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studies upon the Cerebral Cortex in the 
 
 Normal Human Brain and in 
 
 Dementia Paralytica 
 
 By 0. ALFREO LAWRENCE . 
 
 BP^^^Sllbmitted in partial fulfilment of the requirements for the degree of 
 t: Doctor of Philoscfphy in the Faculty of Pure Science, Columbia Univer- 
 f- sity. 
 
 Reprinted from the JOURNAL OF NERVOUS AND MENTAL DISEASES* 
 VoL XXX, Nos. 9, to. U and 12 
 
 COLUMBIA UNn"^PS'TY 
 
 DEPARTMENT OF PHYSiPLOny 
 
 College of Physicians and Surgeons 
 
 437 WEST FIFTY NINTH STREET 
 NEW YORK 
 
 ALLIANCE PRESS COMPANY 
 NEW YORK CITY 
 J903 
 

STUDIES UPON THE CEREBRAL CORTEX IN THE NORMAL 
 HUMAN BRAIN AND IN DEMENTIA PARALYTICA.' 
 
 By G. Alfred Lawrence, M.D., Ph.D., of New York. 
 
 instructor in diseases of the mind and nervous system^ new "vork 
 post-graduate medical school and hospital 
 
 Introductory. The following contribution to the study of the 
 cerebral cortex in the normal human brain as compared to that 
 in dementia paralytica, does not include much that is new to the 
 pathology of the latter, but aims to present the subject in a some- 
 what different manner than has heretofore been done. The 
 writer's perusal of many anatomical and pathological articles has 
 often been unsatisfactory to himself, owing to many generalized 
 statements of conditions found without any adequate illustrations 
 of what was really to be seen. It has been the endeavor in this 
 !-ticle to present and describe photomicrographs of actual sec- 
 jns from a practically norrnal human brain histologically by way 
 • f comparisori, and to follow these by photomicrographs of sec- 
 ons of a brain of a well marked case of dementia paralytica. 
 These photomicrographs have been supplemented by drawings. 
 The possibilities as well as the limitations of photomicrography in 
 preparations stained by the Nissl method, it seems to the writer, 
 ire fairly well brought out in this article, and this was one of the 
 Dbjects sought in its presentation. That photomicrographs show 
 structure and arrangement in but one plane of limited thickness 
 is true. It is also true, however, that they show exactly what is 
 there and the exact relation to other parts, and there is no personal 
 equation such as is bound to occur in any drawing. A drawing, 
 on the other hand, is always more or less composite, does not 
 show exact relationship, and involuntarily the point to be illus- 
 trated is made to assume undue prominence. In work of this kind 
 artefacts are constantly to be looked for and avoided, and the 
 entire process of preparation, as well as the history of the case, 
 must be also carefully considered before any conclusions should 
 be drawn. 
 
 'Submitted in partial fulfilment of the requirements for the degree of 
 Doctor of Philosophy in the Faculty of Pure Science, Columbia University. 
 
2, G. ALFRED LAWRENCE. 
 
 When it is considered how extremely thin the human cortex is, 
 ^•5 to 3.5 milHmeters ; that its exterior surface is estimated at 
 about 200,000 square millimeters ; that it is intricately arranged in 
 convolutions of varying size and direction ; that it is exposed to 
 injury prior to death, at the autopsy, during transportation, and 
 also in the various manipulations of fixation, imbedding, section- 
 ing, staining, decolorizing and mounting, it can readily be seen 
 how artefacts may result by the time the specimen is prepared for 
 examination. This was forcibly brought to the notice of the 
 writer in the examination of some sections but a short time ago. 
 Owing to a dull microtome knife the nuclei of a number of the 
 cells were completely carried outside of the cell-body and the cell- 
 bodies themselves broken and cracked in places. This was at first 
 regarded as a pathological process until attention was called to 
 the fact of the nuclei all being extruded in the same direction, 
 and the breaks and cracks presenting a ragged and irregular ap- 
 pearance. Even when the greatest care is used there will be a 
 variation in thickness in different sections — one being somewhat 
 thinner and the next correspondingly thicker than actually regis- 
 tered by the microtome, although most carefully imbedded, so that 
 variations in the thickness are also to be considered. Further- 
 more, in fixation, shrinkage or swelling may occur, the latter 
 being demonstrated by Donaldson ( 1891 ) , who placed fresh nerves 
 in a solution made up of 2.5 per cent of potassium bichromate, 
 plus one-sixth its volume of 95 per cent alcohol for three weeks. 
 He then washed them for one day in water and placed them in 95 
 per cent, alcohol for three or four days, and finally in 80 per cent 
 alcohol, using six olfactory bulbs, six olfactory tracts, and three 
 pairs of optic nerves of the sheep. This was exactly the same 
 treatment to which his specimens of human nerves had been sub- 
 jected. The volume of specimens of olfactory bulbs subjected to 
 this treatment and afterwards placed in 80 per cent alcohol was 
 found to be 5.2 per cent greater than fresh specimens, those of the 
 olfactory tracts 8.8 per cent greater, while the optic nerves showed 
 but 2.6 per cent increase in volume. Imbedding in celloidin did not 
 affect the volume, while some stains, as acid fuchsin, produced no 
 change, whereas Delafield's hematoxylin caused swelling, and thus 
 
DEMENTIA PARALYTICA. 3 
 
 increase in volume. Hammarburg (195) found by experimenting 
 with small blocks of cortical tissue that by accurate measurements 
 blocks hardened in Miiller's fluid for three days showed a volu- 
 metric increase of 11.7 per cent. Other blocks hardened in Mill- 
 ler's fluid for three weeks, and then, transferred to alcohol and 
 left in the latter for fourteen days, showed, on the other hand, a 
 shrinkage in volume of 43 per cent. In alcohol, 95 per cent, at 
 the end of twenty-four hours, a shrinkage in volume of 20.5 per 
 Cent was observed. This shrinkage is furthermore found to vary 
 with different blocks from the same region of the same brain, and 
 it is found that there is no constant relation between pieces from 
 brains of various grades of hardening. Thus thef method of fixa- 
 tion must always be taken into consideration. Again, in staining 
 under exactly similar conditions, one section on a slide will be 
 found more intensely stained than another section on the same 
 slide, or even one part of a section will be found more intensely 
 stained than some other part of the same section. 
 
 In the subsequent decolorization still greater variations may 
 occur, for, if carried too far, important structures may be com- 
 pletely decolorized. If carried to the other extreme it is impos- 
 sible to differentiate the various parts. The only way to avoid 
 either extreme is by repeated examination of the sections under 
 the microscope while the process is being carried on, as under 
 similar circumstances one section in a given time may become 
 much more decolorized than another. In regard to mounting of 
 sections stained by the Nissl method, as all were that have been 
 employed in this article, xylol-damar has given the greatest satis- 
 faction to the writer. With this mounting medium there was no 
 subsequent shrinkage, and thus a resulting exposure of the sec- 
 tions, also no decolorization was to be observed at later periods. 
 In some sections mounted for over three years, no decororization 
 was observed, even after several exposures to the intense light 
 necessary for photomicrographic purposes, and frequent expo- 
 sures to light in their examination under the microscope, Canada 
 balsam was also used, but in time the sections were found par- 
 tially or completely decolorized. Benzene-colophonium has a 
 
4 G. ALFRED LAWRENCE. 
 
 tendency to shrink and crack and thus expose portions of the sec- 
 tions in some cases. 
 
 It is desired to emphasize the importance of careful attention 
 to all these details at the beginning of the article, in order to 
 impress upon the reader the necessity of the greatest care and 
 conservatism in the interpretation of any changes found in the 
 specimens under observation, and, furthermore, the correct in- 
 terpretation of the same. Before going on to the main subject of 
 the article, a brief historical review of work in this line will be 
 given. 
 
 Historical. The first study of the internal structure of the 
 nerve cells began over fifty years ago when Remak (1841) called 
 attention to a fibrillary structure inside the axis cylinder and cell- 
 body of certain nerve cells. Later, Max Schultz (1872) studied 
 nerve fibers and cells from various parts of the central nervous 
 system of different animals with elaborate descriptions of his find- 
 ings. He dealt with a description of the fibrillary appearance of 
 the interior of the cell-body largely. This doctrine of the nerve 
 cell was afterwards strongly supported by Boll (1873), Schwalbe 
 (1885), and Ranvier (1878). Opposite views were, however, 
 held by Arndt (1874), and Key and Retzius (1876). Arndt, in 
 1874, described the structure of the spinal ganglion cells and 
 spoke of the presence in them of different kinds of elementary 
 spherules which varied in size and general appearance. Key and 
 Retzius stated that the ground substance of the spinal ganglion 
 cells was homogeneous, but that in it numerous strongly refrac- 
 tive, round, oval granules were present, and they thought the ap- 
 pearance of a concentric striation or fibrillation could be simu- 
 lated through the arrangement of the granules in rows. Flem- 
 ming (1-882) saw granules within the cells which would stain 
 with nuclear and azo dyes and hematoxylin, but nevertheless 
 affirmed a fibrillary structure of the central cells and of a tortuous 
 or much curved threadwork within the spinal ganglion cells be- 
 tween the granules. In recently published articles (1896) he still 
 maintains that fibrils exist inside the nerve cell protoplasm. 
 
 Dogiel (1893) has also expressed himself in favor of the 
 views of a fibrillary structure for certain at least of the nerve 
 
DEMENTIA PARALYTICA. 5 
 
 cells. In 1885 Nissl published the first of a series of articles 
 in which he calls particular attention, in tissues hardened 
 in alcohol and stained in basic aniline such as majenta red and 
 methylene blue, to certain structures. By Nissl's method these 
 are brought especially well into view, and their arrangement in 
 the protoplasm and their significance for the function of the cell 
 can be studied. 
 
 These structures had been previously observed by Flemming 
 and Benda (1882), but by less perfect methods. Nissl at first 
 stained tissues hardened in alcohol with magenta red or meth- 
 ylene blue, and cleared in oil of origanum. This has been modi- 
 fied in several ways, so that at present his treatment is as follows : 
 Small blocks of tissue are hardened in 96 per cent alcohol and 
 fastened by Weigert's method with gum arable, without imbed- 
 ding. The sections are received in 96 per cent alcohol and stained 
 in a watch glass. The stain is to be heated over the spirit flame 
 until small bubbles arise which make a crackling, noise (65° to 
 70° C.) ; sections are then transferred to aniline-oil-alcohol until 
 differentiated. The process of differentiation is ended when no 
 more coarse clouds of color go off into the fluid. The section is 
 then transferred to the slide, dried with filter paper, after which 
 some drops of oil of cajeput are applied, and the sections are 
 again blotted with filter paper. A few drops of benzene are 
 poured on the sections, blotted again, and finally some benzene- 
 colophonium added, a cover glass placed over the section, and the 
 slide heated until all the benzene gas has been driven off. Upon 
 cooling, the section is thus permanently mounted. 
 
 The stain is made as follows : Methylene blue, B. pat., 3.75 
 grams; Venetian soap, 1.75 grams; distilled water or soft water, 
 1,000 c. c. The differentiating or decolorizing fluid has the fol- 
 lowing composition: Aniline oil, colorless, 10 parts; alcohol,. 96 
 per cent, ninety parts. Nissl obtains his aniline oil directly from 
 the factory at Hochst and keeps it carefully protected from the 
 light. The benzene-colophonium is prepared by pouring benzene 
 upon colophonium (white rosin) and alowing it to stand for from 
 twenty-four to thirty hours. This results in a fluid transparent 
 mass which can be brought to the desired thickness either by the 
 
6 G. ALFRED LAWRENCE. 
 
 addition of more benzene or by allowing it to evaporate, and then 
 it is ready for use. In mounting, while driving off the benzene 
 gas by heating over the flame, the material may catch fire, but if 
 the flames are blown out immediately no injury is done, and the 
 alterations produced by the burning are quite characteristic and 
 easily recognizable. The above description has been given in 
 detail as it is the classical method, which, as above and with 
 various modifications to be described later, has been used by the 
 writer in this article. This method distinguishes within the cell- 
 body always two and sometimes three constituents. One of these 
 constituents of the protoplasm stains entirely blue by this method, 
 and is spoken of by Nissl as the stainable or visible formed part 
 of the nerve cell. The second part remains entirely unstained, and 
 is spoken of by him as the unstainable or the visible unformed part 
 of the nerve cell-body. In addition to the above, in many nerve 
 cells, pigmentary deposits are visible which have been especially 
 studied recently by Rosin ( 1896) . Nissl has prepared a somewhat 
 elaborate classification of cells according to the character and ar- 
 rangement of the stainable portion to the non-stainable portion 
 of the cell-body in different cells in different parts of the central 
 nervous system. This stainable substance shows a series of dif- 
 ferent forms ; smaller and larger granules of regular or irregular 
 shape, arranged in groups or rows, These stainable masses are 
 sometimes arranged in threads, smooth or rough, and varying in 
 thickness, course, and length. Often larger structures, regularly 
 or irregularly shaped, are seen, which stain with varying degrees 
 of intensity, some appearing homogeneous, others showing a 
 complex internal construction difficult to describe. 
 
 Three varieties of these larger bodies are especially to be 
 noted, (i) the so-called ''nuclear caps" (Kernkappen), stainable 
 masses in the form of regular or irregular cones hollowed out like 
 a cap and corresponding to one pole of the nucleus upon which it 
 rests. There may be two such caps within one cell-body at 
 opposite poles, and occasionally, according to Nissl, three such 
 caps may exist within a single cell. (2) So-called "wedges of 
 division" (Verzweigungs-Kegeln), stainable masses completely 
 filling the angle at the point of division of a nerve cell process. 
 
DEMENTIA PARALYTICA. 7 
 
 (3) Spindles, oblong spindle-shaped stainable bodies, thick in the 
 middle and thinner at both ends, the latter sometimes tapering 
 off into rhread-like filaments. These spindles may be one or two- 
 sided. Any one of these forms may be vacuolated. Nissl makes 
 a rather elaborate classification of these ganglion cells according 
 to their internal morphology, after spending years in the most 
 exact investigations of various nerve cells in the different nerve 
 centers of man and animals. He has come to the conclusion that 
 definite types or variations of nerve cells exist which are constant 
 not only in the same animal but often exist characteristically in 
 homologous localities in a whole series of animals. According to 
 him, all the cells in the nerve centers, except the so-called chromo- 
 phile nerve cells, can be divided into two main classes. The first 
 class includes the nerve cells which possess a well marked cell- 
 body surrounding the nucleus completely on all sides, the proto- 
 plasm having a distinct contour. These are called somatochrome 
 nerve cells. The second class (sub-divided into two groups, cyto- 
 chrome and caryochrome) includes those cells in which, in Nissl 
 preparations, the nucleus is most in evidence, the nucleus has a 
 clear contour, but only indications of a cell-body are present, an 
 appearance due to either the scanty development of the cell-body 
 or to the predominance in it of the unstainable substance. 
 
 These cells often look as if they were naked nuclei, though 
 by Golgi's method it can be shown that they may possess definite 
 axones and dendrites. In some of these cells the stainable sub- 
 stance may be present, but very unevenly distributed, at different 
 points in the cell, the nucleus appearing as if only partially sur- 
 rounded by protoplasm. Nissl classifies these cells with such an 
 ill-defined cell-body, the nucleus appearing only partially sur- 
 rounded and not exceeding in size the nucleus of a neuroglia cell 
 or of an ordinary leucocyte, as "granules" (Korner) or cyto- 
 chrome nerve cells. These cells are present in great numbers in 
 the granular layer of the cerebellum, also in the cerebral cortex 
 and the olfactory bulb — ^being different varieties and not identical. 
 The second subgroup of cells, in which the cell-body is only indi- 
 cated but the nucleus is of the size of an ordinary nerve cell, or 
 at least larger than that of a neuroglia cell, he designates as 
 
8 G. ALFRED LAWRENCE. 
 
 caryochrome nerve cells. There are varieties of these as in the 
 substantia gelatinosa Rolando, and those of the ganglion ha- 
 benula — these types being designated at present by letters of the 
 Greek alphabet. A majority of the nerve cells fall in the first 
 group — the somatochrome cells — w^here the cell-body, in the light 
 of morphology, has apparently greater relative importance than 
 the nucleus. In this group are a series of types of nerve cells to 
 be distinguished from one another partly through differences in 
 the nuclei, but chiefly through different relations of the stainable 
 and unstainable constituents of the cell-body. 
 
 These somatochrome cells were originally divided by Nissl 
 into four groups,, but now he includes them all in three groups as 
 follows : 
 
 Group I. Arkyochrome nerve cells: — stainable portions of 
 cell-body in Nissl preparations in the form of a network, branches 
 of which appear to be distinctly connected. Nissl notes, however, 
 that in many of these cells processes can be made out into which 
 the distinct network of the perinuclear part of the cell-body can 
 go over, thus forming a parallel-striped arrangement. These 
 arkyochrome cells Nissl subdivides into enarkyochrome forms 
 and ampharkyochrome forms. The former shows the stained 
 constituents arranged in the form of a network, which differs 
 from the latter in that the intensely stained radiating nodal points 
 of the network are connected in the cell-body by deeply stained 
 thick bridges so that a further connected network of very deeply 
 stainable substances is observable. Both these sub-groups of 
 cells are widel}^ distributed throughout the central nervous sys- 
 tem. The former have been observed by Nissl in the spinal cord, 
 but are most numerous in the large dorsal nucleus at the proximal 
 end of the medulla. What he formerly classified as Group III, 
 arkyostichochrome nerve cells, are now included in this first 
 group (1897a).- He describes these cells as presenting a striated 
 appearance with a network-like structure united in a most intricate 
 manner. 
 
 The Purkinje cells of the cerebellar cortex were given as typi- 
 cal examples of cells of this sort. (See Plate IX, Fig. 27). 
 
 Group II. Stichochrome nerve cells, stainable substance ar- 
 
DEMENTIA PARALYTICA. 9 
 
 ranged in strise, running in same direction, and usually parallel 
 to contour of cell-body, in part also with surface of nucleus. 
 These strise, made up of different stained elements, threads, spin- 
 dles and granules, are more or less isolated and in rows. Nissl 
 describes four types of these cells represented by (i) nerve cells 
 of motor nuclei, (2) large cells of cornu Ammonis, (3) certain 
 cells of cerebral cortex, and (4) certain cells of spinal ganglia. 
 
 Group III. Gryochrome nerve cells, stainable substance en- 
 tirely made up of small granules distributed in threads or heaps. 
 Nissl does not give an illustration of these cells, but states that 
 they are to be found particularly but not exclusively in the corpus 
 striatum. Nissl states further that transitional forms exist which 
 are difficult to definitely classify, but that the cells of a wholly 
 definite structure are situated throughout, the animal series in 
 homologous localities. He has also shown that all these types of 
 cells may, under certain circumstances, show different, staining 
 relations (1894a), that is, the individual members of a certain 
 group of cells belonging to one type .may be palely,, moderately, 
 or intensely stained. This difference seems to depend upon the 
 concentration of the stainable substance in the cell-body. The 
 darkly stained ceils he designates as pyknomorphous cells, in 
 which stainable portions are arranged relatively most closely ; 
 intermediate stages are designated as parapyknomorphous cells ; 
 while very feebly stained cells are designated as apyknomor- 
 phous, in which stainable masses are not arranged close to one 
 another but are somewhat widely separated by the non-stainable 
 constituents of the cell-body. Nissl furthermore mentions that 
 often the nucleus shows modifications which correspond in 
 greater or less degree to the staining intensity of the cell-body, 
 so that in an apyknOmorphous cell the unstained nuclear sub- 
 stance is relatively more abundant than in the pyknomorphous 
 cells. This holds in the somatochrome cells, and to a less degree 
 in the caryochrome and cytochrome cells. 
 
 Supposed to be more or less in the nature of an artefact are 
 the so-called chromophile nerve cells which one finds often single 
 or in small groups along with the other nerve cells, but in which 
 the stainable substance seems to be evenly diffused throughout 
 
lO G. ALFRED LAWRENCE. 
 
 the cell-body, making it impossible to distinguish a stainable from 
 an unstainable constituent in the cell. Nissl (1896c) states that 
 they are always relatively smaller than pyknomorphous cells. The 
 explanation of these forms is not as yet entirely satisfactory, but 
 they are supposed to be due to the action of the reagents em- 
 ployed, though under certain circumstances they may have a 
 pathological significance. Another nomenclature has been intro- 
 duced by Flesch (1897), in which he speaks of chromophilic cells 
 and chromophobic cells with transitional forms, and attributes the 
 differences to variations in the internal chemistry of the cells, this 
 latter depending in part upon differences in the devolopment, in 
 part upon differences in metabolism or function. 
 
 Von Lenhossek (1895) gives a very accurate description of 
 the appearances within the cells of the ventral horn of the spinal 
 cord and in the cells of the spinal ganglia. He has found that 
 thionin stains as well if not better than methylene blue, and 
 Barker (1899) has obtained similar results, but states that crys- 
 talline deposits have been more frequent in preparations stained 
 with thionin than in those stained with methylene blue. In ma- 
 terial hardened in Lang's solution or other corrosive sublimate 
 solutions, the writer has at times detected crystalline deposits, 
 whether stained with thionin, methylene blue or methylene violet, 
 and attributed the same to the fixative fluid and not to the stain 
 at all, as no crystalline deposits have been observed with other 
 fixative agents-— alcohol, formalin, and Van Gehuchten's fluid- 
 regardless of which stain was used. 
 
 It would be interesting to know whether corrosive sublimate 
 fixation was used by Barker in the above mentioned preparations. 
 Van Gieson uses polychrome to a considerable extent as a stain, 
 but it seems to the writer to give a paler and less distinct stain 
 than either methylene blue or methylene violet, and has a tend- 
 ency to fade after a time. Referring to von Lenhossek again, he 
 objects to the term "granules" for the stainable substance, the 
 masses being ordinarily much too coarse to be so designated. He 
 has given accurate descriptions of their characteristics and ar- 
 rangement in various animal species. This stainable substance of 
 Nissl he designates as "chromophile corpuscles," and later uses 
 the term "tigroid masses" (1896). 
 
DEMENTIA PARALYTICA. II 
 
 Do Quervain (1893) has suggested that the chromophiUc 
 bodies or corpuscles are aggregations of fine granules, but von 
 Lenhossek refuses to admit that all such bodies represent aggre- 
 gations of minute granules. Schaft'er (1893) first described the 
 peculiar behavior of the axone and adjacent portion of the cell- 
 body known as the axone hillock as regards Nissl staining, this 
 space being entirely free from this stainable substance of Nissl. 
 With Kronthal's method the axone and axone hillock stain in- 
 tensely in methylene blue, but Benda (1895) found that when 
 specimens thus prepared were cleared in creosote this region lost 
 its color and only the stainable substance of Nissl in the cell-body 
 and dentrites retained its color. He found one exception, how- 
 ever. In the basal axones of the pyramidal cells of the cerebrum, 
 especially of those known as the giant pyramidal cells of Betz, just 
 at the beginning where a collateral is coming off at right angles, 
 a small wedge-shaped granule, triangular in section, takes up the 
 methylene blue, the axone itself not staining at all. These dif- 
 ferent results obtained by differences in technique emphasize the 
 writer's previous statement of the necessity of a full knowledge 
 of the history of the case and every detail of technique before com- 
 ing to any conclusions in a given case. 
 
 With this brief review of the more important literature on the 
 internal structure of the nerve cell we will now turn to the ar- 
 rangement of the cells in the cortex. To go into the literature of 
 this subject in detail would be sufficient material for an article in 
 itself, so that it will be passed over as briefly as possible. Table I 
 shows the arrangement of the cells as described by the more im- 
 portant contributors to this subject. As early as 1782 Gennari 
 divided the cortex at the posterior pole of the cerebrum into three 
 layers, an external and internal gray layer separated by a white 
 layer (so-called line or band), the "line of Gennari." Vicq d'Azyr, 
 in 1786, described this region as also made up of an inner and 
 outer gray layer between which was a white layer (line or band), 
 the "line of Vicq d'Azyr." Meckel, in 1812, stated that the gray 
 layer of the cortex is single in all parts but the occipital region and 
 cornu Ammonis. In the occipital region a band of white substance, 
 the line of Vicq d'Azyr, separates the gray substance into an 
 
12 G. ALFRED LAWRENCE. 
 
 external and internal gray layer, so that the structure of this 
 part of the brain is more complex than the rest of the external 
 cortical region. Coming down to 1840 Baillarger first examined 
 the cortex carefully, and described three gray and three white 
 layers, or six layers in all, alternating gray and white. From his 
 descriptions the line of Gennari or Vicq d'Azyr, in the occipital 
 region, received the additional name of the "line of Baillarger." 
 In 1841 Remak examined the cortex microscopically as well as 
 macroscopically, but without the use of staining agents, and de- 
 scribed a four-layered type made up of two gray and two white 
 layers alternating with one another. 
 
 Somewhat later (1852) Kolliker described a three-layered 
 plan, the inner layer appearing of a yellowish red color, the mid- 
 dle of a grayish color, and the outer of a whitish color. 
 
 Berlin, in 1858, first used stains in his work, hardening pieces 
 of the cortex in chrome salt and staining with carmine. He de- 
 scribed six layers as the type, the upper five from the character 
 and arrangement of the cells and the lower as a layer free from 
 cells. He describes the layers from within outwards toward the 
 surface, reversing the usual order of all other authors, and' lead- 
 ing to considerable confusion, unless this fact is carefully noted. 
 Clarke, in 1863, described eight layers as the common type, and 
 Luys the following year, 1864, described just one half that num- 
 ber, or four layers, as the common type. Arndt, in 1867, de- 
 scribed a five-layered type, and Meynert in the same year divided 
 the cortex into a motor and a sensory region, the former anterior 
 to the fissure of Rolando, and the latter posterior to the same. 
 He described five layers as the common type, and eight layers as 
 the type in the occipital region. Cleland, in 1870, described 
 rather a complex arrangement of the cortex into a four-layered 
 type, the third layer being separated from the fourth by what he 
 designated as the "primary pale band." The "deep pale band" 
 is included in and forms the lower part of the fourth layer. 
 Henle in the same year described a four-layered type made up of 
 (i) the outer layer, (2) outer spherical cell layer, (3) pyramidal 
 cell layer, and (4) inner spherical cell layer. Charcot, the fol- 
 lowing year, 1871, described the layers of the cortex as five in 
 
DEMENTIA PARALYTICA. 1 3 
 
 number, (i) superficial layer, (2) small pyramidal cell layer, 
 (3) larger pyramidal cell layer, (4) granular cell layer, and 
 (5) fusiform cell layer; approximating that used by many of the 
 subsequent authors. Lewis, in 1876, described five layers as the 
 type for the motor area and six layers as the type for the sensory 
 area. Major in the same year, 1876, described six layers as the 
 common type, and Krause, also in the same year, described seven 
 layers as the common type. Betz, in 1881, made the division into 
 five layers as the type for the motor area, but divided the sensory 
 region into eight layers as the type — a classification somewhat 
 similar to Meynert's, but with a different nomenclature. 
 
 Golgi, in 1883, using his impregnation method, divided the 
 cortex into three layers as the type, (i) superficial or small 
 pyramidal cell layer, (2) middle .or larger pyramidal cell layer, 
 and (3) internal or irregular cell layer. Schwalbe, in 1885, de- 
 scribed a curious arrangement of the cortex into four layers, the 
 upper two known as the "outer Hauptzone" or chief zone, and 
 separated from the lower into two layers, known as the "inner 
 Hauptzone" or chief zone, by the "boundary zone" or "line of 
 ^aillarger;" Obersteiner's (1887) division into a five-layered 
 •type is similar, except as to the nomenclature, to that of Char- 
 cot's common type, Lewis' motor type, and Betz's motor type. 
 Cajal, in 1890, recognized the same three layers as Golgi in the 
 .common type, but added a fourth layer, which he called the first 
 or molecular zone, then followed the second, or zone of small 
 pyramidal cells ; the third, or zone of large pyramidal cells, and 
 •the fourth, or zone of polymorphous cells ; thus making four 
 layers in all. Golgi's first layer is thus seen to include the first 
 and second layers of Cajal. In the occipital lobe, Cajal describes 
 an additional layer of vertical fusiform cells between the first or 
 molecular layer and the layer of small pyramidal cells, the other 
 layers being similar to his common type, and thus making fi:ve 
 layers in this region. Gowers, in 1893, adopted practically the 
 same division into a five-layered motor type and six-layered sen- 
 sory type as described by Bevan Lewis in 1876. Hammarberg, 
 in 1895, described six layers as the type, with numerous varia- 
 tions in. different parts of the cortex. Edinger, in 1896, describes 
 
14 G. ALFRED LAWRENCE. 
 
 four layers, similar to Cajal as the type, and Starr (1896), in 
 his atlas of nerve cells, also describes a similar arrangement. 
 Nissl (1898) describes a four-layered type as follows: First, or 
 layer poor in cells ; second, or layer of pyramidal cells containing 
 2 equals layer of small pyramidal cells (equals 2 of Meynert's 
 layers) plus 3 equals layer of larger pyramidal cells (equals 3 of 
 Meynert's layers) ; third, or layer of small cells (equals 4 of 
 Meynert's layers) ; and fourth, or internal (6) plus external (5) 
 zone of the layer of medullated fibers (equals 5 of Meynert's 
 layers). Region 5 equals ganglion cell layer, and region 6 equals 
 spindle cell layer of Hammarburg. It will be seen that there is 
 much variation and not a little confusion in adjusting these 
 various arrangements and classifications to one another, and in 
 order to simplify the matter as much as possible the writer sug- 
 gests that as the large and small pyramidal cells are so inter- 
 mingled and merged into one another, they should be included 
 in one layer, thus making three layers the common type, as fol- 
 lows : First, or superficial layer, corresponding to the first layer 
 of Cajal and Edinger; second, or pyramidal cell layer, corre- 
 sponding to the second and third layers of Cajal and Edinger; 
 and third, or spindle cell layer, similar to the fourth layer of 
 Cajal and Edinger. This arrangement differs from Golgi's three- 
 layered type in that the latter recognized no superficial or tangen- 
 tial fiber layer, but includes this as the upper part of his first, or 
 layer of small pyramidal cells, whereas in the writer's arrange- 
 ment one pyramidal cell layer includes both the large and small 
 pyramidal cell layers of Golgi. The third layer ,of Golgi and of 
 the writer are the same as the fourth layer of Cajal and Edinger. 
 This classification into three layers as the type will be used for 
 convenience in the subsequent description of the plates. That 
 there are variations from the type in difiPerent parts of the cOrtex, 
 of course, is recognized by all who have worked in this field to 
 any extent, and, furthermore, specialized parts of the cortex have 
 a specialized arrangement, as the cornu Ammonis, for example. 
 
 In turning now to the pathological investigations by means 
 of the Nissl stain (1898), they are found to have been exhaustive 
 and varied, including most parts of the central nervous system 
 
DEMENTIA PARALYTICA. 1 5 
 
 in both man and animals and in many forms of disease. A brief 
 review only will be given of the contributions containing descrip- 
 tions of researches by Nissl's stain in that form of mental de- 
 rangement known as dementia paralytica, or general paresis. 
 Nagy (1894) carried on his investigations by means of the Nissl 
 stain, and found the greatest changes in dementia paralytica, in- 
 cluding various stages of cell degeneration up to complete de- 
 struction of the same — the cells most altered being those of the 
 frontal lobes, and least changed those of the occipital lobes. 
 Changes of a high grade were also shown in the cells of cases 
 dying after severe epileptic insanity — here the gyrus rectus and 
 cornu Ammonis being affected the most. In chronic forms of in- 
 sanity similar changes were found, but the number of cells en- 
 tirely destroyed was undoubtedly smaller than in the above men- 
 tioned forms of illness. In acute hallucinatory confusional 
 insanity only the beginning stages of alteration were found ; simi- 
 larly in mania. He finally states that each form of mental de- 
 rangement showed the highest grade of change in which the 
 clinical picture of the worst suffering was present, while in the 
 curable forms there were found corresponding slight changes. 
 Belmondo (1896) employed the Nissl method in investigating 
 the alterations in the nerve cells in dementia paralytica, and did 
 not find changes of great gravity — at most the cell protoplasm 
 being much diminished and disintegrated 5 now and then pigmen- 
 tary atrophy, as much in the Rolandic region as the frontal lobe, 
 is found, and in other parts a diffuse chromatolysis is to be seen. 
 He condemns the expression meningo-peri-encephalitis, which im- 
 plies a conception of an inflammatory process. 
 
 Boedecker and Juliusburger (1897) examined sections of 
 cortex from the central and parietal convolutions of three cases 
 of dementia paralytica by the Nissl method. They found thick- 
 ening of the pia with septa projecting into the cortex, containing 
 blood vessels whose walls showed no special thickening but were 
 surrounded by rich deposits of pigment granules, which latter 
 were also found here and there, distant from the septa in the 
 cortical network. In regions most affected the cortex did not 
 present its well known layering. There was to be seen a thickly- 
 
1 6 G. ALFRED LAWRENCE. 
 
 compressed granular crowding with different shaped granules ; 
 thin, spindle-shaped, round, or oval, with strongly colored ones 
 lying adjacent to those only slightly colored. There was increase 
 of blood vessels and hypertrophy of the interstitial network, with 
 corresponding decrease in the number and size of the cells. 
 Many cells were considerably diminished in size, markedly 
 shrunken, entirely without processes, and intensely colored. At 
 times a differentiation into nucleus and granular cell-body was 
 not possible, owing to complete chromatolysis, and very seldom 
 were cells found with a strongly colored nucleus, strongly colored 
 fine granules about the same, with larger granules at the peri- 
 phery of the cell-body — a partial chromatolysis. 
 
