Myasthenia gravis / by Charles S. Myers.

  • Charles Samuel Myers
Date:
1902?]
Catalogue details

Licence: In copyright

Credit: Myasthenia gravis / by Charles S. Myers. Source: Wellcome Collection.

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    innocent renal tumour were found. Sossedorf’s case showed early parenchy¬ matous nephritis, Dreschfeld’s (^) case granular atrophy of the kidney. Neuro-muscular lesions.—Of the twenty-two cases on which an autopsy was performed, eight showed no pathological condition of the nervous system. In three cases minute aneurysms or vascular dilatations were noted ] and in two the cerebral arteries appeared thickened. Eight cases were examined by Nissl’s method, in three (or four) of which was thereby revealed slight chroma¬ tolysis. Yacuolation of certain cells of the anterior horns and hypoglossal nucleus with partial degeneration of their nerve fibres was recorded in Mayer’s case. Haemorrhages in the central nervous system, always recent and frequently numerous, were found in six cases. The peripheral nerves and muscle fibres were several times examined, in freshly teased and in hardened specimens. In Laqueur’s and Goldflam’s cases the perimysium of several muscles examined contained metastatic deposits of a thoracic tumour. In Sossedorf’s case the lingual muscles were degenerated, likewise fibres of the ninth and tenth nerves and their nuclei, but no changes were found in the hypoglossal nerves and their nuclei. This case, however, in my opinion approaches more closely to Eisenlohr’s, alluded to on p. 323, than to the cases of true myasthenia gravis. Course of the disease.—In nearly all of the twenty-two cases improvements and remissions were noted during the progress of the disease. The onset of catamenia, hard work, fear or other emotional excitement, intensified the symptoms and often accelerated the end. Of the above twenty-two cases, death resulted in sixteen from asphyxia; in two from choking; in four probably from exhaustion. We have not sufficient knowledge to give the number of cases that have proved fatal or curable. It is now certain that at least twenty- eight of Campbell and Bramwell’s sixty cases ended in death; but the subse¬ quent history of the others is unknown (cf. p. 309). Duration of the disease.—Of nineteen cases death occurred in eleven between five months and two years after the first onset, in two within four months, in four between two and three years, in one fifteen years, and in another eight and a half years after the initial symptoms. PART III. On certain Physiological and Pharmacological Experiments. In this section the results of such physiological and pharmaco¬ logical research will be examined as appear likely to elucidate the nature and site of myasthenia gravis. Hitherto I have striven to * avoid a natural tendency to locate the most striking character of the disease, i.e. the rapid tiring of voluntary movements, in any one part of the neuro-muscular system. Various conjectures at once arise in the mind when we attempt to account for the premature tiring of voluntary movements in myasthenia. We know that the motor path of the volitional impulse starts in the cortical cells of the Eolandic area. It is conceivable that the tiring is produced by a defective condition in or around the cortical dendritic processes of the upper neuron, in its cell body, or in its descending axis cylinder process. We know that the axis cylinder process of this upper (or cortico¬ nuclear) neuron breaks up to surround one or more of the lower (or
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