THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 551 



which had clinically strongly simulated subacute transverse myelitis in the lumbo- 

 sacral region of the cord, without any cerebral symptoms. Death occurred three 

 and a half months after the onset of the disease. There were no macroscopical 

 alterations in the brain or spinal cord. Numerous sclerotic areas were found 

 throughout the whole length of the cord. These were divided into two groups : 

 (l) those in an early stage of myelin sheath degeneration, without participation of 

 the blood-vessels or glial tissue ; and (2) further advanced areas with accumulation 

 of fat granule cells in the vessel walls and glial proliferation. The whole of the 

 lumbo-sacral cord was in a condition of advanced degeneration. In all the areas the 

 participation of the vessels in the sclerotic process was quite evident, and the 

 authors regard the vessel alterations as the key to the whole process. Disseminated 

 sclerosis is looked upon as essentially a disseminated inflammatory process, i.e. a 

 disseminated myelitis, with, however, certain special characteristics. The in- 

 flammatory changes are assumed to be not so intense as in myelitis, and, therefore, 

 there are no " softenings" in the usual sense of the term. 



In their later paper Flatatj and Koelichen again discuss the relation of dis- 

 seminated encephalo-myelitis to disseminated sclerosis. They think that the 

 infectious or exotoxic origin can be admitted for those cases of disseminated sclerosis 

 running an acute course, but that the pathogenesis of most of the cases with a 

 chronic course must be different, and is probably related to an autogenous toxin. 

 Whether the supposed toxin forms in the body, and whether disturbed metabolism 

 or an altered internal secretion plays a part is not stated. As in their earlier paper, 

 the authors see in disseminated sclerosis a chronic irritative process of the whole 

 central nervous system — a process which has acute exacerbations, and which, in the 

 majority of cases, is dependent on autogenous intoxication. 



Nonne (191 1) has made a careful clinical and serological investigation into the 

 phenomenon of inhibition of cobra poison haemolysis. He has investigated all 

 possible cases of organic disease of the central nervous system, and has also made 

 very numerous control tests. He feels justified in stating, yet with a certain amount 

 of reserve, that the cobra reaction is specially frequent in degeneration-neuroses and 

 psychoses, and in hereditary diseases in the neuro-psychopathic sense. In the 

 katatonic group also, and in the group of maniac-depressive psychoses, and in 

 the chief representatives of endogenous psychoses, the reaction is likewise very 

 frequent. Amongst organic diseases of the central nervous system, the reaction 

 appears most frequently in disseminated sclerosis. In healthy individuals the 

 authors found the reaction in 5 per cent. , in people with diseases other than of the 

 nervous system in 15 per cent., in psychoses in 65 per cent., and in disseminated 

 sclerosis in 65 per cent. As the reaction appears even in the early stages of dis- 

 seminated sclerosis, Nonne is tempted to value it as a differential diagnostic sign, 

 especially as the Wassermann reaction, the globulin reaction, and the cytological 

 examination of the cerebro-spinal fluid in disseminated sclerosis give no indication of 