 By the Marchi method these investigators determined a de- 
 generation of the fibers from these cells extending into the spinal 
 cord. They conclude the process to be an intense degeneration 
 and proliferating one, going on hand in hand — degeneration of the 
 cells and proliferation of the interstitial network, with increase of 
 blood vessels. Crisafulli (1897) notes a great variety of changes 
 in dementia paralytica. The cellular changes are most advanced 
 and diffuse in the ' frontal lobes, but are not limited to that 
 region. He examined sections from the frontal, parietal, occipi- 
 tal and temporo-sphehoidal lobes of both hemispheres. He found 
 pallor, granular disintegration, and loss of chromatic substance. 
 Often the cell-bodies were atrophied or contained an excess of 
 yellowish pigment, and their numbers were reduced. The nuclei 
 were often eccentric, and all stages of the destruction of the 
 nucleus were observed. While the alterations shown by Nissl's 
 method were not less constant than those demonstratable by other 
 methods, Crisafulli does not consider them characteristic of the 
 disease or in any way different from those seen in some other 
 mental diseases. They are, however, more or less grave and 
 diffuse and not limited to a single cortical center; with varying 
 degrees of degeneration of the nerve cells. He further states 
 that, -provided the nerve cell element degeneration is not greatly 
 advanced, it is impossible to find any alteration of the blood ves- 
 sels, and, finally, that when the psychosomatic condition of the 
 paralytic is not greatly aggravated and death intervenes from 
 
DEMENTIA PARALYTICA. tj 
 
 Other causes, it is possible that the pathological report will note 
 some elements which are not degenerated, although there may be 
 various alterations. His article is illustrated by eight figures 
 showing cells in various conditions of degeneration, 
 
 Angladi (1898) reports a case of acute dementia paralytica 
 in which death occurred after a series of epileptiform convulsions 
 when the patient was at the age of thirty-seven years. The 
 autopsy showed peri-encephalitis. Preparations were made from 
 the ascending frontal convolutions and the anterior part of the 
 frontal lobe of the left hemisphere. He states that not a single 
 one of the pyramidal cells preserved its normal characteristics, 
 and the transformation in the great majority of cases semed to 
 be various stages of the same process — various stages of chro- 
 matolysis, vacuolization, eccentricity of the nucleus up to rupture 
 of the cell wall and extrusion of the nucleus and, finally, com- 
 plete destruction and disappearance of the cell. The chromatic 
 substance is first attacked, and some few cells relatively healthy 
 showed about the nucleus the first stages of dissolution. De- 
 struction of the achromatic network was shown by formation of 
 vacuoles at the periphery of the cell, increasing gradually up to 
 complete destruction of the substance of the cell. The nucleolus 
 becomes vacuolated and disappears. The nucleus is attacked 
 by central chromatolysis and disappears in situ, or becomes 
 eccentric, or the cell-body may rupture and the nucleus be ex- 
 truded, becoming irregular, compressed or shriveled. The con- 
 tour of the cells is always irregular, and the prolongations either 
 broken or tortuous. He states that the cells of the medulla and 
 cord show identical alterations. Angladi finally concludes by 
 stating that we do not know whether these lesions are the cause 
 or the result of the malady, and asks the question, "Are the 
 lesions primary or secondary to an alteration of the vessels or 
 interstitial tissue?" 
 
 Berger (1898) examined the anterior horn cells of the spinal 
 cord in twelve cases of dementia paralytica and found lesions 
 affecting principally the chromatic substance in 83 per cent of 
 the cases. He failed to find a strict parallel between these cellu- 
 lar lesions and those of the fibers and cortex, or between them 
 
1 8 G. ALFRED LAWRENCE. 
 
 and the clinical symptoms of the disease. He illustrates his 
 
 article by figures of these cells. 
 
 Nissl (96a), in 1896, stated that he maintains the same posi- 
 tion as Kraepelin, namely, that one sees in dementia paralytica a 
 general disease with the histopathology directed especially to the 
 cortex. The pathological changes in the blood vessels are obscure, 
 and the relation of the glia to the blood vessels is complicated, 
 also the condition of the lymphatic vessels. Sorne authors regard 
 the disease as an inflammatory process, others that a chronic in- 
 terstitial inflammation enters into it, others that it is a parenchy- 
 , matous process, and still others that it is a histopathological pro- 
 cess in which the specific tissue is diseased primarily. Nissl notes 
 that an inflammation without the blood vessels sharing in it can- 
 not be thought of. He states that the appearance of the paralytic 
 cortical disease can be present without the blood vessels being 
 diseased and without the blood vessels containing any elements, 
 of an inflammatory process. Also there may be a high grade of 
 disease of the 'tissue (Gewebe) in excess of any disease of the 
 blood vessels, and only a slight involvement of the tissue, and 
 vice versa, a severe tissue damage with only insignificant disease 
 of the blood vessels. Also direct inflammatory blood vessel 
 changes with infiltration of the walls of the same with leucocytes 
 and "mastzellen," which may rarely pass out into the adjacent 
 regions. In some cases this inflarnmatory alteration of blood ves- 
 sels results in a massive production of decay of numerous 
 neurones. These inflammatory changes in the blood vessels have 
 nothing directly to do with the chief paralytic process, and are 
 only found in the cortex when sepsis-producing bacteria are 
 present. It therefore follows that the paralytic cortical disease 
 can be regarded either as the result of disease of the blood vessels 
 or as an inflammatory process. Almost all cases of dementia 
 paralytica show a slight or severe disease of the blood vessels. 
 There may be also a leptomeningitis, disease of the beginning 
 part of the aorta, an injury to the diploe, brittleness of the bones, 
 or there may be a general arterio-sclerosis. If it is not a disease 
 of the arteries or an inflammatory process, it may be a primary 
 disease of the glia or of the cortical neurone. Changes in glia 
 
DEMENTIA PARALYTICA. I9 
 
 are progressive in kind (mitosis of glia nuclei, hypertrophy of 
 gha cells, and increase of glia fibers) with regressive changes in 
 .the cortical neurone — an acceptation that results of investigation 
 directly contradict, since we find in the most luxuriant increase 
 of glia that the nerve cells are only slightly or not at all changed, 
 and vice versa, in the most severe nerve cell changes the increase 
 of glia. may be only slight. The acceptation of a primary glia 
 fiber increase is absurd, since the glia fibers are an intercellular 
 substance. Nissl therefore concludes that the cortical disease of 
 dementia paralytica is a primary disease of the cortical neurone ; 
 at the same time with the regressive changes in the cortical neu- 
 rone goes the progressive changes in the glia cells.. Histo- 
 pathological investigations of paralytic cortical disease has to deal 
 chiefly with the following difficulties : ( i ) a paralytic diseased 
 cortex and the, to us, available cortex of the dead paralytic are 
 two different things. Entire series of original circumstances that 
 damage the neurones of the cortex without having anything to 
 do directly with the paralytic process is to be noted, as the com- 
 plete closure of a blood vessel which only indirectly bears upon 
 the original process. Also death of a paretic froni typhus fever, 
 septic pyemia, etc. The problem is extremely difficult, as there 
 is no specific disease of the cortical cells, and, furthermore, there 
 is no paralytic cortical cell disease, although there is a paralytic 
 cortical disease. The kind of disease of the cortical tissue is 
 worthy of being pointed out. (2) It is not sufficient to know that 
 the cortical neurone is diseased, but it is important to know 
 which cortical neurones are damaged. ■ Attention to the kinds of 
 nerve cells directly diseased is important for the real conception 
 of the disease process, and also for the critical examination of the 
 plan of the cortex and its functions. ' Nissl differentiates the 
 following forms of disease of the cells of the cortex in dementia 
 paralytica : ( i ) Acute progressive disease. In certain cases the 
 disease ends with the complete destruction of the elements of the 
 cortex. (2) The chronic disease progresses slowly, restilting in 
 either a pigmentary degeneration or in a decay of the cell-body 
 and nucleus, and ends with so-called cell sclerosis. (3) The 
 severe disease of the cortex which runs either an acute or sub- 
 
20 G. ALFRED LAWRENCE. 
 
 acute course and terminates with the death of the cell. The 
 necrotic cells persist commonly either bleached out or having the 
 appearance of colliquation or of vaucolization of the ground work. 
 (4) The combined form of the disease, in which the cell may be 
 acutely diseased without either a cure following, or, on the other 
 hand, the ordinary course being taken that terminates with the 
 destruction of the cell. Midway in its course the disease process 
 is arrested and takes on the symptoms of the chronic disease. The 
 severe cortical cell disease is entirely overlooked by former 
 authors. It differs in that the nucleus is also involved and a pro- 
 cess of liquefaction takes place in the same. It becomes smaller, 
 shrunken, the contours become homogeneous and tinged, the nu- 
 cleolus sinks to the nuclear wall, which latter is irregular and 
 shriveled into folds, the network cannot be distinguished, and 
 vacuoles and crystals may be formed. In the necrotic cells cal- 
 careous deposits may be found, as is seen in other cortical cell 
 diseases, as sclerotic elements. These chalky or calcareous con- 
 cretions occur in the form of fine granules, crumbs, placques, or 
 stalactitic masses, which are intensely colored with methylene 
 blue. The entire cell may be bleached or only a single part, as 
 some of the fine dendrites or only a single dendritic process, or only 
 the nucleus, or, finally, only the nucleur membrane. This calcifi- 
 cation, moreover, is an exceedingly important phenomena, since 
 we are entitled to conclude that partially calcified cells are no 
 longer functionally active and are necrotic. Under similar condi- 
 tions in acute diseases we recognize the phenomenon of death in 
 the affected cells. If one places the preparations in alcohol after 
 twelve hours postmortem, any mistake in this direction may be 
 obviated. Whoever grasps the histopathology of the cortical cells 
 will guard against any mistake in regard to the above mentioned 
 death phenomena. Ewing, in 1898, used the Nissl method in 
 observations upon the changes found in ganglion cells of the cen- 
 tral nervous system in various pathological conditions, and stated 
 that various grades of chromatolysis were found in the cortical 
 cells in dementia paralytica. 
 
 Ballet (1898) exhibited sections from the paracentral lobule 
 of both a normal and a paretic brain, stained by the Nissl method. 
 
DEMENTIA PARALYTICA. 21 
 
 In the normal brain, under a magnification of forty-five diameters, 
 the four layers of Schwalbe and Ramon y Cajal were easily dis- 
 coverable, but in the paretic sections, in marked contrast, they 
 were recognized with difficulty ; also in the latter, great numbers 
 of capillaries were noted in the third layer and white subcortical 
 substance, the nerve cells were less numerous, and in all cases less 
 distinct and lost in the midst of a mass of nuclei. At 130 diame- 
 ters the contrast was still more marked, and at 250 diameters 
 vascular lesions were noted consisting of enormous dilatation of 
 the capillaries and arterioles, the investment of these vessels by a 
 casing of lymphatic corpuscles which distended the adventitious 
 sheaths, and the accumulation of pigment at certain points, par- 
 ticularly in the neighborhood of the bifurcations. These altera- 
 tions are also revealed by hematoxylin and picro-carmine, and 
 have been described for a long time by all observers, but the Nissl 
 method shows the changes more clearly than any of the others. 
 
 In addition to these changes one may mention the multiplica- 
 tion of the white corpuscles and their migration from the vessels 
 by diapedesis, as due in part perhaps to the proliferation of cellu- 
 lar elements of the neuroglia which accumulate in the interstitial 
 tissue, principally in the neighborhood of the vessels or about the 
 nerve cells. At 600 diameters one easily distinguishes the small 
 white cells (lymphocytes), with small nuclei deeply colored and 
 with but a small amount of protoplasm ; large white globules with 
 protoplasm somewhat abundant and with voluminous nuclei 
 irregular in form and less impregnated than those of the lympho- 
 cytes by the methylene blue; and, finally, polynuclear leucocytes. 
 But interest in Nissl's method is chiefly in the study of the lesions 
 of the nerve cells. At 600 diameters one sees the profound altera- 
 tions undergone by these cells. In examining the elements of the 
 third layer (large pyramidal cells) or the giant cells of Betz, there 
 is a tendency in them to lose their triangular shape and become 
 oval or rounded, the protoplasmic prolongations are atrophied and 
 but slightly visible, the chromophilic granules for the most part 
 undergo a process of disintegration and are reduced to a sort of 
 fine powder or dust, or are entirely dissolved in the mass of proto- 
 plasm. The author then discusses the nature of the process. 
 
22 G. ALFRED LAWRENCE. 
 
 some authors (Magnan, Mierzijewski, Mendel) claiming the 
 primary disease to be that of the neuroglia framework — an inter- 
 stitial encephalitis. Others on the contrary (Tuezeck, Ziegler, 
 Binswanger, Joffroy, Pierret) claim it affects primarily the 
 nervous tissue, either the nerve fibers or the nerve cells ; thus being 
 a parenchymatous encephalitis. The . more Ballet studies the 
 pathological anatomy of dementia paralytica the more he is con- 
 vinced that the first and most important lesions are those of the 
 blood vessels. These are seen in every case, while those of the cells 
 are inconstant, variable in degree, and subordinated to those of 
 the vessels. This is not to say th9,t the cellular alterations may be, 
 as some authors claim, the result of the mechanical choking of the 
 cells by the proliferating interstitial tissue which makes their 
 pathology more complex, but he thinks the result is due less to the 
 compression by the thickened neuroglia than to the difficulties of 
 assimilation, owing to either the circulatory obstruction or the 
 action of the toxines carried by the blood. Ballet then discusses 
 the relation of syphilis to dementia paralytica, and states that the 
 pathological anatomical findings in the two cases are practically 
 identical, and advocates a syphilitic etiology for the disease. 
 
 In this historical review of the literature on the pathological 
 conditions found in dementia paralytica by the employment of the 
 Nissl method, it is to be noted that but few of the contributions 
 were accompanied by figures illustrating the various pathological 
 findings described in the text. 
 
 Technique. Turning to the technique employed in this work, 
 first will be described a method used in transporting material con- 
 siderable distances in the minimum amount of space, and prepar- 
 ing the same in the shortest possible time. 
 
 On several occasions the writer was enabled to secure more 
 than one brain at th-e same time, and at a considerable distance 
 from the laboratory. ~ It was desired to place small blocks from 
 various parts of each of the brains in various fixative media in the 
 shortest possible time, and to put them into the smallest possible 
 space for transportation. The smallest size of tin boxes known as 
 "Miller's patent seariiless box" (Fig. A) were secured at trifling 
 cost at Eimer & Amend's, in New York city; though any small 
 box would answer the purpose. These measured but 2.5 c. c. in 
 diameter and 1.25 c. c. in depth. One gross of these boxes occupy 
 
DEMENTIA PARALYTICA. 
 
 23 
 
 only a space of 15 c. c. square by 5 c. c. in depth. By piercing a 
 hole in both the cover and bottom of these boxes a free circulation 
 of the fixative medium is secured — as mentioned, any other small 
 box or phial admitting of the free circulation of the fixative me- 
 dium could be used ; but these chanced to be the most convenient 
 and available receptacles to the writer. By placing a bit of ab- 
 sorbent cotton or cheesecloth in both the bottom of the box and in 
 the cover the specimen is perfectly protected. A square box of 
 black pins (Fig. B), such as can be secured at any drygoods 
 store at trifling cost, was purchased. Small squares of cardboard 
 were cut out and numbered in duplicate, using a lead pencil. Each 
 
 
 Fig. A. 
 
 number, with its single duplicate, was placed upon a pin and re- 
 turned to its position in the box. The various fixative fluids 
 desired were carried in small glass jars with ground glass covers. 
 All these preparations are made in advance so that at the autopsy, 
 upon removing the brain, small pieces can be taken from any part 
 of the cortex, each one placed in a separate small tin box with a 
 number from one of the pifts. The other or duplicate number is 
 
24 G. ALFRED LAWRENCE. 
 
 left upon the pin, and the latter thrust into the space on the brain 
 surface from which the block was taken (Plate I, Fig. i). The 
 small tin box is then thrown into whatever fixative fluid is desired, 
 and the fluid entrrs and fills up the interior by means of the open- 
 ings above described, the whole process taking less time than re- 
 quired in explanation. In this way a large number of blocks can 
 
 Fig. B. 
 
 be taken from one or more brains without any possibility of con- 
 fusion, and in a minimum amount of time, and likewise take up a 
 minimum amount of space, requiring no writing or labeling of 
 specimens at the time. After all blocks desired are removed the 
 brain is carefully placed upon cotton in a tin pail of the required 
 size in whatever fixative fluid is desired, and other brains can be 
 treated similarly. 
 
 At the laboratory subsequently the exact locality from which 
 blocks were taken can be noted at leisure in the most accurate 
 
DEMENTIA PARALYTICA. 25 
 
 manner. The writer has by this method taken blocks from vari- 
 ous parts of two separate brains, placed them in half a dozen 
 different fixative fluids, and packed them up, together with the 
 tw^o brams in tin pails of suitable diameter, placing everything in 
 a hand bag of medium size, and carried the same many miles on 
 the train without the slightest inconvenience or knowledge by 
 others of the contents ot the hand-bag. The fixative agents em- 
 ployed in this work were alcohol absolute, alcohol 95 per cent, 
 formalin 10 per cent solution (40 per cent formaldehyde, i part 
 by volume, water 9 parts by volume). Van Gehuchten's fluid 
 (alcohol absolute (5o, chloroform 30, and glacial acetic acid 10 
 parts by volume), and Lang's solution (mercuric chloride 5 
 grams, sodmm chloride 6 grams, acetic acid 5 grams, and water 
 100 grams). The most satisfactory results have come from fixa- 
 tion in Van Gehuchten's fluid, and the alcohols. In the employ- 
 ment of the latter more or less shrinkage results, but this can be 
 recognized, and the chromatic substance within the cell is usually 
 well marked. Van Gehuchten's fluid was used as follows : Small 
 blocks, not more than .3 to .5 c. c. in thickness, were immersed in 
 Van Gehuchten's fluid and left for twelve hours. They were then 
 placed in 95 per cent alcohol, where they remained until desired 
 for use. No changes in the contour of the cells were observed to 
 result, and the chromatic substance in these cells was well shown 
 in the subsequent staining. Blocks to be imbedded were then 
 placed in absolute alcohol, and, for the paraffin method, trans- 
 ferred to xylol, and left in the latter for several hours till thor- 
 oughly permeated. They were then placed in paraflin — melting 
 point about 50° C., for from 45 minutes to one hour, and then 
 transferred to another paraflin bath of the same melting point for 
 the same length of time, so as to secure complete penetration and 
 the removal of all xylol. The blocks were then imbedded and sub- 
 sequently sectioned by a Minot microtome serially. The sections 
 were made varying in thickness from 2 to 15 microns, those from 
 6 to 10 microns being found best for study of the arrangement 
 and internal structure of the cells. The celloidin method was also 
 employed, but it was more difficult to secure thin sections when 
 desired, and especially to arrange them serially. A thin smear of 
 tgg albumin was placed upon a perfectly clean slide, several con- 
 secutive sections placed upon the same, and then a small quantity 
 
26 G._ ALFRED LAWRENCE. 
 
 of water by means of a pipette allowed to flow under the sections. 
 This was gently warmed upon the water bath or over an alcohol 
 lamp until the sections were perfectly flattened out. The water 
 was drawn off and the sections allowed to dry. This treatment 
 permitted all subsequent manipulations with the sections upon the 
 slides, without their floating off or becoming disturbed or injured. 
 The slides were then placed in xylol to dissolve out all paraffin 
 and run down in successive grades of alcohol from absolute alco- 
 hol to 2P P^r cent alcohol, and from the latter immersed in water. 
 The sections were then stained upon the slide by means of an 
 aqueous solution of methylene blue, as given by Nissl (methylene 
 blue, 3.75 grams; A^enetian soap, 1.75 grams, and distilled water 
 I,ooo c. c), or by a i per cent aqueous solution of methylene 
 violet or a i per. cent aqueous solution of thionin. . A counter 
 stain of erythrosin was used in some cases after treatment with 
 methylene blue, giving the achromatic substance a pink color in 
 contrast to the blue color of the chromatic substance. The routine 
 method was to gently heat the slide covered with the stain for two 
 minutes over an alcohol lamp, keeping the slide in constant mo- 
 tion, and only allovv'ing it to becorne sufficiently heated so that the 
 steam would come from the surface, but no bubbling of the dye 
 in solution. The dye v/as then gently washed off, the slide im- 
 mersed in water, and then run up into 30, 50, 70, 80, 
 95 per cent, alcohol, absolute alcohol plus xylol equal parts, 
 xylol, and finally mounted in xylol-damar. Some slides were 
 placed, after immersion in water following the staining 
 process, in anilin-oil 10 parts, absolute alcohol 90 parts, and 
 subsequently treated as described by Nissl, and finally mounted in 
 benzene-colophonium. The first method, however, gave the most 
 satisfactory results in the hands of the writer, and which, as seen, 
 embodies various modifications of the original Nissl method. Sec- 
 tions prepared in the routine method above described have been 
 frequently examined under the microscope, also frequently ex- 
 posed to sunlight, and at times to the powerful rays of the electric 
 arc in the photomicrographic work, but were in nowise faded or 
 injured after a period of two years from the time of preparation. 
 
 In the micrographic work the most painstaking care was em- 
 ployed in every detail of the work. Achromatic objectives of 
 various power with compensating eye-pieces in different combina- 
 
DEMENTIA PARALYTICA. 27 
 
 tions were used so as to produce different magnifications up to 
 1,400 diameters. Oil-immersion lenses were not used, as the 
 above combination secured the greatest possible depth under such 
 high powers. The time of exposure varied from a few seconds in 
 the low power photomicrographs to five minutes in some of those 
 magnified 1,400 diameters. 
 
 Material. Some twenty brains were secured, and sections 
 made from various parts of them all and studied in connection 
 .with this article. Three brains of cases electrocuted at Ossining, 
 I and in which the autopsy occurred immediately afterwards and 
 ;the material placed in various fixative media, were secured. The 
 photomicrographs representing the practically normal brain histo- 
 logically in the first part of this article were taken from one of 
 [these brains, marked A (Plate I, Pig. i), a man thirty-six years 
 of age who had been confined in Sing-Sing State Prison for over 
 two years and leading the regular routine prison life during that 
 iperiod. The autopsy was held immediately after death by electro- 
 ■cution. The body was well nourished, and no pathological condi- 
 [tion of the central nervous S3^stem or other organs was found. 
 ■ Small blocks, .3 to .5 c. c. in thickness, from various convolutions 
 I of the brain were placed in the various hardening or fixative 
 i agents described above, and the brain itself immersed in 95 per 
 icent alcohol. The blocks were subsequently imbedded in paraffin, 
 [sectioned serially, stained, differentiated, and mounted as already 
 • described. 
 
 l '-.Brains from three cases of dementia paralytica were also se- 
 cured and studied. Sections from the one marked B (Plate X, 
 Fig. 29) were used to illustrate this article in its pathological por- 
 tion. The paralytic dement from which brain B was taken was a 
 lawyer, had a collegiate education, was single, no history of syph- 
 ilis, and family history negative. Was native of the United 
 States. The disease began at about the age of twenty-eight years 
 with the usual change of character, followed by grandiose ideas 
 and maniacal excitement. Asylum treatment for over a year 
 caused his symptoms to clear up sufffciently so that he was dis- 
 charged. For nearly two years he was in a fairly quiet condition. 
 He then broke out in a long period of excitement, lasting over a 
 year, followed by terminal dementia lasting for one and a half 
 years before death, which latter was uncomplicated. Duration of 
 
ZS 
 
 G. ALFRED LAWRENCE. 
 
 the disease was thus over five and a half years, during which 
 period there was a remission lasting two years, in which he did 
 not require asylum treatment. There was contracture of both 
 arms and legs for three months preceding death. Mentally he 
 was a little brighter during that time. At death the body was 
 immediately placed upon ice, and the autopsy performed fifteen 
 hours later. The body weighed 78 pounds at death and was 
 
 Plate I, Fig. i. 
 
 flexed. Two small cavities, each the size of a pea, were found in 
 the apex of the right lung. The lymphatics were somewhat en- 
 larged. Heart was atrophied. There was meningeal thickening. 
 The ependyma in the posterior part of the floor of the fourth ven- 
 tricle was very slightly granular. The membranes were anemic, 
 and there was no edema or fluid. The convolutions, especially in 
 the region of the central convolutions, are widely separated from 
 one another ; but, as will be described later, this is largely due to 
 mechanical causes in subsequent fixation. In addition to these 
 brains over a dozen were secured from other sources, mostly from 
 the New York City Morgue, of persons who had committed 
 
DEMENTIA PARALYTICA. 29 
 
 suicide or died suddenly from accident or homicide, with autopsy 
 performed within a few hours after death. 
 
 Normal Cortex. The descriptions and plates herein contained, 
 and illustrating the normal human cortex, are not intended to give 
 the ide^ of being in any way a complete exposition of such a vast 
 subject; but it has been the aim to give photomicrographs with 
 accompanying descriptions of typical sections and cells from vari- 
 ous regions of the cortex, as a basis of comparison with sections 
 taken from corresponding regions of the cortex in a case of de- 
 mentia paralytica. Neither is this contribution intended to be in 
 the nature of an atlas, being much too limited in scope for such a 
 work; but to illustrate as far as practicable the structures found 
 in what can be considered a fairly normal brain, with the condi- 
 tions founa in a brain of one dying from dementia paralytica. 
 Various regions of the normal cortex from brain A, one of the 
 electrocuted cases (Plate I, Fig. i), with its accompanying plates 
 will be first described, and then will follow a like description of 
 the corresponding region with its accompanying illustrations of 
 the brain of the case of dementia paralytica, brain B (Plate X, 
 Fig. 29). Plate I, Fig. i, above referred to, shows the left hemi- 
 sphere of Brain A, natural size ; a normal brain, with well marked 
 convolutions and sulci. The small pieces of cardboard with their 
 contained figures show the particular point from which the subse- 
 quent blocks were taken, and also illustrate the method of exact 
 localization of blocks described under the heading of technique. 
 
 Frontal Region. — Turning now to the several cortical re- 
 gions, various portions of the first, second and third frontal 
 convolutions were examined in different brains, and typical of 
 this region is the section shown in Plate I, Fig. 2, which, with 
 minor modifications, is similar to that of all portions of this re- 
 gion, and will now be described in detail. The block from which 
 this section was taken comprised a part of the external surface 
 of the first, or superior frontal convolution, including the entire 
 width of the gyrus for a distance of .4 cm., and taken from the 
 position shown by the figure i, Plate I, Fig. i. The gyrus at this 
 point measures .6 cm. in width, so that the actual size of this sec- 
 tion is .6 cm. in width by .4 cm. in depth, and it is 6 2-3 microns 
 in thickness. 
 
 The block at autopsy immediately after death was placed in 
 Van Gehuchten's fluid, where it remained for twelve hours, when 
 
30 G. ALFRED LAWRENCE. 
 
 it was placed in alcohol 95 per cent until ready for use. It was 
 then imbedded in paraffin, sectioned serially with a Minot micro- 
 tome, stained for two minutes in warm methylene blue, decolor- 
 ized in alcohol, cleared in xylol, and mounted in xylol-damar. 
 Plate I, Fig. 2, referred to above, shows the, section under a 
 magnification of 14 diameters. The section has been broken in 
 manipulation, but shows the general striated arrangement of 
 the cells radiating outward from the white medullary center to 
 
 • Plate I, Fig. 2.' ■ '■ 
 
 the surface ; also the layering of the cortex. The strip of cor- 
 tex outlined in ink on the plate at a is that porti' n shown in 
 Plate II, Fig. 3, under a magnification of 160 diameters. The 
 outer pale layer, the thicker cellular layers,' and the inner med- 
 ullary white portion can easily be differentiated even with this 
 magnification. 
 
 The outer layer is found to be fairly uniform in thickness in 
 this section, but we will find later that there may be a consider- 
 able variation, not only in the thickness of this layer, but also' 
 of the other layers, and consequently of the entire cortex. The 
 radial arrangement of the cells from the medullary white sub- 
 stance is especially well shown under this magnification, and a 
 more general and comprehensive view of both the normal ar- 
 
DEMENTIA PARALYTICA. 
 
