Eye symptoms in tabes dorsalis / by J. H. Tomlinson.

  • Tomlinson, J. H.
Date:
[1902?]
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Licence: In copyright

Credit: Eye symptoms in tabes dorsalis / by J. H. Tomlinson. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    anatomical change being degeneration of the posterior spinal roots and the posterior columns of the spinal cord.* If this is so, we have to inquire how it is that we get cerebral nerves affected. The cells which degenerate in this disease are those of the ganglia of the posterior roots of the spinal nerves. These cells have T or Y-shaped processes, the lower limbs of which descend the nerve to terminate in sensory end-organs, while the upper limbs enter the column of Burdach, then pass into the column of Goll, and ascend the cord to terminate in the bulb in the region of the gracile nucleus. It is reasonable to assume that the part furthest from the trophic centre shows the effects of diminution of vitality the soonest; hence the beginnings of the degeneration take place in the terminal twigs. Suppose, for example, the ends of the nerve in the muscle spindles, which are considered to be the muscle sense end-organs, begin to lose vitality, a small stimulus is insuffi- cient to start an impulse upwards to the brain; hence delicate movements begin to be difficult or impossible—we have com- mencing ataxia. The sclerosis of the cord, which has been thought hitherto to be the primary lesion, is now looked upon as a secondary process due to the hyperplasia of the neuroglia elements, most probably the result of the irritation of the products of degeneration. Suppose, now, that the degenerative process commences in the upper limb of the axon: an irritation is set up in the region of the nucleus gracilis of the medulla, and, through what channels we do not know, this irritation finally affects especially the nuclei of the second, third, fourth, and sixth nerves, though other cerebral nerves are sometimes affected. One of the cases to which I shall refer presently shows an affection of the first. For the last two years he has been unable to taste {i.e., smell) his food properly. This is rare. In all Duchenne's cases he only had one in which the olfactory nerve was affected. The eighth, ninth, and twelfth are more often included in the degenerative process. I will consider the various eye symptoms as far as possible in the order of their advent. Perhaps neuralgic pains in the eyes—at the back of the eyes—are amongst the earliest symptoms of which patients complain, in the same way that the lightning pains are frequently the precursors for years of ataxia. But in general, I think the contracted and immobile pupil may be considered the first symptom that we can seize hold of, so to speak, and say: Here is a basis of suspicion that we have to do with a case of tabes. What is taking place when the pupil contracts normally under * Allbutt's System of Medicine, vol. vii.