Microscopical appearances of brain in a ease: haemorrhages in the substance of the hemispheres; round, structureless bodies, resembling corpora amylacea, ar ranged in groups; fatty degeneration of the cells of the motor region; shrinkage and vacuolation of the cells of Purkinje. Biruli (St. Petcrsburger med. Woeh., June 30, '94).
In nine cases localization of centres found to be the same as that given by others,—Nonne, for instance. A primary and possibly toxic affection of the nerve fibres supposed. C. W. Burr (University Med. Mag., Apr., '95).
Three cases of pernicious anaemia with spinal-cord symptoms, one ending fatally after several weeks. Angel Money (Aus tralasian Medical Gazette, June 15, '95).
Changes in spinal cord similar to those met with in pernicious anaemia may occur in a variety of other diseases, com bined with cachexia and marasmus, Ad dison's disease, diabetes, etc. IV. Mtiller (13erichte der 24 deutscher Chirurgentag, '95).
Case with arteriosclerosis, parcesthesia, chronic enteritis, and increased knee-jerk. Small haemorrhages found post-mortem in the corpora striata and corpora quad rigemina. Microscopical examination showed, besides changes described by others in the posterior columns, haemor rhages in both the gray and white matter, with degeneration in the anterior and lateral columns of the cord. The change in the gray matter is of chief importance in this disease. Teichnifiller (Deutsche Zeitsch. ffir Nervenheilkunde, B. S, II. 5, 6, '96).
Study of nine cases: small haemor rhages and consecutive sclerosis are fre quently met with in the spinal marrow. These haemorrhages have no significance from a clinical point of view. The vessels often show thickening and com mencing hyaline degeneration (not, how ever, as a rule), combined with degenera tion of the nervous elements. From a study of the literature it appears that comparatively few cases of pernicious anaemia present a real disease of the spinal cord. The symptoms of anaemia remain unchanged in cases in which it. does occur, and it is difficult to explain why the cord should be affected in some cases and not in others. The disease of the cord manifests itself with somewhat varying symptoms, certain of which, however, are exhibited in all cases. From an anatomical point of view the alterations have considerable variations; but this is accounted for, to a great ex tent, by the fact that the process has been observed at a different stage in the various cases. From a closer analysis of the eases it appears that the degenera tion progresses in a fairly regular man lier. It is presumable that these cases of disease of the spinal cord form a special group, even from a neurological point of view. It may be admitted that some toxic condition is the common, immediate cause of the disease of the spinal as well as of the, anemia. The altera tions of the spinal cord are here wholly different from those found in tuberculo sis and diabetes, where the changes can easily be distinguished by slightly marked and chronic degeneration, such as is often found in Addison's disease.
Charles Petr6n (Inaugural Dissertation, Stockholm; Universal Medical Journal, Feb., '96).
Evidence showing that extensive changes may be present in the cord in cases of pernicious anremia without any marked clinical symptoms, and that the lesions are of somewhat diverse charac ter. Whether the degenerations of sys temic tracts depend on hcemorrhagic or myelitie foci in all there seems hardly yet sufficient evidence to show; the predominant affection of the pos terior columns in the majority of cases, and their degeneration throughout the whole length of the cord on both sides, rather point to an independent affection of these tracts. J. Michell Clarke (Brit. Med. Jour., Aug. 7, '97).
In cases of pernicious anemia the de generative changes in the cord sometimes observed are not the result of mere ane mia, but are more probably the result of hitherto undiscovered chemical agents. A thorough examination of the metab olism in pernicious anaemia might, per haps, throw further light on the question. G. V011 Voss (Deutsche Arch. f.
Med., vol. lviii, p. 489, '97).
Study of pathological lesions found in the spinal cord in cases of pernicious anamiia showed that there was usnally a degeneration affecting the posterior •ohnims, sometimes the posterior and lateral together, but never the htteral alone. This degeneration was chiefly in the nerve-fibres, and was unaccompanied by sin-inking of the cord. such as was seen in locomotor ataxia. Seventeen cases analyzed in which initial nervous symptom was always a persistent parr•s thesia, usually of the foot, with .sonic weakness. This was generally followed quickly by ataxia and loss of motor power, and severe pains in the hack arid limbs were not uneommon. The disease progressed rather rapidly, so that often within one or two months the symptoms were well developed. In from six months to a year the progress com monly reached its acme, and during this time the anemia became marked. After a time the control of the bladder and the rectum was lost and in fatal eases death occurred in from six mouths to two years. The essential nature of the process was a primary nerve-degenera tion affecting the neuraxons first. par ticularly in the columns of Gull and the crossed pyramidal tract. The same poison which caused pernicious antenna was responsible for this disease. It usu ally developed between the ages of :,50 and 60 years, and followed the acute infections. prolonged diarrlm-al or dysen teric attacks, lead poisoning,. malarial infection, etc. In 10 per cent. or more of the eases pernicious un doubtedly co-existed. Charles L. Dana (N. Y. Med. Jour., Nov. 19, 'OS).