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MULTIPLE NEUROMATA OF THE CENTRAL NERVOUS SYSTEM. 731 
especially the endoneurium; the difference lying in the difference of the site, the 
nerve trunks, and the fine cutaneous twigs respectively. Von RECKLINGHAUSEN used 
the name “‘neurofibroma” as a compromise with the old-established term ‘‘ neuroma,” 
but he thought this terminologically incorrect, though it served to indicate the nature 
of the tumour (fibroma) and its relation to a nerve. After the appearance of Von 
RECKLINGHAUSEN’S work multiple tumours of the nerves were generally regarded as 
fibromata, and the existence of VircHow’s supposed neuromata were more and more 
discredited, except by a few authors amongst whom must be mentioned Knauss and 
ASKANAZY. ‘These writers believed that many of the tumours described as neuromata, 
with numerous spindle-shaped nuclei, really contained non-medullated nerve fibres. 
They considered, however, that the presence of ganglion cells was essential to true 
neuroma formation, and ascribed the starting-point to the minute sympathetic ganglia 
and branches present in the vessel walls. 
ALEXIS THomson (1900) divided neuromata into true and false, basing this 
classification on the anatomical structure. Under true neuromata he identified only 
those tumours which contained ganglion cells, and he doubts whether true neuromata 
without ganglion cells can occur. Under the term false neuromata he classes 
(1) all circumscribed or solitary tumours growing from the connective tissue of 
nerve trunks or of the ganglionic enlargements of nerves. They resemble similar 
tumours originating in other tissues and organs, and are subdivided into innocent and 
malignant. (2) Traumatic neuroma. (8) Enlargements of nerves in leprosy, syphilis, 
and tuberculosis. (4) Diffuse overgrowths of the connective tissue sheaths of nerves 
and of ganglionic enlargements of nerves, embracing a number of lesions affecting skin 
as well as the nervous system, and capable of assuming very different forms. French 
authors suggested the name ‘‘Von Recklinghausen’s disease” for this group, and 
THomson has given to it the general term “neurofibromatosis.” It includes the 
following forms :— 
~ (a) Multiple neurofibroma (generalised neurofibromatosis).—The endoneurial con- 
nective tissue between individual nerve fibres is the chief seat of the pathological 
process, and its increase may cause visible thickenings and tumours of the nerves 
with a dissociation and wavy course of the nerve fibres. The formation of new 
nerve fibres is “‘ unlikely in the absence of nerve cells.” In addition to the tumours 
on the nerve trunks, the terminal filaments of the nerves exhibit the same 
fibromatosis, so that the tissue of the true skin may be studded with innumerable 
minute tumours. The sympathetic system is frequently extensively involved, and 
the enlargement here also is stated to be due to an overgrowth of the delicate con- 
nective tissue which supports the nerve fibres and ganglion cells. 
(b) Plexiform neurofibroma.—The pathological lesion here is essentially the same 
as in the more generalised form, except in its distribution and localisation. It is to 
be regarded as a fibromatosis confined to the distribution of one or more contiguous 
nerves or of a plexus of nerves. The nerve filaments in the pars recticularis of the 
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