Multiple sclerosis

Historical note and nomenclature
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By Anthony T Reder MD

Greek and Roman physicians did not document multiple sclerosis, but it may have been mentioned in 13th century Icelandic sagas. Saint Lidwina of Holland appears to have developed multiple sclerosis in 1396 (Medaer 1979). The court physician was not optimistic after examining Lidwina, stating, "Believe me, there is no cure for this illness; it comes directly from God. Even Hippocrates and Gallenus would not be of any help here." The clinical description and prognosis of multiple sclerosis have improved in the intervening 500 years, but progress in understanding its etiology is debatable.

Multiple sclerosis was clearly depicted in 1822 in the diary of Sir Augustus D' Este, grandson of King George III of England (Firth 1948). One of his relapses is portrayed here:

"At Florence, I began to suffer from a confusion of sight. About the 6th of November, the malady increased to the extent of my seeing all objects double. Each eye had its separate visions. Dr. Kissock supposed bile to be the cause. I was twice blooded from the temple by leeches. Purges were administered. One Vomit and twice I lost blood from the arm. The Malady in my eyes abated, again I saw all object naturally in their single state. I was able to go out and walk" (Murray 2005).

Cruveilhier in Paris and Carswell in London clearly illustrated central nervous system plaques and sclerosis in the 1840s. Charcot published detailed clinical descriptions and characterized the demyelination in plaques, and Rindfleisch described the perivascular inflammatory CNS lesions in the 1860s (Cook 1998). These observers documented the intermittent and seemingly random neurologic symptoms and the variable evolution of the disease. The history of multiple sclerosis is extensively reviewed by Murray (Murray 2005).

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors