The Histology of Disseminated Sclerosis
Transactions of the Royal Society of Edinburgh. 1916; 50: 517-740.
In this paper, James Dawson provides the greatest pathological account of multiple sclerosis in the English language. After summarizing the literature—and the debate, which went on then as now, about whether the disease is “inflammatory” or “developmental” (degenerative)—Dawson reviews the histology of nine personal cases. Illustrating the text with 22 colour and 434 black-and-white ﬁgures in 78 plates, Dawson describes the form, symmetry, distribution, and histological features of several types of lesions and provides an analysis of changes in each cellular element of the nervous system—nerve cells and their axons, neuroglia, blood vessels, and lymphatics. Dawson then attempts a clinicopathophysiological correlation. (Weakness in the legs is consistent with the extensive spinal cord gliosis, for example.) He also characterizes old and acute lesions. Dawson summarizes his ideas on plaque formation around brain inflammation to include a sequence of events that, although not disease-speciﬁc, produces recognizable clinical characteristics. Maybe he falls into the trap of believing that the pathologist can see the cause, effects, and evolution of disease merely by observing snapshots of its end state.
James Walker Dawson in Edinburgh made a major contribution to the understanding of multiple sclerosis in 1916 with his detailed pathological descriptions of nine cases and in particular by concentrating on one case, LW, a 28-year-old kitchen maid. He showed the changes in lesions at various stages and described shadow plaques and the pattern we now call “Dawson’s Fingers” on MRI.