40 It is held by them that the histological character of the change of the columns of Goll is not different from that in the column of Burdach. Zacher (Archiv für Psychiatrie, xv. p. 435) urges that it does not resemble true secondary degeneration, beginning in the vessels and connective substance instead of the nerve-fibres. Schultze (ibid., xiv. p. 386), on the other hand, recognizes a primary involvement of the nerve-fibres in both of the areas of fascicular degeneration in tabes. The observation of intact axis-cylinders by Babinski in the sclerotic fields is in conflict with the latter's claim, and the various differences of observation and interpretation seem to be reconcilable only on the assumption that there are two different modes of origin, both leading to nearly the same results and occasionally combined in one and the same case.
41 Krause's case and others show that the ataxia of movement is not influenced by lesion of the column of Clarke; but we are not informed as to the static equilibrium of the patients in whose cords these columns were found intensely affected.
It is scarcely necessary to seriously consider the suggestion of Strümpell, that the lesion of the column of Goll is in relation with the bladder disturbance.42 Cases are on record by Wolff and others where this lesion was intense and there was little or no bladder disturbance.43
42 Archiv für Psychiatrie, xii.
43 The column of Goll is not present in those mammals which, like the porpoise, have no developed hind limbs, but these animals have urinary bladders.
If the disease of the column of Goll were a primary systemic affection independent of the disease of the root-field, it would be difficult to understand why it, as well as the likelihood of finding a corresponding degeneration of the direct cerebellar tract, increases with the extent to which this field is involved. This occurrence becomes quite clear when we remember that both the direct cerebellar tract and that of Goll, being centripetal, are under the trophic dominion of the posterior nerve-roots. The opinion is not distinctly expressed, but implied in some writings, that the column of Goll degenerates because of a general transverse cord lesion at a low level; this is not the case in the tabic cord. There is a difference in appearance between that part of the primary field which corresponds to the column of Goll in the lumbar cord and the surrounding sclerosis in early cases: it is more intensely degenerated, more homogeneous in appearance, and more evenly stained. The other part of the triangular field presents a more trabecular appearance. In the specimen represented in the accompanying figure this is easily recognized: the darker field corresponds exactly with the ascending degeneration, which follows compression of the cauda equina,44 and is the sciatic equivalent of the column of Goll.
FIG. 31.
Trans-section of Upper Lumbar Cord of a Patient moderately advanced in Tabes: f, ventral or anterior fissure; g, caput gelatinosum; r r′, entry and deep course of the posterior rootlets; d, degenerated field, including the origin of the tracts which in higher levels form the columns of Goll; n, field near the posterior commissure which remains free from degeneration, both in the lumbar and cervical cord; s, sharply marked leaf-shaped field, bisected by posterior septum, which, as claimed by Strümpell and shown in this case, remains free from disease; z, zone of nearly normal consistency around it; a, diseased field, suspected to be related to the analgesia, not usually affected in early tabes; v, fibres running up and down in front of the gelatinous substance; *, region where the tabic process sometimes begins.