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5) Lesion Explanation in Physical Terms

The manner in which the subject of multiple sclerosis has traditionally been approached has obviously hindered rather than furthered the resolution of the critical problem as to how and why the injuries which allow Carswell's "peculiar diseased state" to be discriminated from any similar kind of lesion concretely come about. The failure to pinpoint what is really multiple sclerosis-specific has even prevented the plain question: What kind of injury can be spread in such a manner that lesion-formations which are peculiar to multiple sclerosis result?

The end of all our exploring
Will be to arrive where we started
And know the place for the first time.

T. S. Eliot, 1942

As regards the unique characteristics of Carswell's "remarkable spinal cord lesion", we will now clarify which mechanisms and forces account for the specific patches' continuous encroachment upon primarily the spinal cord's flanks. And with respect to cerebral "Dawson's fingers" and "Steiner's splashes", we will further elucidate which apparatus and which impacts effect their strange vein-dependent projections primarily off of the cerebral ventricles and into the brain stem. We thus hope to make plain what the actual identifying characteristics of multiple sclerosis can teach us as regards the lesion's cause. Histological findings will mainly serve to clarify pace and direction of the individual lesion developments.

The fact that the multiple sclerosis-specific findings are distinctivly manifest only in the domain of macropathology may be taken to indicate that also their cause must be specifically effective on such a large scale. Regarding the massivity of the impulses required to achieve the observed large-scale effects, we may expect that the actual agents of multiple sclerosis proper are not so minuscule as they are commonly imagined.

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© Dr. F. Alfons Schelling, M.D.