Multiple Sclerosis

Overview of Plates

Plate I.
Carswell’s “peculiar diseased state of the spinal cord and pons”, and his “remarkable lesion of the spinal cord”. This earliest illustration of a specific anatomical pathological spinal cord finding, drawn in 1830 and published in 1838 by Sir Robert Carswell, is commonly celebrated as the first documentation of the existence of multiple sclerosis.

Plate II.
Cruveilhier’s “four cases of grey degeneration of the columns of the spinal cord, by way of a reddish or grey [tissue] transformation in the form of ‘islands’”.
The four specimens displayed actually represent four essentially different kinds of lesions, put together by Jean Cruveilhier in 1839. Only the first specifically corresponds to Carswell’s “peculiar diseased state”.

Plate III.
Cruveilhier’s “new example of degeneration or grey transformation [of the spinal cord in the form of patches]”.
This unique 1841 illustration by Jean Cruveilhier of an entire spinal cord affected by damages once more reflects the specifics of Carswell’s “peculiar diseased state”.

Plate IV.
Charcot’s first illustration of multiple sclerosis affecting the cerebral hemispheres in a specific way.
The co-existence, in one and the same victim, of the specific findings of Carswell’s “peculiar diseased state” with an equally peculiar form of damage affecting the cerebral hemispheres was demonstrated for the first time, in 1867, in this drawing by Jean-Martin Charcot, presented in Leopold Ordenstein’s thesis.

Plate V.
Charcot’s “sclerosed plaques occupying the corpus callosum.”,
This oldest illustration of the distinctive lesion-waves arising from the undersurface of the corpus callosum, presented in Charcot’s 1884 “Lectures”, showed the pattern of distribution of the entire damage to one cerebral hemisphere in a victim of multiple sclerosis.

Plate VI.
Siemerling and Raecke’s “plaques in corpus callosum, cerebral white matter and cortex”.
The plaques’ distinctive spread pattern inside the cerebral hemisphere of a victim of multiple sclerosis was disclosed for the first time in this 1914 illustration by Ernst Siemerling and Julius Raecke.

Plate VII.
Putnam and Adler’s multiple sclerosis observation.
This drawing summarizes the remarkable results of Tracy Putnam and Alexandra Adler’s pioneering 1937 work on the unique form of vein-dependence characterizing the spread of the cerebral plaques in a specimen of multiple sclerosis.

Plate VIII.
Keyhole view of multiple sclerosis: Fragmentary pieces of evidence.
Fig. A. Scheinker’s “Perivenous plaque formation”
Mark Scheinker’s illustrations, from 1947 and 1954, show a plaque bursting forth to the one side of a vein – a particularly revealing finding.
Fig. B. Steiner’s “foci of [spinal cord] demyelination”.
Beside a lesion centering upon the posterior median septum of the spinal cord, already noted by Gabriel Steiner in his presentation of 1962, the rugged pattern of the damages to the spinal cord’s sides deserves attention.

Plate IX.
Frommann’s “grey degeneration of the spinal cord.”
These precise 1867 microscopic observations by Carl Frommann make plain that the specific affection of the spinal cord’s flanks in classic specimens of multiple sclerosis typically advances in the form of a primary, gradually advancing scarring process.

Plate X.
Lauenstein’s “acute myelitis.”
Unique since 1877, this observation by Carl Lauenstein proves that the specific flank affection of the spinal cord can also show an acute evolution and express itself as tissue softening.

Plate XI.
Carswell’s earliest depiction of a deep, periventricular, intracerebral lesion, spreading in conformity to the obstructed arteries’ area of supply.
The possibility of explaining a cerebral vascular lesion’s cause directly from its pattern of distribution seems to have been indicated for the first time in this 1838 drawing by Sir Robert Carswell.

Plate XII.
Eichhorst’s characterization of multifocal myelitis.
These 1913 pictures by Hermann Eichhorst demonstrate the pattern of so-called random scattering of “inflammatory foci” due to a widespread involvement of the terminal vascular bed, i.e the tiniest blood vessels. The difference from the lesion pattern of Carswell’s “peculiar diseased state” is obvious.

Plate XIII.
Oppenheim and Cassirer’s multifocal encephalitis.
Hermann Oppenheim and Richard Cassirer’s 1907 figures demonstrate that, also in the brain, the emergence of the specific, directly vein-dependent lesion formations of multiple sclerosis and the development of “inflammatory lesions” are not the same and that the two kinds of lesion must accordingly be due to essentially different forms of injurious events.

Plate XIV.
Individual venous dispositions which explain the emergence of “Dawson’s-fingers” or Carswell’s “remarkable spinal cord lesion”.
By showing the individual concurrence of some long-known venous variations and anomalies, these figures, drawn by the present author, explain the emergence of the specific lesion formations of multiple sclerosis.