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  • Multiple Sclerosis: The History of a Disease
  • Colin L. Talley
T. Jock Murray . Multiple Sclerosis: The History of a Disease. New York: Demos, 2005. xi + 580 pp. Ill. $29.95 (paperbound, 1-888799-80-3).

Multiple sclerosis (MS) affects perhaps as many as 2.5 million people worldwide, and it is one of the most important problems in neurology. Because of the prominence of the disease, it is surprising that this volume is the first published book-length history of MS. T. Jock Murray, a professor of neurology and director of the Dalhousie MS Program at the Dalhousie Medical School in Halifax, Nova Scotia, provides a much-needed historical overview. The book is a narrative history, based mainly on published medical literature, with two main goals: The first is to argue, through retrospective diagnoses, that MS was not a new disease of the nineteenth century; rather, it has been with us for a long time. The second is to give credit to notable physicians and scientists for priority of description and discovery in the scientific history of the malady.

Murray points out that in previous centuries there were people with symptoms similar to those found in MS, such as paralysis, numbness, and dizziness—but physicians had a much different nosology for categorizing disease in earlier times [End Page 180] and diagnosed such patients using the general terms "paralysis" or "palsy," which included a great many conditions that we would consider separate diseases today. In the eighteenth century, doctors placed patients with similar symptoms in the categories of "paraplegia," "constitutional weakness," or "rheumatism." To establish that some of these early historical cases suffered from MS, Murray examines the records of Lidwina of Schiedam, Holland (1380–1433), Margaret Davies of the Parish of Myddle (d. 1701), and Augustus d'Esté (1794–1848), among others. He concludes that MS has been present in European and European-descended populations for many centuries, but we cannot discern whether it has increased or decreased. Nevertheless, he suggests that its prevalence in the population may have been relatively stable—what has changed has been our perception and way of categorizing diseases.

In the nineteenth century, as medicine began to emphasize greater specificity in classifying disease, MS began to emerge as a separate disease category. Murray establishes that Robert Carswell—rather than Jean Cruveilhier, as some had formerly argued—provided the first illustration of the pathological anatomy of MS in 1838. However, neither man thought he was describing a new disease: Carswell presented his case as an example of the general category "atrophy," and Cruveilhier used the broad category "paraplegia" to describe his illustration. From the 1840s to the early 1860s, German and French clinicians began to notice that there appeared to be a progressive neurological disorder affecting mainly young adults. Murray argues that Friedrich Theodor von Frerichs (1819–95) gave the first clinical diagnosis of a patient with this myelitis later to be known as MS; Carl Rokitansky (1804–78) was the first to use a microscope to study the lesions of MS; and Eduard Rindfleisch (1836–1908) was the first to describe perivascular cell infiltrations and pathological changes in the neuroglia.

Later neurologists noted that Frerichs, Rokitansky, and Rindfleisch had conflated some MS patients with those suffering from other conditions, such as tabes dorsalis, and they recognized the considerable difficulty in making a differential diagnosis of MS in the clinic. It was Jean-Martin Charcot who, with his associate Edmé Vulpian, through longitudinal studies, successfully differentiated MS from other disorders and correlated the clinical symptoms of the disease with its pathological anatomy in 1868. Charcot described what became known as Charcot's triad: intention tremor, nystagmus, and scanning speech. He linked these clinical signs with the scattered destruction of myelin, the overgrowth of glial tissue, and the relative sparing of the axons.

After Charcot, physicians began to diagnose cases of MS in Europe and North America. Murray demonstrates which physician first described MS in several nations. He also considers whether William Moxon penned the first "major" description of MS in the English language in 1875. He then discusses James Dawson's work on MS from 1916 to 1918, which became the most significant systematic...

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