 31 
 
 rangenients and of derangements and disturbances due to path- 
 ological changes can be made out under this magnification than 
 by higher powers in which but minute areas are seen. These 
 latter high magnifications are of course also necessary for the 
 complete study of all the details of such variations or patholog- 
 ical changes. Plate'II, Fig. 3, magnified 100 diameters, is that 
 
 it- ,-4 J. C- i-o X 
 
 portion of the section outlined in ink in Plate I, Fig. 2 at a. De-- 
 colorization has been carried on here to such a degree as to 
 make many of the cells appear somewhat pale and 'washed out, 
 and to cause a complete decolorization of many of the neuroglia 
 cells. This, however, admits of a better study of the arrange- 
 ment of the internal structure of the cells, as a too deep coloriza- 
 tion does not sufficiently differentiate the chromophilic granules 
 and network. The outer surface of the cortex is here seen to be 
 smooth and regular. Immediately beneath is the first or superfi- 
 
,32 G. ALFRED LAWRENCE. 
 
 cial layer, pale in color, .25 mm. in thickness, and characterized 
 by a paucity of cells irregularly arranged and appearing upon 
 a colorless background, which we know from sections treated 
 by the Weigert method to be made up of large numbers of 
 densely packed nerve fibers and processes. In the plate are seen 
 for the most part neuroglia cells, but under a high power here 
 and there nerve cells are found, rounded, spindle-shaped, or 
 polygonal in form, with a nucleus filling up almost the entire 
 cell-body, and with no visible dendritic processes, or at most 
 but one or two extending vertically or at right angles to the 
 surface of the cortex. The cell-body contains but a small mass 
 of chromophilic substance, usually forming a narrow band about 
 the nucleus with thickenings where the dendritic processes are 
 given ofif. The cells with no visible processes of course may 
 have such extending in a direction outside of the plane of the 
 section. Fig. C shows one of these cells containing no visible 
 processes, with a rounded cell^body, a large rounded nucleus 
 almost filling up the same and surrounded by a uniformly thin 
 band of chromatic substance. Fig. D shows another cell from 
 this same region with a single proces vertical to the surface of 
 the cortex. Here again the large rounded nucleus almost fills 
 up the cell-body and is surrounded by a thin band of chromatic 
 substance thickened at the point where the dendritic process is 
 given off, and extending into the same for a short distance. Fig. 
 E shows a similar cell, but with two processes extending in a 
 nearly horizontal direction. The thin chromatic band is here 
 thickened at both extremities. The greatest diameter of the 
 ■ cell in Fig. D is vertical, while in Fig. E it is horizontal, in Fig. C 
 of course being practically uniform. Occasionally cells are seen 
 with one process vertical and the other horizontal, as in Fig. F, 
 this being polygonal in shape. The nuclei in all of these cells 
 are well defined, large, and contain a small amount of chroma- 
 tin in the form of a poorly differentiated network, and at some 
 point containing a distinct nucleolus. According to Nissl's clas- 
 sification of nerve cells these would be known as karyochrome 
 nerve cells. The neuroglia cells are smaller, rounded or oval in 
 shape, contain a nucleus, and are much more numerous in this 
 layer than the comparatively scarce nerve cells. The second or 
 pyramidal cell layer, to simplify the layering of the cortex to the 
 greatest extent, as previously described, is made to include both 
 the large and small pyramidal cells. This measures in the plate 
 (Plate II, Fig. 3) 1.40 mm. in depth. This layer thus includes 
 the large and small pyramidal cell layers and the ganglionic cell 
 layer of Hammarberg, and the large and small pyramidal cell 
 layers of Golgi and of Cajal. (See Table I.) Hammarberg 
 (1895) in his description of this region states that the layer of 
 
DEMENTIA PARALYTICA. 33 
 
 small pyramidal cells does not form a distinct layer, but grad- 
 ually passes over into that of the third layer of large pyramidal 
 cells, so that the two in his division make a layer .80 mm. in 
 depth. He further states that the under border of the third 
 layer is difficult to determine, so that there is no distinct fourth 
 layer. This fourth layer is then described as containing small 
 pyramidal cells less thickly distributed than in the layer above, 
 intermingled with which are some smaller irregular cells, giving 
 the appearance of a region poor in cells ; and he notes further 
 that in many places the difference is so slight that it does not 
 make a separate layer. His fifth layer is described as a .70 mm. 
 thick ganglion cell layer, made up of somewhat larger and 
 more closely packed pyramidal cells. These layers, — second, 
 third, fourth and fifth layers of Hammarberg, are all included 
 in this second layer of the writer, and in this section measures 
 about 1.40 mm. in thickness. It is made up of pyramidal cells 
 varying in size in all parts of the layer, so that in any region, ex- 
 cepting a band below the middle portion to be described later, 
 pyramidal cells of different size may be seen in close proximity. 
 As a rule, however, the larger pyramidal cells are found mostly 
 in the deeper portion of the layer. But here as elsewhere are 
 to be seen the small pyramidal cells interspersed. There are also 
 to be seen some rounded and irregular cells throughout this 
 layer. Just below the middle of this second layer is seen a belt 
 some .30 mm. in width, in which small pyramidal cells decidedly 
 predominate and containing but few larger and medium sized 
 pyramidal cells. This region is comparable to the fourth layer 
 of Hammarberg, but as it contains no elements differing from 
 the region above and below, but simply varies in the relative 
 number and size of the same, it does not seem to the writer 
 worthy the designation of a separate layer with the resulting 
 increase in the number of layers. Both above and below this 
 belt large and small pyramidal cells are intermingled ; the large 
 pyramidal cells increasing in proportion from above downward. 
 Fig G (G of Plate H. Fig. 3) shows the details of structure of 
 one of these small pyramidal cells under a high magnification 
 (x 1,300. No. 3 ocular, 1-12 in. oil immersion objective, Leitz). 
 By focussing in different planes the large, broad, apical, den- 
 dritic process is seen extending vertically towards the surface of 
 the cortex. It contains chromophilic granules arranged . with 
 the long axis parallel to the axis of the cell. The cell-body is in 
 the form of a pyramid with rounded sides. The large nucleus is 
 irregularly oval with the long axis parallel with the long axis of 
 the cell. The nucleolus is centrally located and surrounded by 
 the slightly stained nuclear contents. From the lower portion 
 of the cell-body are given off three dendritic processes, one of 
 which subsequently branches into two processes, at which point 
 
34 
 
 G. ALFRED LAWRENCE. 
 
 a mass of chromatin is seen, one of the so-called "wedges of 
 division" (Versweigungs-Kegln) of Nissl. These dendritic 
 processes contain no chromophilic granules, but at the point 
 where they are given ofif from the cell-body are found aggrega- 
 tions of chromophilic granules which also surround the nucleus 
 on either side, their long diameter extending in general parallel 
 with the long axis of the cell. Plate II, Fig. 4, is a photomicro- 
 graph of this same cell as stated, indicated by the letter G in 
 Plate II, Fig. 3, and shown in Fig. G of the text as already de- 
 scribed. In order to secure a focus by which the cell processes 
 
 Plate II, Fig. 4. 
 
 could be seen even faintly the nucleus and nucleolus are almost 
 entirely out of the plane of focus, the latter showing faintly how- 
 ever. Immediately about the nucleolus there is a slightly pale 
 area, a portion of the nucleus. The contents of this cell-body 
 itself present for the most part the appearance of a very dark, 
 almost homogenous, intensely stained chromatic substance, and 
 gives only a partial idea of the real structure and arrangement 
 of the granules as seen in Fig. G. The contour of the nucleus 
 cannot be distinctly made out, nor the relative position of the 
 nucleolus in the same. The individual chromophilic granules 
 
DEMENTIA PARALYTICA. 35 
 
 cannot be distinguished excepting at the base of the right lateral 
 dendritic process. The apical dendritic process appears as a 
 mere shadow, owing to its being out of the plane of focus. The 
 basal dendritic process show almost as well as in Fig. G, except- 
 ing the branching of the one at the left which is but faintly indi- 
 cated. The small mass of chromatin at this point — the so-called 
 "wedge of division," of Nissl — is also but faintly indicated. The 
 general contour of the cell, points from which the dendritic 
 processes are given off, and position of the nucleolus are accu- 
 rately represented. Had a plane been selected showing the nu- 
 cleus accurately some of the processes would have been entirely 
 out of focus. Other cells adjacent to the one just described are 
 seen to be less deeply stained and the chromatin is seen in the 
 form of larger and smaller indistinctly rounded or elongated 
 granules. It will thus be seen that there are hmitations, and 
 serious Hmitations too, in the use of photomicrographs, es- 
 pecially under high powers, in such a study as this. It would 
 require several photomicrographs at various planes to bring out 
 all the details shown in the single Fig. G, which of course is a 
 composite taken by focussing in all planes under a magnification 
 of 1,300 diameters, and showing certain, but not all, details of 
 the different planes. Of course outlines are not so' distinct in 
 the real cell as must necessarily be made to appear in a drawing, 
 and this latter might be compared to a dissection in which cer- 
 tain parts are brought out prominently at the expense of the 
 normal appearance of the whole in life. No one would hesitate 
 to say, however, that Fig, G gave a much better idea though not 
 an exact representation of the cell, than Plate II, Fig. 4, and 
 that drawings are essential accompaniments of such plates in 
 the full elucidation of a subject of this kind. These cells are 
 known as stichocrome nerve cells of the somatochrome class. 
 Fig. H shows one of the large pyramidal cells (the largest to be 
 seen in the plate) under the same magnification as in Fig. G 
 (x 1,300. No. 3 ocular, 1-12 in. oil immersion objective, Leitz). 
 The internal structure of the large pyramidal cells is found to be 
 made up of distinctly stained chromophilic substance in larger 
 and smaller irregular granules, some so fine and closely ar- 
 ranged as to completely fill up the cell-body, thus presenting a 
 uniform field of closely packed minute granules without any spe- 
 cial relation to one another. In other cells the granules are 
 coarser and present a somewhat parallel arrangement about the 
 nulceus and extending up into the main apical process for some 
 distance and also into the basal lateral processes in the same 
 general parallel manner. In other pyramidal cells there is a 
 fine chromophilic network with larger and smaller aggregations 
 of chromatin as nodes or enlargements of the network. In this 
 figure the cell-body is pyramidal in shape with rounded contour 
 
36 
 
 G. ALFRED LAWRENCE. 
 
 merging above into the large apical dendritic process, which is 
 finally lost to view as it enters another plane. Below at the 
 base, both to the right and left, are given off several dendritic 
 processes, some of which are seen to branch a short distance 
 from the cell-body. The large, slightly oval nucleus is centrally 
 situated somewhat nearer the base of the cell than the apex, 
 and contains a large, eccentrically placed nucleolus, surrounded 
 by the pale, slightly strained, for the most part homogenous, 
 
 Plate II, Fig. 5. 
 
 nuclear protoplasm. Within the cell-body about the nucleus 
 and extending into the apical process, and to a less extent into 
 the basal dendritic processes, are chromophilic granules of 
 rounded or elongated shape, and having a tendency to be ar- 
 ranged in groups in places. Especially at the point where a den- 
 dritic process is given off is frequency to be found a mass of 
 these granules. Often a wedge or cap of chromophiHc sub- 
 
DEMENTIA PARALYTICA. 37 
 
 Stance is seen at the point where a dendritic process is to be 
 given off, as at a, or where a process divides into two branches, 
 as at h, the latter being one of the so-called "wedges of division" 
 of Nissl. The granules vary in size and shape and are arranged 
 in general in a direction parallel to the long axis of the cell- 
 body and of the long axis of the dendritic process when extend- 
 ing into the same. About the nucleus they are often arranged 
 parallel to its wall. Five dendritic processes are given off from 
 the base of this cell, three of which are seen to divide into two 
 branches each; at h, showing one of the so-called "wedges of 
 division" of Nissl, referred to above. Plate II, Fig. 5 is a pho- 
 tomicrograph of this same cell indicated by the figure H in 
 Plate II, Fig. 3, and already described and shown in Fig. H; 
 here under a magnification of 1,400 diameters. The body of 
 another somewhat smaller pyramidal cell is seen just behind 
 the apical dendritic process of this cell and part of it almost in 
 the same place, so that it is difficult to differentiate the two. It 
 will be seen that the nucleus and nucleolus are in good focus, 
 but that the basal dendritic processes, excepting at their origin 
 from the cell-body, can scarcely be distinguished. The shape of 
 the nucleus, size and position of the nucleolus, and arrangement 
 of the chromatin within the same is as well shown as in the 
 figure. Also the shape and contour of the cell-body. The den- 
 dritic processes, however, as mentioned above, are out of the 
 plane of focus, so that only a very hazy, indefinite indication 
 of the beginning of three of them can be made out. The large 
 one at the left can scarcely be determined at all. The more 
 central one at the left is faintly outlined, and at the point of bi- 
 furcation the so-called "wedge of division" of Nissl (B) is seen, 
 but the division itself cannot be determined. Of the three pro- 
 cesses given off from the base at the right the beginning of the 
 one most centrally located can be very faintly seen and a faint/ 
 outline of the other two, appearing as one in the photomicro- 
 graph is seen. The apical dendritic process is so merged with 
 the body of the cell just below it that it is difficult to determine 
 its outline. The cell protoplasm is more differentiated however 
 than in the preceding plate (Plate II, Fig. 4). Here chromophi- 
 lic bodies are seen at the base on the right where the dendritic 
 processes are given off, indicated by A both here and in Fig. H. 
 Chromophilic granules are also seen fairly well indicated to 
 the right and above the nucleus, in larger and smaller bodies 
 without sharp outlines, which is the condition actually found in 
 the cell. They are not sharply and definitely outlined as shown 
 in Fig. H, which in that respect is not accurate, but merely 
 diagrammatic. At the left and below the nucleus in the basal por- 
 tion of the cell-body these chromophilic bodies are so closely 
 
38 G. ALFRED LAWRENCE. 
 
 aggregated as to give almost a homogenous dark appearance 
 to that portion of the cell, and it is only by carefully focussing 
 in various planes that the chromophilic bodies are made out. 
 Here again the photomicrograph without the accompanying 
 drawing would give one only a partial knowledge of the struc- 
 ture of this cell. Cells of this type are to be classified as large 
 stichochrome nerve cells of the somatochrome class. Inter- 
 spersed among these larger and smaller pyramidal cells in this 
 layer are some small irregular and rounded cells consisting of 
 a large nucleus containing a nucleolus, and surrounded by a cell- 
 body containing in the smaller cells a very narrow rim of 
 finely granular chromophilic substance, in some places so nar- 
 row as to be scarcely discernible. In other cells the cell-body 
 is much more developed surrounding the nucleus and giving off 
 several protoplasmic processes which go out in various direc- 
 tions. Neuroglia cells similar to those of the first layer are 
 found interspersed among the nerve cells in all parts of the sec- 
 tion. Small portions of capillary blood vessels are shown as at 
 I in the plate (Plate II, Fig. 3, I) where the vessel is seen to di- 
 vide into two branches below, and also at 2 (Plate II, Fig. 3, 2), 
 showing a single small capillary extending only for a short dis- 
 tance in this plane. The walls are seen to be exceedingly thin, 
 made up of a single layer of nucleated cells, and containing red 
 blood corpuscles. The walls of these blood vessels stand in 
 marked contrast to the thickened and tortuous walled vessels 
 found in the cases of dementia paralytica later to be described. 
 Below this is the third, or spindle cell layer about 1.20 mm. in 
 thickness in this section. The spindle cells in this layer con- 
 tain a large nucleus, with a distinct nucleolus, but no nuclear 
 net work could be made out. The nuclei in many of them pre- 
 sent the appearance of being too large for the cell-body, so that 
 often, as in Fig. I, the cell-body seems to be bulged out on one 
 side to accommodate the large nucleus, giving an eccentric 
 form, and resulting in a spindle with one side very promi- 
 nent and the opposite side quite flattened. The chromatic sub- 
 stance is arranged in no definite network and contains no dis- 
 tinct chromophilic bodies, but consists of minute particles close- 
 ly aggregated about the nucleus, especially at each pole and 
 found in a lesser amount and in variable quantities in the re- 
 mainder of the cell-body. In Fig. J the nucleus is situated ec- 
 centrically at one end of the cell-body, so that most of the other 
 cell contents are at the opposite end with a narrow band of 
 closely aggregated chromophilic substance surrounding the nu- 
 cleus at both ends. The nucleus in this cell is more elongated 
 and oval in shape, with distinct nucleolus and otherwise pale, 
 slightly stained contents. Other cells as Fig. K are more or 
 
DEMENTIA PARALYTICA. 39 
 
 less irregular in shape, in this case having the form of an irreg- 
 ular inverted pyramid containing a large rounded nucleus near 
 the base which is surrounded by a narrow band of dense chro- 
 matic substance. About this is an irregular chromatic network 
 containing nodal thickenings at some points. The nucleus con- 
 tains a distinct nucleolus, but otherwise pale and but slightly 
 stained contents. A large dendritic process is seen given ofif 
 below and two dendritic process go off from the base and to one 
 side. Fig. L shows another irregular shaped cell with a den- 
 dritic process given off from one side in addition to those from 
 
 MMMM 
 
 w 
 
 .-;<:-J^: 
 
 HHi 
 
 r 
 
 ■■•■*^::::i 
 
 
 
 
 \ 
 
 
 ■ i 
 
 J 
 
 
 ;^. 
 
 i '---<? 
 
 1 
 
 
 
 
 ;3b.,-^ -„_-... 
 
 
 i 
 
 
 •«£*■ 
 
 * . 
 
 ^-— 
 
 
 
 ^ 
 
 * '* 1p 
 
 Plate III, Fig. 6. 
 
 each end. The large oval nucleus with distinct nucleolus and 
 otherwise pale contents is centrally placed. Considerable chro- 
 matic substance is seen in the larger cell-body with distinct 
 granules, forming an indistinct network at the point w^here the 
 lateral dendritic process is given off, on the opposite side and 
 also in the cell-body and at the base of each of the vertical pro- 
 cesses. Plate III, Fig. 6, is a photomicrograph, at a magnifi- 
 cation of 1,400 diameters, of a group of the spindle and irregu- 
 lar cells indicated by the letter 1 in Plate II, Fig. 3. 
 
 As will be noted, almost all the forms shown in the above 
 described figures are to be seen here.- The cell lettered I, is 
 
40 G. ALFRED LAWRENCE. 
 
 similar in shape and structure to that of Fig. I, including the 
 bulging out of the nucleus to one side, and showing an aggre- 
 gation of chromatic substance in the form of a nuclear cap at 
 both poles of the nucleus. An irregular network of chromatin 
 is seen within the nucleus surrounding the nucleolus. But little 
 chromatic substance, in addition to the two nuclear caps above 
 described, is to be seen in the small cell-body. Ag'ain the cell 
 indicated by the letter J is very similar to that seen in Fig. J, 
 the nucleus being at one end of the cell-body near the base of 
 that polar dendrite. The nucleolus is situated at the lower por- 
 tion and to the left in the nucleus and with but little faintly 
 stained chromatic substance surrounding it. About the nucleus 
 in the cell-body and extending into both dendritic processes is 
 to be seen considerable chromatic substance arranged in an 
 indefinite network. The cell lettered K is irregularly pyramidal 
 in shape, approximating to that seen in Fig. K. The nucleus 
 is very large and almost entirely fills up the cell-body. The 
 nucleolus has the appearance of being without the nucleus, but 
 is within the same adjacent to the wall at this point. A small 
 amount of chromatin is seen in the lower part of the nucleus, 
 otherwise it is for the most part pale. A process is seen given 
 ofif above as the apical dendrite at the base of which are some 
 few chromophilic granules. 
 
 Two basal dendritic processes are given off, one to the right 
 and projecting almost vertically downward, and the other to 
 the left and almost horizontal in direction. At the base of these 
 processes, especially the one to the left, are seen well marked 
 chromophilic granules. Otherwise the cell-body is practically 
 entirely taken up by the nucleus. The cell indicated by the let- 
 ter L is somewhat similar to that of Fig. L in regard to having 
 two polar dendritic processes, one of which coming off laterally 
 here on the left side and only faintly indicated, being in a lower 
 plane. The nucleus here also is seen to occupy the greater por- 
 tion of the cell-body, the nucleolus being crowded over almost 
 to the edge of the same. The nucleus contains only a slight 
 amount of chromatic substance in its upper portion. Nuclear 
 caps are seen above and below the nucleus in the cell-body, the 
 one above being the larger, and surrounded by some small 
 chromophilic bodies extending up into the dendritic process. A 
 very slight amount of very palely colored chromatic substance is 
 seen below the nuclear cap in the lower dendritic process. The 
 lateral dendrite when seen in focus is found to contain a slight 
 amount of chromatic substance more abundant at the base. The 
 cell lettered M is regularly spindle in shape with two polar den- 
 dritic processes, the lower one not in the plane of focus, and 
 the upper one only partially so, and there are no lateral pro- 
 
DEMENTIA PARALYTICA. 4 1 
 
 cesses. The nucleus is not in distinct focus, so that its outline 
 is indistinct. The nucleolus is seen at the lower part of the nu- 
 cleus, and to the left side surrounded by a rather pale indefinite 
 chromatic network. Below this is seen some dense chromatic 
 substance in the form of a nuclear cap. The nucleus really oc- 
 cupies almost the entire body of this cell extending from the 
 dark mass below which has the form of an irregular nuclear cap, 
 to the base of the upper dendritic process where there is a 
 smaller nuclear cap of chromatic substance. A small amount 
 of protoplasm above and below the nucleus in the cell-body 
 extends for a short distance into the dendritic process from 
 these nuclear caps. The other cells seen in this plate are sim- 
 ilar in appearance and structure to those already described. 
 Several neuroglia cells as at N, rounded or oval in shape, 
 are to be seen here also interspersed among the nerve cells, 
 and they increase in number proportionate to the nerve cell de- 
 crease as the white medullary center is reached. Several capillary 
 blood vessels are to be seen in this layer, cut in different planes. 
 Their walls are made up of a single layer of thin nucleated cells 
 and the vessels filled with red blood corpuscles. The cells of 
 this layer belong to the somatochrome class and either the 
 archyochrome or gryochrome group, depending on whether one 
 regards the chromatic substance as making up a distinct net- 
 work as in the archyochrome group or as small granules ar- 
 ranged in threads or heaps as in the gryochrome group. It is 
 difficult to determine a network of any distinctness in the ma- 
 jority of these cells, and they seem to the writer to belong 
 more to the gryochrome group. The entire cortex thus meas- 
 ures in this section approximately 2.85 mm. in thickness as it 
 is really an arbitrary division to state just where the gray cor- 
 tex ends and the subcortical white medullary substance be- 
 gins, there being a gradual transition from the one to other here 
 as well as between the layers of the cortex. In order to ob- 
 tain the approximate number and ratio of the nerve cells to the 
 neuroglia cells an effort was made to count the same in various 
 sections of the photomicrograph, counting the nerve cells 
 first and marking each one as counted by black ink, and after- 
 wards doing the same for the neuroglia cells. Upon subse- 
 quently using a Zeiss ocular micrometer divided into millimeter 
 squares in a No. 3 ocular with a No. 6 objective, thus giving a 
 magnification of 390 diameters, it was found that the former 
 method, in which only a magnification of 100 diameters was 
 used did not show all the structures present, and those shown 
 were not sufficiently distinct at times to determine accurately 
 their real nature, whether neuroglia cells, portions of nerve 
 cells, etc. With the above magnification, — 390 diameters, — and 
 
42 G. ALFRED LAWRENCE. 
 
 upon focussing in various planes, it was found for instance that 
 a single mass upon the photomicrograph could be resolved into 
 two or more neuroglia cells close to one another and in slightly 
 different planes. By using the above combination it was found 
 that one side of the millimeter square in the eye-piece corre- 
 sponded to .033 mm. of the stage micrometer and thus of the 
 surface of the section under observation, so that a square milli- 
 meter of the ocular network was therefore equivalent to .03323, 
 or .00999 square millimeters (practically .01 square millimeters, 
 which latter decimal was used for convenience in this work) of 
 surface of the section under examination. The ocular microm- 
 eter was divided into 36 squares and the number of nerve cells 
 in each of these squares was counted and recorded in seven dif- 
 ferent fields, in this case in different parts of the section, thus 
 making 252 squares in all. The result was added up and di- 
 vided by 252 in order to give the average number of nerve cells 
 for each square. This number was equivalent to that contained 
 in .01 sq. mm. of actual surface of the section, or practically 
 i-ioo of a square mm. The total number of neuroglia cells in 
 108 squares from three different fields was determined in the 
 same manner, the resulting total being divided by 108 to give 
 the average number of neuroglia cells for each sq. mm. of the 
 ocular net-micrometer or .01 sq. mm. of actual surface of the 
 section. These results multiplied by 100 thus will give the num- 
 ber of nerve and neuroglia cells for each square millimeter of 
 actual surface of the section. With this method the average 
 number of nerve cells to each sq. mm. of the ocular net-microm- 
 eter was found to be 1.1685; multiplied by 100 gives 116.85 ^^ 
 the average number of nerve cells to be found in each sq. mm. 
 of this section in the second and third layers. In the region just 
 below the middle of the second layer previously described as 
 made up almost exclusively of small pyramidal cells these lat- 
 ter are found very densely packed together, in many parts as 
 many as 2."/ cells were found to each square on an average. 
 This result multiplied by 100 as before gives the high average 
 of 270 nerve cells to each square millimeter in this narrow re- 
 gion, whereas the general average for the entire second and 
 third layer, not including this region, is but 93 nerve cells to the 
 sq. mm., thus showing the great variation in regions of the 
 same section closely approximating one another. The nerve 
 cells of the first layer were so few and scattered that they were 
 not included in this count. In the same way the average num- 
 ber of neuroglia cells to the square millimeter of surface of the 
 section was found to be 125. Counts were also made from a 
 section from the first frontal convolution, somewhat anterior to 
 that from which Plate II, Fig. 3, was taken. This latter block 
 
DEMENTIA PARALYTICA. 43 
 
 was hardened in alcohol, the section was lo microns in thick- 
 ness, and similarly stained with methylene blue. Decolorization 
 was not carried on to such an extent, so that the neuroglia cells 
 were not decolorized, and the section being lo microns in thick- 
 ness in comparison to 6 2-3 microns in Plate II, Fig. 3, the neu- 
 roglia cells were found to be more numerous. This would 
 seem to indicate that fixing in Van Gehuchteivs fluid and stain- 
 ing the same length of time in warm methylene blue results in 
 a somewhat greater decolorization of the neuroglia cells in the 
 following differentiation than in sections hardened in alcohol 
 and treated similarly in respect to staining and dififerentiation. 
 As stated this section was 10 microns in thickness, whereas that 
 of Plate II, Fig. 3 is but 6 2-3 microns in thickness ; but it will 
 be seen by the following figures that whereas there is only a 
 slightly greater number of nerve cells in the former as compared 
 to the latter the neuroglia cells are considerably in excess in the 
 former. Here counts were made in seven different fields of 36 
 squares each in various parts of the second and third layers for 
 the nerve cells, and in all three layers for the neuroglia cells. 
 The average number of nerve cells was found to be 1.27 to each 
 sq. mm. of the ocular net-micrometer, Avhich multiplied by 100 
 gives 127 as the average number of nerve cells to the sq. mm. of 
 surface of the section. In the same way the average number of 
 neuroglia cells was found to be 1.64 to the square millimeter of 
 the ocular net-micrometer, which again multiplied by 100 gives 
 164, as the average number of neuroglia cells to each sq. mm. of 
 surface of the section. The difference in the number of nerve 
 cells in the two sections is not very great, — about 10 per cent, 
 but in the number of neuroglia cells it is much more marked, — 
 over 30 per cent, due partly to the difference in thickness and 
 partly to the greater decolorization of the first section described 
 (Table II). Hammarberg (1895) for counting nerve cells, and 
 Popoff (1894) for determining the ratio of increase in neuroglia 
 cells in acute and chronic cases of Asiatic cholera, used the 
 ocular net-micrometer in a manner similar to that made use of 
 in this article, but in each case in a different line of investiga- 
 tion ; the former in the study of idiocy, and the latter, as already 
 stated, in Asiatic cholera. The number of nerve cells and of 
 neuroglia cells, as well as their ratio to one another, varies in 
 the different layers of the cortex. In the first layer there are 
 but few nerve cells, whereas the nuroglia cells are about the 
 same or even more in number than in the other layers, thus 
 making a high ratio. In the second and third layers, however, 
 the cells are the important elements and occupy the greatest 
 amount of space, and although fewer numerically than the neu- 
 loglia cells the latter are much smaller, less conspicuous, and 
 
44 
 
 G. ALFRED LAWRENCE. 
 
 the ratio is not so great. Then again the cells are not evenly dis- 
 tributed, but have a tendency to be arranged more or less in 
 irregular groups, so that in some places they are relatively 
 widely scattered, whereas in others they are more closely ag- 
 gregated, so that a number of counts in various parts of the 
 field are necessary to get an approximate average of the num- 
 ber of cells. The thickness of the section, degree of staining, 
 and extent of dififerentiation or decolorization must also be 
 
 Plate III, Fig. 7. 
 
 considered in Nissl work, as too great decolorization will pre- 
 vent some cells from being recorded in a photomicrograph, and 
 an extremely thin section would not contain as many cells as a 
 thicker one. Sections 6 2-3 and 10 microns in thickness (two 
 and three clicks of the Minot microtome) were used in this 
 work, and when well stained and decolorization is not carried 
 too far, will show all cells to be found in such a plane. 
 
 Central Region Turning now to the region posterior to this 
 we come to the motor region of the cortex, comprising the an- 
 
DEMENTIA PARALYTICA. 45 
 
 terior and posterior central convolutions. This region is of 
 especial interest in many ways, and has probably been more 
 extensively studied than any other of the various regions of the 
 cortex. Plate III, Fig. 7, is a photomicrograph magnified 14 
 diameters, taken from a section 10 microns in thickness at the 
 upper third of the anterior central convolution of Brain A. 
 (Plate I, Fig. i, 2.) This block was also fixed in Van Gehuch- 
 ten's fluid, imbedded in paraffin and sectioned serially by a 
 Minot microtome. This section was then stained with warm 
 methylene violet, differentiated in alcohols, 30, 50, 70 and 95 
 per cent., and absolute, cleared in xylol and mounted in xylol- 
 damar. The actual size of the section which includes the entire 
 width of the gyrus, is .7 of a c. m. in width by .7 c. m. in depth, 
 and taken from a block .4 cm. in thickness, the plane of the sec- 
 tion being at right angles to the direction of the gyrus. At the 
 point a and outlined in ink is the strip seen in Plate III, Fig. 
 8, at a magnification of 100 diameters. The outer layer of the 
 cortex is seen to be fairly uniform in thickness, with the excep- 
 tion of the regions indicated at h and c. At b this layer is con- 
 siderably thicker than in any other part, gradually diminishing 
 in thickness near a where it is of the average thickness. At the 
 point c is seen a slight thinning of the cortex, which in Plate 
 IV, Fig. 9, results in the entire disappearance of this layer and 
 is intermediate in degree in Plate IV, Fig. 11. This condition 
 will be more fully discussed in the description of these latter 
 plates, and it will be simply stated now that this is an artefact 
 probably due to manipulation. The general radiating appear- 
 ance of the cortex from the white medullary center to the per- 
 iphery is well seen here. In the region of the lower part of the 
 second or middle cortical layer even with this low magnification 
 can be distinctly seen the giant pyramidal, or Betz cells ar- 
 ranged singly or in groups. Below this the cortex becomes 
 paler and finally merges into the central medidlated white sub- 
 stance. This magnification is especially good for studying the 
 arrangement of the Betz cells. Beginning with the first group 
 in the lowest part of the section on the right, which is the 
 posterior surface of the gyrus, opposite I is a single Betz cell 
 of moderate size; just above this, opposite 2 is a group of two 
 Betz cells, one nearer the surface and above the other in the 
 lower part of the second or pyramidal cell layer. Somewhat 
 higher up, opposite 3, and somewhat deeper, are seen two very 
 large Betz cells, one deeper and further from the surface, as 
 well as higher up than the other. Opposite 4 are three Betz 
 cells too far separated to be considered as a single group, so 
 must be regarded as solitary cells. Just above them at 5 are 
 three smaller cells, one above the other at about the same depth 
 of the cortex. Opposite 6 are two small Betz cells, one nearer 
 
46 G. ALFRED LAWRENCE. 
 
 the surface than the other. Then for a considerable distance 
 no Betz cells are to be seen until we reach a point opposite 7 
 where a fair sized solitary cell is made out. Just above this 
 opposite 8 are two rather small Betz cells, and a short distance 
 above at 9 a group of three containing two large and one small 
 Betz cell. Opposite 10, and just below the lower ink mark are 
 two very large Betz cells, one overlapping t-he other, giving the 
 appearance of one in the plate. Just above the ink line opposite 
 II is to be seen a group of four Betz cells, one large, and the 
 other three smaller. These and those above and included be- 
 tween the two parallel ink lines can be seen at a magnification 
 of 100 diameters in Plate III, Fig. 8, this group being on the 
 extreme right of the latter. Opposite 12 is a group of four Betz 
 cells arranged radially, the upper of the two in the middle being 
 the largest, and the lowest next in size. Opposite 13 is a large 
 solitary Betz cell, and above this and opposite 14 is a group 
 of three Betz cells. Opposite 15 is another large solitary Betz 
 cell, below which, and a little deeper in the cortex between it 
 and the previously described group, is another Betz cell of me- 
 dium size. Just above this is a group of two smaller Betz cells. 
 Opposite 16 are three large cells in a group which are just to 
 the left of Plate III, Fig. 8, and are intermediate in type be- 
 tween the well defined Betz cells and the ordinary large pyram- 
 idal cells, above this and opposite 17 is another group of four 
 cells similar in type. Opposite 18 is a group of two Betz cells, 
 one considerably larger than the other and nearer the surface 
 of the cortex ; in the same radial line is a medium sized solitary 
 Betz cell. Just above this are five Betz cells opposite 19 and 
 radially arranged in a row. Opposite 20 is a solitary Betz cell, 
 and just above opposite 21 is a group of two Betz cells, one very 
 large and the other quite small. Above this (to the left) are a 
 number of pyramidal cells scarcely large enough to be consid- 
 ered as Betz cells, although as previously noted there are inter- 
 mediate forms which might be considered as very small Betz 
 cells or very large pyramidal cells. Opposite 22 are seen three 
 Betz cells rather scattered, the one in the middle being at a 
 deeper level of the cortex. Opposite 23 is seen a small soli- 
 tary Betz cell, and opposite 24 is another solitary Betz cell 
 which is on the anterior aspect of the gyrus. Between it and 
 the last described cell are quite a number of large cells interme- 
 diate in type between the Betz cell and the largest pyramidal 
 cells. Opposite 25 is still another solitary Betz cell. Then 
 comes a region for a considerable distance in which are seen 
 several large cells at this level, but hardly large enough to be 
 considered as Betz cells until we reach that part of the cortex 
 on the anterior aspect of the convolution opposite 26, where we 
 see a group of two made up of a large Betz cell and a smaller one. 
 
DEMENTIA PARALYTICA. 47 
 
 Finally below this, at a considerable distance and opposite 27, 
 is a group of three Betz cells, the one in the middle being large, 
 and the other two small. It will be seen that the Betz cells are 
 larger and more numerous on the posterior aspect of the gyrus 
 than upon the anterior aspect. There are thirty-one groups of 
 these cells in all, 13 of which contain but a solitary cell, so can 
 hardly be considered as a group, though of cpurse many of them 
 form, part of a group, the remaining cells being in another 
 plane. Ten of these groups contain two cells each, 5 cells each, 
 and but two groups have four cells each, and one group has five 
 cells, making 61 Betz cells in all in this section. Beginning pos- 
 teriorly and following around to the lowest group on the ante- 
 rior surface, the number of cells in each group as seen in the 
 same plane is as follows : — i, 2, 2, i, i, i, 3, 2, 1,2, 3, 2, 4, 4, i, 3, 
 I, I, 2, 2, 2, I, 5, I, 2, 3, I, I, 1,2 and 3. These cells lie deeper 
 in the cortex and thus at a greater distance from the surface in 
 the posterior aspect of the gyrus than at the vertex or at the an- 
 terior aspect. Of course the number of cells in this one plane 
 does not represent in every case all the cells in a group, but only 
 those in this particular plane. As many of these groups are 
 more or less spherical no one plane wall show more than a part 
 of such a group, and as stated above some of these solitary cells 
 are the outer members of some of these groups. 
 
