A manual of diseases of the nervous system / by Sir W.R. Gowers ; edited by Sir W.R. Gowers and James Taylor.

  • William Richard Gowers
Date:
1899
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Licence: Public Domain Mark

Credit: A manual of diseases of the nervous system / by Sir W.R. Gowers ; edited by Sir W.R. Gowers and James Taylor. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    CAUSES. they are often extremely numerous, and almost every nerve m the body may be transformed into a chain of growths. In the case figured more than 200 were counted in the right arm alone, and the total number of growths in the body cannot have been less than 1000, while in another 3020 were counted * These multiple neuro-fibromata have a great tendency to undergo sarcomatous degeneration. They have hence been termed secondarily malignant neuromata.f The tumours are almost always within the sheath of the nerve (Fig. 50). Sometimes they are on one side, and the nerve may pass by unchanged. More often the substance of the nerve is involved, and the fibres may be separated and spread out on the surface (Fig. 49). Even then they may not be damaged. They suffer far more in heterologous growths than in true neuromata. Causes.—The causes of neuroma are generally obscure. Multiple neuromata are sometimes hereditary, and are probably due, m most cases, to a congenital tendency of tissue growth. Plexiform and multiple neuromata have been met with in the same family. They are said to be sometimes the result of general neurotic predisposition, and evidence of this is found in the occasional occurrence of neuro- mata in the subjects of cretinism or idiocy, of which some remarkable examples have been recorded. It is now generally held that multiple and plexiform neuromata, together with the affection known as ele- phantiasis neuromatodes, are results of the same congenital process. J Multiple neuromata are said to be almost confined to men. The isolated form is not uncommon in women. They may occur at any age. Virchow believes that they are unusually common in the phthisical and scrofulous. Of traceable immediate causes the most frequent is traumatic injury. Pressure, punctured wounds, or division of the nerves may give rise to them, apparently by a perversion in the process by which cicatrisation takes place. A well-known instance is the formation of the so-called amputation neuromata, or bulbous nerves, round or oval growths, the size of a bean or larger, which form on the divided extremities of the nerves in the stump left after an amputation. The occurrence of new growths containing nerve-fibres may seem to .be very remarkable. We must remember, however, how frequently they are connected with traumatic causes, i. e. take origin in cicatricial processes. In such processes the nerve-fibres present a remarkable power of growth. Ranvier has shown that from the end of each old fib're several new fibres grow, only one of which probably ultimately persists. Under apparently mechanical influences some of these fibres may twist about, and even turn and grow upwards. It is thus not * ' Med. Times and Gaz.,5 1883, i, p. 152. t Gam'., ' Hcitriige z. klin. Clrir.,' ix; Seheven, ibid., xvii. X See especially Finotti, ' Vireh. Arch.,' cxliii. Some go so far as to include molluscum fibrosum in the same category (Soldau, ' Inaug. Diss.,' Berlin, quoted in 'Vireh. Jahrb.,' xxx, i, ]>. 231).