Sclerosis

“ In the case of marked sclerosis, the opening need not be large because, if the bone between the cortex and the antrum be solid, it is hardly probable that infection can spread through it to any outlying cells in the tip of the mastoid or elsewhere. ”

“ Syphilis, rheumatism, gout, auto-intoxication and many other constitutional disorders are well recognized agencies which induce sclerosis in body tissues, so there can be little doubt that these conditions produce pathological sclerosis of the meshwork of the iris angle. Psychic disturbances, congested portal or renal system, hard mental or muscular work, etc., etc., induce increased pressure of the general circulation, and so simultaneously the intra-ocular pressure. ”

“ DIFFERENTIAL DIAGNOSIS.—In view of what has been already stated regarding the numerous clinical types found in disseminated sclerosis, it is easily understood why the diagnosis of this disease is becoming more and more uncertain: every new set of researches removes some one or several of the old and cherished landmarks ”

“ In the diagnosis of diffuse sclerosis the question of differentiation from neuroses not based on ascertainable structural disease, such as are called functional, will be most frequently raised. In differentiating between organic and functional spinal disorders all known exact signs of organic disease must be excluded before the case can be considered as appertaining to the latter group. Symptoms of hysteria, nervous exhaustion, and spinal irritation frequently coexist with diffuse sclerosis as well as with the disseminated form ”

“ Syphilis is prone to cause small localized lesions in the nervous system. The changes in the patient’s condition, with improvements and regressions are equally characteristic of both diseases. How closely the symptomatology of neurosyphilis may simulate that of typical multiple sclerosis is shown in the next case (Lauder, 71) . When the sclerotic area of multiple sclerosis occurs in appropriate parts of the cerebrum, symptoms of mental disturbances will occur. In its histological picture multiple sclerosis is at times highly suggestive of syphilis, even showing mononucleosis and meningitis. ”

“ SYMPTOMS.—The development of sclerosis is usually very insidious. After some years' indulgence in spirit-drinking or affected for a length of time with the other causes of the malady, a gradual decline of vigor occurs. The complexion takes on a fawn color, stigmata slowly form on the face, there is more or less yellowness of the conjunctiva, and attacks of headache, giddiness, and even severe vertigo, are experienced. An increasing indisposition to mental effort, some hebetude of mind, and a gradually deepening despondency are felt. ”

“ Hysterical and other obscure neuroses have been claimed to act as predisposing causes. But, inasmuch as it is well established that sclerosis is not a legitimate sequel of even the most aggravated forms of true hysteria,147 and, on the other hand, that disseminated sclerosis, particularly in the early stages, may progress under the mask of spinal irritative or other neuroses, it is reasonable to suppose that cause and effect have been confounded by those who advanced this view. According to Charcot, the female sex shows a greater disposition to the disease than the male. ”

“ Tuberous sclerosis is an inherited disease whose neurological symptoms can run the gamut from speech disorders, mental retardation, and behavioral problems to motor difficulties and seizures. Small benign tumors may grow on the face and eyes, as well as in the brain, kidneys, and other organs. In its most devastating form, tuberous sclerosis leaves patients completely helpless and dependent. ”

“ Few Americans have heard of tuberous sclerosis, but for an estimated 10,000 of us, this disease and its devastating effects are all too real. For these people, life is a perpetual struggle with convulsive seizures, mental retardation, tumors throughout the body, and other physical handicaps. Because tuberous sclerosis is hereditary, its threat extends to future generations; children of those afflicted with it stand a 50 percent chance of developing the disease themselves. ”

“ Re multiple sclerosis, Lépine remarks that there are numerous army cases of pseudo multiple sclerosis which are actually hysterical or hystero-traumatic cases of hypertonus and tremor. The true cases of multiple sclerosis, according to Lépine, are of interest inasmuch as they are usually found in officers. These men have apparently at first but a slight motor disorder, quite compatible with desk work. We have usually under-rated the cortical element in multiple sclerosis. Spells of confusion, delusional ideas, sometimes grandiose, start up without warning in these cases. ”

“ The best authorities recognize the existence of a large number of cases in which the supposed pathognomonic signs of disseminated sclerosis are absent, notwithstanding the existence of characteristic lesions, and thus the more cautious earlier investigators are justified in the reserve they had maintained. ”

“ A number of instances are on record by careful observers—and are probably much more numerous than is commonly suspected—where no decisive evidence of spinal or cerebral disease could be detected during life, and yet disseminated foci of sclerosis existed in the nerve-centres. ”

“ Arterio-sclerosis and arterial degeneration are the almost universal71 accompaniments of thyroid deficiency, and are in most cases the result of that condition.
There is no main or royal road to the successful management of sclerosis; every little cause must be thought out and righted if possible, but as a foundation nothing is so important, I think, as a clean, healthy intestine, which hitherto has been much neglected. A microscopical examination of the fæces will often show what is wrong, and also the direction and results of treatment. ”

“ Instead they have become hard and stiff. We call this by a Greek term for hardening, sclerosis, and arterial sclerosis is one of the most marked and striking characteristics of old persons. Now when the arteries become thus stiffened, it requires a greater force and greater effort of the heart to drive the blood through them, and in response to this new necessity, the heart becomes enlarged in an effort of the organism to adapt itself to the new unfavorable condition of the circulation established by age. ”

“ Cerebral softening, abscess, and sclerosis are practically inaccessible to treatment, otherwise than such relief as may be afforded by the administration of opiates and general tonics, and, in fact, the diagnosis is largely presumptive. ”