 Plate III, Fig. 8, as previously stated, shows the strip a of 
 Plate III, Fig. 7, under a magnification of 100 diameters and in 
 strong contrast to Plate II, Fig.' 3, is to be seen the much larger 
 number of neuroglia cells, the methylene violet stain seeming to 
 have a stronger affinity for the neuroglia cells than the methyl- 
 ene blue stain. The cortex in this plate is also seen to be more 
 condensed and not so deep as in Plate II, Fig. 3. The first layer 
 measure but .20 mm. in thickness in contrast to .25 mm. in the 
 above mentioned plate. In this layer neuroglia cells are more 
 numerous, with a few scarcely scattered nerve cells only to be 
 made out under high magnification, and similar to those found 
 in the first layer in Plate II, Fig. 3. The second or pyramidal 
 cell layer is of special importance and interest. It is deeper 
 than the corresponding layer in Plate II, Fig. 3, measuring 1.75 
 mm. in thickness as contrasted to 1.40 mm. in the former. Here 
 too in addition to the large and small pyramidal cells are found 
 the giant pyramidal or Betz cells, irregularly distributed, singly 
 or in groups, and at different levels, so that it is impossible to 
 describe them as forming a distinct layer, although in this plate, 
 with the exception of one cell, at a they appear to be placed in 
 the lower part of this portion of the cortex now being described. 
 In taking one section after another, however, it will be found 
 that these cells are located at different levels, the majority be- 
 ing in the lower portion of this second layer. They furthermore 
 
48 G. ALFRED LAWRENCE. 
 
 have a tendency to be arranged in groups containing from two 
 to ten cells, rarely more, and finally we find some sections con- 
 taining no Betz cells at all. The pyramidal cells in the motor 
 area are found to be larger in size on an average than those of 
 the frontal region. The chromatic substance is not arranged in 
 such large distinct bodies as in the Betz cells, but may be seen 
 distributed in clumps of finer or coarser granules in different 
 parts of the cell-body, especially about the nucleus and about 
 the base, and at the beginning of the dendritic processes in 
 the cell-body. Fig. M (M, of Plate III, Fig. 8), shows one of 
 these cells under a high power, X1300 (No. 3, ocular, 1-12 inch 
 oil immersion objective. Leitz). Here the finely granular chro- 
 matic substance is distributed in a ring about the nucleus, a 
 clump is seen at the base to the left where a dendritic process is 
 given off and also clumps are seen at the base of the dendritic 
 process on the right and other clumps in the upper part of the 
 cell-body and in the apical process. In addition to this, small 
 sized linear and rounded chromophilic bodies are seen in the 
 upper part of the cell-body and apical process and also in the 
 dendritic processes given ofif at the base. The nucleus here is 
 large, rounded, centrally placed, and contains a round, deeply 
 stained, prominent nucleolus, surrounded by slightly stained 
 homogeneous nuclear substance. In some cells the finely gran- 
 ular chromatic substance predominates in the cell-body, while 
 in others the small chromophilic bodies are more prominent, 
 whereas the majority contain both, as in the above described 
 cell. In some of the smaller pyramidal cells the large nucleus 
 almost fills up the cell-body, with but a narrow rim of finely 
 granular chromatic substance surrounding the same and ex-, 
 tending into the apical and basal processes. These latter cells 
 would be classified under the group of karyochrome nerve cells ; 
 whereas the larger pyramidal cells with the stainable substance 
 arranged in strife in the same direction as the contour of the 
 cell-body come under the head of the stichochrome nerve cells 
 of the somatochrome class. Turning to the Betz cells and ex- 
 amining these under a high power (No. 3 ocular 1-12 inch oil 
 immersion objective, Leitz. X1300) they are seen to contain 
 numerous distinct chromophilic bodies varying in size and shape. 
 In Fig. N (N, of Plate III, Fig. 8) the upper part of the cell is 
 not included in this section. From below are seen two dendritic 
 processes given off from the under side of the cell-body, that is 
 having the cell-body from a lower plane than figured in the 
 drawing, upon the right side ; and one slightly larger process 
 from the left side. These at intervals contain distinct chromo- 
 philic granules, for the most part linear in shape, with the long 
 axis parallel to the axis of the process and extending for a con- 
 siderable distance into the process — as far as they could be 
 
Table II. 
 Nerve Cell and Neuroglia Cell Counts by Ocular Net-Micrometer. 
 
 
 
 
 
 THICK- 
 NESS OF 
 
 SECTION 
 IN MI- 
 CRONS 
 
 AVERAGE NO. 
 
 AVERAGE NO. 
 
 BRAIN. 
 
 REGION. 
 
 
 NERVE CELLS 
 
 TO SQUARE 
 
 MM. 
 
 NEUROGLIA 
 
 CELLS TO 
 
 SQUARE MM. 
 
 Brain 
 
 A. 
 
 First Frontal 
 
 
 6.6 
 
 116.85 
 
 125.00 
 
 Brain 
 
 A. 
 
 First Frontal 
 Ant. Cent. 
 
 Upper 
 
 10 
 
 127.00 
 
 164.00 
 
 Brain 
 
 A. 
 
 Third 
 Ant. Cent. 
 
 Upper 
 
 10 
 
 95.00 
 
 293.00 
 
 Brain 
 
 A. 
 
 Third 
 
 Ant. Cent. 
 
 Lower 
 
 10 
 
 94.00 
 
 84.00 
 
 Brain 
 
 A. 
 
 Third 
 Post. Cent. 
 
 Middle 
 
 10 
 
 108.00 
 
 248.00 
 
 Brain 
 
 A. 
 
 Third 
 
 
 6.6 
 
 185.00 
 
 109.20 
 
 Brain 
 
 A. 
 
 First Tempora 
 
 1 
 
 6.6 
 
 146.00 
 
 131.90 
 
 Brain 
 
 A. 
 
 Parietal 
 
 
 6.6 
 
 104.00 
 
 180.90 
 
 Brain 
 
 A. 
 
 Occipital 
 
 
 6.6 
 
 164.00 
 
 199.00 
 
 Brain 
 
 B. 
 
 First Frontal 
 
 
 6.6 
 
 100.00 
 
 56.90 
 
 Brain 
 
 B. 
 
 First Frontal 
 Ant. Cent. 
 
 Upper 
 
 10 
 
 82.91 
 
 303.00 
 
 Brain 
 
 B. 
 
 Third 
 Ant. Cent. 
 
 Upper 
 
 6.6 
 
 39.60 
 
 204.0c 
 
 Brain 
 
 B. 
 
 Third 
 Ant. Cent. 
 
 Upper 
 
 ID 
 
 49.10 
 
 300.0c 
 
 Brain 
 
 B. 
 
 Third 
 Ant. Cent. 
 
 Upper 
 
 10 
 
 55-50 
 
 305.00 
 
 Brain 
 
 B. 
 
 Third 
 Ant. Cent. 
 
 Upper 
 
 ID 
 
 53-50 
 
 4330 
 
 Brain 
 
 B. 
 
 Third 
 Ant. Cent. 
 
 Upper 
 
 lO 
 
 36.50 
 
 289.00 
 
 Brain 
 
 B. 
 
 Third 
 Ant. Cent. 
 
 Lower 
 
 6.6 
 
 59.20 
 
 320.00 
 
 Brain 
 
 B. 
 
 Third. 
 
 
 10 
 
 46.60 
 
 236.00 
 
 Brain 
 
 B. 
 
 Post. Cent. 
 
 Middle 
 
 
 
 
 
 
 Third 
 
 
 6.6 
 
 59.91 
 
 134-37 
 
 Brain 
 
 B. 
 
 First Temporal 
 
 6.6 
 
 56.74 
 
 205.90 
 
 Brain 
 
 B. 
 
 Parietal 
 
 
 6.6 
 
 68.63 
 
 192.70 
 
 Brain 
 
 B. 
 
 Occipital 
 
 
 6.6 
 
 62.50 
 
 215.01 
 
Table III. 
 
 Plate III. 
 
 Fig. 7 
 
 Plate IV. 
 
 Fig. 9 
 
 Plate IV. ^'^- "■ 
 
 
 NO. OF CELLS IN 
 
 
 NO. OF CELLS IN 
 
 NO. OF CELLS IN 
 
 GROUP. 
 
 
 GROUP 
 
 
 GROUP. 
 
 
 EACH GROUP. 
 
 
 EACH GROUP. 
 
 EACH GROUP. 
 
 I. 
 
 I. 
 
 I. 
 
 I. 
 
 I. 
 
 3- 
 
 II. 
 
 2. 
 
 II. 
 
 4- 
 
 II. 
 
 I. 
 
 III. 
 
 2. 
 
 III. 
 
 I. 
 
 III. 
 
 3- 
 
 IV. 
 
 I. 
 
 IV. 
 
 3- 
 
 IV. 
 
 I. 
 
 V. 
 
 I. 
 
 V. 
 
 I. 
 
 V. 
 
 I. 
 
 VI. 
 
 I. 
 
 VI. 
 
 I. 
 
 VI. 
 
 I. 
 
 VII. 
 
 3- 
 
 VII. 
 
 3- 
 
 VII. 
 
 2. 17 Groups on 
 
 VIII. 
 
 2. 
 
 VIII. 
 
 2. 
 
 VIII. 
 
 I. Posterior As- 
 
 IX. 
 
 I. 
 
 IX. 
 
 2. 
 
 IX. 
 
 I. pect of Gy- 
 
 X. 
 
 2. 25 Groups on 
 
 X. 
 
 2. 19 Groups on 
 
 X. 
 
 I. rus. Total of 
 
 XI. 
 
 3. Posterior As- 
 
 XL 
 
 I. Posteri- 
 
 XL 
 
 2. 27 Cells. 
 
 XII. 
 
 2. pect of Gy- 
 
 XII. 
 
 2. or Aspect of 
 
 XII. 
 
 2. 
 
 XIII. 
 
 4. rus. 
 
 XIII. 
 
 I. Gyrus. To- 
 
 XIII. 
 
 I. 
 
 XIV. 
 
 4. 
 
 XIV. 
 
 I. tal of 37 
 
 XIV. 
 
 3- 
 
 XV. 
 
 I. Total of so 
 
 XV. 
 
 3. Cells. 
 
 XV. 
 
 2. 
 
 XVI. 
 
 3. Cells. 
 
 XVI. 
 
 I. 
 
 XVI. 
 
 I. 
 
 XVII. 
 
 I. 
 
 XVII. 
 
 I. 
 
 XVII. 
 
 I. 
 
 XVIII. 
 
 I. 
 
 XVIII. 
 
 6. 
 
 
 
 XIX. 
 
 2. 
 
 XIX. 
 
 I. 
 
 XVIII. 
 
 2. 
 
 XX. 
 
 2. 
 
 
 
 XIX. 
 
 8. 6 Groups on 
 
 XXI. 
 
 2. 
 
 XX. 
 
 9. 2 Groups on 
 
 XX. 
 
 3. Vertex of 
 
 XXII. 
 
 I. 
 
 XXI. 
 
 6. Vertex f 
 
 XXL 
 
 2. Gyrus. Total 
 
 XXIII. 
 
 5- 
 
 
 Gyrus. Total 
 
 XXII. 
 
 2. of 19 Cells. 
 
 XXIV. 
 
 I. 
 
 
 of 15 Cells. 
 
 XXIII. 
 
 2. 
 
 XXV. 
 
 2. 
 
 
 
 
 
 
 
 XXII. 
 
 I. 2 Groups on 
 
 XXIV. 
 
 4. 6 Groups on 
 
 XXVI. 
 
 3. 2 Groups on 
 
 XXIII. 
 
 6. Ant. Aspect 
 
 XXV. 
 
 I. Ant. Aspect 
 
 XXVII. 
 
 I. Vertex of Gy- 
 
 
 of Gyrus. 
 
 XXVI. 
 
 I. of Gyrus. 
 
 
 rus. Total of 
 
 Total of 7 
 
 XXVTT 
 
 I. Total of 9 
 
 
 4 Cells. 
 
 
 Cells. 
 
 XXVIII. 
 
 I. Cells. 
 
 
 
 
 
 XXIX. I. 
 
 XXVIII. 
 
 1.4 Groups on 
 
 
 
 
 
 XXIX. 
 
 I. Ant. Aspect 
 
 
 
 
 
 XXX. 
 
 2. of Gyrus. To- 
 
 3. of 7 Cells. 
 
 
 
 
 XXXI. 
 
 
 
 
 3 1— Tot. 
 
 6i=Total No. 
 
 23— Tot. 
 
 S9=Total No. 
 
 29z=Toi. 
 
 55=Total No. 
 
 No. of 
 
 of Cells. 
 
 No. of 
 
 of Cells. 
 
 No. of 
 
 of Cells. 
 
 Groups 
 
 
 Groups. 
 
 
 Groups. 
 
 
DEMENTIA PARALYTICA. 49 
 
 traced in the section. About the middle of the left dendritic 
 process is seen a large irregular chromophilic body at a point 
 where a branch is probably given off, as wedge-shaped chro- 
 matic masses are often found at the point of branching of a den- 
 dritic process, Nissl's so-called "wedges of division." Within 
 the cell-body the granules are seen to be elongated, rounded or 
 irregular in shape, the first mentioned predominating; some 
 much larger than others, and with the general arrangement of 
 the long axis parallel to the sides of the cell-body. The nucleus 
 is large, well defined, and placed in the upper part of the cell- 
 body and nearer the right than the left side. There is a well 
 defined, deeply stained nucleolus centrally placed and surrounded 
 by a homogeneous, slightly colored nuclear substance, with no 
 well defined network. At the base of the cell-body, occupying a 
 space somewhat larger than the cell nucleus is a deposit of 
 yellowish pigment, elliptical in outline, and entirely displacing all 
 other cell contents. No other pigment is to be found in this cell. 
 The arrangement of the chromophilic granules in striae in the same 
 direction as the contour of the cell-body classifies it as a sticho- 
 chrome nerve cell of the somatochrome class. Fig.o (o of Plate III, 
 Fig. 8) shows another of these Betz cells examined under the 
 same magnification of 1,300 diameters (No. 3 ocular, 1-12 in oil 
 immersion lens, Leitz), in which the arrangement of the chro- 
 mophilic bodies in striae parallel to the contour of the cell-body 
 is very well marked. This arrangement extends far out in the 
 basal process and high up in the apical process. The nucleus is 
 situated more on one side of the cell-body than the other, and the 
 nucleolus is not included in this plane. There are three dendritic 
 processes to be seen, the apical extending, for a considerable dis- 
 tance towards the periphery, and gradually decreasing in size, 
 and two basal processes, the one to the left unbranched, while 
 the one on the right gives off a large branch shortly after leaving 
 the cell-body, at which point a is one of the so-called "wedges of 
 division" of Nissl. There is no pigment in this cell, but in the 
 one seen just below this in Plate III, Fig. 8, marked P, a large 
 mass of yellow pigment is seen above and to one side of the nu- 
 cleus at the base of the apical process. There are but few 
 chromophilic bodies in this cell compared to the two previously 
 described, the chromatin being for the most part in the form of 
 fine granules arranged in larger and smaller masses in different 
 parts of the cell. The Betz cell seen lying just below and to the 
 right of this latter, and marked O in Plate III, Fig. 8, also con- 
 tains a small mass of pigment poorly defined, and lying just below 
 the nucleus at the base of the cell. The other Betz cells seen 
 in this plate contain no pigment. While discussing the Betz cells, 
 and before proceeding to the description of the third layer, sev- 
 eral other photomicrographs will be described as illustrating the 
 
50 
 
 G. ALFRED LAWRENCE. 
 
 grouping and structure of these cells. The first of these, Plate 
 IV, Fig. 9, is a photomicrograph magnified 14 diameters of a 
 section in close proximity to that seen in Plate III, Fig. 7, of the 
 same size as this latter and treated in the same way, excepting 
 that methylene blue was used as the stain here. Opposite a, and 
 enclosed in ink lines, is the segment of the section shown in 
 Plate IV, Fig. 10, under a magnification of 100 diameters. The 
 other la5^er is seen to vary in thickness, being much thicker at the 
 posterior aspect, at h, than at the vertex or the anterior aspect. 
 
 f 
 
 if ' 
 
 1 ■ 1 
 
 
 /a 
 
 // 
 
 /y 
 
 
 A 
 
 
 
 f 
 
 /f 
 
 D ; 
 
 
 
 B 
 
 f . 
 1 
 
 S 
 J- 
 
 ¥ 
 J 
 
 P L S- "f-" €- 
 
 3^ig. J. 
 
 At c and d the second layer is seen at the surface, due no doubt 
 to injury in manipulation, probably more from pressure than 
 actual tearing, as the surface is smooth and continuous at both 
 ends, with the adjacent surfaces. No doubt artefacts similar to 
 this, and of greater or less extent, must be carefully guarded 
 against and considered in all work upon such a delicate and yield- 
 ing tissue as the brain, especially when secured within a few 
 minutes after death, as in this case, and before any post-mortem 
 fixity results. The second layer shows the radial arrangement 
 of the cells, but the most conspicuous feature is the distribution 
 and arrangement of the Betz cells contained in the lower part 
 
DEMENTIA PARALYTICA. 5^ 
 
 of this layer singly or in groups of varying number and size. 
 Below this the less conspicuous third layer is gradually lost to 
 view as it merges into the white medullary substance. The ar- 
 rangement of the Betz cells will be described in detail as photo- 
 micrographs of this magnification, 14 diameters, show their dis- 
 tribution especially well. Beginning at the posterior portion of 
 the convolution below^ the letter h, the first large Betz cell is to 
 be seen opposite the figure i, and is solitary, whereas just above 
 and opposite 2, is a group of four Betz cells all of about the 
 same depth of the cortex. Above this, opposite 3, is a large soli- 
 tary Betz cell. Opposite 4 is a group of three cells arranged 
 radially above one another. Opposite 5 is another solitary Betz 
 cell. Above it a small portion of a Betz cell is seen which lies 
 mostly in another plane, while below it small portions of three 
 Betz cells are seen lying for the most part in another plane. 
 Above this, and opposite 6, is a group of two Betz cells at the 
 same depth, and one just above the other. Between 6 and 7 are 
 seen cells, two in number, w^hich might be regarded as inter- 
 mediate in character between the large pyramidal and Betz cells, 
 having a similar arrangement of chromophilic substance, but of 
 intermediate size. Opposite 7 is a group of two Betz cells, and 
 opposite 8 is another group of two Betz cells somewhat nearer 
 the surface, and just under this latter group and deeper in the 
 cortex is a solitary Betz cell. Opposite 9 is a group of two Betz 
 cells, only a very small portion of the upper cell being seen in this 
 plane. Opposite 10, a portion of a solitary Betz cell is seen, and 
 opposite II is still another solitary Betz cell. Opposite 12 is a 
 group of three Betz cells, and just to the right of this and at the 
 same level, is a part of a solitary Betz cell, while nearer to the 
 surface and in the same radial line is still another small solitary 
 Betz cell. Opposite 13 is a group of six Betz cells, two of which 
 are large, and appear very prominently, the other four lying 
 somewhat to the right, being smaller, but having the characteris- 
 tic structure of the Betz cells. Opposite 14 is a solitary Betz 
 cell, and next we come to the two groups seen under a magnifica- 
 tion of 100 diameters in Plate IV, Fig. 10, and in this plate seen 
 enclosed in ink lines and opposite figures 15 and 16. The first 
 group, or that opposite 15, contains nine well defined Betz cells, 
 while the adjacent group, opposite 16, contains six Betz cells, 
 three large cells and the segments of three others, the greater 
 part of these latter lying in another plane. Opposite 17 are four 
 scattered cells at about the same depth of the cortex, and inter- 
 mediate in size and structure, between the large pyramidal and 
 the Betz cells. Opposite 18 is a large solitary Betz cell, above 
 and below it being the cells intermediate in type just described. 
 At 19 is a group of six, made up of one large Betz cell and five 
 smaller ones about it. Above and below this are other pyramidal 
 
52 
 
 G. ALFRED LAWRENCE. 
 
 cells at this level, and of the above described intermediate type. 
 There are in all fifty-nine of these Betz cells in this section, ar- 
 ranged singly or in groups; beginning posteriorly at i, and 
 proceeding around to the anterior and last group at 19, as fol- 
 lows : I, 4, I, 3, I, I, 3' 2, 2, 2, I, 2, I, I, 3, I, 
 I, 6, I, 9, 6, I and 6, thus making twenty-three groups in all, 
 eleven of which contain solitary cells, four contain two cells, three 
 
 Flate IV, Fig. 10 
 
 contain three cells, one contains four cells, three contain six cells, 
 and one nine cells, in the plane of this section. Of these cells thirty 
 contain distinct pigmentary deposits, these being practically all 
 of the larger cells. Quite a number of the others in the plane of 
 the main portion of the cell would undoubtedly also contain pig- 
 mentary deposits. The grouping, of course, is here described for 
 only the plane of this section and the probability is that some at 
 
DEMENTIA PARALYTICA. 
 
 53 
 
 least of these solitary cells are a part of a group, the remaining 
 cells lying in another plane. Furthermore, some of the groups 
 described may contain additional celb lying in the plane above and 
 below that of this section. Plate IV. Fig. lo, previously men- 
 tioned, has a magnification of lOO diameters, and includes the strip 
 a outlined in ink in Plate IV. Fig. 9. Two groups of Betz cells 
 are seen, one containing nine and the other six cells. Two other 
 cells, a and b, though smaller yet in structure approach in charac- 
 
 
 /I 
 
 /2- 
 
 ? 
 
 B ' 
 
 
 • 1 
 
 
 i 
 
 4' 
 
 Plate IV, Fig. 11 
 
 ter the Betz cells. It will be noticed that the cortex is not so deep 
 in this plate, the first layer being but .175 mm. in thickness, and 
 the second but 1.20 mm. in thickness in comparison to .20 and 1.75 
 mm., respectively, in Plate III. Fig. 8. It will be noted, however, 
 that this strip was taken from the vertex of the section where 
 the cortex is not so, deep as on the posterior aspect from which 
 Plate III. Fig. 8 was taken. These two groups of Betz cells are 
 but 1.20 mm. from the surface of the cortex here in contrast to 
 1.70 mm. in Plate III. Fig. 8, showing the variability in thickness 
 of the cortex in close proximity, as both plates were made from 
 
54 G- ALFRED LAWRENCE. 
 
 sections cut from the same block which was not more than half a 
 centimeter in thickness. The Betz cells here have the same 
 structural characteristics as those described in Plate III. Fig. 8, 
 and five of the cells, marked c, d, e, f, and g, of the larger group, 
 and two of the cells, marked i and /, of the smaller group, contain 
 distinct yellowish pigment. The larger of the two groups and 
 containing nine Betz cells is made up of two very large cells cut 
 in the plane of the nucleus, four smaller cells also cut in the plane 
 of the nucleus, while the remaining three cells show only a small 
 portion of the body of each cell here, the large portion of these 
 latter being in another plane. Five of these nine cells contain de- 
 posits of pigment, and all show the chromophilic granules, being 
 seen especially well in the cells marked c, d, e, and h. The cells in 
 this group are quite close to one another and do not take up a very 
 large space. The smaller group to the left contains six Betz cells, 
 three large and conspicuous, and three others, one to the right and 
 two to the left of these large cells which lie only partially in this 
 plane and are small in size. Two of the three large cells marked 
 i and / contain deposits of yellowish pigment at the base of the 
 body of the cell, and all contain well defined chromophilic bodies. 
 Plate IV. Fig. ii is another photomicrograph of a section from 
 the same block as that from which the sections represented in 
 Plate III. Fig. 7, and Plate IV. Fig. 9, were taken. This section 
 is 10 microns in thickness, stained with methylene blue and other- 
 wise similarly treated as the above mentioned plates. This mag- 
 nification of 14 diameters shows the outer layer to be fairly uni- 
 form in thickness, excepting at the points h and c. At h it is of 
 relatively the same thickness as at the same point b in Plate IV. 
 Fig. 9, about one and one-half times as thick as at d into which 
 it gradually merges. At c where no outer layer is to be seen in 
 Plate IV. Fig. 9, here the outer layer is distinctly seen but 
 somewhat thinner than on either side, showing the artefact to be 
 less in degree in this section. At a the group of cells represented 
 in Plate V. Fig. 13, is seen, and each cell can easily be distinguish- 
 ed and counted under this magnification of 14 diameters. The 
 second layer here is also especially interesting in respect to the 
 size, number and distribution of the Betz cells singly or in groups 
 in the lower portion of the layer near the transition into the third 
 or spindle cell layer. This latter is less distinct and lost below 
 in the medullary white substance in the interior of the gyrus. A 
 detailed description of the arrangement of these Betz cells will be 
 given in order to compare the same with those of Plate III. Fig. 7, 
 and Plate IV. Fig. 9. Beginning with the first group at the lowest 
 part of the section on the right, which is the posterior surface 
 of the gyrus, opposite I, is seen a group of three large Betz cells. 
 Above this some distance opposite 2, is a solitary Betz cell. Op- 
 posite 3, is another group of three Betz cells at a slightly greater 
 
DEMENTIA PARALYTICA. 55 
 
 depth. Above this and opposite 4 and 5, respectively, are large 
 solitary Betz cells. Then there is a considerable interval where 
 there are a number of large pyramidal cells but scarcely approach- 
 ing the size of a Betz cell until the point opposite 6 is reached 
 where a large solitary Betz cell is seen and just above it a group 
 of two Betz cells somewhat smaller in size is to be noted. Oppo- 
 site 7 is a solitary Betz cell at a greater depth. Just above this 
 and slightly nearer the surface are several intermediate type cells 
 arranged in two rows, one at a slightly greater depth than the 
 other. Opposite 8 and at the same level as the preceding is a 
 solitary Betz cell, and above this opposite 9 is a larger solitary 
 Betz cell. At the same depth and slightly nearer the vertex is a 
 group of two Betz cells, one large and the other small. About 
 midway between these and the surface of the cortex are seen sev- 
 eral very large pyramidal cells, the so-called intermediate type 
 between the Betz cells or giant pyramidal cells and the ordinary 
 sized large pyramidal cells. Opposite 10 is seen a group of two 
 very large Betz cells just below and to one side of a large blood 
 vessel. Just above this and nearer the surface is a small solitary 
 Betz cell. Opposite 11 are three groups of Betz cells, the first con- 
 taining three, the second two, and the third above and nearer the 
 surface consisting of a large solitary Betz cell. Opposite 
 12 is a large solitary Betz cell, considerably nearer the 
 surface than the groups just described. A group of two large 
 Betz cells, one just above the other, is seen opposite 13. This 
 brings us to the large group opposite a and seen under a magni- 
 fication of 850 diameters in Plate V. Fig. 13, containing eight 
 Betz cells which will be described in detail later when discussing 
 this latter plate. To the left of this group opposite 14 are seen 
 three Betz cells of small size and somewhat separated from one 
 another. To the left of these at a short distance are seen two 
 Bfetz cells, one above the other. Opposite 15 are seen two groups 
 of two each, the cells in the first group being somewhat separated 
 from one another and one above the other. Opposite 16 is a well 
 marked group of four Betz cells, two being very large and the 
 other two smaller in size. Below this and upon the anterior sur- 
 face of the gyrus opposite 17 are two solitary Betz cells, one 
 lower than the other and nearer the surface. Opposite 18 is still 
 another smaller solitary Betz cell at a greater depth. For some 
 distance below this no Betz cells are to be seen until opposite 19 is 
 a solitary Betz cell. Just below this and slightly nearer the sur- 
 face is a group of three of the intermediate sized cells. Opposite 
 20 are two large solitary Betz cells, the lower larger one being at 
 a slightly greater depth. Then comes another region barren of 
 these cells until the point opposite 21 is reached where a small 
 solitary intermediate size cell is seen, and below this a group of 
 two of these same cells is to be noted, one at a greater depth than 
 
56 G. ALFRED LAWRENCE. 
 
 the other. Opposite 22 is a very large solitary Betz cell. Just 
 below this are two intermediate size cells, and still below this 
 and at a slightly greater depth are three of these intermediate size 
 cells. This includes all the Betz cells though, as above noted, here 
 and there in different parts of this layer; but for the most part 
 in the same relative position, are to be seen very large pyramidal 
 cells approximating these Betz cells both in size and structure, 
 and the writer thinks should be regarded as intermediate in type 
 between the large pyramidal cells and the giant pyramidal or Betz 
 cells, — a transition form, if they might be so called. There are 
 twenty-eight groups of these Betz cells in all in this plate, varying 
 in number from one to eight cells in each group, one to three being 
 the usual number. Fourteen of these groups contain but one cell 
 each, and these so-called solitary cells are usually of large size. 
 There are eight groups containing two cells each, four groups of 
 three cells each, but one group containing four cells, and one 
 group containing eight cells. Taking the groups from the lower 
 portion of the posterior surface in succession, as above described, 
 and the number of cells in each of the twenty-nine groups is 
 found to be as follows : 3, i, 3, i, i, i, 2, i, i, i, 2, 2, i, 3, 2, i, i, 
 2, 8, 3, 2, 2, 2, 4, I, I, I, I, I, making a total of fifty-five Betz cells 
 in the section, and thus averaging about two cells to each group. 
 The number of groups is somewhat more than in Plate IV. Fig. 9, 
 in which there were twenty-three groups containing in all fifty- 
 nine Betz cells, and somewhat less than in Plate III. Fig. 7, where 
 there are thirty-one groups containing sixty-one cells. It will 
 thus be seen that the average number of groups and total number 
 of cells in these three sections from near-by portions of the same 
 block are fairly uniform in regard to the arrangement and dis- 
 tribution of the Betz cells. It is to be noted that more cells are 
 found on the posterior aspect of the gyrus than on the anterior. 
 In Plate III. Fig. 7, there are fifty cells arranged in twenty-five 
 groups on the posterior aspect of the gyrus, with but four cells in 
 two groups at the vertex, and seven cells in four groups on the 
 anterior aspect. In Plate IV. Fig. 9 there are thirty-seven cells 
 arranged in nineteen groups on the posterior aspect of the gyrus, 
 fifteen cells in two groups at the vertex, and seven cells in two 
 groups on the anterior aspect. Finally, in Plate IV. Fig. 11, there 
 are twenty-seven cells arranged in seventeen groups in the pos- 
 terior aspect of the gyrus, nineteen cells in six groups at the ver- 
 tex, and nine cells arraned in six groups on the anterior aspect. 
 It will thus be seen that most of the Betz cells are on the pos- 
 terior aspect of the gyrus and gradually diminish in number upon 
 approaching the vertex until upon the anterior aspect there are 
 but few to be seen. Table III. shows the above results in tabu- 
 lated form. Upon referring to this latter it will be seen that the 
 average number of cells in each section is fairly uniform — 55, 59 
 
DEMENTIA PARALYTICA. 
 
 57 
 
 and 6i for the three sections ; the grouping is somewhat more 
 variable — 23, 29 and 31, most of the cells singly or in groups of 
 two or more being upon the posterior aspect and vertex. This 
 corresponds to the findings of Lewis and Clarke ('78) who ex- 
 amined sections from various parts of the left anterior central con- 
 volution and the posterior portion of the two upper frontal con- 
 
 Plate V, Fig. 13 
 
 volutions on the same side in several human brains microscop- 
 ically, and made diagrams of the distribution of the Betz cells at 
 various points instead of employing photomicrographs showing 
 the number, arrangement and relation to other elements of the 
 cortex of these Betz cells as in this article. Plate V. Fig/ 13 is 
 a beautiful photomicrograph of a group of these Betz cells mag- 
 nified 825 diameters and taken from the point marked a in Plate 
 IV. Fig. II. Here is seen a "nest," or group of these cells, eight 
 
58 G. ALFRED LAWRENCE. 
 
 in number. All of these Betz cells contain pigment excepting the 
 one marked a which in size is not much larger than one of the 
 large pyramidal cells, but in structure resembles the Betz cells. 
 This pigment, varying in amount, is situated at the base of the 
 cell below the nucleus, excepting in the cell marked h where it is 
 just above the nucleus. In the cell marked c it extends down into 
 the large basal dendritic process, given off to the right for a short 
 distance. In the cells marked c, d, e, f and g, the cell body appears 
 of a lighter color in the photomicrograph where this yellowish pig- 
 
 Plate IV, Fig. 12 
 
 mentary deposit is found. The cell marked c, sectioned outside of 
 the plane of the nucleus, shows very well the general arrangement 
 of the rounded or elongated chromophilic bodies in a direction 
 parallel to the contour of the cell-body, thus classifying it with 
 the others of similar type as stichochrome nerve cells of the 
 somatochrome class. The cell marked e shows the general parallel 
 arrangement of the chromophilic bodies in the apical process very 
 well. The group, as a whole, is very compact and as each cell is 
 cut in a somewhat different plane from the others most of the 
 features of such a "nest" are thus brought out. Of course, there 
 may be other cells in this group lying outside of the ones seen here 
 — in the planes above and below this. Plate IV. Fig. 12 is a pho- 
 
DEMENTIA PARALYTICA. 
 
