Volume 1

A manual of diseases of the nervous system / by W.R. Gowers.

Date:
1886-1888
Catalogue details

Licence: Public Domain Mark

Credit: A manual of diseases of the nervous system / by W.R. Gowers. Source: Wellcome Collection.

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

    180/488 (page 160)
    may attain a degree and an acuteness out of all proportion to the causal compression. The membranes may be the seat of hsemorrhage which compresses the cord, or inflammation which irritates it, even when the organ is not invaded in appreciable degree. The series of recognised lesions of the spinal cord, obvious or micro- scopic, does not by any means exhaust the list of its morbid states. Changes may occur in the nutrition of its elements interfering with their function, which are, and are likely to remain, altogether beyond our means of detection. Such morbid states are often called func- tional diseases, but when prolonged they are probably more accurately conceived as nutritional diseases (see p. 1). Derangements of function that we can regard as purely such are few and rare. It is thus convenient to think of the pathological conditions of the cord under the four types which we considered (p. 2) as presented by diseases of the nervous system generally. The types are not always sharply separated, but are not therefore less useful. (1) Organic dis- ease, conspicuous to naked-eye examination, such as a haemorrhage or tumour. (2) Structural disease, presenting only change in tint or con- sistence to the naked eye, but distinct tissue-changes on microscopical examination. (3) Nutritional disease, causing no change recognisable even by the microscope. (4) Functional disease, purely such. In connection with the general pathology of diseases of the spinal cord, it is important to note certain general facts of their causation : — (1) An inherited tendency to disease of the nerve-elements, manifested by such affections as epilepsy and insanity. This cause is chiefly in- fluential in producing the structural and nutritional diseases, begin- ning in the nerve-elements, and especially, among structural diseases, the system-degenerations as they are called. (2) Injury.—A severe concussion of the cord may cause (a) instant grave damage, usually hsemorrhacre. Or (b) it may cause no immediate effect, but symptoms may come on at the end of a few days and progress slowly or rapidly. Such symptoms are usually due to inflammation, simple, or secondary to minute spots of injury. Lastly (c), the concussion sometimes seems to pervert the process of nutrition in the nerve-elements. Slow sym- ptoms of impaired function may result, and these may progress until after months or years, there is actual structural disease (3) Exposure to cold.-Wet cold is especiaUy effective The frequent effect of a severe exposure is acute inflammation, but habitual exposure may produce chronic inflammation, or degenerative disease. The exposure that is effective may be general, or chiefly of the feet and legs, occasionally of the back. (4) Syphilis.-Tlie demonstrated ways in which syphilis interferes with the spinal cord are (a) by a syphi itic growth, compressing or invading the cord, and (6) by chronic syphihtic Lningitis, damaging the cord and the nerve-roots. But (c) acute and chronic inflammations of the cord are often met with an syphi i ic subiects, and have been thought to be, in many instances, of syphilitic origin It is doubtful whether they present any syphilitic characters.