krn,on .l...n.l.T ..»tl.rnt. „n.l l»«n .1- pi.;.." '•"'■"'''"""'"■"a ' h Z Knit,. nu.« k .on l/iro' «.-".-.»': ""l" "-l"-" "■"""'" f,^ "•«" ""T'TmI,^' D^ Mm.h.-n Kl..n.!n .in,l .1.. .!«.«.» .i...l... ...lt.n..na ..it, U. .,, 1 12 ' , von ..in.n.kr rnll nt I>. m.n In »Mn.-n Al»..hnitt..n .l..h ....■i.l nut Th.llc .l.-r .in»ln..n |ir»«.n S«ven..-ll.n (n.ut lltt. 1 .u o".!h.r:.",t.,-,»l«.n.,.h.».n ^.,.. on ,n.nn, K,«„,..n.„ ■^''-'^''ZZ^r^iZZ .urr.ll.'n.l l.n«.. Sttock.. ohn.. Brn-" N.-,™n.rll-n .■r«-ho,nt. l.«rn ,i,.ll..ichl .Icnn... h f l.^lrr. a • ;„,'h ,L I-Hll-ftion „nk™ntl„l, ...nl-n, In,n,..rhln .1.., .,o..n In .Ln, .,,«l..n ,!.■» . n » n.n ,L..n N,.rv..n.,.n..n l«.tln.lli..h.n, ,rn~..r,.n o.l-r kl.ln.n.n Z.l«-h.nr.u,n,.n ,lj.nn..-h .1- cln.eln.n llZont. '|.r !l..ll.-n- nnd Ko,n.r«h,.l.t In „n»ilWb... IXrOh-un, r,-,,. V.Tl.,n.lun», .1. h. .. uhlloM>n Ht.'n.'n. It 1... I„,.l .1-olt .Kh lhinn.T ».^tln..., ho ««,l.l .lm,l.ll«. tnvo m..t .iti. in.l.mc.'n o( p,.„t..r l„,..rv,.Kl«.., -v..,. allowing f.>rlh...lill..n.„.,. I„ .hkkn.-. .. "■«""""•'' "'';''; "™ Z unlikely Ihnt iWn- 1- li. .ho o»«. l...n. .I,.«rll.,l n,. „...,ml .ll,.,l..,..l..n In ' - '°'"' ' 2;' of Purkhij. .-llH «. ron,|»>n,l wHh S.ilUnK'. «...«"«.. < h. .-.n.pnn-,., with cn.n, I'-P" ""<»'"• „. 1.., n.pn.1.,0.,. » ».lin„ of Ih- h. i"l.I.l»- "' ";•• "-"7 "• » '''".r"'" '™* " „,.vn.th..nto Itmvl.. h. "hi'* " I" Pn-.u.n.bly no .1 min..l.on in th„ numlxr of Piirkink. r.'llr.. T1.0 IntPrnpncT. Ii.lw.vn lolN nn' »«n to 1») Tory Inrp'. I,' K "hn.V ™.o nf';,„,phy ..t Iho „...Wlh,n;, „..-. with in n„ »'»«'-^: '•"l^-',^ D„,..hl«nV l„l«ra.ory, Ihoro w». oxl.-n.ivo „t„,phy of Iho cr-.U-llnn. n. « "''"'^■;'''' "'."•" .liminullon i,. thick,.*., pntlicnkrly of Iho moWnlnr Inj.r. n plac.-. th„ 1 J, ^'"^ "»" ""^ ,li«p,,..,nHl ..nlln.ly, l,.n.inK open, empty -pn.^,. in their place., nnrt Iho "^'''^J" "^l " ° B,.n.'n.l w,.n, ranrkodly -hn.nken. Then, «en.«l lo be but UttI lt.ral.on .u .he granul»r layer or in the white medullary Bub.tau<». Cekural cortex; 0„n.» cn„r,.li. nn(.™r -The |fr»y matter 1. 2 mm. thick on Ih, .urface 2 Ji to 8 mn. thick on the wall, of the .ulci. The pWform layer n...a.,.re. 0.319mm. in !'■ "!•»«■"• Tl^e variou, l,.y..r. of pyramidal cell, an, pre«,„t in Ni.-1 pieparation.. I can make out no definite n,^«,l 0.1156 mm. in depth. I. contain, a ..-ry few mattered n,Klel, the ■""'""I'li^nlte, and ro„..d and looki..g Ilk. ordinary Rlia n,.cl ... A few po ygon..l and »P "'""f"'*^ ^"'^ are, however, al«. pr..«.nt in Ihi. layer. The layer of .n.« 1 W^^'dal ceU. a... It" '^^"'^ m.,di..m.m».d pyramidal cell, toRether meamtn, 0.M8 mm. .n depth. The layer of !"■«• '«'™ Sro 133 mm. deep, that of the « all .tellate ell., 0.292 mm., and that of the ™all pyra- m.'d. celK with aJ.,.dinK axone., U.119mm. d.*p. The giant pjram,d« »»' "'1-'*'^ "movM fLoneanother and their cellbodie. and nuclei look normal The l-J"-- "' P^""^ SZw^hcurvrf, amending axo„.-»mea,un»0.11« mm. in depth and the h^erof.p,..dle-.haped cU., OJO. The total thickuMS of the gray matter her. is 1.6 mm. m it. thtnuMt part. ,w o K„.-,"A.»pb,otc™b.ll».l.c.t.-v~~.w«««».~l««.«l'x~«".'""''°'' I*-!"."")- i- «*»iii«_r. B«»»i ( BteUMR or M.)|.BI„ AXATuMi ' llio hrilm and ,.u„|« „f |.,t|. ,..^, ,^ -v.;.). n.. ,„..i„.i„„. ,z .h.. nor :;;t;, ':,,i;7'"'''"' "■;■'-'»''>•■.' ■>-. ;;r :"^ -^ ....„„„, ^,j^,., ...An^ir :;,:,:•;. ^-rr.:;; «.n«:::z:"'T::' "z!;:;::!!:::'"' -" ■■- '> -..