Nashville Journal of Medicine and Surgery

The affection attempted to be described in this essay is one rarely met with. Indeed, many physicians have doubtless practiced a lifetime without once meeting a case, basing this judg ment upon my own personal experience, as I have been practicing medicine twenty-six years, and so far have observed only one case. Because of its rarity, and in view of the perplexities confronting the practitioner who for the first time meets with the disease, and to call attention to, and to cause investigation of the subject, is my excuse for bringing it before the Society.

The first mention we have of the disease was by Cruveilhier, in 1835. From this date until 1862 the disease has been described by different writers-Turck, Rokitansky, Freichs, Valin

*Read before the Middle Tennessee Medical Association, held in Lewisburg, November 19-20, 1896.

tina, Charcot, Vulpian, and others-but as late as 1868 the disease does not seem to have been known in England.

Disseminated sclerosis consists, as the name indicates, of a number of isolated points of sclerosis throughout the brain or spinal cord, or both. These consist of circumscribed grayish spots, more or less regular in contour, sometimes discrete, sometimes confluent, while the surrounding nervous parenchyma has undergone no alteration. These sclerous patches are found in the walls of the ventricles, in the white substance of the "centrum ovale," in the septum lucidum, in the corpus callosum, in the optic thalami and the corpus striatum, occasionally in the cerebellum, in the medulla oblongata, in the pons, and in the spinal cord; and of the cranial nerves, the optic, olfactory, and trigeminus are most prone to be affected.

In some cases the patches are raised above the surrounding surface and seem as if turgescent; in some not raised, in others even depressed. The consistence of these patches is usually somewhat firmer than that of the brain tissue, and they are sometimes quite hard. In the brain the cortex is seldom affected whilst in the spinal cord the patches appear upon the surface, and sometimes the whole thickness of the cord is affected. The nerve fibers are peculiarly affected; the medullary sheath undergoes degeneration, but the axis cylinders persist to a remarkable degree, though they may ultimately disappear, whilst all the vessels are thickened and occasionally the nerve cells are atrophied. From this pathology it must be apparent to anyone that there must be two sets of clinical symptoms, viz: General ones and localizing ones. In other words, there are certain symptoms common to disseminated sclerosis, wherever the site of the patches may be; while there must be localizing symptoms due to impairment in function by the patches of some particular portion of the cerebro-spinal axis. The general symptoms are tremor, slight weakness, or incoordination, nystagmus, increase of tendon reflexes, contracture, optic nerve atrophy, peculiar speech and vertigo. These general symptoms are all common and frequent in disseminated sclerosis, yet none of them constant, and only two of them considered diagnostic, viz: Tremor and peculiar speech. The tremor is generally present only when voluntary movements are made, and to this the name of intention tremor has been given.

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Nashville Journal of Medicine and Surgery, Bind 59