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Plate IV.
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Plate IV. Charcot's Original Commentary:
Fig. 1, a-a, "Sclerosed plaque affecting the [upper] wall of the lateral [cerebral] ventricle" - reaching, up to one centimeter, off the ventricular border; fig. 2, a,a, "Sclerosed nuclei", exposed by sectioning the pons parallel to its anterior front.

Fig. 3. a,a, "Sclerosed plaques of pons and spinal bulb"; b,b, "ependyma" [membranous wall] of the brain's fourth ventricle.

Fig. 4, Spinal cord cross-sections (d, the cord's front) : A, above cervical enlargement; B,B', at middle; C, three centimeters over lower end. The spinal cord's lateral columns appeared throughout primarily and, in the lumbar section, exclusively involved.

Specific Lesion Features:
Fig. 1 shows a massive, peripherally undulating epiventricular lesion expanded into a cerebral hemisphere; it embeds the local venous blood vessels' stems and their branches' proximal, i.e. more central, segments. Most lesion-veins appear silhouetted by unevenly asymmetrically widened perivascular spaces; the larger veins show a winding course and appear related to broader lesion projections.

Fig. 2 shows winding and bumpy, multiheaded lesions expanded in the surface (c.f. Plate II, fig. 1) and into the depth of the pons (c.f. fig. 3, a,a).

Figg. 3 and 4 confirm the specific involvement of, above all, the spinal cord's flanks. The laterally based lesion wedges are partly interconnected (figg. 4; B, B') and appear one times turned backwards (fig. 4: C, left side; c.f. Plate I, fig. B, right side; Plate III, fig. 1'', left side).

This plate, drawn by Charcot and presented in Ordenstein's 1867 Parisian thesis, was the first to display specific ventricle-based lesion expansions into the cerebral hemispheres. It forms the earliest and still unmatched synopsis of the specific post-mortem findings of multiple sclerosis of brain and spinal cord.

© Dr. F. Alfons Schelling, M.D.