Secondary degenerations of the spinal cord : The Gulstonian Lectures delivered at the Royal College of Physicians, March 1889.

  • Tooth, Howard Henry.
Date:
1889
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Licence: Public Domain Mark

Credit: Secondary degenerations of the spinal cord : The Gulstonian Lectures delivered at the Royal College of Physicians, March 1889. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    us concerning the paths in the cord which conduct the multitu- dinous motor, sensory, and visceral impressions, then, and not till then, shall we fully understand all the symptoms that present in many diseases better known by name than by nature. Let it not, then, be supposed that the subject I have chosen is one of aca- demic interest only. It is true that at present our knowledge of the anatomy of the cord and medulla is ahead of our diagnosis, and also that our diagnosis is far in advance of our treatment j but who dares to say how long this shall remain so ? It is but a very few years since the workers at cerebral localisation, too svell known to need even mention by me, were looked upon as scien- tific dreamers, and now their dreams have become the most strik- ingy^^r/j in the medicine and surgery of the day. Spinal localisation follows close, and already begins to bear fruit. These facts, then, must be my justification, if, indeed, such be needed, for dwelling minutely on points that appear to be of little practical importance at the present moment. It is a common thing for observers to speak of Degeneration, degeneration of nerve tubes in the spinal cord as being comparable to, and moreover of the same nature as, the corresponding lesions in nerves. As I wish to institute a close comparison between the two, it would be well to sum up the features of the so-called Wallerian degeneration first. When a nerve is cut its peripheral end de- D^eneraUon generates, because it is cut off from the centre, which is believed to exert some nutritive or trophic influence over it. Certain changes make their appear- ance in the ultimate nerve tubes. The first change that occurs is a loss of transparency of the nerve fibres to the naked eye. This is coincident with, and probably caused by, a cleavage of the myeline, or white medullary substance of Schwann. It may be seen to occur in forty-eight hours, or later, up to four days. This change is more rapid in summer than in winter, and is associated with diminution of irritability of the nerve to all stimuli. Under the microscope at this period the white substance is seen to split across into masses or cylinders,