“ Less frequently the trabecular framework is added to by the formation of new bone, resulting in a remarkable degree of sclerosis, and if, following upon this, there is caseation of the tubercle and death of the affected portion of bone, there results a sequestrum often of considerable size and characteristic shape, which, because of the sclerosis and surrounding endarteritis, is exceedingly slow in separating. ”

“ The initial period of diffuse sclerosis is sometimes confounded with rheumatism—an error less pardonable than in the case of tabes, inasmuch as in diffuse sclerosis the pains are not usually premonitory, but associated with motor paresis. It is erroneous to regard a pain as rheumatic because it is aggravated or relieved by changes in the weather. There are many subjects of myelitis who regard themselves as veritable barometers, and with more justice than most rheumatic patients. ”

“ Some of them have heard of multiple sclerosis {584} and are much disturbed. They must be reassured and it must be made clear to them that their disease is really due to over-consciousness and consequent lack of control. ”

“ The condition of our arteries that we call sclerosis is much more common in the sedentary brain-worker than it is in the outdoor man. We see it rarely in the farmer, the sailor, the labourer, unless it is as the result of habitual intemperance; we see it rarely in the athlete. The average blood-pressure of the indoor worker is certainly higher than that of the open-air worker, even in perfect health. ”

“ Tuberous sclerosis has no known cause or cure. Early detection, accurate diagnosis, careful use of anticonvulsant drugs, and support of family and friends can go far in helping a victim cope with the disease. Research to help us learn how to treat, cure, and prevent this dread disease is being supported by the National Institute of Neurological and Communicative Disorders and Stroke and by two voluntary health agencies-the National Tuberous Sclerosis Association and the Tuberous Sclerosis Association of America. ”

“ The choroid plexus is congested and swollen with infiltration. The brain tissue adjacent is firmly adherent and there is a hyperplasia of its connective tissue constituting a veritable sclerosis. At some points, however, the compressed nervous tissue has undergone degeneration and softening. As might be expected from the pressure of the liquid, anæmia of the brain tissue is a marked feature of the morbid condition. ”

“ When they are thus allowed to run a protracted course or to continue in a chronic form, they manifest another tendency of great importance—namely, to have the inflammation extend by continuity from the fibrous and muscular structures of the small bronchi into the connective tissue of the pulmonary lobules, inducing sclerosis of the latter tissue and consequent compression or obliteration of the alveoli or air-cells, and permanent contraction of the chest. ”

“ Probably the best method of palpating the arteries, especially the radial, to determine the degree of sclerosis and thickening, is to use the tip of the finger and roll it carefully over the artery. The tip of the finger is exceedingly sensitive and, moreover, it is a firmer palpating surface than the ball, thus enabling one to appreciate degrees of sclerosis which could not be differentiated by palpation with the soft yielding ball. ”

“ Yet how often does it happen that individuals, apparently in the best of health, suddenly succumb to an asthmatic or uremic attack, an apoplexy, cessation of the heart beat, or a rupture of the heart due to arteriosclerosis!
In order to arrive at an intelligent opinion in regard to prognosis certain factors must be taken into consideration, chief of which are: the seat of the sclerosis; the probable stage; the existing complications; and, last and most important, the patient himself. The whole man must be studied and even then our prognosis must be most guarded. ”

“ The character of the symptoms depends upon the seat of the softening or abscess within the brain.
Cerebral sclerosis sometimes follows inflammation in the structure of the brain affecting the connective tissues, which eventually become hypertrophied and press upon nerve cells and fibers, causing their ultimate disappearance, leaving the parts hard and indurated. This condition gives rise to a progressive paralysis and may extend along a certain bundle of fibers into the spinal cord. Complete paralysis almost invariably supervenes and causes death. ”

“ Even in children of tender years the abuse of spirits can usually be traced. Nevertheless, there are instances of the disease the origin of which cannot be referred to alcoholic excess. The congenital cases, as that narrated by Virchow, and the instances occurring in children and adults not given to spirits in any form, indicate that there are other pathogenetic influences which may bring about a sclerosis of the liver. Virchow58 was one of the first to illuminate the subject of visceral syphilis and to demonstrate the occurrence of sclerosis of the liver from syphilitic infection. ”

“ So too in regard to the strictly morphological diseases, knowledge may bring mastery; and even sclerosis, that disease from which we are all assumed to be suffering in varying degrees, may, ere long, find itself subject to man.
Of the services which embryology has rendered to medical science within the last twenty-five years, the best known and probably the most important, certainly the most spectacular and unforeseen, is the revelation of the structure of the nervous system and of the relation of the nerve cells to one another. ”

“ Multiple cerebro-spinal sclerosis of the descending form may be confounded with general paralysis while the symptoms are obscure and consist in change of character, when, indeed, organic disease can only be suspected to be present.
Lead has been known to attack the central nervous system in such a way as to produce an intellectual apathy and muscular weakness somewhat resembling the early stage of the demented form of general paralysis, but without its ataxic symptoms and its regular progress. ”

“ The spontaneous ameliorations in the course of tabes dorsalis and the less marked ones of diffuse sclerosis, coupled with temporarily improved sensation in the former and improved motion in the latter disease, show that retrogressions of this character are possible and do occur. How is the physician to imitate the action of nature? how to intensify it so as to secure the permanent improvement which nature unaided does not grant? The first factor to be considered is the removal of the cause of the disease. A number of cases are due to exposure to wet and cold and to over-exertion. ”

“ This disease is fully described in the standard works on neurology. Ataxic alalia will also occur in disseminated sclerosis, posterior spinal sclerosis, dementia paralytica, and cretinism. It forms in general disorders an instructive symptom, and is to be distinguished by a tremulous utterance and by facial spasm from the hesitation of the stammerer and from the convulsive utterance of the stutterer. ”