-«■ .«.. "-;-" ' '-""Hor::!::;r::;:t;;:^:;-:::^;-"''".'"i..n » r.L xviii'u::: -i^rr:;^^::^^'-"' '■ ^ -• - -' c^ dentate n«,.l,.„a of tl,o «.n.|x.Ilum and ill ^"'° """"' "'^-olv.'m.ntof ,!,„ of .... inferior olivary nnC.uof'^^ ^jlr '"7'"'""'"-. ™' I-Lahlv „,« thore may be a -n«h. diminution ,„Iltro 7 'l "' "'° ""'"' "''™""" - fibers of the non-,.-rool. ' "'" ""'"'""' ''»ra «'ll8, and of th,. b« ^t:^z: i^r x';~::': "■"- 1™ -' "- "-- "'-. "- nonaged in the dor™lf„nic.„,„V,h„nriro arc! 7.r, "''"'' " "''"""'■^ ■"""• P- lo th,. dir«.l cB,^b.ll,r tract. '" "' "■" '"""'' '"°'''"'"» ™rr™,„nclin« that o.|^ff™„:r,/;™ I5;.'is:;x\r w'f' "'°'""' '''"'"''".-""y. •>"< l..«.on,b„e made '.ul . marked diminntio, in The nlh^ "o .■.r..nm«.rib,,l o..r,...ilar ■........■.^.j..„..^::£.';-*::r.':zt.rr~'" 48 Desc biptiqs of Bbaim and Spisal Ooid in Heeeditabi Ataxia part ot the fnsciculM gracilis, and to a leaa extent the posterior |«>rt of this fasciculm and the most mi'dial part of the fasciculns cmneatus. , . , ,, In general, then, the lesions in the three cases thus far studied are nearly identi- cal as regards the neurones involved, though there are differences in the extent of the process quite in accord with the differences to clinical symptoms as the cases were more or less advMiced. Dr. M.-ycr interprets the degeneration in the posterior funiculus as a degeneration ot the collaterals which connect the lower leveU with he higher (cerebral and cereliellar) apparatus, comparable to the degeneration of the lateral pyramidal tracts of the lower segments ot the cord where the basilar part ot the cerebral lieduncle and the pyramids of the medulla show no degeneration. I am incline.1 to look upon the degeneration in the posterior funiculus rather as systemic; ,■ c as involving certain only ot the stem-flbers and collaterals of the intramedullary continuation of the posterior roots, namely, those corresponding to one period of medullation in the embryo. Recent studies make it appear probable 1) that he medullalion of the fibers of the posterior roots corresponds more or less closely to the m«lullation of their intraf unicular continuations, and (2) that the fibers of the posterior funiculi which terminate in the nucleus dorsalis are terminals ot the mam ascending limb of bifurcation rather than collaterals. In the near future the writer hopes, in another paper, to enter into a rather full discussion of the relation of the lesions found in these cases to the clinical symptoms presented by the patients during life, a discussion li-hich necessarily involves some consideration ot the whole question of co-ordination. The discussion ot the relations ot the disease to Friedreich s ataxia and similar maladies, and ot the validity ot Marie's' classification of hereditary cere- bellar ataxia is also deferred. It will be ot especial interest to contrast the Hand family studied clinically by Klippel and Durante and anatomically by Thomas and Eoux with the cases described above. In the French family the lesion involved chiefly the ventrolateral cerebellar fasciculus of Gowers'; Meyer's studies and my own show that, in the American family described by Sanger Brown, the dorsolotera cerebellar tract is the one which degenerates. The present report together with that ot Dr. Adolf Meyer, makes it very clear that the morbid anatomy of the affected members