On the progressive locomotor ataxia : its history, symptomatology, pathology, and treatment / by Roberts Bartholow.

  • Roberts Bartholow
Date:
1866
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Licence: Public Domain Mark

Credit: On the progressive locomotor ataxia : its history, symptomatology, pathology, and treatment / by Roberts Bartholow. 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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    tincture of iodine. In the posterior cornua of the g*ray substance there occur the same alterations, but to a less marked extent. The changes in the posterior roots do not differ from those of the corres- ponding column. The vessels also are seen to be considerably enlarged, their coats thickened and incrusted with fat granules. To sum up, says Axenfeld, all of these alterations clearly consist in an atrophy of the nervous elements. Topinard (p. 335) also, after a very elaborate discussion of the micro- scopic appearances, sums up his conclusions in a few words : The mi- croscopic examinations have shown the essential lesion in the different parts of the nervous system to consist of a gray, semi-transparent, or as it is styled by Cruveilhier and Virchow, a gelatiniform degeneration with a progressive atrophy of the nervous elements, hypergenesis of the conjunctive substance, amyloid bodies, and molecular granules. Are the above described alterations constant to all stages of this dis- ease? Is the progressive locomotor ataxia, in any part of its course, a functional disorder? At what period do these lesions of the posterior columns and roots manifest themselves? These are questions of pecu- liar interest. It has been said that the case of Kelch was not one of progressive locomotor ataxia, because the symptoms were evolved in so short a period of time, and were so much mitigated by treatment. For- tunately, the data exist for a solution of two of the problems proposed for our consideration. Let us take the testimony of Trousseau upon the first two questions. This ablest of modern physicians, in his lec- ture on this subject (vol. ii, p. 545-6), places this disease among the neuroses. He bases this opinion upon clinical observation, upon the nature of the symptoms which characterize the nervous troubles, upon the apyretic march of the symptoms, and upon the mode of evolution, the variety, and especially the mobility of the symptoms. When, says Trousseau, I assert that the malady is not subordinate to the ex- istence of material lesions, I refer only to those lesions appreciable by our means of investigation. He quotes in support of this opinion the remarkable case observed by M. Gubler, in which, although the patient had been long afflicted with progressive locomotor ataxia, after death by variola, there was found absolutely nothing in the encephalon, in the medulla oblongata, and in the posterior columns and roots of the spinal cord. The cord was, it is true, generally injected, but this may be explained by the paralysis supervening in the course of the variola. The optic nerves had undergone gelatiniform degeneration, and the motores aculorwm were flattened, diminished in volume, but were not gray. Jn every other part of the nervous system the characteristic
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