 59 
 
 tomicrograph of a Betz cell magnified 1,400 diameters from a sec- 
 tion adjacent to and upon the same slide as that from which Plate 
 III. Fig. 8 was taken. The section is, therefore, similar in shape 
 to the one in Plate III. Fig. 7, and this cell is situated in a posi- 
 tion opposite to the letter d, and in the lower portion of the second 
 
 Plate V, Fig. 14 
 
 or p3Tamidal cell layer of this latter. The section is ten microns 
 in thickness and stained with methylene violet. It can readily be 
 appreciated from this photomicrograph that only an extremely 
 thin plane can be seen under such a high magnification and not 
 all of this even will be in sharp focus. The nucleus here is mostly 
 below the plane of the section and the deeply stained nucleolus en- 
 tirely so. Two dendritic processes are faintly seen coming off 
 from the base of the cell, the one on the right but faintly shown 
 as it is at a different level for the most part. The one on the left 
 
6d G. ALFRED LAWRENCE. 
 
 is somewhat more distinct and chromophilic bodies are found to 
 enter the base and extend for a considerable distance into the 
 same. These bodies of varying size and in general rounded or 
 linear in shape, are closely packed in most parts of the cell-body, 
 excepting at the base where a large deposit of yellowish pigment, 
 taking up about the same area of space, as the nucleus, is to be 
 found. These chromophilic bodies are arranged in general par- 
 allel to the contour of the cell-body and extend into both the 
 basal dendritic processes and the apical process as far as they can 
 be traced. A portion of another Betz cell smaller in size is seen 
 above and to the left. About the larger cell are several neuroglia 
 cells singly or in groups, and these are seen to be distinctly round- 
 ed or oval with usually a ring of chromatic substance of varying 
 thickness at the periphery and several irregular deeply stained 
 bodies in the center. Twenty neuroglia cells in all are seen in 
 this plate. Plate V. Fig. 14, is a photomicrograph of the same 
 magnification, — 1,400 diameters, — as the preceding and taken 
 from a section of the same block. The section of the same 
 form and size as that seen in Plate III. Fig. 7, is ten microns in 
 thickness, and stained with methylene blue instead of methylene 
 violet, but otherwise treated in exactly the same way. One 
 noticeable point about this plate is the absence of neuroglia cells, 
 in marked contrast to Plate IV. Fig. 12, indicating again that the 
 neuroglia cells do not retain the methylene blue stain with the 
 same intensity as when similarly treated with methylene violet. 
 Here is seen a group of two Betz cells, the upper one, at this 
 plane broadly pyramidal in shape, and the lower one presenting 
 an irregular spindle shape. This latter, however, is only the base 
 of the cell, the process above and to the left and that below and to 
 the right being basal dendritic processes, and the apical dendritic 
 process extending upward beyond the base of the upper cell in a 
 different plane. There are two other Betz cells just above and 
 slightly to the right of these cells in the section, not shown in the 
 plate, thus making the group consist of four cells in all. Both of 
 these cells are cut in the plane of the nucleus and large, rounded, 
 deeply stained nucleolus. The nuclear body also contains some 
 chromatic substance arranged in an indefinite network. At the 
 base of the lower cell and extending into the large basal dendrite 
 to the right as far as it is seen in this section is a distinct mass of , 
 yellowish pigment displacing the other cell contents. In the plate 
 it is of a lighter color than the rest of the cell. Above this in the 
 cell-body about the nucleus, and extending into the other basal 
 dendrite, are numerous rounded and linear chromophilic bodies. 
 The upper cell shows three dendritic processes going off from the 
 base of the cell-body on the right side, and two from the left side. 
 These processes and the large apical process contain mostly linear- 
 shaped chromophilic bodies, arranged in distinct striae, parallel to 
 
DEMENTIA PARALYTICA. 6l 
 
 the contour of the same. This arrangement also holds good at the 
 periphery of the cell-body, the strize there too being parallel to the 
 contour of the same, but about the nucleus the chromophilic bodies 
 are so closely packed that it is more difficult to make out this par- 
 allel arrangement. There is no pigmentary deposit in this cell. 
 No neuroglia cells are to be seen in this plate, the methylene blue 
 stain being used as stated above. Plate V. Fig. 15, from the same 
 region and under the same magnification, 1,400 diameters, from 
 a section ten microns in thickness and stained also with methy- 
 lene blue, is an exceptionally fine photomicrograph of one of these 
 
 Plate V, Fig. 15 
 
 Betz cells, inasmuch as it shows the processes, especially the apical 
 process, as far as the edge of the plate. It is usually difficult to 
 obtain such an extent of surface of a cell in the same plane under 
 such high magnification even when the microtome cuts in exactly 
 the plane of the long axis of the cell. These dendritic processes 
 are seen to be of no mean size, especially the apical process and 
 the chromophiHc granules extend far up into the same. Three 
 processes are seen given off from the base, one at each angle, and 
 the third descending from the center. The nucleus is distinct, cen- 
 trally located, and contains a large nucleolus surrounded by an 
 irregular chromatic network. The chromophilic granules are 
 
62 G. ALFRED LAWRENCE. 
 
 larger and smaller rounded and irregularly spindle-shaped granules 
 in the triangular-shaped body of the cell, approaching to a more 
 linear form in the processes. This is a stichochrome nerve cell of 
 the somatochrome group. 
 
 Turning again to Plate III. Fig. 8, the third layer will now 
 be described. This is but .70 mm. in thickness as compared to 
 1.20 mm. for the same layer in Plate II. Fig. 3. The nerve cells 
 in this layer are similar in form and structure to those found in 
 the above mentioned plate. The neuroglia cells are much more 
 numerous in all the layers than in Plate II. Fig. 3, due in large 
 part, the writer believes, to the difference in the staining method. 
 Capillary vessels, showing the walls made up of a single layer of 
 nucleated flattened cells, are seen in several places, especially in 
 the lower layer. Counts were made of the nerve and neuroglia 
 cells in different regions in the manner previously described, using 
 the same method and magnification. Counts of the nerve cells in 
 eight different fields from various portions of the second and 
 third layer were made, each field containing thirty-six squares, 
 so that 288 squares were examined. There were found to be an 
 average of .95 nerve cells to each square millimeter of the ocular 
 net-micrometer, which multiplied by 100 gives 95 as the average 
 number of nerve cells found to the square millimeter in the second 
 and third layer of the cortex in this section. The first layer con- 
 tained so few scattered nerve cells that no field was included 
 for this portion of the cortex, as some fields here would contain no 
 nerve cells whatsoever and would thus greatly reduce the general 
 average where the Nissl stain is employed. On this account the 
 nerve cell counts in this and all subsequent sections, as well as 
 that of Plate II. Fig. 3, include only the second and third layers 
 of the cortex. The nerve cells are thus fewer in number than 
 in Plate II. Fig. 3, but they average larger in size, especially in 
 the region of the large pyramidal and Betz cells ; thus the frontal 
 convolutions seem to to contain more nerve cells than the central 
 convolutions. 
 
 Neuroglia cell counts were made from three fields of thirty-six 
 squares each or 108 squares in all from all three layers of the cor- 
 tex. The average number of neuroglia cells was found to be 2.93 
 for each square millimeter of surface of the ocular net-microme- 
 ter, which multiplied by 100 gives 293 as the average number of 
 neuroglia cells in each square millimeter of surface of the cortex 
 from this section. The number in each square here varied from 
 none in some squares to fourteen in one of the squares. The next 
 highest number was eight, several contained seven, but most of 
 them contained from one to four. Counts were also made from 
 a section of the same thickness, ten microns, and from the same 
 block as the preceding, but stained with methylene blue instead 
 of methylene violet. With this exception the technique was ex- 
 
DEMENTIA PARALYTICA. 
 
 63 
 
 actly the same in the two preparations. Counts were made from 
 six different fields of thirty-six squares each, and the average 
 number of nerve cells to each square mm. of the ocular net- 
 micrometer from various parts of the second and third layers was 
 .94. This result multiplied by 100 gives 94 as the average num- 
 ber of nerve cells to each sq. mm. of surface of the section as 
 compared to 95 in Plate III. Fig. 8, a remarkably small difference 
 of only one cell to each square millimeter, both counts being made, 
 the one entirely independent of the other. Counts were made 
 
 N -- 
 
 ^. 
 
 
 c ."' 
 
 
 
 ■i.j.' 
 
 ^ . ' 
 
 
 • 
 
 1 
 
 ,6 
 
 \ s^ 
 
 Plate VI, Fig. 16 
 
 from seven different fields of 36 sq. mm. each from various parts of 
 all three layers of the cortex to determine the average number of 
 neuroglia cells. The average number to each square millimeter 
 of the ocular net-micrometer was found to be .84, which multi- 
 plied by 100 gives 84 as the average number of neuroglia cells 
 to each square millimeter of the section as compared to 293 in 
 Plate III. Fig. 8, where the methylene violet stain was the stain 
 used. This further confirms the statement previously made that 
 methylene violet has a greater affinity for these neuroglia cells and 
 the latter retain this dye much more tenaciously than they do the 
 methylene blue in the subsequent differentiation, whereas the 
 nerve cells retain either dye about the same. The same fact is well 
 
64 G- ALFRED LAWRENCE. 
 
 brought out in Plate IV. Fig. 12, and Plate V. Fig. 14, previously 
 described. In the latter two, Betz cells are seen under a magnifica- 
 tion of 1,400 diameters. The stain used here is methylene blue, 
 and no neuroglia cells are to be seen. In Plate IV. Fig. 12, of 
 the same magnification, but stained with methylene violet, twelve 
 of these neuroglia cells are seen in the immediate vicinity of this 
 large Betz cell. Sections were also prepared from blocks taken 
 from the middle and lower thirds of this same convolution, — the 
 anterior central, — and it was found that the general type of 
 cortical lamination and histological structure remained the same. 
 Plate VI. Fig. 16, is a photomicrograph of a section taken from a 
 block including the entire anterior central convolution for a dis- 
 tance of .4 mm. in its lower third and is representative of the 
 entire lower portion of this convolution. The shape of the con- 
 volution is seen to have undergone considerable modification as 
 compared to the upper third, seen in Plate III. Fig. 7. This 
 section is ten microns in thickness, fixed in alcohol 95 per cent., 
 stained with methylene violet, the other technique being similar to 
 previously described sections. The segment of cortex shown in 
 Plate VI. Fig. 17, under a magnification of 100 diameters, was 
 taken from the point indicated by the ink lines here and opposite a. 
 It is seen from the mechanical arrangement of the cortex to be 
 at the most acute angle and where the same is thickest. At the 
 opposite less acute angle the cortex is not quite so thick, and in- 
 termediate between these angles, and also on the anterior and 
 posterior surfaces the cortex is still thinner. It will be noted 
 that the depth of the sulcus anteriorly at c where it passes over 
 into the third frontal convolution and is thus adjacent to the 
 motor speech area, is more shallow than the posterior sulcus or 
 fissure of Rolando. The first layer is irregular in depth, some- 
 what thicker at the angle opposite a, and still thicker at h and c, 
 whereas at the vertex it is thinner. The general radial direction 
 of the cells from the medullary central white substance to the sur- 
 face is fairly well seen here. In the second layer the most notice- 
 able feature is the entire absence of the Betz cells which are so 
 marked in the upper portion of the convolution. Some very large 
 pyramidal cells, intermediate in size to the Betz cells and the 
 ordinary larger pyramidal cells, are to be seen in this layer how- 
 ever, as will be noted in the following (Plate VI. Fig. 17) : 
 This layer merges into the third or irregular cell layer, which 
 latter is gradually lost in the white central substance of the gyrus. 
 At the vertex in the cortical layer the section is cracked ; this be- 
 ing an artefact resulting from manipulation. The outer layer is 
 seen to be also torn in places from the same cause. Plate VI. 
 Fig. 17, is taken from the strip indicated in ink in Plate VI. Fig. 
 16, and is magnified 100 diameters. The first layer is .25 microns 
 in thickness and similar in structure to the same layer in the 
 
A>i J!' 
 

 
 ■ Ki?i ..'••J '■ : .-<■■■ .. 
 
 
 
 ■y^'vVi^.f;;-- ■^■■■ 
 
 
 UV;, 
 
 1 . 'f . 
 
 ■« '; 
 
 ^'■"tf 
 
 ■i5.vi-;i^A!daaiiJy>- "^?:tH 
 
 Plate II, Fig. 3. 
 
 Plate III, Fig. 8. 
 
 Plate VII. Fig. ig. 
 Plate XIII, Fig. 41. 
 
 Plate Vll, Fig. 21. 
 
DEMENTIA PARALYTICA. 65 
 
 upper portion of the convolution already described. In the second 
 layer, however, the greatest difference is found. The large, Betz 
 cells practically disappear in the lower third of this convolution, 
 although large pyramidal cells simulating them in general struc- 
 ture, but lacking the size, are found in the middle portion of this 
 layer. In this lower third of the convolution the second layer as 
 seen in this section is 1.50 mm. in thickness, and the large pyram- 
 idal cells are seen arranged in irregular groups in its middle 
 portion. Below them is seen a region a averaging .25 mm. in 
 thickness in which small pyramidal cells are almost exclusively 
 found. Below this larger pyramidal cells are seen, but not in great 
 numbers. The divison between this and the lower or spindle cell 
 layer is not well marked, the latter measuring .90 mm. in thick- 
 ness. The cells here are irregularly polygonal or spindle shaped 
 and do not differ from those in the same region in the upper part 
 of this convolution. The total thickness of the cortex at this 
 point is 2,65 mm., exactly the same as of the section shown in 
 Plate III. Fig. 8. Counts of the nerve and neuroglia cells were 
 made in this region in exactly the same manner as in the previously 
 described regions. This section, as above stated, is ten microns 
 in thickness and stained with methylene violet and in seven fields 
 of 36 sq. mm. each from various portions of the second and third 
 layers, the average number of nerve cells to each square milli- 
 meter of surface of the ocular net-micrometer was found to be 
 1.08, multiplied by 100 gives 108 as the average number of nerve 
 cells to each square millimeter of surface of the section in the 
 second and third layer. The nerve cells in the first layer were so 
 few and scattered that no counts of the same were made. In 
 eight fields of 36 sq. mm. each from various portions of the three 
 layers of the cortex in this section the average number of neu- 
 roglia cells to the square millimeter of surface of the ocular net- 
 micrometer was 2.48, multiplied by 100 gives 248, as the average 
 number of neuroglia cells to each square millimeter of surface of 
 the cortex of this section. Here again it will be seen that the 
 methylene violet stain shows a larger number of neuroglia cells — 
 248, while the nerve cells — 108, are but slightly in excess of the 
 average number in the two previously described sections of the 
 upper portion of the anterior central convolution, and slightly less 
 in number than in the sections described from the frontal con- 
 volution (Table II.). 
 
 Passing now to the region posterior to this, we come to the 
 posterior central convolution of this central or motor region. 
 This posterior central convolution is regarded as a transition 
 region between that anterior to the fissure of Rolando, or motor 
 region, and that posterior to the same region, or sensory region of 
 those authors who divide the cortex into a sensory and motor type 
 
66 G. ALFRED LAWRENCE. 
 
 of cortical lamination. The first and third layers here are prac- 
 tically the same as in the region anterior to the fissure of Rolando. 
 The second layer, however, lacks the regularity of the correspond- 
 ing layer in the above mentioned region, but as will be seen in the 
 plate (Plate VII. Fig. 19), there is nothing new or different in 
 this layer from the corresponding layer in the plates already de- 
 scribed. The large Betz cells seen only in limited portions of the 
 region just anterior to this and contained in but a very small por- 
 tion of this so-called motor region are replaced here by some 
 
 Plate VI, Fig. 18 
 
 smaller sized, irregularly situated pyramidal cells, singly or in 
 groups, and of similar internal structure, and mostly to be found 
 in the middle and lower portion of the layer. As typical of this 
 posterior central convolution, a section was taken from a block 
 including the middle portion of this convolution in its entirety for 
 a distance of 4 cm. (5, Plate I. Fig. i). The section is 6 2-3 
 microns in thickness, fixed in 95 per cent, alcohol, and stained with 
 methylene blue, technique otherwise similar to all other sections. 
 Plate VI. Fig. 18, is a photomicrograph of this section, magnified 
 14 diameters. The convolution here presents a peculiar mechanical 
 
DEMENTIA PARALYTICA. 6j 
 
 formation, causing a great variation in thickness of the cortex in 
 different portions, being over twice as thick at h as at the point a, 
 from which latter point Plate VII. Fig, 19 was taken. This condi- 
 tion is not an artefact, as under high magnification no indication 
 of disturbance of the relations of the cells is to be observed. At 
 the vertex, however, there is an artificial break in the first and 
 upper part of the second layer at two points. The first layer is 
 seen to vary in thickness, being thicker at the acute angle below h, 
 and gradually becoming thinner as it approaches the vertex, to 
 become again thicker below a. The general radial direction of 
 the cells is well seen, especially at the vertex and anterior aspect, 
 as at a. Ar h it is not quite so well made out, but exists to a fairly 
 well marked degree when examined under a higher power. 
 Pyramidal cells of considerable size are seen in some parts of this 
 layer, more especially in the middle portion, but in no case do 
 they approach in size to the Betz cells, nor are they for the most 
 part situated in the same portion of the cortex. The third layer 
 is thin and soon lost to view in the medullary white substance. 
 Plate VII. Fig. 19, is a photomicrograph of the strip a enclosed in 
 ink lines in Plate VI. Fig. 18, and magnified 100 diameters. The 
 first or upper layer at this point is somewhat irregular in contour 
 and averages .20 mm. in thickness. It contains neuroglia cells 
 and some scattered nerve cells similar in appearance and structure 
 to those described in Plate II. Fi. 3, for the same region. The 
 second or pyramidal cell layer is especially interesting, owing to the 
 irregularity of the distribution of its cells. At the upper portion 
 the small pyramidal cells are seen closely aggregated together. 
 Below this these cells become more scattered, and irregularly in- 
 terspersed among them are medium sized and larger pyramidal 
 cells. Some of the larger of these have a tendency to be ar- 
 ranged singly or in groups and have an internal structure similar 
 to the giant pyramidal or Betz cells found in parts of the anterior 
 central convolution and in the posterior part of the first frontal 
 convolution. The chromophilic granules are, however, of smaller 
 size though similarly arranged in some of the cells. About the 
 middle of this layer, opposite a, is seen another region in which 
 the small pyramidal cells predominate, and in which there are 
 scarcely any larger pyramidal cells. Just below this again are 
 seen large pyramidal cells arranged singly and in groups, forming 
 the lower portion of this second layer which measures about 1.45 
 mm. in thickness and below gradually merging into the third or 
 spindle cell layer. In addition to the spindle cells there are many 
 irregular polygonal cells founds in this layer which at this point 
 is about .60 mm. in thickness and only partially shown in the 
 plate ; the upper two-thirds being seen here. The lower third, not 
 shown, is similar and gradually merges into the white medullary 
 
68 G. ALFRED LAWRENCE: 
 
 substance. The entire cortex is thus 2.25 mm. in thickness at this 
 point, whereas, as above mentioned at point b in Plate VI. Fig. 18, 
 it is over 5 mm. in thickness. Taking into consideration the varia- 
 tions found in different parts of the same area, often quite near 
 together, and considering the general type of arrangements, it 
 does not seem to the writer that this area varies to a very marked 
 degree from the general type, or at least to such an extent as to be 
 especially marked off from the other regions of the cortex. There 
 is certainly a greater variation between dift'erent regions of the 
 anterior central convolution as in the upper and lower portions, 
 where some parts have no Betz cells and others have thern vari- 
 ously distributed, as well as other differences, than between this 
 region and the frontal region as a whole. Those who separate the 
 cortex into two types, — an anterior or motor type, and a posterior 
 or sensory type, — regard this convolution as the transition region 
 between the two. An examination of sections, both anterior and 
 posterior to this convolution, shows that the same general plan of 
 arrangement is carried out in all parts of the external surface of 
 the cortex with only miiior differences which do not seem sufficient 
 to make such a marked distinction applicable anatomically, and 
 certainly not histologically. The size and form of the cells and 
 their general arrangement differs but slightly from that of the 
 region anterior and posterior, with the exception of the Betz cell 
 groupings in localized portions of the former. 
 
 Nerve cell and neuroglia cell counts were m'ade with the ocular 
 net-micrometer here in this region in the same manner as in the 
 other previously described sections. Eight fields of thirty-six 
 square millimeters each, from various portions of the second and 
 third layers of the cortex, were examined and 185.5 nerve cells 
 were found to be the average number for each square millimeter 
 of surface of the section. In the same manner the neuroglia cells 
 were counted in eight fields from all three layers of the cortex 
 and 109.2 neuroglia cells were found to be the average number for 
 each square millimeter of surface of the section in the cortex. 
 Here methylene blue was the stain employed with the resulting low 
 average number of neuroglia cells, whereas the average number 
 of nerve cells is found to be higher than in any of the previously 
 described sections anterior to this region, and it will be seen sub- 
 sequently that it is also higher than that found for the region 
 posterior as well although the section is 6 2-3 microns in thick- 
 ness, and some already described are 10 microns in thickness 
 (Table II.). This, however, bears out the statement previously 
 made that sections between six and ten microns in thickness con- 
 tain practically all nerve cells that can be seen in one plane. 
 
 Parietal Region. — Posterior to the region just described we 
 come to the parietal region, made up of the superior parietal, 
 
DEMENTIA PARALYTICA. 
 
 69 
 
 supra-inarginal, and supra-angular convolutions. The general 
 arrangement of the layering of the cortex is fairly uniform 
 throughout this region and the section represented in Plate VII, 
 Fig. 20. from a block taken from the supra-marginal convolu- 
 tion is typical of this region (7, Plate I. Fig. i). The block was 
 fixed in Van Gehuchten's fluid, stained with methylene violet, and 
 other technique as for previous regions. The actual size of this 
 section is 7 mm. in its greatest width, and 8 mm. in length, and it 
 is 6 2-3 microns in thickness. As seen in the photomicograph, 
 
 c. 
 
 
 A 
 
 .^ 
 
 \ ■ 
 
 / 
 
 / 
 
 <9 
 
 p ■ 
 
 \ 
 
 \ ■ 
 
 
 
 
 
 ,4 
 
 Plate VII, Fig. 20 
 
 magnified 14 diameters, the convolution is wider above at the 
 surface than deeper down in the sulcus. At the point a is seen 
 the position of the strip from which the photomicograph repre- 
 sented in Plate VII, Fig. 21 was taken. At h and c, owing to the 
 greater angle, the cortex is considerably thicker than at a. The 
 shape of the convolution here is seen to be different again from 
 any of the preceding, thus giving a somewhat different mechanical 
 arrangement, with a broad flattened vertex and shorter anterior 
 
70 G. ALFRED LAWRENCE.. 
 
 and posterior aspects. At the lower portion, on the right, a part 
 of the cortex was cut away in removing the block. In the vicin- 
 ity of a there are some minute artefacts, causing an irregularity 
 of the surface here, and small fragments are partially torn away 
 at two points. The first, or superficial layer, is fairly uniform in 
 thickness, excepting opposite a, which will be discussed more 
 fully in describing the next plate (Plate VII, Fig. 21), and upon 
 the posterior and anterior aspects, where this layer is slightly 
 thicker. The radial arrangement of the cells of the second layer 
 is well shown, and the cortex is seen to be thicker at the angles 
 b and c, as before mentioned. Throughout the middle and lower 
 part of this layer well developed pyramidal cells are seen, some 
 almost approaching in type small Betz cells. The third layer pre- 
 sents nothing unusual, and gradually passes over into the white 
 medullary substance. Plate VII, Fig. 21, shows the strip indi- 
 cated in ink opposite a in Plate VII, Fig. 20, under a magnifica- 
 tion of 100 diameters. The first or superficial layer is seen to be 
 irregular at this point, about 20 mm. in thickness at the right of 
 the plate, then increasing rather suddenly to .25 mm. for a short 
 distance, when the outline suddenly descends, decreasing the 
 layer at this point to .15 mm. It then gradually increases until, 
 at the left of the plate, it is .22 mm. in thickness. The extreme 
 thickness near the center, although the surface is only slightly 
 torn at several points and scarcely noticeable, yet has the appear- 
 ance of an artefact, due no doubt to the unequal pressure in the 
 manipulation of removal, when the brain was in its natural soft 
 condition, prior to any post-mortem changes. A short distance 
 below the surface at this point the cortical substance itself is seen 
 slightly broken, thus confirming the artificial nature of the irregu- 
 larity and increase in depth. The nerve and neuroglia cells are 
 similar to those found in this layer in the regions anterior to this. 
 The second or pyramidal cell layer is 1.60 mm. in thickness, and 
 contains small pyramidal cells exclusively in the upper portion. 
 Very soon, however, larger pyramidal cells appear, and at about 
 the middle of the layer are the greatest in size and most numerous 
 of the layer. Some of these large pyramidal cells in point of size 
 and structure appear intermediate between the large and giant 
 pyramidal or Betz cells. They also tend to be arranged singly or 
 in groups, with smaller cells about them. Just below the middle 
 of this layer, at a, is found a region .20 mm. in thickness, con- 
 spicuous by the almost entire absence of large pyramidal cells, 
 and made up for the most part of small pyramidal cells. Below 
 this large pyramidal cells again appear, intermingled with the 
 small pyramidal cells, and the layer gradually passes over into the 
 lower or spindle-cell layer. The pyramidal cells have the same 
 internal structure as those in the region anterior to this, in the 
 
DEMENTIA PARALYTICA. 71 
 
 lars^est ones the chromophilic granules simply being larger and 
 more conspicuous ; thus these cells come under the same classifi- 
 cation, according to Nissl, as those in the frontal and central con- 
 volutions. The third or spindle-cell layer is .70 mm. in thickrress, 
 and not distinctly separated from the layer above. The arrange- 
 ment of the cells and their form and size, as well as the internal 
 structure, is in no way ditterent from the corresponding layer in 
 the cortex anterior to this. The total thickness of the cortex here 
 is then 2.50 mm., being .25 of a mm. thicker than in the section 
 of the posterior central convolution previously described, .15 mm. 
 less in thickness than the section shown in Plate III. Fig. 8, from 
 the anterior central convolution, and .35 mm. less than in the sec- 
 tion of the first frontal convolution shown in Plate II, Fig. 3. 
 The variation in thickness is thus seen to be slight and no greater. 
 and even not so great as can be found in contiguous portions of 
 any one convolution. In other parts of the parietal region the 
 arrangement of the cortical lamination is similar to that de- 
 scribed above with minor modifications, due to differences in 
 shape, etc., of the convolutions. Here nerve cell and neuroglia 
 cell counts were made in the same manner as in previous regions, 
 and the average number of nerve cells to the square millimeter of 
 surface of the section was found to be 104, w^hereas the average 
 number of neuroglia cells for the same area of surface of the sec- 
 tion w'as 180.90. This is the lowest average of nerve cells in any 
 region of this, brain, with the exception of the upper portion of 
 the anterior central convolution. The methylene violet stain 
 makes the average number of neuroglia cells quite high, however, 
 though considerably less than in the upper portion of the anterior 
 central convolution. 
 
 Temporal Region. — Below the parietal region just discussed 
 W'C come to the three temporal convolutions — the first, second and 
 third. Here the general arrangement of the cortical laminations 
 and the cell structure is practically the same in the three convolu- 
 tions, and bears a striking resemblance to that found in the frontal 
 region. A block was. taken from the anterior portion of the first 
 temporal convolution near the apex (6, Plate I, Fig. i), the entire 
 width of the convolution and for a distance of .4 cm. The actual 
 size of the section from this block represented in the photomicro- 
 graph r Plate A'll. Fig. 22) is 8.5 mm. at the wddest point, and 
 8.5 mm. in length on the right, and 6 mm. in length on the left, 
 and it is 6 2-3 microns in thickness. The block was fixed in Van 
 Gehuchten's fluid, stained w'ith meth}lene blue, all the other 
 details of technique being similar to that employed for previously 
 described sections. This photomicrograph is magnified 14 diam- 
 eters, and here the shape of the gyrus is seen to be somewhat 
 similar to that in Plate Yll, Fig 20, but broader above, and also 
 
72 
 
 G. ALFRED LAWRENCE. 
 
 with a broader base. The vertex is flattened similarly, resulting 
 in the more acute anglg at b and the slightly obtuse angle at c, 
 at which points the cortex is thicker than at the vertex or the 
 anterior or posterior aspects. The cortex is seen to be uniformly 
 thicker along the surface, opposite d, than upon the opposite 
 aspect at and above and below a. The first or superficial layer is 
 thicker at c than in other portions, and is somewhat b'-oken in 
 places along the vertex. The second layer varying in thickness, 
 being thickest at the points mentioned above, where the entire 
 
 G 
 
 \ 
 
 
 
 
 b ■ 
 
 D 
 
 
 
 ■\ 
 
 '4 
 
 
 
 
 ■^ 
 
 • t 
 
 
 * 
 
 
 
 
 Plate VII, Fig. 22 
 
 cortex is thickest, shows the radial arrangement of the cells very 
 well, especially at the vertex and opposite a and b. The larger 
 nerve cells appear quite conspicuous in the middle and lower por- 
 tion of this layer in places. The third layer is quite uniform, dis- 
 appearing in the white medullary central substance. Plate VIII, 
 Fig. 23, shows the strip a of Plate VIII, Fig. 22 at a magnification 
 of 100 diameters. Here the dififerentiation has been carried to 
 about the same stage as in Plate II, Fig. 3, and the paucity of 
 neuroglia cells is equally as apparent. Again the general arrange- 
 
DEMENTIA PARALYTICA. 73 
 
 nient of the cells in the two plates is remarkably similar. The 
 first or superficial layer is here .25 mm. in thickness, and contains, 
 for the most part, neuroglia cells and a few scattered nerve cells. 
 The second or pyramidal cell. layer measures 1.65 mm. in thick- 
 ness, as compared to 1.40 mm. in Plate II, Fig 3, being thus 
 slightly thicker than in the latter. The cells are arranged prac- 
 tically the same, however, the small pyramidal cells above inter- 
 mingled with larger pyramidal cells in increasing numbers deeper 
 down in the layer. Here again, at a point somewhat deeper than 
 in Plate II, Fig". 3. is to be found a region at a, of the same thick- 
 ness — .30 mm., where small pyramidal cells arc found almost ex- 
 clusively, followed again by a region containing large pyramidal 
 cells in considerable numbers in addition to small pyramidal cells. 
 This layer finally passes over into a narrow (.40 mm. thick) third 
 or spindle-cell layer. This layer is also similar to that of Plate 
 II, Fig. 3, with the exception of its depth, the latter having a 
 spindle or irregular cell layer, measuring 1.20 mm. in thickness. 
 As will be seen by referring to Plate I, Fig. 2, the strip a repre- 
 sented in Plate II, Fig. 3, was taken from the point of greatest 
 curvature, where the cortex is usually the thickest, whereas Plate 
 VIII, Fig. 23, was taken from the point a shown in Plate VIII, 
 Fig. 22, from the side of the section where the cortex is thinner. 
 The entire depth of the cortex is found to be 2.30 mm., as com- 
 pared to 2.85 mm. in Plate II, Fig. 3, a difference of .55 mm. 
 There are no larger pyramidal cells here intermediate in size be- 
 tween the Betz cells and the ordinary large pyramidal cells, as were 
 noted singly or in small groups scattered in the central and parie- 
 tal convolutions already described, and, as we shall see, also occur 
 in the occipital convolution. The internal structure of these cells 
 and their classification are similar to that for the cells described in 
 Plate II, Fig. 3. Nerve and neuroglia cell counts were made 
 from this section, which, as above mentioned, is 6 2-3 microns in 
 thickness and stained with methylene blue. Seven fields of 36 
 sq. mm. each gave an average of 146 nerve cells to each square 
 millimeter of surface of the section, and eight fields of the same 
 size gave an average of 131.90 neuroglia cells to each square milli- 
 meter of surface of the section. It will be seen upon comparing 
 these figures with those from sections of regions more anterior 
 and above, that they show a larger number of nerve cells than in 
 the sections from the regions anterior to the fissure of Rolando, 
 but a, less number than that for the posterior central convolution, 
 and more than from the parietal region. The neuroglia cells are 
 about the same in number as in Plate II, Fig. 3 of the frontal 
 region. 
 
 " Occipital Region. — Coming to the posterior pole of the ex- 
 ternal cortex, the typical structure of the occipital lobe is repre- 
 
74- G. ALFRED LAWRENCE. 
 
 sented by Plate VTII, Fig. 24, a section magnified 14 diameters 
 from a block taken from the point indicated by the figure 8, Plate 
 I, Fig. I. The section is 6 2-3 microns in thickness, is 6 mm. in 
 width at the widest portion, and 7 m.m. in length, stained with 
 methylene violet, fixed in Van Gehuchten's fluid, other technique 
 as previously described. This convolution is seen to be quite dif- 
 ferent in shape from the two previously described of the temporal 
 and parietal regions, having a broader base and narrower rounded 
 vertex. The cortex is seen to be thickest on the lateral aspect b, 
 thinner on the opposite lateral aspect c, and thinnest at the vertex 
 in the vicinity of a; the central white medullary substance being 
 reduced to a minimum. The outer layer varies in thickness, being 
 thickest at c. Above this it is broken away for a short distance, 
 is quite thin at the vertex, and becomes somewhat thicker on the 
 lateral aspect b. Above b the section is seen to be cracked, an 
 artefact resulting from its fixation upon the slide, also at c numer- 
 ous small breaks are noticed, due to the microtome knife. Oppo- 
 site a, and enclosed in ink lines, is the segment of this section, 
 represented in Plate IX, Fig. 25, under a magnification of 100 
 diameters. The radial arrangement of the cells is well made out 
 at the vertex, but not quite so readily seen on the lateral aspects 
 of the gyrus here, but under a higher magnification can be dis- 
 tinctly made out. About the middle of the second layer, especially 
 at the vertex, some very large pyramidal cells are to be seen 
 singly or in groups, and approaching the Betz cells in type in 
 some cases. The third or lower layer presents nothing unusual, 
 and disappears below into the white medullary substance of the 
 interior of the gyrus. Plate IX, Fig. 25, is a photomicrograph of 
 the segment a, enclosed in ink lines in Plate VIII, Fig. 24, at a 
 magnification of 100 diameters. Here the cortex is found thinner 
 than in any of the preceding plates, measuring scarce 2 mm. in 
 thickness. The first layer averages only .15 mm. in thickness, and 
 in structure and arrangement of the cells is similar to this layer in 
 the preceding plates. The second layer measures 1.15 mm. in 
 thickness, containing small pyramidal cells above and quite closely 
 packed together, but increasing in size below and being somewhat 
 more scattered. About the middle of this layer a number of large 
 cells are seen, many singly, but some arranged in groups in places. 
 Some of these are even larger than those found in the parietal 
 convolution, and are intermediate in size between the Betz or 
 giant pyramidal cells and the large pyramidal cells. These latter 
 are not very numerous in this region, the small pyramidal cells 
 making up by far the greatest part of the cellular elements of this 
 layer. Below the middle of this layer is to be found a region, at a, 
 almost exclusively made up of small pyramidal cells about .25 
 mm. in width. Between this and the lower border large pyram- 
 
DEMENTIA PARALYTICA. 
 
