The Gulstonian lectures on secondary degenerations of the spinal cord : delivered at the Royal College of Physicians, March, 1889 / by Howard H. Tooth.

Date:: 1889

Credit: The Gulstonian lectures on secondary degenerations of the spinal cord : delivered at the Royal College of Physicians, March, 1889 / by Howard H. Tooth. 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.

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$consider descending lesions from cortical injury. For our present purpose the first two may be considered together. The third requires special consideration. In the close neighbourhood of the initial lesion Degeneration. we have to consider the traumatic degenera- tion. This was first described by Schieffer- decker* (1876), but more fully later by Hom(^n.t It is found both above and belovr the lesion for about the distance of I ctm. It is essentially inflammatory in character, and must be distinguished from secondary degeneration proper. It affects the whole diameter of the cord, but even here shows a tendency to affect certain tracts above and others below. There are many leucocytes crowding the tissues. The large cells of the grey matter are swollen and granular. There are many lacunae, some filled with vitreous masses (Homen) which do not take any stain easily. In some cases, even, after many months, the inflamed tissue contains masses of material which stains faintly by Weigert's haematoxylin, and is presumably broken down myeline. Homen describes oval masses lying in the long axis of the cord, believed by him to be altered axis cylinders. They stain deeply with anilines. There is a tendency often to the formation of small local collections of purulent matter, even as far as two roots from the lesion. Both Schiefferdecker's and Homen's accounts refer to cases of experimental lesions in which one would expect to find signs of inflammation, as well as degeneration, in the vicinity of the wound. In cases of crushing after fracture-dislocation, in which of course there could be no septic contamination, there is in-my experience very little sign of ach've inflammation at all, and yet in the immediate neighbour- hood of the injury, both above and below, we fin'd a more advanced stage of degeneration usually than in points remote from the injury ; and in cases which have survived many months there is a considerable thickening of the neuroglia mesh-work. The * Schiefferdecker Ueber Regeneration und Architectur des RUcken- markes, VircA. Arch., 1876, p. 542. •ixuLKeii- t Homen, Contribution Experimentale k la Patholome et I'Anofow^- Pathologique de la Moelle Epini5re, 1885. at a 1 Anatomie$