67 Loc. cit.
68 Union méd., 1880.
69 Deutsches Archiv f. klin. Med., Bd. xxii. H. 2.
70 Virch. Jahresb., 1877.
71 Virch. Arch., 1879, Bd. lxxv.
72 Arch. Virch., Bd. lxxxix., 11, 2, 1882.
73 Quoted by Pekelharing—the first from the Aerztliches Intelligenz Blattmünchen, 1879; the second from the Lancet, 1881, vol. ii., No. 16.
Müller's case74 is that of a woman thirty-four years of age who at the age of four fell out of bed, and from that time began to walk with difficulty, and ultimately acquired a double talipes equinus. The right leg atrophied, the left remained of tolerable thickness. At the age of thirty-four she was admitted to an insane asylum during the incipient stage of dementia paralytica, and death occurred two years later of pneumonia. The autopsy showed—1st. That the calf-muscles on both sides were converted into masses of fat, streaked with whitish-red remnants of muscular tissue. The short muscles of the feet were atrophied; all the other muscles of the body normal. 2d. In the brain the blood-vessels showed a thickening of the adventitia by delicate connective-tissue fibrillæ, between whose meshes nucleated cells were strewed. The ependyma of the ventricles was thickened and granular, and their cavity was filled with serous effusion. 3d. In the cord was found diffused degeneration, especially of the lateral columns, consisting in thickening of the interstitial connective tissue, with proliferation of its cells; atrophy of a part of the primitive nerve-fibres with granular degeneration of the medullary sheath, and occasionally atrophy of the axis cylinder. The adventitia of the blood-vessels was thickened, the perivascular spaces dilated. In the central gray substance the ganglion-cells were everywhere intact, but the intercellular substance was thicker, and seemingly composed of a thick net of stout, finely-granular fibres. Traces of an infantile polio-myelitis were found in the lower part of the lumbar enlargement (atrophy of the anterior cornua, especially the right, together with their ganglion-cells).
74 Beiträge zur pathol. des Ruckenmarkes, 1871.
The final lesion of importance was the obliteration of the central canal, which was moreover surrounded by a dense ring of connective tissue. In this case the suddenness of the original paresis, the atrophy of the right leg, and the lesions of the lumbar cord found at the autopsy prove that the initial disease was an acute anterior polio-myelitis. Upon this a very localized pseudo-hypertrophy seems to have been grafted during childhood, while in adult life a chronic lepto-meningitis and internal hydrocephalus were certainly the cause of the symptoms, and probably of the lesions in the cord.