The Goulstonian Lectures on Secondary Degenerations of the Spinal Cord
Authors: H. H. Tooth
Journal: BMJ (1889)

PRESIDENT AND GENTLEMEN,-It was with feelings almost apologetic that I announced the subject of these lectures.I felt that it might be expected that a subject of wider clinical interest should be chosen.But, on referring to the terms of the bequest of the founder of this lectureship, I discovered that he had antici- pated my difficulty.He was evidently aware that the younger Fellows would be more able to do useful work in the realm of pathology than in clinical medicine.He provides that the lec- turer shall give what is more of a demonstration than a lecture on the dead body (if such be procurable).Two hundred and fifty years and more have elapsed since his death, and yet the wisdom of the method implied in the wording of his bequest becomes not less, but more apparent.If our art is t) be raised from the level of mere empiricism, it must be grounded on the sure basis of pathology.In ordinary pathological inquiries.i; is usual to study the normal and to reason from it concerning the abnormal.This method is followed in my,first lecture, on the Histology of Secondary Degeneration.But when we wish to study the course of the fibres in the cord we reverse the usual pro- cess, and make use of pathology to teach us anatomy.It is not too much to say that without this method our knowledge of the anatomy of the cord would be of the vaguest and most rudi- mentary description.When we have learnt all the lessons that pathology can teach us concerning the paths in the cord which conduct the multitudinous motor, sensory, and visceral impressions, then, and not till then, shall we fully understand all the symptoms that present in many diseases, better known by name than by nature.Let it not, then, be supposed that the subject I have chosen is one of academic interest only.It is true that at present our knowledge of the anatomy of the cord and medulla is ahead of our diagnosis, and also that our diagnosis is far in advance of our treatment, but who dares to say how long this shall remain so?It is but a very few years since the workers at cerebral localisa- tion, too well-known to need even mention by me, were looked upon as scientific dreamers, and now their dreams have become the most striking facts in the medicine and surgery of the day.Spinal localisation follows closely, and already begins to bear fruit.These facts, then, must be my justification (if, indeed, such be needed) for dwelling minutely on points that appear to be of little practical importance at the present moment.Higtology of Degeneration.-It is a common thing for observers to speak of degeneration of nerve-tubes in the spinal cord as being comparable to, and moreover of the same nature as, the corre- sponding lesions in nerves.As I wish to institute a close com- parison between the two, it would be well to sum up the features of the so-called Wallerian degeneration first.Wallerian Degeneration.-Whena nerve is cut, its peripheral end degenerates, because it is cut off from the centre, which is be- lieved to exert some nutritive or trophic influence over it.Certain changes make their appearance in the ultimate nerve-tubes.The first change that occurs is a lo0s of transparency of the nerve-fibres to the naked eye.This is coincident with, and probably caused by, a cleavage of, the myeline, or white medullary substance of Schwann.This may be seen to occur in forty-eight hours, or later, up to four days.This change is more rapid in summer than in winter, and is associated with diminution of irritability of the April 6, 1889.