The microscopic examination of three of the excised ganglia was made by
my friend, Dr. Carl Fisch, of St. Louis. The specimens were those from
Cases I., II., and III. Of the two ganglia removed from Case II. only
the first one—the left—was examined.
Transverse and longitudinal sections of the three specimens were studied
microscopically, by means of a great number of different staining
methods. Owing to the method by which the ganglia had been
preserved—weak formalin solution—the employment of the Golgi—Marchi—and
the more delicate Nissl stains was rendered impossible. In general it
may be said that the pathologic changes found were the same in the three
cases, although a little less pronounced in No. 2 than in 1 and 3.
Most striking of all was a very marked hyperplasia of the connective
tissue, which in some places resulted in dividing up the ganglion into
small groups of nervous elements separated by broad bands of fibrous
elements. The walls of the vascular structures showed decided sclerosis;
the connective-tissue sheaths of the ganglionic cells were much
increased in thickness. In Case I. small foci of round-cell infiltration
were seen in this hyperplastic growth, of an inflammatory character. No
plasma nor mast cells could be demonstrated.
The ganglionic cells were markedly pigmented. Together with a number of
cells normal to all appearance there were great numbers showing
different stages of degeneration. As a rule the nucleus, besides having
lost part of its peculiar staining property, had assumed the parietal
position; the nucleus was reduced in size or even missing in a large
percentage of the cells. While in some cells the chromatic elements were
well preserved, in others the process of chromatorhexis and
chromatolysis could be followed up through all of its stages. Only
comparatively few cells were seen showing the normal dendriform
processes; very often the processes were short, ending bluntly, or they
had even disappeared altogether. The general peripheral network of
processes was much reduced in volume and compressed by the pressure of
the connective-tissue formation. Only very few medullated fibers were
seen. Unfortunately it was impossible to study their structure with the
Marchi method.
The general pathologic aspect was that of a decided sclerosis,
originating in inflammatory processes going on in, and starting out
from, the walls of the vascular structures. The changes of the nervous
elements were most likely not idiopathic, but due to pressure and
inhibited nutrition.
The plates accompanying this paper have been made from drawings of
sections of superior cervical ganglia.