Multiple Sclerosis: The History of a Disease
http://www.100md.com
《新英格兰医药杂志》
The history of multiple sclerosis is in many ways the history of how medicine has moved from the simple observation and classification of disease to the complex probing of biologic systems using sophisticated new techniques. The chief clinical feature of multiple sclerosis — progressive paralysis — was apparent from its first description and has been the driving force behind the study of the disease. There are few clinical conditions more dramatic than paralysis. What could cause someone to lose his or her ability to walk?
Illustration of Multiple Sclerosis by Robert Carswell.
Plate 4, Figure 4 of Pathological Anatomy: Illustrations of the Elementary Forms of Disease (London: Longman, 1838).
Wellcome Library, London.
T. Jock Murray, a veteran neurologist who has been treating patients with multiple sclerosis for decades, tells the history of the disease in a comprehensive book that begins with the first recorded descriptions. The basic narrative of the history of any disease has three stages: first, the classification of the disease as a unique biologic entity; second, the identification of the biologic variables associated with expression of the disease; and third, the development of therapies that interfere with, correct, or prevent the biologic defects from happening. Furthermore, the telling of such a history requires that enough time has elapsed so that the event — or in this case, the disease — can be put in the appropriate historical context.
Murray has crafted a rich and detailed history of multiple sclerosis, replete with figures and wonderful quotations that form a tapestry of the events that have led to the current view that this condition is an autoimmune disease. Murray states from the outset that not enough time has elapsed to tell the story of therapy and the immunologic basis of the disease, and thus, he focuses more on the earlier history of multiple sclerosis, up to the 1960s. Most of the research on multiple sclerosis has been in the last quarter century and although he does describe it, Murray warns that it is difficult to put it into proper historical context.
The first clearly recognizable case of multiple sclerosis appears to have been that of Augustus d'Este (1794–1848), the grandson of George III of England and cousin of Queen Victoria, who carefully documented his illness in a diary, although some historians believe that Lidwina of Holland, born in 1380, had multiple sclerosis. The description of the disease as a distinct entity was made by the French neurologist Jean-Martin Charcot in 1868. During the next century, various theories were proposed to explain the cause of multiple sclerosis, including infection and toxins. The first drugs — all of which acted by modulating the immune system — that were approved by the Food and Drug Administration (FDA) for multiple sclerosis became available in the 1990s. The chief technological advance that allowed physicians to view the disease process and that ultimately led to FDA approval of drugs for multiple sclerosis was magnetic resonance imaging (MRI). In terms of understanding the disease process, the MRI has been for multiple sclerosis what chest radiography was for tuberculosis.
What is clear from Murray's book is that the history of multiple sclerosis has been a collective effort over the past two centuries, with many physicians and scientists bringing their powers of observation and scientific inquiry to the disease. Many are missing from his book. For example, there is no mention of Henry McFarland and the late Dale McFarlin, at the National Institutes of Health, who pioneered the study of multiple sclerosis in both patients and animal models.
The history of disease is ultimately related to the question that every patient with multiple sclerosis asks: When will multiple sclerosis be cured? This is not a new question. One of the many insightful quotations in Murray's book is from a young man who succumbed to multiple sclerosis in 1919, who wrote, "It would be nice if a physician from London, one of these days, were to gallop up hotspur, tether his horse to the gait post and dash in waving a reprieve — the discovery of a cure!" Actually, there are three possible cures for multiple sclerosis: reversing a fixed neurologic deficit, halting the progression of the disease, and preventing the disease from ever occurring. Current therapy is aimed at halting disease progression, and in many patients, this is indeed happening. Thus, we are beginning to cure multiple sclerosis. Murray may be right to reserve historical judgment on the most recent advances in the disease, but they are occurring at such a rapid pace that we will probably not need to wait another 100 years to put them into the correct historical context.
Howard L. Weiner, M.D.
Brigham and Women's Hospital
Boston, MA 02115
hweiner@rics.bwh.harvard.edu(By T. Jock Murray. 580 pp)
Illustration of Multiple Sclerosis by Robert Carswell.
Plate 4, Figure 4 of Pathological Anatomy: Illustrations of the Elementary Forms of Disease (London: Longman, 1838).
Wellcome Library, London.
T. Jock Murray, a veteran neurologist who has been treating patients with multiple sclerosis for decades, tells the history of the disease in a comprehensive book that begins with the first recorded descriptions. The basic narrative of the history of any disease has three stages: first, the classification of the disease as a unique biologic entity; second, the identification of the biologic variables associated with expression of the disease; and third, the development of therapies that interfere with, correct, or prevent the biologic defects from happening. Furthermore, the telling of such a history requires that enough time has elapsed so that the event — or in this case, the disease — can be put in the appropriate historical context.
Murray has crafted a rich and detailed history of multiple sclerosis, replete with figures and wonderful quotations that form a tapestry of the events that have led to the current view that this condition is an autoimmune disease. Murray states from the outset that not enough time has elapsed to tell the story of therapy and the immunologic basis of the disease, and thus, he focuses more on the earlier history of multiple sclerosis, up to the 1960s. Most of the research on multiple sclerosis has been in the last quarter century and although he does describe it, Murray warns that it is difficult to put it into proper historical context.
The first clearly recognizable case of multiple sclerosis appears to have been that of Augustus d'Este (1794–1848), the grandson of George III of England and cousin of Queen Victoria, who carefully documented his illness in a diary, although some historians believe that Lidwina of Holland, born in 1380, had multiple sclerosis. The description of the disease as a distinct entity was made by the French neurologist Jean-Martin Charcot in 1868. During the next century, various theories were proposed to explain the cause of multiple sclerosis, including infection and toxins. The first drugs — all of which acted by modulating the immune system — that were approved by the Food and Drug Administration (FDA) for multiple sclerosis became available in the 1990s. The chief technological advance that allowed physicians to view the disease process and that ultimately led to FDA approval of drugs for multiple sclerosis was magnetic resonance imaging (MRI). In terms of understanding the disease process, the MRI has been for multiple sclerosis what chest radiography was for tuberculosis.
What is clear from Murray's book is that the history of multiple sclerosis has been a collective effort over the past two centuries, with many physicians and scientists bringing their powers of observation and scientific inquiry to the disease. Many are missing from his book. For example, there is no mention of Henry McFarland and the late Dale McFarlin, at the National Institutes of Health, who pioneered the study of multiple sclerosis in both patients and animal models.
The history of disease is ultimately related to the question that every patient with multiple sclerosis asks: When will multiple sclerosis be cured? This is not a new question. One of the many insightful quotations in Murray's book is from a young man who succumbed to multiple sclerosis in 1919, who wrote, "It would be nice if a physician from London, one of these days, were to gallop up hotspur, tether his horse to the gait post and dash in waving a reprieve — the discovery of a cure!" Actually, there are three possible cures for multiple sclerosis: reversing a fixed neurologic deficit, halting the progression of the disease, and preventing the disease from ever occurring. Current therapy is aimed at halting disease progression, and in many patients, this is indeed happening. Thus, we are beginning to cure multiple sclerosis. Murray may be right to reserve historical judgment on the most recent advances in the disease, but they are occurring at such a rapid pace that we will probably not need to wait another 100 years to put them into the correct historical context.
Howard L. Weiner, M.D.
Brigham and Women's Hospital
Boston, MA 02115
hweiner@rics.bwh.harvard.edu(By T. Jock Murray. 580 pp)