THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 



519 



CONTENTS. 



Prepack 



I. Introduction 



II. Historical 



III. Methods of Investigation 



IV. Histological Study — 



(1) Introduction : Clinical History of 



Case I 



(2) Structure of Different Types of 



Areas 



(3) Characteristics in Special Situations 



(4) Changes in the Individual Tissue 



Elements .... 



(5) Other Histological Features 



(6) Conclusion : with Note on the 



Pathological Physiology 



PAGE 



517 

 519 

 526 

 552 



558 



563 

 592 



604 

 618 



625 



V. Pathogenesis and Etiology — A Critical 



Discussion — 636 



( 1 ) The Nature of the Pathological Process 638 



(2) Its Origin 646 



(3) Etiological Factors .... 652 



(4) Mode of Action of the Causal Agent . 661 



VI. Conclusion 673 



Appendix : Cases II-IX — 



(1) Clinical Notes . 688, 694, 698, 704, 707, 



711, 714,717 



(2) Post-mortem Reports . 689, 694, 699, 704, 



707, 711, 714, 717 



(3) General Features of the Areas . 689, 695, 



699, 704, 707, 712, 715, 717 



(4) Their Topographical Distribution . 690 



696, 700, 705, 708, 712, 715, 718 



Bibliography 721 



Description op Plates 725 



INTRODUCTION. 



The following study is based upon the detailed histological examination of the 

 nervous organs from nine cases of disseminated sclerosis. This name and its 

 synonyms — multiple sclerosis, insular sclerosis, sclerose en plaques disseminees, 

 Herdsklerose — indicate that the disease they designate has, as its chief anatomical 

 feature, irregular sclerotic patches distributed throughout the central nervous system. 

 Its manifestations, therefore, are protean, and an exact knowledge of its pathological 

 anatomy is essential to the understanding of the various clinical forms of the disease. 



The works of Charcot, who first gave classical pictures of the disease — the 

 clinical and anatomical, — show that to him the condition was a distinct morbid 

 entity, and that it bore no relation to the other non-system diseases of the central 

 nervous system. All subsequent studies have been influenced by the fundamental 

 observations of Charcot, and around the three cardinal points emphasised by him, 

 proliferation of glia, degeneration of nerve fibres, and blood-vessel changes, have been 

 grouped the various theories put forward to account for the origin of the process. 



The etiology of the disease remains absolutely obscure. The supposition of a 

 selective poison acting through the blood-vessels, which has received the support of 

 most recent investigators, is justified as an hypothesis but remains undemonstrated 

 as a fact. Chief interest has, therefore, centred in the pathological anatomy of the 

 condition, and the object of this study has been to trace, by means of the most 

 recent available specific staining methods, the characteristics of the pathological pro- 

 cess and to determine, as far as possible, the histological changes which form its basis. 



