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History of MS
Mid-Century Evidence

A young woman called Halldora, who lived in Iceland around the year 1200, suddenly lost her vision and mobility, but after praying to the saints, recovered them seven days after. Saint Lidwina of Schiedam (1380-1433), a Dutch nun, may be one of the first clearly identifiable multiple sclerosis (MS) patients. From the age of 16 until her death at 53, she suffered intermittent pain, weakness of the legs, and vision loss indicating symptoms typical of MS. Both cases have led to the proposal of a "Viking gene" hypothesis for the dissemination of the disease.

Augustus Frederick d'Este (1794-1848), an illegitimate grandson of King George III of Great Britain, almost certainly suffered from MS. D'Este left a detailed diary describing his 22 years living with the disease. His diary began in 1822 and ended in 1846, although it remained unknown until 1948. His symptoms began at age 28 with a sudden transient visual loss after the funeral of a friend. During the course of his disease, he developed weakness of the legs, clumsiness of the hands, numbness, dizziness, bladder disturbances, and erectile dysfunction. In 1844, he began to use a wheelchair. Despite his illness, he kept an optimistic view of life.

Another early account of MS was kept by the British diarist W. N. P. Barbellion, nom-de-plume of Bruce Frederick Cummings (1889-1919), who maintained a detailed log of his diagnosis and struggle with MS. His diary was published in 1919 as The Journal of a Disappointed Man.

Early Discovery

Robert Carswell (1793-1857), a British professor of pathology, and Jean Cruveilhier (1791-1873), a French professor of pathologic anatomy, had described and illustrated many of the disease's clinical details, but didn't identify it as a separate disease.

Jean-Martin Charcot (1825-1893) was an eminent 19th century French neurologist who worked at the Salpêtrière hospital in Paris. Without any doubt, Charcot was one of the most important characters in the history of MS, his findings representing a huge breakthrough for the clinical understanding of the disease. Charcot the first person to recognize Multiple Sclerosis as a distinct disease in 1868.

In 1868, Charcot carefully examined a young woman with a tremor of a sort he had never seen before. He noted her other neurological problems including slurred speech and abnormal eye movements, and compared them to those of other patients he had seen. When she died, he examined her brain and found the characteristic scars or "plaques" of MS.

Charcot's contribution extended to the development of diagnostic criteria, which included the now famous Charcot's triad, diplopia (double vision), ataxia (disturbances of balance or co-ordination) and dysarthria (difficulties with, or slurred speech) which he observed in his own housekeeper. Charcot also observed cognition changes, describing his patients as having a "marked enfeeblement of the memory" and "conceptions that formed slowly".

Charcot was the first to make definite links between the hitherto mysterious symptomatology, now known to be MS, and the pathological changes seen in post-mortem samples. For the first time, almost forty years after the discovery of the lesions, the clinical condition was described by Charcot as 'sclérose en plaques' and MS as recognised as a distinct disease entity.

Charcot also gave the first complete histological account of MS lesions, describing many important features including loss of myelin and proliferation of glial fibres and nuclei.

In the latter half of the 19th century, examinations of MS symptoms began to be published. The first was by Dr. William Moxon in England in 1873 followed by Dr. Edward Seguin in the United States in 1878. Most of the observations that the doctors made at the time are common place now. Since both doctors were not knowledgeable of the immune system, they could not identify it as an autoimmune disease.

Also in 1878, the French histologist and pathologist Louis Ranvier discovered myelin, the protective covering around nerves that is damaged by MS.

At the Salpêtrière, the hospital in Paris where he worked, therapy was attempted for cases of MS and the approach for ataxia was a suspension apparatus that held the person elevated by straps around the chest and under the arms.

Later Discovery

In the early 1900s, researchers discovered chemicals that allowed them to observe nerve cells under a microscope. In 1916, Dr. James Dawson of Scotland, described the inflammation and damage to myelin he saw when he looked at brain cells from those with MS under a microscope. The cells that make myelin (oligodendrocytes) were identified in 1928. Later in 1943 the composition of myelin was discovered.

After Charcot's description, Eugène Devic (1858-1930), Jozsef Balo (1895-1979), Paul Ferdinand Schilder (1886-1940), and Otto Marburg (1874-1948) described special cases of the disease.

An English neurologist of the early 20th century, Sir Gordon Holmes (1876-1965), noted that the intention tremor of cerebellar involvement had errors of rate, range, direction and force of movement, and neurologists developed specific tests to observe the tremor, the best known being the finger-to-nose test and the heel-shin test.

During the 20th century, neurologists following the description by Charcot recognized that tremor and ataxia were very difficult to treat and were very disabling to the patient. The basis of the tremor and ataxia was an incoordination of muscle movements and resulted in the unsteady action of the limbs and other muscles.

Diagnosis

The year 1913 brought the first reliable diagnosis of the disease through a lumbar puncture. It was found that the spinal fluid contains antibodies or proteins that are typical to MS and can be identified by electrophoresis.

There were major technological advances in magnetic resonance imaging (MRI) during the late 1970s. It became more useful as a diagnostic tool for disease. 1981 marked the first time that MRI was used to view the brain of someone with MS. Dr. I.R. Young performed the honors in England, and within a few years, it was clear that this new technology could show doctors the damage incurred by MS, even when patients experienced no outward symptoms.

Now when her brother became ill with MS, Sylvia Lawry realized that there was no effective treatment for the disease. After publishing an appeal in the New York Times, she was able to recruit 20 neurologists and was able to create the National Multilple Sclerosis Society in the United States. This brought forth the 43 MS Societies throughout the world and all with the same purpose, to end MS.