On peripheral neuritis : a treatise / by James Ross and Judson S. Bury.

  • Ross, James, 1837-1892.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: On peripheral neuritis : a treatise / by James Ross and Judson S. Bury. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    of the fingers were slightly inco-ordinated. The lower limbs presented all the typical characters of advanced ataxia, the inco-ordination being markedly increased in the dark or with the eyes closed. The knee-jerks were totally absent, and the plantar reflexes were diminished. In the legs and feet the cutaneous sensibility to touch and pain was diminished and retarded. The patient complained of a constant dull aching in his back and lower limbs, and the latter were the seat of frequent attacks of lancinating pains. The muscles were nowhere atrophied, and their mechanical irritability and electrical reactions were unimpaired. During a residence of two and a half months in the hospital all these symptoms somewhat rapidly increased, and the patient died of exhaustion. On post-mortem examination the essential lesion was found to consist of a series of isolated sarcomatous tumours situated chiefly in the posterior portion of the pia mater of the cord. These involved the posterior spinal roots, but without causing their degeneration; indeed the only histological change that could be detected was unusual swelling of the white substance of Schwann. The state of the nerve trunks with their peripheral terminations in the muscles and skin were not examined. The tumours were most numerous in the lower dorsal and lumbar regions. The posterior columns of the cord were everywhere perfectly normal. A sarcomatous growth was also found in the floor of the fourth ventricle. It extended downwards, and surrounded the central canal. It is unfortunate that the cutaneous and muscular nerve endings escaped examination, but it is clear, as Dr. Bennett points out, that the primary disease did not originate there, and it seems fair to regard the ease as an important pathological link between the classical lesion in the posterior root zones and the cases of nervo-tabes peripherique, described by D^jerine. A study of the relation of ataxia to peripheral neuritis brings out two points :— 1. That ataxia is a rare symptom in cases of multiple peripheral neuritis, even when cutaneous and muscular sensibility are profoundly affected. 2. That it occasionally occurs when signs of muscular weakness and of diminished cutaneous sensibility are slight or absent. It is probable that the presence of ataxia in cases of multiple neuritis points to disease of sensory muscle-nerves, but it is very remarkable that extreme degeneration of terminal nerve-fibres to both skin and muscle has been found in cases which presented no signs of muscular inco-ordi- nation during life. It is highly important in all cases of multiple neuritis which come to post-mortem examination, that the results of