The framing of MS: 1824-1924
T. Jock MURRAY
Although it is commonly said that Charcot discovered and named MS (multiple sclerosis) in 1868, neither of these statements is true. He acknowledged those who described the disease before his famous 1868 leçons and paid particular tribute to his friend and colleague Vulpian who first used the term sclérose en plaque disseminée. Although others knew of the peculiar disorder that caused paraplegia and showed scattered grey patches of degeneration at autopsy, the great contribution of Charcot was to brilliantly frame the clinical and pathological features so that others could then diagnose the disorder. A flurry of case reports and case series were published over the next few decades but his description was little changed until well into the 20th century.
This talk will outline the views and approaches to paraplegia in young adults before MS was defined by Charcot, using some sample cases, such as Saint Lidwina of Scheiden, Margaret Davies, Augustus d’Este, Heinrich Heine, Alan Livingston and Margaret Gatty. Some of these would be regarded as “probable MS” due to some missing detail, but others were clearly clinically definite MS.
There were many developments in clinical and pathological medicine, as well as in the use of the microscope, staining techniques and the arrangements in the French hospitals that led to the observations of Ollivier d’Angers, Carswell, Cruveilhier, Frerich, Rindfleisch, Rokitansky, Leyden, Frommann, Türck, Vulpian and others, that preceded the Charcot leçons and these influences came together when Charcot strode onto the stage at the Salpêtrière in 1868.
The publications of Charcot’s students and the international contributions over the next half century will be discussed, leading to the major ARNMD conference on MS in New York in 1921 and the subsequent discussions and reports.
Although the understanding of MS advanced with changes in scientific knowledge and techniques during the period, little changed in the empirical approach to management and therapy. I will also indicate that many of the fundamental questions we are pondering today were raised in the 19th century.
Session VIII -- Multiple Sclerosis Seminar
Montreal, Quebec, Canada