Myasthenia gravis / by Charles S. Myers.

  • Myers, Charles S. (Charles Samuel), 1873-1946.
Date:
1902?]
Catalogue details

Licence: In copyright

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

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    methods. Drs. F. E. Batten and H. Morley Fletcher have already published (2) the results of these microscopical examinations, together with a brief clinical abstract of the case. The following is a concise summary of their report;— The cells of the third, the seventh, and the ninth cranial nuclei were unusually swollen, the granules of ISTissl no longer retained their triangular form, but were fragmentary, smaller than usual, and irregularly or diffusely distributed throughout the cell substance. The nuclei of the cells stained and were placed naturally; those of the cells of the third nucleus were some¬ what small. The cells of the fifth and sixth nuclei were normal, they were well stained, and their dendritic processes were good. The cells of the anterior horn in the cervical, dorsal, and lumbar regions of the spinal cord were normal^ save that the chromatophilic substance was occasionally replaced by a yellowish-brown pigment,^ which in osmic acid preparations was stained brown and had a granular appearance. The cerebral cortex, the peripheral nerves, and the muscles were not microscopically examined. After the above description I need not remark that I was wholly unprepared for the sad issue of this patient’s illness. I assumed that the case was an unusual example of hysteria. Not until after the necropsy was my attention called to a recognised group of similar cases, often fatal owing apparently to bulbar failure, in which, after- death, no accountable lesion was discoverable. Only three such cases^ had then been published in England, namely, by Wilks Shaw (^), and Dreschfeld (^). Abroad, more particularly in Germany, a greater number had been described. I have gathered together in an appendix con¬ densed accounts of all the undoubted cases of this disease I can find in which a post-mortem examination has been made. The history of the gradual recognition of the disease from a study of such cases may be thus summarised. In 1877 Wilks (^) described what is generally accepted as the first recorded case terminating in fatal, apparently bulbar, paralysis, in which no lesion was discoverable by macroscopical and microscopical examination of the bulb. This was followed by the publication of three cases with similar symptoms by Erb (®) in the next year, only one of which, however, proved fatal; no examination post-mortem was made. Ten years later the negative results of an autopsy on another similar case were published by Oppenheim Still later, Shaw (^) in 1890, Jolly (®) in 1891, Dreschfeld (^) in 1893, Striimpell (®) in 1896, Hall in 1899, and Goldflam in 1902, recorded fatal cases, in which careful examination of the central nervous and often of the peripheral nervous and muscular systems revealed no lesions whatever. In 1887 a case examined by Eisenlohr showed recent minute haemorrhages and hyperaemia in the region of the sixth nucleus. Nuclear haemorrhages, all recent, were likewise found by Hoppe (^2) in 1892, by Toby Cohn(i2) in 1893-97, by Charcot and Mari- nesco(^^) in 1895, by Schule(^^) in 1899, and by Oppenheim in 1901, in their published cases of this disease. Moreover, while Striimpell, the first among these writers to use Nisshs mode of staining nerve cells with methylene blue, Toby Cohn, and Coldflam found no changes even by this delicate method, other observers (e.g. Batten and Fletcher in my own case. Batten also in an unpublished case. Burr and McCarthy, and Cuthrie in 1901) have found ^ The deposit of yellow pigment appears at the expense of NissTs granules. It has been variously held to be an expression of functional activity, of senility, or of degeneration, change.