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But taking all circumstances into due consideration, particularly the very gradual manner in which the disease commences, and proceeds in its attacks; as well as the inability to ascribe its origin to any more obvious cause, we are led to seek for it in some slow morbid change in the structure of the medulla, or its investing membranes, or theca, occasioned by simple inflammation, or rheumatic or scrophulous affection.
The medulla oblongata not growing so hard as the spinalis, was doubtless owing to its not being confined in an osseous theca, but surrounded with soft parts, which allowed it room to spread.
All that has been ventured to assume here, has been that the disease depends on a disordered state of that part of the medulla which is contained in the cervical vertebræ. But of what nature that morbid change is; and whether originating in the medulla itself, in its membranes, or in the containing theca, is, at present, the subject of doubt and conjecture.
The result of this would be a thickening of the theca, or membranes, and perhaps an increase in the volume of the medulla itself, which would gradually occasion such a degree of pressure against the sides of the unyielding canal, as must eventually intercept the influence of the brain upon the inferior portion of the medullary column, and upon the parts on which the nerves of this portion are disposed.
A chronic inflammatory involvement of a theca through which an important tendon plays may cause adhesions to form. Or there may occur erosions of the parts with eventual hypertrophy and loss of function, partial or complete.
In addition to aspirating synovia, the introduction of equal parts of alcohol and tincture of iodin into the theca is necessary. The quantity of this combination injected, depends upon the size of the sheath affected and the amount of synovia retained at the time injection is made.
Uncertainty existing as to the nature of the proximate cause of this disease, its remote causes must necessarily be referred to with indecision. Assuming however the state just mentioned as the proximate cause, it may be concluded that this may be the result of injuries of the medulla itself, or of the theca helping to form the canal in which it is inclosed.
In the wall of the follicle two layers are distinguished, the theca externa, which is more fibrous, and the theca interna, which is more cellular.
Besides these, however, the same ancient schists have yielded two genera of brachiopods, Orthis and Orbicula, a Pteropod of the genus Theca, and four echinoderms of the cystidean family.
In the connective tissue stroma of the ovary between the follicles are scattered, or in some cases aggregated, epithelioid cells known as the interstitial cells, and it is stated that the cells of the theca interna are exactly similar to the interstitial cells.
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