There was very palpable visceroptosis, including the liver, kidneys, spleen, intestines, and stomach. The uterus was retroverted and moderately fixed. Rectum was normal; the eye grounds were normal. There were slight bedsores over the sacrum; the patient lay Fourth lumbar. Post column degenerated. Oval bundle of Fleschsig normal. Lateral tracts unequally degenerated. Remainder of cord and nerve roots normal. CASE 2, FIG. 2.-(Weigert-Pal.) About level of twelfth thoracic. Post. degeneration more extensive and sclerosed. Lateral more extensively and almost equally degenerated. in bed with the thighs and legs flexed and closely approximated. There was some atrophy of the muscles of the lower extremities, chiefly of the extensor groups. The knee jerk was increased; there was slight ankle clonus, more of the left than of the right; Babinski's sign was present in the right, but not in the left. There was slight anesthesia of the feet and legs; muscular sense was absent; there was some disturbance of the temperature sense in certain areas, Degeneration very extensive-involving the whole periphery of the cord. The gray matter of cord, the post. root zone and Lissauer practically normal. where both heat and cold were felt as touch only. There was a small area in the left inguinal region and upon the outer surface of the right thigh where heat was felt as pain. There was a noticeable loss of power in the legs, and this was more marked in the right than in the left. The sphincters of the rectum and bladder Level of eighth cervical. Posterior columns, and the pyramidal, direct cerebellar and Gower's tracts in the lateral columns and the direct pyramidal tracts extensively degenerated and sclerosed. The gray matter, Clark's nucleus, Lissauer and the root zone free. were relaxed. The muscular power and sensation of the skin in the upper extremities seemed normal. The patient complained of a sense of constriction about the abdomen in the waist line. The eye grounds were normal. The stomach contents contained no hydro chloric acid. The urine was normal. The blood showed 610,000 red cells; 20 per cent of hemoglobin, and 3,200 whites. Poikilocytosis was very marked, and there were many nucleated cells, the megaloblasts predominating. The patient remained in the hospital from that time until the date of death, February 27, 1901. Repeated blood examinations confirmed the diagnosis of pernicious anemia. The spinal cord involvement increased; and finally resulted in flaccid paraplegia. The patient's mental condition remained fairly clear, although she did not apparently recognize the gravity of her condition. The arms became finally ataxic, although the patient was, at all times, able to feed herself and to button her clothes; but there was a distinct loss of power in the upper extremities. The sensations objectively remained normal, which was a most curious phenomenon when one notes the condition of the cervical spinal cord. chloric acid upon repeated examinations. During the latter part of There was at no time any disturbance of the eye grounds, nor of the oculomotor muscles. The appetite remained fairly good; the patient vomited occasionally. The stomach contents showed no hydrothe patient's illness she developed a cystitis, and later a pyonephrosis. As a result, there was an irregular type of fever, with a rapid pulse, until death closed the scene. The post mortem examination was made by Professor Hektoen, of Rush Medical College, at the Presbyterian Hospital two hours after death. There was general anemia; red marrow in the femur; splenic hyperplasia; ascending cysto-uretero-pyelonephritis; bronchopneumonia fatty liver; sclerosis of the aorta; chronic pelvic peritonitis, with tubo-ovarian adhesions; extensive sacral decubitus, edema of the feet, and degeneration of the posterolateral columns of the spinal cord. The, microscope revealed the usual extensive atrophic and fatty degeneration of the organs of the body, and the liver an increase of iron by the Quincke test. For the sake of brevity, I will omit a further histologie description of the organs, excepting of the spinal cord. Sections of the spinal cord were stained with toluidin blue, VanGieson and Marchi. The Weigert-Pal method showed degenerative changes, with absence of the myeline sheath from many of the tracts. At about the fourth lumbar, the posterior column was invaded, leaving, however, normal white tissue in proximity to the gray matter and presenting undegenerated the oval bundle of Flechsig. The lateral tracts showed degeneration in the right more than in the left. In the lower dorsal region the degeneration had become more extensive, involving almost completely the posterior columns, but leaving a narrow normal band of white tissue next to the gray commissure and posterior horn; the lateral tracts were almost equally involved, and one direct pyramidal tract, showing extensive degeneration. The posterior root zone and the column of Lissauer remained normal. In the middorsal region the sclerosis was very extensive, involving, to a greater or less extent, the complete periphery of the cord. The sclerosis still left a slight band of tissue next to the gray commissure, and a larger band along CASE 2, FIG. 5.-(Weigert-Pal.) Level of junction of cord and medulla. Column of Goll entirely degenerated, except at gray commissure. The medial and posterior parts of the columns of Burdach are completely degenerated, leaving the lateral portion normal. Both direct cerebellar tracts are degenerated. One pyramid is much degenerated; the other very slightly changed. CASE 2, FIG. 6-(Weigert-Pal.) Level of inferior medulla. The upper extremity of column of Goll is completely degenerated. Burdach and the posterior horn, is degenerated. The direct cerebellar tracts are degenerated. One pyramid is much, the other only very slightly altered. the posterior gray horns. The columns of Goll and Burdach were almost completely involved, while in the lateral column the pyramidal tract, the direct cerebellar tract and Gowers' tract were scler Both direct pyramidal tracts were implicated. In the cervical swelling the posterior column, and in the lateral columns the pyramidal tracts, the direct cerebellar tract, and in the anterior column the direct pyramidal tracts, were extensively sclerosed. Here, again, the root zone and the column of Lissauer were practically free. At the junction of the cervical cord and the medulla one pyramid was extensively involved, while the other one but slightly degenerated. Both direct cerebellar tracts were degenerated. The column of Goll was entirely degenerated, except at the gray commissure. The medial and posterior parts of the column of Burdach were completely degenerated, while the lateral portion was unchanged. The spinal tract of the trigeminus was not affected. In the lower medulla one pyramid was much degenerated, the other slightly so. The upper extremity of Goll was completely degenerated. The column of Burdach, excepting a small triangular area, between the nucleus of Burdach and the posterior horn, was degenerated. The internal arcuate fibers, which go to the lemniscus, were normal. In the medulla the pyramids were practically normal, there being only a slight, if any, degeneration. The white matter around the spinal extremity of the olive was normal. The internal arcuate fibers and the interolivary layer of the lemniscus were normal; likewise the external arcuate fibers. In the upper medulla the white fibers of the hypoglossal nerve were normal. Both pyramids were slightly and diffusely degenerated, more upon one side than upon the other. The white cap of the olivary body was normal. The olivary fibers to the restiform bodies were normal. The restiform bodies were normal. The tractus solitarius was normal. A section through the lower pons showed a marked degeneration of both pyramids, one slightly more than the other. This is remarkable, because of the absence of degeneration in the pyramids of sections below. The posterior longitudinal bundle was normal. The middle cerebellar peduncle was normal. The upper pons in the dorsal region showed the normal stain; the posterior longitudinal bundle was well marked. The central tegmentary path appeared normal. The medial and lateral lemniscus were normal, as was also a section of the superior cerebellar peduncle. In the ventral pons long fasciculi, including the fibers of the pyramidal tract, and those from the cerebrum to the pons, appeared normal. The transverse fibers of the pons stained intensely. This section showed a light line in its most ventral part, which may be an artefact. In the thoracic cord the anterior horn cells and the Nissl bodies in the center were round and granular, while in the periphery of the cell the Nissl bodies were spindle shaped and stained normally. In Clarke's nucleus cells were small and much less in number. The cells of the lateral horn showed disintegration of the Nissl bodies. The blood vessels contained leucocytes, but in smaller number than in Case 1. In the cervical region the Nissl |