 75 
 
 idal cells are again found intermingled with the smaller. The 
 third or spindle cell layer is here .70 mm. in thickness, containing 
 larger and smaller spindle and irregularly polygonal cells, the 
 lower border being gradually lost in the white medullary sub- 
 stance below. The nerve cells are found quite numerous and 
 closely aggregated in this region, as counts by the same method 
 
 Plate VIII, Fig. 24. 
 
 and manner as in all previous sections, give here an average of 
 164 nerve cells to the square millimeter of surface of the section, 
 and 199 neuroglia cells, the section being 6 2-3 microns in thick- 
 ness and stained with methylene violet. The cells are thus seen 
 to be more numerous than in any other region of the external 
 surface of the hemisphere, with the exception of the posterior cen- 
 tral convolution. The fact of the greater number of the pyramidal 
 
76 
 
 G. ALFRED LAWRENCE. 
 
 cells being- small, permits of their closer aggregation, and no doubt 
 is an important factor in the result of the nerve cell counts. The 
 number of neuroglia cells averages higher than in any other 
 region posterior to the fissure of Rolando, but they are less in 
 number than in the anterior central convolution. 
 
 This includes the plates of the external surface of the cortex, 
 but for the purpose of comparison, several plates will be intro- 
 duced from other parts of the central nervous system. The first 
 of these is a photomicrograph, Plate IX, Fig. 26, of several large 
 
 Plate IX, Fig. 27. 
 
 pyramidal cells from the layer of large pyramidal cells of the 
 hippocampus major or cornu ammonis; between the alveus, repre- 
 senting the white medullary substance of the ordinary gyrus, and 
 the stratum radiatum containing the apical dendrite processes of 
 these hippocampal pyramidal cells. This plate and the two follow- 
 ing are not presented as a basis of comparison with similar 
 regions of the pathological brain subsequently to be described, 
 but to give an idea of the appearance of these cells in a normal 
 brain as seen in a photomicograph of a Nissl preparation magni- 
 
DEMENTIA PARALYTICA. 
 
 11 
 
 fied 1,400 diameters, as distinct types in Xissl's classification. 
 These large cells of the cornu ammonis are given as one of the 
 four types of Group II of the stichochrome nerve cells in his 
 classification ; the other three types being ( i ) the nerve cells of 
 the motor nuclei, (2) certain cells of the cerebral cortex, and 
 (3) certain cells of the spinal ganglia. In shape these cells ap- 
 
 Plate IX, Fiff. 26. 
 
 proach the larger pyramidal cells of the external surface of the 
 cortex, second layer, but are somewhat more slender, of a narrow 
 pyramidal shape, have fewer basal dendritic processes, and a long, 
 somewhat slender, apical dendritic process. The chromatic sub- 
 stance here is made up of very small granules fusing into larger 
 
78 G. ALFRED LAWRENCE. 
 
 and smaller masses in places, so that in the photomicrograph it is 
 difficult to differentiate and determine their arrangement accu- 
 rately. In some of the cells, as in the cell to the extreme right of 
 the plate, and partially out of the field, the rounded and linear 
 granules above the nucleus, and extending into the apical process, 
 are seen to have a general parallel arrangement. The nuclei of 
 these cells are large, and contain a large, well marked nucleolus 
 and a more or less irregular chromatic network. As this section 
 was stained with methylene violet, numerous neuroglia cells are 
 distinctly seen scattered among the pyramidal nerve cells. 
 
 From the cerebellar cortex a photomicrograph was taken of 
 two Purkinje cells, magnified 1,400 diameters, and shown in Plate 
 IX, Fig. 27. The section from which this photomicrograph was 
 taken was situated on the external surface of the left hemisphere, 
 cut transversely to the horizontal axis of the same, fixed in alcohol 
 95 per cent, stained with methylene blue : other technique similar 
 to that of previously described plates. The section is 10 microns 
 in thickness. These Purkinje cells were given by Nissl as typical 
 examples of what he formerly described as Group II, arkyosti- 
 chochrome nerve cells of the somatochrome class, in which was 
 presented a striated appearance, with a network-like structure, 
 united in a most intricate manner, thus having characteristics of 
 both the arkychrome and the stichochrome cells. He now classi- 
 fies them as one of the types of Group I, the arkyochrome nerve 
 cells. In the Purkinje cell, to the right, the base of each of the 
 two large dendritic processes is seen, one going off to the right, 
 the other to the left, subsequently to divide and subdivide in the 
 internal layer, not shown in the plate. The Purkinje cell 10 the 
 left shows only one of these processes in this plane, that going 
 off to the left which divides in the same manner as above de- 
 scribed for the other cell. The large rounded nucleus, with its 
 centrally placed nucleolus, is fairly well shown in the cell to the 
 right, and contains a fine network of chromatic substance. The 
 chromatic substance of the body of the cell is made up of larger 
 and smaller irregularly-rounded chromophilic bodies, arranged in 
 an indefinite network extending up into the base of the dendritic 
 processes. A nuclear cap is seen above the nucleus of the Pur- 
 kinje cell on the right. The closely-packed fine granular cells of 
 the granular layer of the cerebellum are seen just below these two 
 Purkinje cells, and are included in the class of cytochrome nerve 
 cells in Nissl's classification. They contain a nucleus almost 
 filling the cell body, and which is surrounded by only a very nar- 
 row rim of chromatic substance. Within the nucleus is a nucleo- 
 lus, and in some of these nuclei several irregularly-arranged chro- 
 matic granules are also seen. Between the Purkinje cells is a 
 small nerve cell with rounded body and an apical dendritic pro- 
 
DEMENTIA PARALYTICA. 
 
 79 
 
 cess. It contains a nucleus, nucleolus, and some chromophilic 
 granules irregularly arranged in the cell-body. 
 
 The last photomicrograph in the series of the normal histo- 
 logical material is that shown in Plate X, Fig. 28. of a typical 
 multipolar ganglion cell from the anterior horn of the lumbar 
 enlargement of the spinal cord, under a magnification of 1,400 
 
 Plate X, Fig. 28. 
 
 diameters. The segment of cord from which the section was 
 taken was fixed in Van Gehuchten's fluid; this section is 6 2-3 
 microns in thickness and stained with methylene violet. This cell 
 is, according to Nissl's classification, an arkyochrome nerve cell, 
 Group I, of the somatochrome class, the chromophilic bodies being 
 
bo G. ALFRED LAWRENCE. 
 
 arranged more in the. form of a network than in a parallel ar- 
 rangement in the cell-body, though within the dendritic processes 
 these bodies are more or less distinctly parallel in arrangement. 
 The cell -body is irregularly polygonal in outline, with five large 
 dendritic processes going off in different directions, and contain- 
 ing at the base, and for a considerable distance, linear-shaped 
 chromophilic bodies, arranged in a more or less parallel niaririer 
 and spreading out and connected with the cell-body network. This 
 latter is made up of irregularly-rounded and elongated chromo- 
 philic bodies, arranged in an irregular network. The nucleus is 
 large, rounded, slightly eccentric in situation, and contains a large 
 rounded nucleolus and a pale indefinite network of chromatic 
 substance. Numerous neuroglia cells are seen scattered about, 
 singly or in groups, in the immediate vicinity of this cell. Part of 
 another large ganglion cell is seen at the upper portion of the 
 plate, on the left. 
 
 This concludes the very brief discussion of the cortex of the 
 normal brain, in which an endeavor has been made to present 
 typical sections of the main divisions of the external surface of 
 the cerebral hemisphere by means of photomicrography, upon 
 which the greatest care was employed, in order to give an accurate 
 idea of the usual appearance to be seen under the microscope in 
 the study of such sections in contradistinction to the common 
 diagrammatic figures that one usually associates with such work, 
 and which do not show the actual arrangement and structure, but 
 rather the ideal or embodyment in one figure of what is to be 
 found in parts of many. The writer, on the other hand, does not 
 wish to be understood as not favoring diagrammatic or schematic 
 figures in work of this kind, as he regards them as highly im- 
 portant and a valuable accessory to photomicrography and accu- 
 rate drawings in the proper conception of the intricate structure 
 and arrangement of the various portions of the nervous system 
 as well as other systems. That there are minor variations from 
 these plates in the dififerent regions has been repeatedly stated, 
 but the variation is only a minor one, and does not depart suffi- 
 ciently from the type to be considered as more than a modifica- 
 tion. Furthermore, in going over the various plates from the 
 different regions it will be seen that there is a general uniformity 
 of arrangement and structure of the cells, and that one region 
 does not vary to any great extent from that of any other region. 
 This is well illustrated by comparing the plates from the frontal 
 region with those of the temporal region, in which it would be 
 difficult to determine the one from the other. The Betz cells in 
 parts of the motor cortex are a conspicuous modification, but 
 when we consider that only a small part of the motor area con- 
 tains these cells, and again that these cells, though large, represent 
 
Plate IX, Fig. 25. Plate XI, Fig. 31. 
 
 Plate XI. Fig. 33 Plate XI V, Fig. 43. Plate XV, Fig. 45, Plate XV, Fig. 47. 
 
DEMENTIA PARALYTICA. 8l 
 
 but a miinrte fraction of the total number of cells in the cortex at 
 this point it will be seen their presence makes but a slight modi- 
 fication in the general cortical arrangement as a whole. The 
 pyramidal cells intermediate in size between the large pyramidal 
 cells and the Betz cells are of especial significance to the writer 
 as perhaps indicating that, with increased specialization of func- 
 tion, carried on through long periods of time, increased specializa- 
 tion of the structure and size of the cortical cells is going on 
 hand in hand, and that perhaps the so-called Betz cells, now 
 almost entirely limited to certain portions of the central convolu- 
 tions, some time in the future may be found in all parts of the 
 cortex. Their large size, with resulting large amount of proto- 
 plasm in the cell-body and large nucleus, the comparatively enor- 
 mous amount of 'chromatic substance, as possibly stored up food 
 products, all point to great capacity for storing up nervous energy 
 to be given out when indicated as powerful efferent impulses, or, 
 on the other hand, the capacity of receiving as equally powerful 
 different impulses. Increased specialization in mental activity 
 may result in greater numbers of nerve cells being set apart and 
 increased in size and capacity for carrying out special functions. 
 
 Paretic Brain. — Turning now to Brain B, the case of demen- 
 tia paralytica, from which all the succeeding plates were taken, we 
 see in Plate X, Fig. 29, a photograph of the left hemisphere of the 
 brain, natural size. The macroscopic appearance at first sight 
 would seem to indicate that there was marked atrophy and shrink- 
 age in parts of several convolutions, especially the anterior central 
 and frontal convolutions ; but a careful study of the sections taken 
 from these regions shows this not to be altogether the case, or at 
 least only to a slight degree. As any one who has studied brain 
 topography to any extent well knows, there is much variation, not 
 only in the shape and arrangement of any given convolution, but 
 also in its size, so that great care should be observed in not mis- 
 taking such normal variation for atrophy. A study of the various 
 plates shown here under a magnification of 14 diameters, con- 
 taining' the entire cross section from the several convolutions in 
 the brain and comparing them to the preceding brain will make 
 this point clear. Here and there a considerable quantity of the 
 cortex has been torn away with the pia mater, whereas in many 
 places small depressions are seen in which only a very small por- 
 tion of the superficial layer of the cortex has been torn away. The 
 convolutions are here well marked and the sulci very deep, so that 
 there is a large area of cortical surface. The sulci in the middle 
 portion of the hemisphere are widely open, owing to the support 
 being placed only in the middle of the median surface of the 
 hemisphere, so that the weight of the poles, anterior and posterior, 
 caused these latter to become depressed, resulting in this con- 
 
82 
 
 G. ALFRED LAWRENCE. 
 
 spiciions widening of the' central sulci. The posterior pole of the 
 brain — the occipital lobe — is practically normal macroscopically, 
 and it will be seen later also microscopically, there being none or 
 but very slight pathological changes in the cortex in that region. 
 This photograph of the brain was taken before any blocks were 
 removed, it having been previously fixed in 95 per cent alcohol. 
 As each block was removed the exact location was noted and indi- 
 cated in the photograph by the letters of the alphabet, and the 
 place from which the block was taken enclosed in ink lines. 
 
 Frontal Conz'ohition. — This portion of the cortex is repre- 
 sented bv the block K, taken from the external surface of the first 
 
 Plate X, Fig. 29. 
 
 frontal convolution in its middle third, the exact location being 
 seen in Plate X, Fig. 29, K. The photomicro2:raph seen in Plate 
 X, Fig. 30, was taken from a section 10 microns in thickness, and 
 is magnified 14 diameters. The gyrus here is somewhat narrow, 
 and the sulci on either side were quite open and deep, and from 
 the macroscopic appearance one might at first be inclined to think 
 that there was some atrophy of the gyrus ; but a detailed study 
 of sections from this region shows that this is not the case. 
 Block K was fixed in 95 per cent alcohol ; this section is i cm. in 
 length, .63 cm, in width at its widest part, and, as above stated, 
 10 microns in thickness, being stained with methylene blue ; the 
 
DEMENTIA PARALYTICA. 83 
 
 other technique being the same as for all the other plates. The 
 shape of the section is somewhat that of a truncated pyramid, 
 broader at the base and narrow at the rounded vertex. This me- 
 chanical arrangement makes the cortex thicker at the vertex than 
 on the lateral aspects. At a, and enclosed in ink lines, is the 
 segment represented in Plate XI, Fig. 31. The first or superficial 
 layer is seen to vary somewhat in thickness, being thicker on the 
 
 Plate X, Fig. 30. 
 
 lateral surface below b, with another thickened portion below a, 
 a third just to the left of the vertex, and finally at the lower part 
 of the left lateral aspect. The second or pyramidal cell layer does 
 not show quite as distinct arrangement of the cells in a radial 
 direction as in the corresponding region of the normal cortex, 
 and there is especially to be noted the numerous portions of 
 minute capillaries of varying size and tortuosity, singly or 
 branched. This second layer passes over into the indistinct third 
 layer, \^ich is lost below in the pyramidal-shaped white medul- 
 lary cenier, which also contains numerous capillaries. Plate XI, 
 
84 G- ALFRED LAWRENCE. 
 
 Fig. 31, is a photomicrograph, magnified 100 diameters, of a 
 segment corresponding in position to a of a section adjacent to 
 and from the same block as that shown in Plate X, Fig. 30. The 
 section is 6 2-3 microns in thickness, and of the same length and 
 breadth as that shown in the preceding plate. Decolorization has 
 been carried on to a considerable extent, about to the same degree 
 as in Plate II, Fig. 3, and thus causing the plate to appear rather 
 pale. Additional causes are the paucity of large pyramidal cells 
 in the second layer, and the shrunken condition of many of the 
 cells, as well as other pathological alterations. The upper layer 
 averages .20 mm. in thickness, and contains for the most part 
 scattered neuroglia cells. The second or pyramidal-cell layer is 
 1.80 mm. in thickness. Here is to be found a very similar ar- 
 rangement of the cells to that in the corresponding region of the 
 normal brain A. In the upper portion are to be seen the small 
 pyramidal cells in considerable numbers, just below the super- 
 ficial layer. Then they become more scattered, with a tendency 
 to an arrangement into larger and smaller irregular groups, the 
 cells becoming larger in the deeper portions. A little below the 
 middle of this layer is found a narrow strip at a, where the small 
 pyramids predominate almost to the entire exclusion of the larger 
 ones, which latter, however, are seen above and below. Below 
 this again are to be seen the larger pyramids, which finally give 
 way to the irregular and spindle cells of the third layer. The 
 nerve cells themselves show various changes. Many of them 
 appear to be atrophied or shrunken, this process varying in degree 
 in different cells. This in many cases has resulted in the forma- 
 tion of larger or smaller pericellular spaces as seen about many 
 of these cells, as at P in this plate and in Fig. P of the text, for 
 instance. Here a large pericellular space completely surrounds 
 the cell. The basal dendrites are represented by only one small 
 shrunken process given off at the left and extending but a short 
 distance. The body of the cell is shrunken and irregular in con- 
 tour. A large mass of yellowish pigment is seen at the base to the 
 right. A small amount of finely granular chromophilic substance 
 is found about and above the nucleus. The nucleus itself is dis- 
 placed downward into the base of the cell-body, to the extreme 
 left. It is small, irregular in outline, and contains a well defined 
 nucleolus but no chromatic substance. The apical process is 
 shrunken and irregular in direction, and contains traces of chro- 
 mophilic substance in places. The chromatic substance in the 
 large majority of these cells has become diffused and decreased in 
 amount in variable degrees, so that a large number of the cells 
 present the appearance of chromatolysis up to almost complete 
 disappearance of chromatin in some of them. These latter present 
 a pale, washed-out appearance, as shown by the cell marked Q in 
 
DEMENTIA PARALYTICA. 85 
 
 this plate and seen enlarged in Fig. Q, where only a small amount 
 of chromatin is found in the apical process and a slight amount 
 of pigment in the lower part of the base. Some cells show loss 
 of chromatin only about the nucleus, and are spoken of as in- 
 stances of central chromatolysis. Others have a disappearance of 
 chromatin at the periphery of the cell-body only, and this condi- 
 tion is known as peripheral chromatolysis. The nuclei of many 
 of these cells are found frequently displaced to one side, crowded 
 into the base of a dendritic process, near the base of the cell-body, 
 or near the base, or up into the proximal portion of the apical 
 process. Many of these are irregular in shape and diminished in 
 size. Quite a large pt-oportion of the larger pyramidal cells con- 
 tain light yellowish pigment in variable quantity and usually at 
 the base of the cell, often extending into the base of a dendritic 
 process. The cell P, above described, in addition to the pericellu- 
 lar space, demonstrates these last two points, the nucleus being 
 crowded into the base of the dendritic process given off on the 
 left and a considerable deposit of pigment being found at the base 
 and extending into the right dendritic process. The cells contain- 
 ing this pigment are marked with a cross, adjacent to them, in 
 this plate. It will be seen that they are to be found mostly in the 
 middle and lower portion of this layer, and also some few scattered 
 irregular-shaped cells in the third layer. The dendritic processes 
 in many of these cells end abruptly beyond their base, and in but 
 few cases can they be traced to any great distance from the cell- 
 body. The apical process shares in this general atrophy, and 
 often is curved and irregular in direction, instead of presenting a 
 regular straight course towards the periphery of the cortex. In 
 some cells the nucleus is difficult to distinguish, the limiting mem- 
 brane being indeterminable and the nucleolus appearing to be in 
 the midst and surrounded by only the cell-body, and usuallv in an 
 eccentric position. Numerous blood vessels are here to be seen, 
 all, with thickened walls and pursuing a tortuous course. Large 
 perivascular spaces are also seen about many of these blood ves- 
 sels, as at d, for instance. The third, or spindle or irregular cell 
 layer -is here .90 mm. in thickness, and is made up of irregular 
 and spindle cells, some of the former, as some of the cells of 
 the second layer, contain pigmentary deposits. Here also the 
 chromatin is found in diminished quantity, and various stages of 
 chromatolysis are seen. The nucleus is diminished in size in 
 many cases and does not appear to be as prominent a factor as in 
 the normal cells of this region. The cells as a whole appear 
 smaller in size and more or less atrophied, containing less proto- 
 plasm in the cell-body. as well as a diminished amount of chro- 
 matin. The blood vessels are here also found to have thickened 
 walls, and are tortuous in direction. At e is seen one of these 
 
86 G. ALFRED LAWRENCE. 
 
 vessels, with thickened walls and surrounded by a large perivas- 
 cular space. The entire thickness of the cortex at this point is 
 found to be 2.90 mm. ; almost the same as in the corresponding 
 region in Brain A, as seen in Plate 11, Fig. 3. Counts were made 
 of the nerve and neuroglia cells in various parts of this section in 
 the same manner as in the previous sections, and in eight different 
 fields of 36 sq. mm. each of the ocular net-micrometer from vari- 
 ous portions of the two lower layers for the nerve cell counts, and 
 in all three layers for the neuroglia cell counts. There was found 
 to be an average of 100 nerve cells and 56.90 neuroglia cells to 
 each square millimeter of surface of this section. The small num- 
 ber of neuroglia cells being due to the methylene blue stain em- 
 ployed and differentiation carried on to a considerable degree in 
 a section 6 2-3 microns in thickness. In the section shown in 
 Plate X, Fig. 30, 10 microns in thickness, and more deeply stained, 
 the number of nerve cells is not quite so great, whereas the num- 
 ber of neuroglia cells is almost six times as great, although the 
 two sections are quite near together and from the same block. 
 This is due to the neuroglia cells in Plate XI, Fig. 31, being al- 
 most completely decolorized in the greater differentiation, where- 
 as the cells, although paler, yet were not decolorized, and can all 
 be made out. The same method of using the ocular net-microm- 
 eter was employed here as in all the other plates, and counts were 
 made from eight different fields of thirty-six squares each from 
 different parts of the second and third layers of this section, and 
 the average number of nerve cells was found to be 82.91 to the 
 square millimeter of surface of the section, as compared to 100 
 for the same area in Plate XI, Fig. 31, so that there are on an 
 average less nerve cells in this section, 10 microns in thickness, 
 than in the section from which Plate XI, Fig. 31 was taken, which 
 was but 6 2-3 microns in thickness, the same stain being used in 
 both cases. The nerve cells, however, are more deeply stained in 
 this latter section, and appear more distinct, and there are also 
 more large cells. The neuroglia cells in eight different fields of 
 thirty-six squares each from various parts of the three cortical 
 layers average 303 to the square millimeter of surface of the sec- 
 tion, as contrasted to 56.90 to the square millimeter in Plate XI, 
 Fig. 31. Here increased thickness makes a difference in favor 
 of this plate, and in addition to that the deeper stain with less 
 decolorization cause all the neuroglia cells to appear more promi- 
 nent. As stated before it was found that sections from 6 2-3 to 
 10 microns in thickness contain all the nerve cells to be seen in one 
 plane. As the neuroglia cells are much smaller in diameter and 
 often arranged in dense clusters, there may be a greater number 
 in a section 10 microns in thickness than in one 6 2-3 microns in 
 thickness. (See Table II.) 
 
DEMENTIA PARALYTICA. 
 
 87 
 
 Central Region. — Turning' to the region posterior to the one 
 just discussed, we come to the central re2,'ion, or motor area, made 
 up of the anterior and posterior central convolutions. Typical of 
 the anterior central convolution in its upper portion is the section 
 rep'"esc nted in Plate XI. Fi^". 32, under a magnification of 14 
 diameters. The exact location of the block from which this sec- 
 tion was taken is indicated by the ktter D in Plate X, Fig. 29. 
 The wide separation of the convolutions f^om one another, with 
 resulting gaping sulci, is especially marked in this region. As 
 
 Plate XI, Fig. 22- 
 
 previously mentioned, this is largely due to mechanical agencies, 
 a central support permitting the opposite poles, owing to their 
 weight, to become depressed and force open the sulci in this 
 region during the process of hardening or fixation. In the re- 
 moval of the pia mater, small portions of the adhering cortex have 
 been removed in places. This is seen just below the letter O, and 
 in many places in the convolutions both anterior and posterior to 
 this. By referring back to Plate TIT, Fig. 7 of the normal brain 
 
88 G. ALFRED LAWRENCE. 
 
 it will be seen that this section was taken from approximately the 
 same relative position of the convolution as that seen in Plate III, 
 Fig. 7, and, furthermore, the two convolutions are quite similar 
 in shape ; this convolution being somewhat broader and less 
 rounded at the vertex than that of the normal brain, however. 
 The outer cortical layer is here more irregular and torn than in 
 Plate III, Fig. 7, and at the vertex of the convolution at b the 
 outer part of the first layer is seen stripped off for some distance. 
 This, of course, is an artefact, the detached part being more 
 adherent to the stripped off pia than to the cortex below. This 
 outer layer furthermore presents a somewhat irregular contour, 
 being broken in places as at c and d. The layer is thicker oppo- 
 site a, and on the left lateral aspect, than elsewhere. The second 
 or pyramidal cell layer shows the general radial direction of the 
 cells, but not so well marked as in Plate III, Fig. 7. The chief 
 point of interest, however, is almost complete disappearance of 
 the Betz cells, which are seen so prominently in this region in the 
 normal brain in plates of this magnification (14 diameters). In 
 photomicrographs of 100 diameters we will find this disappear- 
 ance is not complete, and that the cells, although much atrophied 
 and. pale, so as to scarcely appear under the lower power, are 
 much more apparent here, and are seen in all stages of dissolution. 
 In this plate only scattered Betz cells are seen singly or in small 
 groups at wide intervals, and these few are small, shrunken and, 
 for the most part, pale. Fig. R is a drawing of the large Betz 
 cell marked R in this plate. The nucleus is quite centrally situ- 
 ated, with a large distinct nucleolus and some faint chromatic 
 substance. Some few chromophilic bodies are seen interspersed 
 among the finely granular chromatic substance. The cell pro- 
 cesses are pale, irregular, and soon terminate at a short distance 
 from the cell-body. No pigment is found in this cell. Figs. S 
 and T show two other near-by cells, the former containing an 
 eccentric nucleus, irregular, shrunken cell-body, with some pig- 
 ment at the left of the nucleus. The processes being irregular and 
 short. The cell in Fig. T is much shrunken and distorted, the 
 nucleus irregular, a small nucleolus, and but little diffuse chro- 
 matic substance. There are no basal processes, and the apical 
 process is narrow and irregular in direction. Numerous capil- 
 laries are seen with thickened walls, and some with perivascular 
 spaces. The third layer is indistinct, and fades into the white 
 medullary substance, where many large capillaries with thickened 
 walls, tortuous course and perivascular spaces are found. At a, 
 and enclosed in ink lines, is the segment of this section, corre- 
 sponding in position to that seen in Plate XI, Fig. 33. This sec- 
 tion is 8 mm. wide, 6.5 mm. long, and 10 microns in thickness, 
 fixed in 95 per cent alcohol, stained with methylene violet, and 
 
DEMENTIA PARALYTICA. 89 
 
 other technique similar to all the other sections. Plate XI, F*^. 
 33, is the photomicrograph magnified 100 diameters of a segment 
 corresponding to a of Plate XI, Fig. 32, and from a section taken 
 from the same block, and but a short distance from the above. 
 At this point the first or outer layer measures .25 mm. in thick- 
 ness, whereas in Plate XI, Fig. 32, it would measure at least .40 
 mm. in thickness. It contains numerous neuroglia cells, with here 
 and there a small pale nerve cell in which is situated a small 
 nucleus surrounded by a mere trace pf chromatic substance. Be- 
 low this is the second or pyramidal cell layer, measuring 1.30 mm. 
 in thickness. In the upper parts the pyramids are seen to be small 
 and quite closely packed together. About the middle of the layer 
 they are seen to be much larger and more scattered. Below this 
 again, at a, is seen a region containing for the most part only 
 small pyramids, and this finally merges into the lower portion of 
 this layer, where are seen the large and giant pyramidal cells. 
 These latter, or Betz cells, are seen in irregular groups or "nests," 
 consisting of from one to several (six or more) cells. All of these 
 cells show a diminished amount of chromophilic substance and 
 no distinct granules. Various stages of advanced chromatolysis 
 are seen, from a general diffusion of the chromatic substance to 
 almost complete absence of the same. The cells are for the most 
 part shrunken, the nuclei small and indistinct, displaced in many 
 cases, and the cell processes atrophied and tortuous. Many of 
 these larger cells contain a varying amount of yellowish pigment. 
 Fig. U shows the cell marked U in the plate. No processes are 
 seen, the cell-body is shrunken and contains but a small amount 
 of diffused chromatin, showing no structure and pale in color. 
 The nucleus is small, shrunken and indistinct, with a pale nucleo- 
 lus. No pigment is to be seen in the cell. To the left of the cell- 
 body is a small pericellular space. Several neuroglia cells are 
 seen in apparent direct contact with the cell-body and others in the 
 pericellular space and the wall of the latter. The cell just below 
 and to the left of this in the plate is similar in regard to the 
 amount of chromatin, is pale, and the nucleus and nucleolus are 
 not visible. Three processes are seen given off at the base, but 
 atrophied and extending for only a short distance. A small peri- 
 cellular space is seen about this cell also. The cell just below 
 and, to the right of this, and marked V in the plate and seen in 
 Fig. V, shows the same grade of chromatolysis. The remnant of 
 a shrunken and atrophied process is seen at the base on the right. 
 The shrunken nucleus, with pale nucleolus, is centrally situated, 
 and below this are found diffused pigmentary deposits. Through- 
 out the cell-body, less in the upper than in the lower part, is 
 scattered pale diffuse chromatic substance, and without any 
 definite arrangement. A narrow pericellular space is seen along 
 
90 
 
 G. ALFRED LAWRENCE. 
 
 the right side of this cell. The general contour and lack of struc- 
 ture are seen in Fig. V. Here, too, neuroglia cells are seen lying 
 upon and in close juxtaposition to the cell-body. Numerous blood 
 vessels with thickened and tortuous walls and perivascular spaces 
 are seen throughout this layer. The third or spindle or irregular 
 cell layer here measures .90 mm. in thickness, and is made up of 
 shrunken spindle and irregular cells, pale, and containing but a 
 small amount of diffuse chromophilic substance. Many of them 
 are surrounded by pericellular spaces of varying size. The letter 
 
 Plate XI, Fig. 34. 
 
 W indicates one of these spindle cells seen in the drawing, Fig. W. 
 The polar processes are here filamentous, and distorted in direc- 
 tion, the cell-body shrunken and containing but a small amount 
 of diffuse chromatic substance, so that it is pale in color, the 
 nucleus is small and indistinct, and contains a small nucleolus. 
 The cell-body is partially surrounded by a distinct pericellular 
 space, with a neuroglia cell upon the edge at one point. Numer- 
 ous blood vessels with thickened walls and perivascular spaces are 
 also seen in this layer. The entire depth of the cortex here is 
 3.05 mm., all three layers being slightly thicker than in Plate III, 
 Fig. 8, of Brain A, the first layer being .05 mm., the second .15 
 
DEMENTIA PARALYTICA. 
 
