141 Archiv für Psychiatrie, xvi. p. 698.
CAUSES.—Disseminated sclerosis may develop as a sequel of an acute myelitis. An excellent observation of Singer,142 in which a unilateral optic-nerve atrophy of central origin occurred after recovery from an acute inflammation of the cord, proves that sclerotic foci may develop secondarily to an acute process. Westphal believes that obstruction to the circulation, both of blood and lymph, in the cord may act as a predisposing factor in the production of multiple sclerosis. He rests this opinion on a case where the cord had been compressed by a tumor, and sclerotic foci of probably later date were found in the neighboring segments of the cord.
142 Prager medizinisch Wochenschrift, 1885, No. 8.
The myelitic affection discovered by the same observer143 to be an occasional sequel of typhus, smallpox, diphtheria, measles, and erysipelas is a true disseminated sclerosis. The foci are usually very small and very numerous. A focal sclerosis of the posterior columns of the disseminated type has been found by Brigidi-Bandi in a case of pellagra which presented ataxic symptoms.144
143 Archiv für Psychiatrie, iii. p. 376, iv.; Oertel, Deutsches Archiv für klinische Medizin, viii.; Damaschino, Gazette médicale de Paris, 1871, p. 505. In one case now under observation a typical disseminated sclerosis developed in a robust young man of thirty after typhoid fever.
144 Lo sperimentale, December, 1879.
Among the exciting causes, prolonged exposure to wet and cold are acknowledged to occupy an important position. The frequent combination of these factors with over-exertion and depressing emotions among the poorer classes probably account for its great frequency among them. In some cases excessive grief has been the only discoverable etiological factor: in three of my own cases this was so prominent and connected a feature that I could not doubt its influence, if not as a primary at least as an exciting cause.145 Fright has been distinctly connected with the outbreak of the disease in a number of cases.146 There is considerable unanimity among observers regarding the effects of shock and injury in producing disseminated sclerosis, usually of that anomalous type which approximates the diffuse or fascicular form. Railway spine is undoubtedly the mask of a disseminated inflammatory trouble in a number of cases; the only authority of weight who opposes this view is Charcot, and his opposition is abundantly neutralized by a number of carefully-studied American and European cases.
145 The coincidences among these three cases were remarkable. All three were Germans, all three musicians, two had lost an only son. In all, the emotional manifestations were pronounced from the initial to the advanced period of the disease.
146 A Bohemian cigar-maker was startled by the sudden firing of a pistol-shot in a dark hallway, and on arriving at the factory, and not fully recovered from the first fright, he was again startled by the sudden descent of an elevator and the fall of a heavy case from it close to where he stood. From the latter moment he trembled, and his tremor continued increasing till the last stage of his illness was reached. This was my shortest duration, four years, and of nuclear oblongata paralysis type.
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. Erb, who bases his remarks on the surprisingly small number of nine cases, is inclined to account for Charcot's statement on the ground that it was at a hospital for females that Charcot made his observations. On comparing the figures of numerous observers, it will be found that in the experience of one the females, and of the other the males, preponderate. In my own experience the males far exceed the females both in private and in dispensary practice. Of 22 cases with accessible records, only 7 were females.