56 STUDIES ON THE CENTRAL NERVOUS SYSTEM 



Some years ago I published biological reflections on dis- 

 seminated sclerosis. Further observations have not al- 

 tered these ideas. Hence I shall repeat them, especially as 

 some workers have misunderstood my point of view. 



Sclerosis multiplex is, as you are aware, a chronic infec- 

 tious disease of the central nervous system. The noxious 

 agent, which as yet is not known, must be conducted chiefly 

 along the bloodvessels to the central nervous system. This 

 is proved by the fact, that the smaller sclerotic spots corre- 

 spond in extent with the territories of the bloodvessels. 

 This is not so clear in the bigger plaques because several of 

 them have flown together. 



These sclerotic areas are very irregularly distributed 

 throughout the brain and the spinal cord. I remind you, 

 that in this disease the myeline is far more seriously dam- 

 aged than the cells and the axis cylinders. Hence the lesion 

 of the central nervous system always seems to be worse 

 than it really is. Impulses can be conducted through these 

 foci, but not so well as under normal conditions. 



Clinicians, accustomed to check their clinical findings by 

 anatomical researches, know how dangerous it is to prophesy 

 the extension and the localisation of the sclerotic foci from 

 the clinical symptoms. Several authors expected, in cases 

 with severe dysarthry, to see extensive damage in the 

 medulla oblongata but did not find this. The contrary also 

 occurs; one often sees many parts of the central nervous 

 system strewn with sclerotic foci, while during life there 

 were no clinical symptoms, indicating so serious alterations. 

 Usually the anatomical section shows more than might have 

 been expected at the clinical examination. So Oppenheim 

 mentions, that in all the cases, anatomically controlled, he 

 found plaques in the spinal trigeminal root, while no dis- 

 turbances of sensibility in the face were found. 



It is striking, that in this disease, where the central ner- 

 vous system is so irregularly strewn with foci, there is yet 

 some regularity in the clinical image. Sclerosis multiplex 