 91 
 
 mm., and the third .20 mm., thicker than in the latter. As varia- 
 tions of this extent are found in sections of convolutions in close 
 proximity, and even in different parts of the same section in any 
 brain, it seems doubtful to the writer whether we can attach any 
 special significance to such a slight variation, due possibly to me- 
 chanical causes, acting in embryonic or even post embryonic life. 
 Counts of the nerve and neuros:lia cells here show a decided fall- 
 
 Plate XII, Fig. 35. 
 
 ing off in number of the former. This section is 6 2-3 microns in 
 thickness and stained with methylene violet. The same method 
 with the ocular net-micrometer was used, counting the nerve cells 
 in eight different fields of thirty-six square millimeters, each in 
 various parts of the second and third cortical layers, and the 
 neuroglia cells in the same number of different fields in all these 
 cortical layers. The average number of nerve cells to each square 
 millimeter of surface of the section was found to be but 39.60, 
 whereas the average number of neuroglia cells to the same area 
 was found to be 204. The number of nerve cells is thus seen to 
 be much diminished as compared to Plate III, Fig. 8, the corre- 
 sponding region of the normal brain A, where there are an aver- 
 
92 
 
 G. ALFRED LAWRENCE. 
 
 age of 95 nerve cells to the square millimeter of surface of the 
 section. The number of neuroglia cells is also less here, being 
 204 in this plate in comparison to 293 in Plate III, Fig. 8. The 
 latter section is. however, 10 microns in thickness, as compared to 
 6 2-3 microns for this plate, and as previously noted, owing to the 
 small size and close aggregation of the neuroglia cells, more 
 would be normally found in the thicker section, although this 
 
 Plate XII, Fig. 36. 
 
 hardl}- accounts for the great difference, as both were stained in 
 the san.e manner with methylene violet. Plate XI, Fig. 34, is a 
 photomicrojraph, magnified 14 diameters, from a section taken 
 from the point L of the upper portion of the anterior central con- 
 vokition of Brain P> (see Plate X, Fig. 29), and as seen by refer- 
 ring to this latter, is from a more inferior portion of this gyrus 
 
DEMENTIA PARALYTICA. 93 
 
 than the section represented in Plate XI, Fig. 32. This section 
 was fixed in 95 per cent alcohol, is 6 2-3 microns in thickness, and 
 stained with methylene violet. The first la3'er is seen to be fairly 
 uniform in thickness at the lower two-thirds, as seen at c. Above, 
 and at the vertex, and also along the anterior aspect of the con- 
 volution, as at d, the surface is more or less torn and irregular, 
 due to carrying away of small fragments with the adherent pia. 
 By referring to Plates XI, Fig. 32, and XIII, Fig. 39, the varia- 
 tions in shape and mechanical arrangement of the convolution in 
 adjacent portions will be noted. In Plate XI, Fig. 32, the vertex 
 is broadly rounded and somewhat flattened. In Plate XIII, 
 Fig. 39, the vertex is more narrow and pointed, while in this plate, 
 intermediate in position between the above two plates the vertex 
 is less pointed. Large perivascular spaces are noted in many 
 places throughout this section, especially marked in the upper 
 portion to the left of the vertex, where but a fragment of the 
 blood vessel is to be seen only at the lowest point of an enormous 
 perivascular space. The radial arrangement of the cells is but 
 poorly shown, the Betz cells seem to have disappeared almost en- 
 tirely in the second layer, in marked contrast to the plates of the 
 same magnification of Brain A. (Plates III. Fig. 7; I\', Fig. 9, 
 and lY, Fig. 11.) Under a high magnification, however, the rem- 
 nants of many of these Betz cells can be made out, showing vari- 
 ous pathological changes. The other nerve cells also show a 
 wealth of pathological change of varying degree and kind to 
 which the nerve cell is subjected — all grades of chromatolysis, 
 pigmentation, atrophy, and shrinkage of the nerve cells and pro- 
 cesses, with larger or smaller pericellular spaces. Numerous 
 capillaries, with thickened walls and perivascular spaces, are seen 
 scattered throughout the various parts of the section. The actual 
 size of this section is 8 mm. wide at the point opposite d. 8.5 mm. 
 long, and 6 2-3 microns in thickness. At the points a and h are 
 seen the Betz cells, shown under a magnification of 1,400 diame- 
 ters in Plates XII, Fig. 35, and XII, Fig. 36. The former of 
 these is a photomicrograph as stated, under a magnification of 
 1,400 diameters of the nerve cell, indicated by the letter a in 
 Plate XI, Fig. 34. By referring to this latter plate, and then to 
 Plate X, Fig. 29, we can locate almost the exact position of this 
 cell in the cortex of Brain B. The cell-body is seen shrunken and 
 deformed, lying in a pericellular space partially surrounding it. 
 The nucleus is eccentric, being crowded over to the extreme edge 
 of the cell-body on the right side. It is also shrunken and indis- 
 tinct, but contains a well-marked and prominent nucleolus. The 
 apical process above and to the right appears quite sharply de- 
 flected at a point but a short distance from the base, but this is 
 not really the case, as the portion from a to the edge of the plate 
 
94 G. ALFRED LAWRENCE. 
 
 is one of the walls of a blood vessel, the opposite wall not being 
 seen in this plate at all. At the point a, this apical dendritic 
 process appears to come in direct contact with this portion of the 
 wall of the blood vessel, and is there lost to view. The other 
 dendritic processes— seven in all — are shrunken, and contain a 
 small amount of diffuse chromatin. Within the cell-body the 
 chromatin is considerable in amount, and quite generally diffused 
 in fine granules throughout the cell-body, lacking any definite 
 structural arrangement. There is a somewhat greater amount 
 at the base to the left and below the nucleus, and also at the upper 
 part of the cell-body. Above and to the left of the nucleus, where 
 the cell-body appears most pale, and extending into the base of the 
 dendritic processes here, is a considerable mass of yellowish pig- 
 ment. Numerous neuroglia cells are seen in the vicinity of this 
 Betz cell. Plate XII, Fig. 36, is also a photomicrograph, magni- 
 fied 1.400 diameters, of another of these Betz cells trom the point 
 h of Plate XI, Fig. 34. Here there is but Httle diffuse chromatin, 
 confined principally to the base of the dendritic process given off 
 on the right. All the lower part of the cell-body, excepting this 
 portion, contains palely yellow pigment. The nucleus is displaced 
 almost to the extreme edge of -the cell-body, and lies just below 
 the two neuroglia cells seen at a. The nucleolus, on this account, 
 can not be determined at this plane. On microscopic examination 
 the nucleus is found to be shrunken and indistinct. Numerous 
 neuroglia cells are seen upon and in the immediate vicinity of this 
 cell. The basal dendritic process b, which is but faintly seen here, 
 owing to its lying in a somewhat lower plane, has eight neuroglia 
 cells in close apposition to it. The dendritic process on the right 
 can be traced for some distance, is somewhat shrunken, and con- 
 tains no chromatic substance. Another small dendritic process is 
 given off from the base opposite the point c, and being in a lower 
 plane, only its base is seen here. It is colorless, and extends but 
 a short distance from the cell-body. The apical dendritic process 
 contains no chromatin, and. as seen, has several neuroglia cells 
 surrounding it a short distance from its base. A large pericellu- 
 lar space almost entirely surrounds the cell, excepting at the base 
 to the left. Plates XII, Fig. 37, and XII, Fig. 38, are photomi- 
 crographs of the same magnification (1,400 diameters), taken 
 from an adjacent section of the same block as the two preceding 
 plates, and are also 6 2-3 microns in thickness. This section was 
 prepared in exactly the same way, with the exception that 
 methylene blue was used as the stain instead of methylene violet. 
 This will be at once apparent upon noticing the neuroglia cells, 
 which are here pale and washed out, many to the point of com- 
 plete decolorization, so as not to be seen at all. The Betz cell in 
 the center of Plate XII, Fig. 37, is seen surrounded by a large 
 
DEMENTIA PARALYTICA. 
 
 95 
 
 pericellular space. All the processes, four in number, including 
 the apical dendritic process, are pale, and terminate but a short 
 distance from the cell-body. The nucleus is eccentrically situated 
 near the wall at the left, is small, and contains a large nucleolus, 
 but no nuclear network. Within the cell-body finely granular 
 chromatic substance is found at the base below and to the right of 
 
 Plate XII, Fig. Z7- 
 
 the nucleus. There is no pigment present. This cell presents an 
 advanced stage of partial chromatolysis. Above and to the right 
 is an almost indeterminable mass, which, under the 1-12 inch oil- 
 immersion objective, appears to be the remnant of a capillary, 
 surrounded by a large perivascular space. Other cells are seen 
 here in various stages of disintegration, surrounded by large peri- 
 cellular spaces, some containing none or onlv the remnants of den- 
 
96 
 
 G. ALFRED LAWRENCE 
 
 dritic processes, indistinct and shrunken nuclei, some distinct nu- 
 cleoli and others none at all, and all in a more or less advanced 
 state of chromatolysis, with but little of the diffused stained chro- 
 matic substance present. The neuroglia cells that are visible at 
 all are pale and poorly stained, while many are almost or corn- 
 
 Plate XII, Fig. 38. 
 
 pletely decolorized. Plate XII, Fig. 38, is a photomicrograph of 
 a Betz cell on the same section and but a short distance from the 
 cells of the preceding plate, and under the same magnification 
 (1,400 diameters). Here there is almost complete chromatolysis, 
 there being but little finely granular, diffuse chromatic substance 
 scattered in the cell-body, slightly more at the base than above 
 the nucleus. The latter is small, rounded, centrally situated, and 
 
DEMENTIA PARA LYTIC A. 
 
 97 
 
 contains a large, rounded, distinct nucleolus. - The three basal pro- 
 cesses are narrow, pale, and terminate at no great distance from 
 the cell-body. The apical process is pale and slender, extending 
 for some little distance before coming" to an end. Part of a pale, 
 atrophied cell is seen to the right of the same. The ghosts of 
 several neuroglia cells may be seen here, but most of them are 
 completely decolorized. 
 
 Plate XIII, Fig. 39, as will be seen by referring to Plate X, 
 Fig. 29, is from the lower portion of the upper third of the an- 
 terior central convolution, from the point marked O, and is magni- 
 fied 14 diameters. This section, as already mentioned, is found to 
 
 Plate XIII, Fig. 40. 
 
 vary somewhat in shape from that of the preceding sections 
 shown in Plate XI, Fig. 32, and Plate XI, Fig. 34, being narrower 
 and more pointed at the vertex. From the strip marked a, and 
 enclosed in ink. the structure and arrangement of the nerve cells 
 were carefully studied, and both nerve and neuroglia cell counts 
 made and will be referred to again later. The irregularity and 
 difference in thickness of the first layer in different parts is to be 
 noted, being especially thick at h, where it almost presents the 
 appearance of an artefact, but under a high power no derange- 
 ment of the structure can be made out. At a the laver is seen to 
 
98 G. ALFRED LAWRENCE. 
 
 be very thin, owing to some of the surface of the cortex having 
 remained adherent to and been stripped off with the thickened 
 pia mater. Large perivascular spaces are to be especially noticed 
 in the subcortical portion of the section. Here is to be noted the 
 almost entire absence of the Betz or giant pyramidal cells in the 
 ixjwer part of the second layer, although some large pyramidal 
 cells are to be found, they are not, however, so large -nor are they 
 arranged in such distinct groups as in the region higher up. Un- 
 der higher magnification the remnants of some of these Betz cells 
 are seen in various stages of necrosis and disintegration. The 
 cortex lacks the distinct striated appearance seen in the sections 
 of the normal cortex. This layer passes indistinctly into the third 
 or spindle cell layer, which in turn is lost in the white medullary 
 substance below. Numerous capillaries are seen, many with 
 thickened walls and perivascular spaces throughout the section. 
 This section was fixed in 95 per cent alcohol, sectioned 10 microns 
 in thickness, stained with methylene violet, with other technique 
 similar to that of all the previous sections. The actual size of the 
 section is 9 mm. at its greatest width and 13 microns in length. 
 The strip a varies from that of Plate XI, Fig. 33, only in the 
 number and arrangement of the cells in the second layer. At this 
 point the three layers are respectively .20 mm., 2.00 mm., and .90 
 mm. in thickness. The first layer contains some few scattered 
 irregular nerve cells and numerous neuroglia cells. The second 
 layer contains small pyramidal cells above, increasing in size until 
 a little above the middle of the layer is a strip some .30 mm. in 
 width, in which are to be seen large pyramidal cells arranged 
 singly or in irregular groups. Some of these cells almost ap- 
 proach the giant pyramidal cells in size. Many of them show but 
 a slight shrinkage and contain an almost normal amount of chro- 
 matic substance. The chromophilic bodies, however, are not as 
 numerous or as large as in the normal brain. Other cells show a 
 complete absence of chromophilic bodies, but contain the chro- 
 matic substance diffused throughout the cell in minute particles. 
 Still others are pale, and contain but little chromatic substance. 
 The nuclei are larger, less eccentric, and there is a less degree of 
 atrophy of the cell-body and processes. Below this is a region of 
 small pyramidal cells with only a few scattered larger pyramidal 
 cells merging into the lower part of the layer, where large pyrami- 
 dal cells are again seen scattered irregularly among the smaller 
 cells. These large pyramidal cells are somewhat smaller than the 
 giant pyramidal or Betz cells seen in the upper part of this con- 
 volution. These cells show more advanced pathological changes, 
 in some cases marked atrophy and shrinkage with large pericellu- 
 lar spaces, atrophy of the dendritic processes, eccentricity and 
 shrinkage of the nucleus, pigmentary deposits, complete absence 
 
DEMENTIA PARALYTICA. 
 
 99 
 
 of or but a small amount of diffuse chromatic substance. The 
 third layer presents the same general appearance as in the pre- 
 ceding plate (XI, Fig. 33), with many cells much shrunken and 
 atrophied and little or no chromatic substance within the same, 
 and surrounded by pericellular spaces of varying size. Numer- 
 ous large and small capillaries are seen scattered throughout this 
 
 Plate XIII, Fig. 39. 
 
 section, with thickened walls and surrounded by larger or smaller 
 perivascular spaces. The entire depth of the cortex here is 3.10 
 mm., the second layer being slightly thicker than in Plate XI, 
 Fig. 33. The nerve cells were found to average but 36.50 to the 
 square millimeter of surface of the section here ; less than in any 
 of the other plates, whereas the neuroglia cells average 289 to the 
 square millimeter of surface of the section, almost as great a num- 
 
iOO G. ALFRED LAWRENCE. 
 
 ber as in the previous sections of the same thickness, ten microns, 
 and stained with methylene violet. The most conspicuous differ- 
 ence between this and Plate XI. Fig. 33, higher up in the convolu- 
 tion, is the arrangement of the large pyramidal cells, the absence of 
 the typical Betz cells, and on the whole less advanced pathological 
 changes. Plate XIII, Fig. 40, is a photomicrograph magnified 
 fourteen diameters of a section from the block B of Plate X, Fig. 
 29, and is thus seen to be situated a little above the middle of the 
 posterior central convolution. This section is 6 2-3 microns in 
 thickness, 8 mm. in length, and 9 mm. in width at the widest point, 
 was fixed in 95% alcohol, stained with methylene blue, and other 
 technique similar to that of all previously described sections. This 
 section at the vertex, especially to the left, shows the striated ap- 
 pearance of cell arrangement very well, but upon the anterior and 
 posterior aspects of the gyrus it is but indistinctly shown. The 
 first layer is fairly uniform in thickness with broken spaces here 
 and there, especially about the entrance of capillaries. This layer is 
 somewhat thicker in certain places than in others. At a, for in- 
 stance, it is thicker than at the vertex. This section has a broad, 
 flattened vertex with considerable cortical area on both the anterior 
 and posterior surfaces. The cortex opposite the angles c and b is 
 somewhat thicker than elsewhere. This mechanical arrangement 
 admits of a large, broad mass of fibres from various parts of this 
 and the adjacent regions of the brain, leaving from and entering 
 into relations with the cells of this portion of the cortex. The 
 section is broken (an artefact) at the left and numerous capillaries 
 are found scattered throughout all the cortical layers and also the 
 white medullary center. The segment represented in Plate XIII, 
 Fig. 41, was taken from a point corresponding to a, but from an 
 adjacent section of the same block, and is magnified 100 diameters. 
 It is from relatively the same position as the segment shown in 
 Plate VII, Fig. 19, the strip a of Plate VI, Fig. 18, of the normal 
 brain, but, as will be seen by referring to the latter, the shapes of 
 the two sections are quite different. The distribution and arrange- 
 ment of the cells in this plate is somewhat different from that in 
 Plate VII, Fig. 19, also. In this latter, as already described, some 
 large pyramidal cells are irregularly distributed in parts of the 
 upper half of the second layer, followed by a narrow region made 
 up almost exclusively of small pyramidal cells to be followed by 
 larger pyramidal cells in the lower portion of this layer. In this 
 plate, however, there are but few of the larger pyramidal cells in 
 the upper portion of the second layer, there being practically only 
 small pyramidal cells in this upper portion with the larger pyra- 
 mids mostly in the lower portion of this second layer. The cell 
 seen in the lower part near the center (a, Plate XIII, Fig. 41), 
 approaches in size to the Betz cell type. The first or superficial 
 
DEMENTIA PARALYTICA. lOI 
 
 layer here contains nothing but capillaries and neuroglia cells and 
 is .25 mm. in thickness. The second or pyramidal cell layer is 
 1.40 mm. in thickness and shows not only numerous capillaries 
 with irregular and thickened walls, but also the cells in variom 
 pathological conditions. Chromatolysis is complete in many of 
 these cells as in the large pyramidal cell marked a for instance, 
 where only traces of minute finely powdered chromatin can be seen 
 in some parts of the cell-body. Here also the nucleus is indistinct, 
 with a well marked nucleolus, and the basal processes are much 
 atrophied, terminating but a short distance from the cell-body. A 
 small pericellular space is seen at the base of this cell-body. Many 
 cells show eccentricity of the cell nucleus, shrinkage of the cell- 
 body, various grades of chromatolysis, pigmentation, atrophy, and 
 distortion of the dendritic processes and are surrounded by peri- 
 cellular spaces. The capillaries are numerous, have thickened 
 and irregular walls, and are surrounded by perivascular spaces of 
 varying "size and' extent. Numerous neuroglia cells are also inter- 
 spersed about the cells and capillaries in this layer. The third or 
 ipindle cell layer is only partially seen in this plate, and is about 
 .90 mm. in thickness (only upper portion shown in Plate XIII, 
 Fig. 41), and is similar to that in preceding plates of the motor 
 region, and contains for the most part shrunken and irregular 
 spindle and polygonal shaped cells, with numerous neuroglia cells 
 and capillaries interspersed among them. Most of these cells 
 show the various pathological processes mentioned above for the 
 pyramidal cells. The cortex here thus measures 2.55 mm. in 
 thickness, almost the same as for the two upper layers in Plate 
 VII, Fig. 19, but here the third layer is .90 mm. in thickness as 
 compared to .60 mm. in the above mentioned plate of the normal 
 brain. Nerve and neuroglia cell counts were made here with the 
 result that an average of 59.91 nerve cells and 134.37 neuroglia 
 cells were found to the square millimeter of surface of the section 
 as compared to an average of 185.50 nerve cells and 109.20 neu- 
 rogHa cells for the same area in the strip of cortex represented in 
 Plate VII, Fig. 19, of the corresponding region of the normal 
 brain. Both sections were 6 2-3 microns in thickness and both 
 stained with methylene blue. The difference in nerve cells is very 
 marked, whereas the difference in number of neuroglia cells is 
 not so great, and as the technique was identical throughout in 
 the preparation of the two sections, the marked pathological pro- 
 cess shown in this latter, it seems to the writer must be attributed 
 as the cause of this difference to a large extent at least. 
 
 Parietal Region. — Plate XIV, Fig. 42, is a photomicrograph 
 magnified fourteen diameters, of the parietal region from the 
 point H. in Plate X, Fig. 29, this being a part of the supra-angu- 
 lar gyrus and from the same relative part of the gyrus as the 
 
I02 
 
 G. ALFRED LAWRENCE. 
 
 corresponding plate (VII, Fig. 20) of the normal brain. The 
 section was fixed in 95% alcohol, stained with methylene violet, 
 and treated otherwise as the preceding plates. This section 
 measures 6 mm. in width, 16 mm. in length, and is 6 2-3 microns 
 in thickness. Its shape is long and narrow and quite different 
 from that of Plate VII, Fig. 20. At the vertex of the convolution 
 
 Plate XIV, Fig. 42. 
 
 the first layer has geen cut away with the paraffin in preparing the 
 block for sectioning serially with a Minot microtome, and, of 
 course, this condition is an artefact. The first layer is seen to be 
 fairly uniform in thickness with this exception. In the second 
 layer it is difficult to determine the well marked striated arrange- 
 ment of the cells, as seen in Plate VII, Fig. 20. Numerous peri- 
 vascular and pericellular spaces are seen with or without the capil- 
 
DEMENTIA PARALYTICA. IO3 
 
 laries or cells, as the case may be. The third layer is indistinct 
 and fades away into the white medullary center which also con- 
 tains many pericellular and perivascular spaces. No doubt the 
 fixation in 95% alcohol has produced some shrinkage, but by no 
 means all, as the plates of the occipital convolution just posterior 
 to this show a much less degree of shrinkage than is here present 
 and not only every block taken from this brain was fixed in ex- 
 actly the same way, but also some of the blocks from Brain A. 
 At a and surrounded by ink lines is the segment of the section 
 shown under a magnification of 100 diameters in Plate XIV, 
 Fig. 43, and as is here seen is taken from the lateral aspect near 
 the vertex, instead of from the vertex as in the corresponding 
 plate of the normal cortex (Plate VH, Fig. 21). The first layer 
 averages .25 mm. in thickness and contains numerous capillaries 
 with thickened walls, and tortuous course with larger and smaller 
 perivascular spaces. Numerous neuroglia cells are scattered 
 throughout this layer. The second layer is here 1.50 mm. in 
 thickness. Here, too, are seen numerous capillaries with thick- 
 ened walls, irregular course, and large perivascular spaces. In 
 the upper half of the layer the small pyramidal cells gradually 
 are intermingled with larger pyramidal cells as the lower portions 
 are reached, until just above a the largest pyramids of the sec- 
 tion are seen singly or in groups in a comparatively narrow zone. 
 Below and opposite a is a narrow zone, some .25 mm. in width 
 in which there are practically no large pyramidal cells. Below 
 this again is a very narrow zone at the lower part of this layer 
 in which some few large pyramidal cells are seen scattered among 
 the smaller and irregular cells. These cells present all stages of 
 chromatolysis, pigmentation, shrinkage of the cell-body and pro- 
 cesses and irregularity in direction of the latter, eccentricity and 
 shrinkage of the nucleus and larger and smaller pericellular 
 spaces. Numerous neuroglia cells are scattered throughout the 
 layer. The third, or spindle cell layer, measures scarce .50 mm, 
 in thickness and contains for the most part shrunken and irregular 
 spindle cells in larger or smaller pericellular spaces, in many in- 
 stances in various stages of chromatolysis. Numerous neuroglia 
 cells in many cases appearing in direct contact with the cell-body 
 are seen in this layer, as well as in the above layer. The vascular 
 changes are also similar. The entire depth of the cortex here is 
 thus 2.25 mm., somewhat less than in Plate VII. Fig. 21, but 
 about the same as on the lateral aspect of this latter plate. Nerve 
 and neuroglia cell counts were made here in the same manner 
 as in previous sections, and it was found that there was an average 
 of 68.63 nerve cells and 192.70 neuroglia cells to each square 
 millimeter of surface of the section as compared to 104 nerve cells 
 and 180.90 neuroglia cells in the corresponding region of Brain A, 
 
I04 
 
 G. ALFRED LAWRENCE. 
 
 both sections being of the same thickness and stained in the same 
 manner with methylene violet. 
 
 Temporal Region. — Turning to the region below this we come 
 to the temporal region represented here by a section from the 
 first temporal convolution near its anterior extremity, from the 
 
 ! J 
 
 L-:^ 
 
 Plate XIV, Fig. 44. 
 
 point / in Plate X. Fig. 29, and shown under a magnification of 
 fourteen diameters in Plate XIV. Fig. 44. This convolution is 
 also much narrower than the corresponding convolution of Brain 
 A, seen in Plate VIII, Fig. 22, thus having a somewhat dissimilar 
 mechanical arrangement. To the right is seen the first temporal 
 fissure and a portion of the second temporal convolution. The 
 convolution measures 5.5 mm. in width and 8 mm. in depth from 
 
DEMENTIA PARALYTICA. 105 
 
 the vertex to the point on the level with the bottom of the first 
 temporal fissure and is 6 2-3 microns in thickness. The convolu- 
 tion at this point is seen on the right to curve around and fuse 
 with the second temporal convolution, being free above at h, 
 which is the lower boundary of the fissure of Sylvius at the be- 
 ginning of the posterior branch. At a and enclosed in ink lines 
 is the segment of the section shown in the following plate under 
 a magnification of 100 diameters. The first or superficial layer is 
 quite uniform in thickness, broken in several places, especially 
 above h on the superior surface. The second layer shows the 
 striated arrangement of the cells only very indistinctly at some 
 few points and contains many pericellular and perivascular spaces, 
 some with and others without contents. The third layer is indis- 
 tinct and fades into the white medullary center which is narrow 
 and passes inferiorly over to connect on the right with that of the 
 second temporal convolution. 
 
 In Plate XV, Fig. 45, strip a of Plate XIV, Fig. 44, under a 
 magnification of 100 diameters, the pathological conditions are 
 seen to be well marked. The section is 6 2-3 microns in thick- 
 ness and stained with methylene violet. Here the first layer aver- 
 ages about .20 mm. in thickness and to the right a fragment of a 
 blood vessel is seen at the surface, but penetrating the cortex in 
 a different plane. In the center and reaching into the second 
 layer is a large capillary with thickened walls, with larger caliber 
 above and smaller below, being somewhat funnel shaped and sur- 
 rounded by a large perivascular space. Some smaller fragments 
 of capillaries and neurogha cells are scattered about in the layer. 
 The second or pyramidal cell layer is 1.50 mm. in thickness and 
 presents very much the same general plan of arrangement as the 
 corresponding region in the normal brain, as seen in Plate VIII, 
 Fig. 23, and also in the region of the first frontal convolution, as 
 seen in Plate II, Fig. 3, and XI, Fig. 31. Small pyramidal cells 
 almost exclusively are seen in the upper part of the layer below 
 this gradually increasing in size to the middle of the layer. Then 
 opposite a is a narrow strip some .20 mm. in thickness in which 
 there are small pyramidal cells almost exclusively. Below this 
 again and in the lower part of this layer are larger 
 pyramidal cells, intermingled with smaller pyramidal and 
 irregular shaped cells. Here, too, the majority of the cells are 
 seen shrunken and surrounded by larger and smaller pericellular 
 spaces. Various stages of chromatolysis, shrinkage and eccen- 
 tricity of the nucleus and atrophy of the cell processes are to be 
 observed. The blood vessels show the same pathological condi- 
 tions as in the upper layer and numerous neuroglia cells are in- 
 terspersed thickly everywhere. 
 
 The third layer is .80 mm. in thickness and presents the same 
 
io6 
 
 G. ALFRED LAWRENCE. 
 
 pathological conditions of the cells and blood vessels as previously 
 described for this layer in Plate XIV, Fig. 43, of the parietal 
 region. The entire depth of the cortex here is 2.50 mm., some- 
 what thicker than the corresponding region of Brain A. Nerve 
 and neuroolia ceil counts were also made here and in a similar 
 manner, an average of 56.74 nerve cells and 205.90 neuroglia 
 
 Plate XV, Fig. 46. 
 
 cells being found to the scjuare millimeter of surface of the cor- 
 tical portion of this section, as compared to 146. nerve cells and 
 131.90 neuroglia cells to the square millimeter of the surface of 
 the cortex in the corresponding region of Brain A. In the latter 
 methylene blue was the stain used, the thickness of the sections 
 being the same in both cases, and as has been seen in every in- 
 stance the metlnlene violet stain has greater affinity for the neu- 
 roglia cells than the methylene blue, whereas, the nerve cells stain 
 about the san:e with the one as with the other. 
 
DEMENTIA PARALYTICA. 107 
 
 Occipital Region. — Plate XV, Fig. 46, is a photomicrograph 
 magnified fourteen diameters of a section taken from the block / 
 of Plate X, Fig. 29, situated in the upper portion of the lateral 
 aspect of the occipital convolution. The section is 5 mm. wide, 
 8 mm. in length and 6 2-3 microns in thickness, was fixed in 95% 
 alcohol, and stained with methylene violet. As may be observed, 
 upon the posterior aspect, the sulcus is very shallow, the cortex 
 here fusing with that of the adjacent gyrus not far from the 
 vertex, whereas anteriorly the sulcus is well marked and quite 
 deep. The first or outer layer is thicker both on the posterior and 
 anterior aspects than at the vertex and is quite uniformly regular 
 in outline. The second layer is well marked and shows the 
 striated arrangement of the cells quite as well as in Brain A, at 
 this point. Numerous large cells, some of which quite approach 
 the Betz cells in size and structure, are seen scattered in the middle 
 and lower portions of the layer. The third or spindle cell layer 
 below is gradually lost in the white medullary substance. Through- 
 out the entire section the cells and their arrangement are well 
 made out, the capillaries although having thickened walls and 
 somewhat tortuous are less conspicuous, the pericellular spaces 
 smaller and less numerous, and most of the cells are fairly normal 
 and show no distinct pathological changes. At a and enclosed in 
 ink lines is the position of the segment in the adjacent section 
 from which Plate XV, Fig. 47, was taken. This latter corre- 
 sponds most favorably with Plate IX, Fig. 25, from the corre- 
 sponding region of the normal brain and some of the nerve cells 
 here in Plate XV, Fig. 47, are larger and more numerous than 
 in the corresponding section from Brain A. The first or outer 
 layer is uniform in outline and measures here but .15 mm. in 
 thickness. It contains numerous neuroglia cells and some scat- 
 tered small nerve cells similar to those described in Plate II, Fig. 
 3, and seen in the text as Figs. C, D, E, and F. The second or 
 pyramidal cell layer is of special interest and measures 1.40 mm. 
 in thickness, being somewhat deeper than in Plate IX, Fig. 25, 
 but with a similar arrangement of cells. Above are small pyra- 
 midal cells only, then larger pyramidal cells are seen in the deeper 
 portions until about the middle of the layer is a region containing 
 very large pyramidal cells, same as the one indicated by the 
 letter X, for instance, being similar in size and structure to the 
 Betz cells. Below this at a is a region .30 mm. in thickness in 
 which numerous small pyramidal cells are alone seen. Below this 
 again is a narrow zone containing some larger pyramidal cells 
 scattered amongst the small pyramidal and irregular cells. The 
 cell marked in the plate by the letter X is seen magnified in Fig. 
 X, It is very large, contains irregularly elongated and linear 
 chromophilic bodies of considerable size and arrangement in a 
 
I08 G. ALFRED LAWRENCE. 
 
 more or less parallel direction to the cell-body and extending into 
 the dendritic processes. The nucleus is large, rounded, distinct, 
 and centrally located with a distinct rounded nucleolus and inde- 
 finite chromophilic network within. No processes are given off 
 at the base in this plane, but a large process is given off upon the 
 right at the level of the nucleus and soon divides into two 
 branches. Another process is given off to the left on the oppo- 
 site side of the cell -body at a level just above the nucleus. The 
 apical dendric process contains numerous linear chromophilic 
 bodies extending for some distance into the same. This is a 
 stichochrome nerve cell of the somatochrome class, and, in size 
 and structure, is similar to the Betz cell. The two cells to the 
 extreme right are similar in structure but not as large as the 
 above. There are no pathological changes to be determined in 
 the cells of this layer. Several small capillaries are seen with 
 somewhat thickened walls, indicating that possibly the blood ves- 
 sel changes are the first to be found in the disease, but of course 
 much more extended observation and study would be required 
 to determine the full relation of all these pathological processes 
 to one another. The third or spindle cell layer is here .90 mm. in 
 thickness and made up of spindle and irregular polygonal cells, 
 quite normal in appearance for the most part; some, however, 
 showing slight' shrinkage, pericellular spaces, and slight begin- 
 ning chromatolysis. Some capillaries with thickened walls and 
 perivascular spaces are to be observed here also. The entire thick- 
 ness of the cortex measures 2.45 mm. being .45 mm. thicker than 
 in Plate IX, Fig. 25. Nerve and neuroglia cell counts were made 
 here with the results that 62.50 nerve cells and 215.01 neuroglia 
 cells were found on an average to each square millimeter of sur- 
 face of the cortex here, as compared to 164. nerve cells and 199. 
 neuroglia cells in the same area of the corresponding section of 
 Brain A, both sections being 6 2-3 microns in thickness and 
 stained with methylene violet. From a study of the above plates 
 from these two brains, the cortex in Brain A, would seem to be 
 thinner and more compact, whereas, the cortex of Brain B, on an 
 average measures somewhat thicker, yet the cells seem more 
 scattered, so that a very much higher average of nerve cells is to 
 be found in the former, far more it seems to the writer than could 
 be accounted for by the possible destruction of some of the cells 
 in the sections of Brain B, due to pathological agencies. 
 
 The careful detailed study of the sections from various parts 
 of the different regions of Brain A, practically normal from a 
 histological standpoint, and of corresponding sections of Brain B, 
 a case of advanced dementia paralytica in the manner as described 
 
DEMENTIA PARALYTICA. 109 
 
 in this article has led the writer to the following conclusions : 
 I. Photomicrography is a useful and valuable adjunct to such 
 work, giving greater accuracy in relations of parts to one another 
 than is possible in drawings and showing conditions as they actu- 
 ally appear to the eye of the observer in each particular plane 
 when the sections are seen under the microscope. Powers of 14 
 or 20 diameters show very well relations of the layers to one 
 another, and also the relation of the groups of large cells ; such as 
 the Betz cells in the central regions, for instance. Powers of 100 
 diameters are well adapted to the study of the more minute detail 
 of these relations of the layers and of various cells to one another, 
 and also some of the morphology of the individual cells can be 
 made out. Powers of 1,000 to 1,500 diameters show the internal 
 structure of the cell to excellent advantage, but only in the very 
 limited plane at which the object is focussed. On the other hand, 
 the disadvantage of photomicrography is that everything is shown 
 in any one plane so that special parts or structures are not brought 
 out as prominently as in schematic drawings, and on this account 
 all such work should be accompanied by such drawings to make it 
 more complete. It is furthermore often quite difficult to obtain 
 any one plane showing most of the cell structure, to say nothing 
 of all of the same. 
 
 II. Artefacts of many kinds are to be found in such work, and 
 should be carefully avoided and eliminated in every instance be- 
 fore definite conclusions are drawn from any series of observa- 
 tions. Pressure and other mechanical causes acting before death, 
 that due to manipulation at autopsy, artefacts resulting from fixa- 
 tion, imbedding, sectioning, staining, decolorizing, and even 
 mounting, are all possibilities, and are often most difficult to deter- 
 mine in contradistinction to the pathological changes. 
 
 III. The method of transporting- material by means of small 
 metallic boxes or similarly sized phials, permitting of a free cir- 
 culation of various kinds of fixative fluids, without injury, and 
 also permitting of subsequent exact localization, the process re- 
 quiring a minimum of time and space is, to the mind of the writer, 
 of decided practical value in such work. This method is fully 
 described in the text under the heading of "Technique." 
 