of the family described by Dr. Sanger Brown presents very constant features; we now know with certainty the neurone-systems principally involved in the imlividuals who are affected, though we are as yet entirely ignorant as to why just these neurone-systems should be picked out. LEGENDS FOR FIQCRES (PLATES XXVIII-XXXIX) Fio 1— CaseXVm. Cerebelhim. Fiicies superior. Pio 2-CilseXVIII. Cerebellum and rhombencephalon. Faciea inferior. Fio 3 —Case XVIII. Cerebrum. Hemisphneriura dextrum, polus frontalis. Fig 4 -Case XVIII. Cerebrum. Hemi»pho!rium simBtnim, iwlua frontaUs. Fio B -Case XVIII. Cerebrum. Hemisphierium sinistnim, polus occipitalis. Fio. 6.-Caae XVIII. Cerebrum. HemisphKrium deitrum, polus occipitalis. • P M..n. "Sdt l'Mrld».l..l. rfrtbeU.™," Semal«. mid.. P.tl., Vol. Xlll (l«m. PP- "1-'. 3M Lewgllth p. Barker 4!) Fio. 7.— CaseXVIII. Pio. 8. -Ca»e XVIII. Pro. 9.— Case XVIII. Pio. 10.— Case XVIII. Fio. n.— Case XVIII. Fio. 12.— Case XX. Fio. 13.— Case XX. Fio. U.— Oiao XX. Fio. 16.-C,i.se XX. Pio. 16.— Case XX. Fio. 17.-Ca»«"d cerebellum. Ventml view. P^'w"?^v- Cb'^'*"''™- Fades superior. Left half. PioS~?*'tv ?"'!»'|!'"»- Ficie. superior. Bight half. FioS"?"tt ?"'^'™- F«cie. inferior. Bight half. Fo.24.-Case XX Cerebellum. Facies inferior. Left half. suppi^ifnori'rtrSo'f'ss'reir '•■'''■"' "' " '""" ■"»'■» "' ■"^-*-"' ^''-'- Fig. 2^!°' ^-*""°" "'™'«'' «"*'««°' hemisphere of Ca«, XX, same magnification a, in r!^' » ~£IS f^l""^" ^P^""' of Case XX; same magnification „ in Fig. 27 nuiiof"rn''u^Srorc!u':s:5L"'°r:'r "t^'t ■""""■" "' ^-^ ^^' *°-°« "i-- iu many otherlL°U..r b^^ ?:„ ? ".minufon is more pronounced in this section than represented ' " ""^ ""^"^ P''^ "'"'"' "■» "'•1« "» « lew as here of ce,Mnfp;est."bVScr''°'" "' """ -'- °"™Hs inferior, showing the number scetionTsttin^et^hanlLtr^Fi' S""T.'^'.u'' V*'" °"™"' '"'""'>' »' <=»'«' ^X- The oa.ffh5-rx^-:it;;-zXS^!'"'-"'^°-'-"^'^^ XX. shifg-sjiTabiitfof :^ri.Sir ■""-'"' '"'"*'' °' "" ■™" "'°'»* -■ -^ ''- g.rt pre;a«iL^'""" "™*'' '"'""""' '°'^*'' ■'■"' P"" '»»"-» Po"'i» -" Case XX. Wei- lion ^m»'h,^!r"°'' "'""*'' •"■" "' '"""'' °' '■""■hium pontis. Case XX. Weieert Drepara- rugh^ii'^tTrosrrhoiiZr.r "■'-'- °' "- '=•-'' •■°-- - -=- iio. 88.-Section through the upper part of the medulla oblonpit;,, Case XX. 896 no De SCBTTION of BbAIS and SriNAL CQ»U IK IlEBEUlTAK V ATAJ»A Fin. 39.-S«:tloii throUKh the mwJulk olilongata «l lh„ fcvol i.f Hu- tom.r pilrt of the °"*Z''r'lt;:;r.hru«f .be meduH, oUong^t. u. tUB u„^.r ,«.rt „f the d»u,»a.io lemnist-orum and uueleua olivaris nccwaoriua. Case aX. ,..,.„| „f il,. F.n 11 Sei'tion throush the lower part ot the medulla cbloDKaln at Ih, level „,t,a lutnbaha. '^"'Fro7r!-SectionlhK.UBhthe»pinalcordofCa»eXX. Para thoracalls. Fltk-Sectiou through the spiual ami of Case XX. Iutume«=ent.a lumbalra. Level of L ill Decevxiii. Pi hlk atii)\s, X I'MTi: X.WIII m V t)ECE\XIAI. PtHMIATIuNN, X I'l.ATK XXX Flo. Il> DbcEKXIAI. PUBtlOATIONK, X §• / 1 ^^^■tekT^Jpr jA •^ V nY -. \ ,^,^ Plate XXXI V Pra. 18 Fio. U DlCIKItlAL PuSLIOATIOm, X PtAT« xxxn Fio. n nri'iiKxiAi. 1*1 ni.ictTiiiNii, X Pi.«T« XXXIII Decennial Publicationh, X Plate XXXIV Decennial Publicationh, X Plate XXXV Fio. 82 Fn. 8S Decennial Publioationh, X Plate XXXVI I'm. 40 Decennial Piblicatiunh, \ Plate XXXVII \ DCCKXIAL PUBLIOATIONK, X PlATE XXXVIII ^ 1 DEmVNIAL I'l BLK ATIIIN'K. X Plate XXXIX Fic. i6 "^y-l!^:^.