A clinical lecture on remissions and relapses in insular sclerosis / by Thomas Buzzard.

  • Buzzard, Thomas, 1831-1919.
Date:
[1904]
Catalogue details

Licence: In copyright

Credit: A clinical lecture on remissions and relapses in insular sclerosis / by Thomas Buzzard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    through the lumbar cord showed in some parts of the anterior and lateral columns grey semi-gelatinous patches. In the mid-dorsal region the whole transverse area of the cord flowed out on section, having an opaque grey colour. In the mid-cervical region sections showed grey gelatinous patches occupying various portions of the axis. In the present state of our ignorance regarding the etiology of insular sclerosis there is no advantage in disguising the fact that we are unable to point to any mode of treatment which appears to influence the progress of this disease. It becomes then a question of considerable importance whether the remarkable tendency to the occurrence of remissions and relapses in its course is calculated to throw any light on the mode of its causation. As it seems to me the most likely view (and possibly that which finds most favour) is that in insular sclerosis the essential cause is the presence in the blood-vessels of an infective agent which sets up an inflammatory process in the interstitial tissue. This may occur at any part of the cerebro-spinal axis: On the other haud, it has been suggested that the pathological process is essentially dependent upon some congenital abnormality. I am disposed to think that such an explanation must be set aside. The grossness of the anatomical findings alone would seem to be incon- sistent with such an hypothesis. Besides this, insular sclerosis cannot be said to be a family disease, which might be expected were the disease of congenital origin. It is, in my experience, exceedingly rare to meet with more than one example in a family. Diseases of the nervous system of endogenous origin are usually characterised as well by the fineness of the changes observed in the structures involved as by their slow and comparatively steady progress, un- interrupted by any important tendency to marked remissions and relapses. On the other hand, if we turn to disease of exogenous origin we shall find that in one. undoubtedly and pre-eminently of infective origin—syphilis—we are apt to meet with this peculiar feature very distinctly exhibited. Thanks to the fact that specific treatment in syphilis has a powerful and very definite influence upon most cases of the disease, it is quite likely that the tendency to recovery, followed sooner or later by relapse, in that disease is a good deal obscured. But, even as it is, that tendency is constantly showing itself after a time when the beneficial effects of the