 IV. Nerve and neuroglia cell counts have been alluded to 
 
no G. ALFRED LAWRENCE. 
 
 above, but a few remarks upon method may be of value. The 
 method of counting the same from photomicrographs of moderate 
 magnification is not accurate, as cells may overlap or be arranged 
 in dense groups or their images may not all be sufficiently distinct 
 so as to differentiate them properly, especially does this apply to 
 the neuroglia cells, which are very small and often closely aggre- 
 gated. Photomicrographs magnified a thousand diameters or 
 more, although showing all the cells visible, are much too limited 
 in area. For these reasons the use of the ocular net-micrometer 
 was found to be the best and most accurate for this work, using 
 a stage micrometer to determine the relation of the ocular field to 
 the actual size of the section. In this way the exact number of 
 nerve and neuroglia cells can be determined for -any number of 
 fields and an average obtained for any area, as was done in vari- 
 ous plates in the brains employed in this work, as seen in Table II. 
 As will be noted by referring to this latter, there is considerable 
 variability in ihe number of nerve and neuroglia cells not only in 
 different cortical regions but also from adjacent sections of the 
 same region. The stain is seen to play an important role here 
 in the resulting average number of neuroglia cells, methylene 
 violet having a greater affinity for these cells than methylene blue. 
 Sections stained by the latter cannot always be depended upon to 
 show all the neuroglia cells. In comparing the normal paretic 
 brain there is marked diminution of the nerve cells in the latter as 
 compared to the former, whereas the neuroglia cells, making due 
 allowance for variability, are somewhat increased in number in 
 the paretic brain. 
 
 V. The thickness of the layers is not constant in different 
 parts of the same gyrus, nor even in different portions of a single 
 transverse section of a gyrus, to say nothing of different regions 
 of the cortex. In the same way there is greater or less variability 
 in the shape and mechanical arrangement of each gyrus in con- 
 trast to the other gyri making up the surface of the hemisphere 
 and different parts of the same gyrus vary in this respect. This 
 will be best observed by referring to the several plates of both 
 Brains A and B, magnified 14 diam.eters, and of the various 
 regions of the cortex. 
 
 VI. After a quite extended perusal of the literature upon the 
 
DEMENTIA PARALYTICA. ill 
 
 structure of the cortex as presented in the first portion of this 
 article, the writer incHnes to the view of a three-layered type of 
 cell arrangement in the cortex, as the type with, of course, varia- 
 tions in special parts, as the cornu ammonis, for instance. This is 
 shown in Table I, and brief is as follows: i, or superficial layer, 
 containing- but few nerve cells, many neuroglia cells, and many 
 chiefly tangential fibers. The first two elements only are seen 
 with the Nissl stain, whereas the latter element is most conspicu- 
 ous with Weigert's stain, and for this latter reason Ramon y Cajal 
 designated it as the tangential fiber layer ; 2, or pyramidal cell 
 layer, to reduce the layering of the cortex to its lowest terms, and 
 including the small, large, and giant or Betz pyramidal cells all in 
 this one layer ; 3, or spindle cell layer, including both the spindle 
 cells which are in the majority and the less numerous irregular 
 pol3^gonal cells. Below these three layers is the sub-cortical white 
 medullary substance. 
 
 VII. The study of the internal structure of the normal brain 
 from a histological standpoint (Brain A) by the Nissl method 
 shows four principal types of nerve cells : ( i ) The small rounded 
 nerve cells of the first layer with or without one or more dendritic 
 processes — rarely more than two, containing a rounded nucleus 
 almost fillmg the body of the cell, this latter surrounded by a 
 partial or complete narrow band of finely granular chromophilic 
 substance. The neucleus contains a well marked neucleolus and 
 slightl}' stained protoplasmic substance. These are co-called kar- 
 yochrome nerve cells of Nissl's classification. (2) The pyramidal 
 cells of the second layer, of which there are four varieties (a) the 
 small pyramidal cells, (b) the large pyramidal cells, (c) cells in- 
 termediate in size and structure between the large pyramidal cells 
 and the typical giant pyramidal or "Betz" cells, and (d) the giant 
 pyramidal or "Betz" cells. In the smaller pyramidal cells it is 
 difficult to distinguish distinct chromophilic granules, but the 
 chromatin is arranged in larger or smaller finely granular masses 
 in various parts of the cell-bod}^ sometimes aggregated about the 
 nucleus, at other times near the base or dendritic processes. The 
 larger pyramidal cells, however, have the increasing amount of 
 chromatic substance arranged in more or less- distinct larger and 
 smaller chromophilic granules, and these arranged in a direction 
 
112 G. ALFRED LAWRENCE. 
 
 parallel to the surface of the cell-body. Still larger in size and 
 more distinct in the arrangement of chromophilic granules in this 
 general parallel manner are the intermediate variety of these 
 pyramidal cells, which, although larger than the average pyramidal 
 cell are considerably smaller than the typical Betz cell, and have 
 a wider range of distribution not only in the vertical extent of the 
 second layer of the cortex, but also in the different regions of the 
 cortex, being found in the central, parietal, temporal, and occipital 
 regions. Finally the largest in size and most distinct in structure, 
 especially in the arrangement of the chromatic substance, are the 
 giant' pyramidal or Betz cells, in which larger size, large distinct 
 nucleus and nucleolus, and also large parallel arranged chro- 
 mophilic granules are seen in the cell-body, and often extending 
 far up into the dendritic processes. These are localized, for the 
 most part, in the lower portion of the second layer in certain areas 
 of the central convolution and the posterior portion of the superior 
 frontal convolutions. These pyramidal cells as a whole can best 
 be designated as stichochromc nerve cells of the somatochrome 
 class in Nissl's classification, although the smaller pyramidal cells 
 may simulate more the gryochrome nerve cells of this same class, 
 owing to the indistinct arrangement of the chromatic -substance. 
 
 (3) The spindle cells found in the third layer and containing a 
 very large nucleus with well marked nucleolus. The nucleus is 
 often so large that it seems disproportionate to the size of the 
 latter. The chromatic substance here is finely granular and ar- 
 ranged in irregular masses or heaps about the nucleus, and ex- 
 tending into the base of the dendritic processes, these latter, usu- 
 ally two in number and opposite, producing a bipolar condition. 
 These cells are gryochrome nerve cells of the somatochrome class. 
 
 (4) Finally irregular or polygonal nerve cells are found in the 
 second and third layers. These cells are irregular in shape, with 
 three or more dendritic processes, a large nucleus containing a 
 well marked nucleolus. In the cell-body are irregular finely 
 granular masses of chromatic substance similar to the spindle cells 
 in this respect, so could fall in the same classification as gryo- 
 chrome nerve cells of the somatochrome class. In the cerebellum, 
 the Purkinje cells, with their chromatic substance more or less 
 arranged in a network, are classified as arkychrome nerve cells of 
 
DEMENTIA PARALYTICA. II3 
 
 the soniatochronie class, whereas the small nerve cells of the granu- 
 lar layer, with small nucleus, appear only partially surrounded by 
 the cell-body, are classified as cytochrome nerve cells. The four 
 types of cells above mentioned, as found in the cerebral cortex, 
 were seen in all the regions of the external surface of the hemi- 
 sphere studied. In addition to these cellular elements of the nerv- 
 ous tissue the neuroglia cells of the interstitial tissue were every- 
 where to be seen, and in the walls of the blood vessels the vascular 
 cellular elements were also to be found. 
 
 VIII. Previous investigators, in the study of the cerebral cor- 
 tex in dementia paralytica by the use of the Nissl method, have 
 noted the following pathological changes : Various stages of cell 
 degeneration up to complete destruction of the same, consisting of 
 diminution, disintegration, and vacuolization of the cell proto- 
 plasm, all stages of chromatolysis up to complete disappearance 
 of the chromatic substance, shrinkage with deformity of the con- 
 tour of the cell-body, atrophy of the dendritic processes, various 
 degrees of pigmentation and pigmentary deposits in the cell-body, 
 also adjacent to blood vessels; shrinkage with diminution in size, 
 irregularity, compression, vacuolization, and eccentricity of the 
 nucleus with even extrusion of the same from the cell-body by the 
 rupture of the cell wall, or complete sclerosis of the nucleus with 
 homogeneous and tinged contents or crystalline deposits, nucleolus 
 displaced to nuclear wall or indistinguishable or vacuolated, cal- 
 careous deposits in the form of fine granules, crumbs, placques, or 
 stalactitic masses intensely colored with methylene blue and found 
 in the bodies of the sclerosed cells, part or whole of cell entirely 
 bleached, complete necrosis of cells, reduction in number of nerve 
 cells, thickening of pia with septa projecting into the cortex, 
 granular crowding of variously stained granules, obscure layering 
 of the cortex, multiplication of white corpuscles, proliferation of 
 neuroglia cells, increase in and dilatation of capillaries and arteri- 
 oles, with thickening of walls of same by encasement of latter with 
 lymphatic corpuscles, and finally proliferation of interstitial net- 
 work. The writer has observed all of these changes excepting 
 the following: vacuolization of the cell protoplasm was not ob- 
 served in the paretic material examined in this work, no pigment- 
 ary deposits were observed outside of the nerve cell bodies, al- 
 
1 14 G. ALFRED LAWRENCE. 
 
 though varying amounts were found in many of the nerve cells. 
 No vacuolization of the nucleus or extrusion of the same was 
 found here, no crystalline or calcareous deposits were made out 
 in any of the cells, no septa were observed penetrating from the 
 thickened pia into the cortex, multiplication of white corpuscles 
 was not observed, and proliferation of neuroglia cells as seen from 
 the nerve and neuroglia cell counts as tabulated in Table 11. 
 seems to have existed to but a slight extent in small localized 
 places, as about some of the necrosed nerve cells. The writer 
 does not mean to say that this may not occur in some cases, for 
 on the contrary he is inclined to think it may occur under certain 
 conditions, either localized or more general. Also no prolifera- 
 tion of the interstitial network was observed here. About the 
 nerve cells pericellular spaces of greater or less extent were ob- 
 served in many cases. In some only a small portion of the cell- 
 body, or a single dendritic process, was surrounded by a limited 
 space ; in many, however, a large portion of all the cell-body was 
 thus surrounded. Perivascular spaces were also observed of 
 varying size and extent about many of the blood vessels of the 
 cortex. Pigmentation, in addition to being present in many of 
 the nerve cells of the first and second layers of the cortex in the 
 central regions, was also observed in cells of these layers in the 
 frontal region as well ; also in the parietal and temporal regions, 
 but not in the occipital region. The pathological process here 
 was most severe in the central and frontal regions, extending to a 
 lesser extent, but still very marked, into the temporal and parietal 
 regions, whereas the occipital region almost entirely escaped and 
 appears practically normal. In the regions involved in this case 
 the disease seems to be a chronic disease of the nerve cells with 
 pigmentary degeneration and a necrosis of the cell-body, partial 
 or complete, with accompanying involvement of the blood vessels. 
 The relation of the vascular and cell changes to one another and 
 the order of procedure in time is one that the writer believes re- 
 quires much more extended investigation before it can be answered 
 satisfactorily. 
 
 In conclusion the writer gratefully acknowledges the kindly 
 interest, suggestions, and assistance offered by Professor H. Fair- 
 field Osborn, Professor Bashford Dean, Dr. Oliver S. Strong, 
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DEMENTIA PARAL YTICA. 1 1 5 
 
 Giesen, former Director of the New York State Pathological Insti- 
 tute; Dr. H. T. Brooks, Professor of Histology and Pathology 
 at the New York Post-Graduate Medical School, and Hospital; 
 Dr. Philip F. O'Hanlon, Coroner's Physician, New York City, and 
 Dr. Robert T. Irvine, of Ossining, N. Y. 
 
 LITERATURE. 
 
 Anglade, D. "Sur les alterationes des cellules nerveuses de la cellule 
 pyramidale in particular dans la paralysie generale." Annales Medico- 
 Psychologiques. Huitieme Serie, Tome Huitieme, Sinquante sixieme Annee 
 (1898), p. 40. 
 
 Arndt, R. "Untersuchungen iiber die ganglion-Korper des Nerves 
 sympathicus." Arch. f. mikr. Anat. Bonn. Bd. X. (1874), S. 208-241. 
 
 Baillarger, J. "Recherches sur la structur de la couche corticale des 
 circonvolutions du cerveau." (1840). Annales Med.-Psychol. (1855). I., 1-3. 
 "De ridiotie." Gaz. des hop. (185^). No. 84 Canst. Jahresber. (1855). 
 III., p. 8, Mem. de I'Acad. de Med., (1880). VIII. Bull, de I'Acad. de 
 Med. (1856, Juillet). Gaz. habdom. (1859). (Cit, Griesinger, p. 366). 
 Acad, de Med. (Cit. Griesinger, p. 360). Annal Med.-Psychol., 1882, VII. 
 I, p. 19. Baillarger et Gratiolet. Acad, de Med. (May 26, 1857) (Cit. 
 Griesinger). 
 
 Ballet, Gilbert. "Les Lesions cerebrales de la paralysie generale 
 etudiees par la methode de Nissl." Ann. Med. psychol. Par. 8. s. t. VII 
 (1898), pp. 448-459- 
 
 Barker, L. T. "The Nervous System and Its Constituent Neurones. 
 D. Appleton & Co., N. Y., 1899. 
 
 Belmondo, F. "Alterazione dei centri nervosi nella paralisi progres- 
 siva." Annali di Neurolgia (1896). p. 475. 
 
 Berger, H. "Degeneration du Vorderhornzellen des Ruckenmarks 
 bei Dementia paralytica." Monatschrift f. Psych, u. Neur. (1898), H. I. 
 
 Berlin, R. "Beitrage sur .Structurlehre d. Grosshirnwindungen." Er- 
 langer (1858). 
 
 Benda, C. "Ueber die Bedeutung der durch basiche Anilinfarben dar- 
 stellbaren Nervenzellstructuren." 'Neurol. Centralbl. Leipz. Bd. XIV, 
 
 (1895), s. 759-768. 
 
 Betz, W. "Ueber die feinen Structur d. Menschl. Gehirnrinde. Med. 
 Centralbl. (1881). Centralbl. f. d. Med. Wissensch. (1881). N. r. 11-13. 
 Centralbl. f. d. Med. Wissensch. (1874). N. 37-38. 
 
 Boedecker and Juliusberger. "Anatomische Befunde bei Dementia 
 paralytica." Neur. Cent. (1897), p. 774- 
 
 Boll, F. "Die Histiologie und Histiogenese der nervosen Central- 
 organe." Archiv. f. Psych. (1873), IV, pp. 1-38. 
 
 Cajal, S. Ramon y. "Les nouvelles idces sur la Structure du systeme 
 nerveux chez I'homme et chez les vertebres." (1895.) 
 
 Charcot, J. M. "Anatomic Pathologique." Le Progres Medical, p. 
 253 (1871). 
 
 Clarke, L. "Notes on Researches on the Intimate Structure of the 
 Brain." Proc. Royal Society of London, Vol. XII, p. 716 (1863). 
 
 Cleland, John. "Human Anatomy, General and Descriptive." p. 627 
 
 (1876). ... 
 
 Crisafulli, E. "Studio comparative clinico istologico sulla paralisi 
 
 generale progressiva." Ann. di Neurolog. 14, p. 255. Also: Ulteriore con- 
 
Il6 G. ALFRED LAWRENCE. 
 
 tribute alia istologia path, della paralisi generale progressiva." Annali di 
 Neurolog. (1897), p. 194. 
 
 De Quervain, Fritz. "Ueber die Veranderungen des Central nerven- 
 systems bei experimentellen Kachexia thyreoidea der Thiere." Arch. f. 
 path. Anat. etc., Berl. Bd. CXXXIII (1893), S. 481. 
 
 Dogiel, A. S. "Zur Frage iiber den Bau der Nervenzellen und iiber 
 des Verhaltniss ihres Achencylinder (Nerven) Fortsatzes zu den Proto- 
 plasmsfortsatzen (Dendriton)." Arch. f. mikr. Anat, Bonn. Bd. XLI 
 (1893), S. 62-87. Also: "Zur Frage iiber des Verhalten der Nervenzellen 
 zu einander. Arch. f. Anat. u. Physiol. Anat. Abth. Leipz. (1893), S. 
 429-434- 
 
 Donaldson, H. H. "The Size of Several Cranial 'Nerves in Man as 
 Indicated by the Areas of their Cross-sections." Amer. Jour, of Psychol.', 
 
 4, 1891-1892, p. 227. 
 
 Edinger, L. "Anatomy of the Central Nervous System in Man and 
 in Vertebrates in General." (1896.) 
 
 Ewing, James T. "Studies on Ganglion Cells." Archiv. of Neurol, 
 and Psychopath., Vol. I, No. 3 (1898). 
 
 Flemming, W. "Beitrage zur Anat. u. Embryol. als Festgabe fur J. 
 Henle," (1882), Bonn. S. 12. 
 
 Cf. also, "Ueber den Bau der Spinalganglienzellen bei Saugethieren, 
 und ■ Bemerkungen iiber den centrallen Zellen." Arch. f. mikr. Anat., 
 Bonn. 1895. Bd. XLVI, S. 379-394, and, "Die Struktur der Spinalgan- 
 glienzellen bei Saugetieren. Arch. f. Psychiat. u. Nervenkr., Berl. Bd. 
 XXIX (1897), H. 3. S. 969-974. . 
 
 "Ueber die Sti-uktur centrallen 'Nervenzellen bei Wirbeltieren." Anat. 
 Hefte, I. Abth., 19. Heft. (1896) (Bd. VI, H. 19, p. 561). 
 
 Flesch, M. "Ueber Verschiedenheiten im chemischen Verhalten der 
 Nervenzellen." Mitth. d. Naturf. Gesellsch. in Bern (1897) M. 1169-1194, 
 
 5. 192-199- Bern. P. Haller (1888). 
 
 Gennari, Francisco. "De peculiaris structura cerebri, non-nulisque 
 ejus morbis. Pancae aliae anatom. observat. accedunt." XVI, pp. 87, 4rfc. 
 "Pannae ex regis typg." (1782.) 
 
 Golgi, C. "Sulla fina Anatomia Organi Centrali del Sistema Nervosa." 
 (1885.) p. 65. Archiv. ital. de Biol. (1883.) Ref. 
 
 Gowers, W. R. "Diseases of the 'Nervous System." Vol. II, p. lO 
 
 (^893)- 
 
 Hammarberg, Carl. "Studien iiber Klinik und Pathologie die Idiotic 
 nebst Untersuchungen iiber die Normale Anatomic der Hirnrinde."(i895.) 
 
 Henle, J. "Anatomic," 2nd Ed. Vol. II, p. 306 (1876). 
 
 Jelliffe, Smith Ely. "Biographical Contribution to the Cytology of 
 the Nerve Cell." Arch, of Neurology and Psychopathology. Vol. I, No. 
 3 (1898), p. 441- 
 Key, E. A. H., and Retzius, G. "Studien in der Anatomic des Nerven- 
 systems und des Bindegewebes." 4to. Stockholm (1876). 
 
 Kolliker, A. "Mikroskopische Anatomic." Band II (1830). "Hand- 
 buch der Gewebelehre." Leipzig (1867). 
 
 Krause, W. "Anatomic." Vol. I, p. 439 (1876). 
 
 Lewis, Bevan. "Comparative Structure of the Cortex Cerebri." Med. 
 Times and Gaz. (1876, Mar. 4). Brain (t868). Vol. I. Philosophy. 
 Transact. (1880). Lewis and Clarke. "On the Cortical Lamination of 
 the Motor Area of the Brain." Proc. of the Royal Soc. of London (1878). 
 Vol. 27, p. 38. 
 
 Luys, J. "Systeme Nerveux," p. ,162 (1864). 
 
 Major, H. C. "The Histology of the Island of Reil." West Riding 
 Lunatic Asylum Medical Reports. Vol. VI (1876), p. 5. 
 
 Meckel, J. F. "Anatomic." Vol. II, p. 443. 
 
DEM EXT I A PARA L VTICA. 1 1 7 
 
 Meynert, T. "Der Bau der Grosshirnrinde und seine ortlichen Ver- 
 schiedenheiten nebst einem pathol. anat." Vierteljahrschr. f. Psychiatrie 
 von Leidesdorf und Meynert (1867). u. (1868). "Corallium," Leipzig 
 (1872), und Strieker's Handbuch (1871). Allg. Wiener med. Ztg. (1868), 
 XIII, Psychiatry, translated by Sachs, B. (1885). 
 
 Nagy, A. "An ag'yking idigsijtjunek elvatozasarol ehnebautalmaknae." 
 Maggae Arvosi Archivum (1894). 
 
 "Ueber die Veranderurgen der Hirnrindenzellen bei Psychosen." Neur. 
 Cent. (1894), p. 820. 
 
 Nissl, Franz. (a) "Ueber die Untersuchungsmethoden der gross 
 himrinde." Tagebl. d. 58, Versamml. Deutsch. naturf. u. aerzte in 
 Strassburg (1885), S. 506.' 
 
 (b) "Ueber den Zusammenhang von Zellstruktur und Zellfunktion." 
 Tagebl. de 61 Versamml. Deutsch. naturf. u. aerzte in Koln (1888). Inter. 
 Klin. Rundschau. II (1888). No. 43. 
 
 (c) "Die Kern d. Thalamus beim Kaninchen." Tagebl. d. Naturforsch. 
 V. 2. Heidelberg (1890), S. 509. _ " "=!,"! 
 
 (d) "Ueber die Veranderungen der Ganglienzellen in Facialis Kiern 
 des Kaninchens nach ausreissung der Nerven." Allg. Ztschrift. f. Psych. 
 Bd. XLVIII (1891-92), S. 197. 
 
 (e) "Ueber experimentell erzeugte Veranderungen an den Vorder- 
 hornzellen des Riickenmarkes bei Kanincheri mit Demonstration mik- 
 roskopische Praparate." Allg. Ztschr. f. Psychiat. Bd. XLVIII (1891- 
 92), S. 675-682. 
 
 (f) "Mittheilungen zur Anatomic der Nervenzelle." Allg. Ztschrft. 
 f. Psychiatrie. Bd. L. (1894), S. 370. 
 
 (g) "Ueber Rosin's neue Farbemethode des gesammten Nervensys- 
 tems und dessen Bemerkungen iiber Ganglienzellen." Neurolog. Central- 
 blatt, XIII (1894), S. 96-141. 
 
 (h) "Ueber eine neue Untersuchungsmethode des Centralorganes 
 speziell zur Feststellung der Localization des Nervenzellen. Neur. Cen- 
 tralbl. (1894), S. 507-S(S. Centralbl. f. Nervenh. K. und Psychiatrie, Bd. 
 XVII (1894, S. 337-344. Arch. f. Psychiat, Bd. XXVI (1894), S. S97-6i2. 
 
 (i) "Ueber die sogenannte Granula der Nervenzellen." Neurolog- 
 isches Centralblatt., Bd. XIII (1894), S. 676, 781, 810. 
 
 (j) "Mittheilungen iiber Karyokinese in Centralen Nervensystem." 
 Allg. Ztsch. f. Psych., Bd. LI (1894), S. 245. 
 
 (k) "Bernhard von Gudden's hirnanatomische experimentale Unter- 
 suchungen." Allg. Ztschr. f. Psychiat., Bd. LI (1894), S. 527-549. 
 
 (1) "Der gegenwartige Stand der Nervenzellen Anatomic und Path- 
 ologic." Centr. f. Nervenheilk. und Psychiatrie, Bd. XVIII (1895). Allg. 
 Ztsch. f. Psych. (1895), P- 981. 
 
 (m) "Ueber die Nomenclatur in der nervenzellenanatomie und ihre 
 nachsten Ziele." Neurolog. Centralblatt., Bd. XIV (1895), S. 96-104. 
 
 (n) "Mittheilungen zur pathologischen Anatomic der Dementia par- 
 alytica." Arch. f. Psychiatrie, Bd. XXVIII (1896), S. 987-992. 
 
 (o) "Ueber die Veranderungen der Nervenzellen nach experimentell 
 erzeugter Vergiftung, Neurolog. Centralblatt, Bd. XV. (1896), S. 9. 
 
 (p) "Die Beziehungen des Nervenzellensubstanzen zu dem thatigen 
 ruhenden, und ermiideten Zellzustanden." Neurolog. Centralblatt (1896). 
 Allg. Ztschr. f. Psychiat. (1896), Bd. LII S. 1147. 
 
 (q) "Die Hypothese der Specifischen Nervenzellenf unction." Allg. 
 Ztschrft. f. Psych. Berl.Bd. LIV (1897), S. 1-107. 
 
 (r) "Ueber die ortlichen Bau verscheidenheiten die Himrinde." Arch, 
 f. Psychiat., Bd. XXIX (1897), S. 1025-1027. 
 
 (s) "Ueber Nervenzellen und graue Substanz." Miinchen med. Woch., 
 Bd. XLV (1898), S. 988; 1023; 1060. 
 
Il8 G. ALFRED LAW REN Lh. 
 
 (t) Die Neuronenlehre und ihre Anhanger; ein Beitrag zur Losung 
 des Problems der Beziehungen zwischen Nervenzelle Faser und gran. Jena. 
 1903- 
 
 Obersteiner, H. "Central Nervous Organs, Anatomy of in Health 
 and Disease," p. 350 (1887). 
 
 Popoff, N. M. "Pathologische anatomische Veranderungen des Cen- 
 tralnervensystems bei der asiatischen Cholera." Virchow's Archiv., 1894, 
 
 p. 57- . 
 
 Ranvier, L. "Legons sur I'histologie du systeme nerveux." Paris, 
 1878. 
 
 Remak, R. "Anatomische Beobachtungen iiber das Gehirn, das 
 Riickenmark, und die Nervenwurzeln." Muller's Archiv. f. Anat. und 
 Phy. (1841.) 
 
 Neurologische Erlautungen. Arch. f. Anat., Physiol., u. wissensch. 
 Med. Bui., 1844, S. 463-472. 
 
 Rosin, H. "Ein Beitrag zur Lehre vom Bau der Ganglienzellen." 
 Deutsche med. Wochenschr. Leipz. u. Berl., Bd. XXII (1896), S. 495- 
 
 497- 
 
 Schaffer, K. "Kurze Anmerkung iiber die morphologische Differenz 
 des Axencylinders in Verhaltnisse zu den protoplasmatischen Fort- 
 
 satzen- bei Nissl's Farbung." Neurol. Central., Leipz., Bd. XII (1893), S. 
 
 489-857- 
 
 Schultz, Max, in Striker's, S. A. "Manual of Histology." Am. trans- 
 lation. 8vo., N. Y., 1872, p. 134, et seq. 
 
 Schwalbe, G. "Lehrbuch der Anatomic des Menschen," arranged by 
 Dr. August Rauber (1885), p. 463. Fig. 279. 
 
 Starr, Learning and Strong. "Atlas of Nerve Cells," p. 72. Fig. 10 
 (1896). 
 
 Vicq d'Azyr, Felix. "Traite d'anatomie et de physiologie.' V. I. "Anat- 
 omic et physiologie du cerveau," 123, 117 pp., 35 pi. (1786.) 
 
 Von Lenhossek, M. "Der feinere Bau des Nervensystems im Lichte 
 neuesten Forschungen." 2te Aufl., Berlin (1895). 
 
 "Ueber Nervenzellenstructuren." Vorhandl. d. Anat. gesellsch., Jena 
 (1896), Bd. X, S. 15-21. 
 
 EXPLANATION OF PLATES. 
 
 Plate I. Fig. i. Brain A. Left hemisphere. Electrocuted case, nor- 
 mal histologically. 
 
 Plate I. Fig. 2. Brain A. Suture from point indicated by the figure 
 I in Plate I. Fig. i. Section 6 2-3 microns in thickness stained with 
 methylene blue and magnified 14 diameters. 
 
 Plate II. Fig. 3. Brain A. First frontal conv. Strip a of Plate I, 
 Fig. 2, magnified 100 diameters. 
 
 Plate II. Fig. 4. Brain A. First frontal conv. Cell G. of Plate II, 
 Fig. 3 magnified 1400 diameters. 
 
 Plate II. Fig. 5. Brain A. First frontal conv. Cell H of Plate II, 
 Fig. 3 magnified 1,400 diameters. 
 
 Plate III. Fig. 6. Brain A. First frontal conv. Group of spindle 
 cells / of third layer of cortex shown at / in Plate II, Fig. 3 magnified 
 1,400 diameters. 
 
 Plate III. Fig. 7. Brain A. Ant. cent, conv. Upper third, taken 
 from point indicated by the figure 2 in Plate I., Fig. i. Section 10 microns 
 in thickness stained with methylene violet, and magnified 14 diameters. 
 
 Plate III. Fig. 8. Brain A. Ant. cent. conv. Upper third. Strip a 
 of Plate III, Fig. 7 magnified 100 diameters. 
 
 Plate IV. Fig. 9. Brain A. Ant. cent. conv. Uppe- third. Section 
 
DEMENTIA PARALYTICA. II9 
 
 frt m same block and adjacent to that shown in Plate III, Fig. 7. Section 
 10 microns in thickness, stained with methylene blue, and magnified 14 
 diameters. 
 
 Plate IV. Fig. 10. Brain A. Ant. cent. conv. Upper third. Strip 
 a of Plate IV, Fig. 9, magnified ico diameters. 
 
 Plate IV. Fig. 11. Brain A. Ant. cent. conv. Upper third. Sec- 
 tion taken from same block and adjacent to that shown in Plate IV, Fig. 9. 
 Section 10 microns in thickness, stained with methylene blue, and magni- 
 fied 14 diameters. 
 
 Plate IV. Fig. 12. Brain A. Ant. cent. conv. Upper third. Giant pyramidal 
 cell from lower portion of second layer of cortex from section adjacent to 
 that shown in Plate III, Fig. 7. Section 10 microns in thickness, stained 
 with methylene violet and magnified 1,400 diameters. 
 
 Plate V. Fig. 13. Brain A. Ant. cent. conv. Upper third. Portion 
 o of Plate IV, Fig. 11, magnified 825 diameters. 
 
 Plate V. Fig. 14. Brain A. Ant. cent. conv. Upper third. Two 
 giant pyramidal cells from lower portion of second layer of cortex from 
 section adjacent to that shown in Plate IV, Fig. 9. Section 10 microns in 
 thickness, stained with methylene blue and magnified 1,400 diameters. 
 
 Plate V. Fig. 15. Giant pyramidal cell from Ant. cent. conv. Upper 
 third, lower part of second layer from approximately the same region as 
 the cells shown in Plate V, Fig. 14, and stained with methylene blue. Sec- 
 tion 10 microns in thickness, and magnified 1,400 diameters. 
 
 Plate VI. Fig. 16. Brain A. Ant. cent. conv. Lower third, taken 
 from point indicated by the figure 4 in Plate I, Fig. i. Section 10 microns 
 in thickness, stained with methylene violet, and magnified 10 diameters. 
 
 Plate VI. Fig. 17. Brain A. Ant. cent. conv. Lower third. Strip a 
 of Plate VI, Fig. 16, magnified 100 diameters. 
 
 Plate VI. Fig. 18. Brain A. Post. cent. conv. Middle third. Sec- 
 tion taken from the point indicated by the figure 5 in Plate I, Fig. i. Sec- 
 tion 6 2-3 microns in thickness, stained with methylene blue, and magni- 
 fied 10 diameters. 
 
 Plate VII. Fig. 19. Brain A. Post. cent. conv. Middle third, upper 
 portion. Strip a of Plate VI, Fig. 18, magnified 100 diameters showing 
 first and second layers and upper portion only of third layer. 
 
 Plate VII. Fig. 20. Brain A. Supra-marginal conv. of parietal re- 
 gion taken from point indicated by the figure 7 in Plate I, Fig. i. Sec- 
 tion 6 2-'j microns in thickness, stained with methylene violet, and magni- 
 fied 14 diameters. 
 
 Plate VII. Fig. 21. Brain A. Supra-marginal conv. of parietal re- 
 gion. Strip a of Plate VII, Fig. 20, magnified 100 diameters. 
 
 Plate VIII. Fig. 22. Brain A. First temp. conv. taken from point 
 indicated by the figure 6 in Plate I, Fig. i. Section 6 2-3 microns in thick- 
 ness, stained with methylene blue, and magnified 14 diameters. 
 
 Plate VIII. Fig. 23. Brain A. First temp. conv. Strip a of Plate 
 VIII, Fig. 22, magnified 100 diameters. 
 
 Plate VIII. Fig. 24. Brain A. Occipital conv. taken from point indi- 
 cated by the figure 8 in Plate I, Fig. i. Section 6 2-3 microns in thickness, 
 stained with methylene violet and magnified 14 diameters. 
 
 Plate IX. Fig. 25. Brain A. Occipital conv. Strip a of Plate VIII, 
 Fig. 24, magnified 100 diameters. 
 
 Plate IX. Fig. 26. Brain A. Large pyramidal cells from layer of 
 large pyramidal cells of the hippocampus major or cornu ammonis. Sec- 
 tion 6 2-3 microns in thickness, stained with methylene violet, and mag- 
 nified 1,400 diameters. 
 
 Plate IX. Fig. 27. Brain A. Purkinje and granular cells from cortex 
 
Date Due 
 
 
 
 
 
 
 
 
 
 
 i. 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 i 
 
 
 
 
 
 
 
 
 
 
 
 
 
 f) 
 
 
 
 
RC381 U3 
 
 Lavtfrence