Lectures on diseases of the spinal cord / by J.M. Charcot translated by Cornelius G. Comegys.

  • Charcot, J. M. (Jean Martin), 1825-1893.
Date:
1881
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Licence: Public Domain Mark

Credit: Lectures on diseases of the spinal cord / by J.M. Charcot translated by Cornelius G. Comegys. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    there can hardly exist a destructive lesion of that nervous column without secondary degeneration, under some form, following it. I. Considering, to begin, a focal lesion as the cause of all the accidents, and we have a very simple case, and at the same time of a very common species. Let us take the slow compression of the spinal marrow, such as is seen, so commomly, in Potts' disease. We know very well since the researches of Michaud, the ordinary mechanism of that sort of compression. The agent in such a case is the thickened dura mater. On its external surface it is in contact with the caseo-tuberculous deposit which issues from the vertebral bodies, and when the destruction of the posterior vertebral ligament is complete there arises an inflammation equally caseo-tuberculous (^pachymeningite externe caseo-tiiberculeiise). On account of this thickening of the dura mater, the marrow is repelled and compressed to an extent that varies according to the development of the caseous neoplasm, generally as long as two or three centimetres. Sometimes it is only compressed from before backward, at other times it is squeezed on all sides—in some sort strangulated. But the action there is not always a jDure mechanical phe- nomenon j in fact, there is soon produced in the organ, in place of compression, a reaction of an inflammatory order; in other terms, a partial myelitis is a consequence—nearly obligatory, from the spinal compression. Be that as it may, there is developed there a destructive lesion which, in the region lesed, affects indiscrimi- nately the gray substance and all of the white fasciculi, both anterior and posterior; it is what may be called a total tratisverse lesion. It is well to understand that this same alteration is produced outside of Potts' disease, with the same characters and the same effects so far as it concerns secondary degenerations, whatever may be the cause of the compression. Thus cancerous and sarcomatous tumors, psammoma, originating without the spinal marrow, are sufficient as they grow, to determine a transverse myelitis by compression, with all its consequences. Moreover, gentlemen, compression, properly speaking, is not a necessary fact. Intra-spinal tumors, glioma, syphiloma, solitary tubercles, syphilitic, traumatic, or other forms of myelitis will be