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22. Digitizing Fads and Fashions: Disintermediation and Glocalized Markets in
Creative Industries
PAUL M. HIRSCH AND DANIEL A. GRUBER

PART 6 POLICY AND DEVELOPMENT

23. Copyright, the Creative Industries, and the Public Domain
FIONA MACMILLAN
24. Copyright and its Discontents
MARTIN KRETSCHMER
25. Public Policy for the Creative Industries
HASAN BAKHSHI, STUART CUNNINGHAM, AND JUAN MATEOS-GARCIA
26. Global Production Networks in the Creative Industries
NEIL M. COE
27. Creative Industries and Development: Culture in Development, or the Cultures of
Development?
ANDY C. PRATT

Author Index
Subject Index
 LIST OF FIGURES

1.1 A typology of change in the creative industries

1.2 Examples of change in advertising, architecture, and videogames
1.3 Examples of change in fashion and textiles, museums, and performance arts
7.1 Chinese auction sales (all categories) 2000–10
11.1 Timeline of evolution of the market for modern Indian art
11.2 Timeline of evolution of the fashion industry in India
12.1 Performance in the creative industries: dimensions and relationships
16.1 Box: Open source software and user communities in the software sector
18.1 Typology of niches
19.1 Hypothetical production possibility frontier for entertainment and all other
products and services
19.2 Stylized relation between sunk costs and variety of entertainment products
19.3 Hypothetical evolution of exogenous sunk costs needed for the production of
an entertainment prototype, pre-industrial times to the present
19.4 Informal comparative ranking of sunk costs and product differentiation
across various entertainment products and services
19.5 Ticket price versus cumulative ticket-selling capacity for entertainment
venues in Boston in 1909 ($ and number of tickets)
19.6 Stylized hypothetical Hotelling ranking of selected forms of spectator
entertainment, 1890s to the present
19.7 A stylized example of sunk costs, revenues, and average costs without and
with price discrimination
19.8 Price versus cumulative number of viewings for a typical Hollywood film,
1990s ($ and number of viewings)
19.9 Producer ’s share of ticket price and average costs versus cumulative number
of viewings for a typical Hollywood film with a $40m production budget,
1990s
19.10 Total annual production outlays for various US film producers, 1913–1927,
in constant 1913 dollars: semi-logarithmic scale
19.11 Market size and concentration in the US film industry, 1893–1927, constant
1913 dollars and four-firm concentration ratio: semi-logarithmic scale
19.12 Average real recorded music sales per music copyright registered, new
 copyrights and all copyrights ever registered, United States, 1921–1970
19.13 Hypothetical representation of the boundaries of the project-based segments
of the creative industries and various other industries
19.14 Stylized representation of the interlinked intra- and inter-industry webs of
project-based entertainment industries
20.1 Figurative view of the creative trident
21.1 Brokerage Roles (Gould and Fernandez, 1989)
 LIST OF TABLES

1.1 Appendix: The most common definitions of creative industries

11.1 Comparison between the two cases of modern Indian art and Indian fashion
18.1 Main economic trends (1950–2010)
19.1 Qualitative analysis of successive shifts in the production possibility frontier
for various forms of entertainment during the nineteenth century
19.2 Contributions to output growth in spectator entertainment, 1900–1938, per
cent per annum
19.3 Revealed comparative advantage (RCA) rankings of the tradable
entertainment sector for selected countries, 1899–1950
19.4 Stylized comparison of household versus market production of entertainment
19.5 Product differentiation within and between product categories
19.6 Worldwide prices, audience, sales potential, and consumer surplus for a
typical Hollywood motion picture, 1990s
19.7 Stylized comparison of revenues and profits of a high vs. a low capacity film
for a hypothetical cinema
19.8 Economic tendencies in the development of the entertainment industry
20.1 Tabular view of the creative trident
20.2 The UK creative employment trident for 2001 based on CCI analysis of ONS
census data
22.1 Cultural industries: a historical overview
 LIST OF CONTRIBUTORS

Sondos G. AbdelGawad Assistant Professor, Entrepreneurship Department, IE

Business School

Patrick Adler Doctoral Candidate, Urban Planning, Luskin School of Public

Affairs, UCLA

N. Anand Shell Professor of Global Leadership, IMD Business School

Hasan Bakhshi Director, Creative Economy Policy and Research, Nesta, and
Adjunct Professor, Queensland University of Technology

Gerben Bakker Associate Professor, Department of Economic History, London

School of Economics and Political Science

Gino Cattani Associate Professor of Management and Organizations, Leonard N.

Stern School of Business, New York University

Neil M. Coe Professor of Economic Geography, Department of Geography,

National University of Singapore

Mariachiara Colucci Associate Professor, Department of Management, University

of Bologna

Grégoire Croidieu Assistant Professor, Grenoble Ecole de Management

Stuart Cunningham Distinguished Professor and Director, ARC Centre of

Excellence for Creative Industries and Innovation, Queensland University of
Technology

Elizabeth Currid-Halkett Associate Professor of Urban Planning, Sol Price

School of Public Policy, University of Southern California

Robert DeFillippi Professor, Sawyer Business School, Suffolk University

Anna M. Dempster Senior Lecturer, Sotheby’s Institute of Art

Eleonora Di Maria Associate Professor, Department of Economics and Business,

University of Padova

Simone Ferriani Professor of Entrepreneurship, Department of Management,

University of Bologna and Cass Business School, City University London

Vladi Finotto Assistant Professor of Business Strategy and Entrepreneurship,

Department of Management, Ca’ Foscari University of Venice

Richard Florida Director, Martin Prosperity Institute, Rotman School of

Management, University of Toronto

Stephen Flowers Principal Lecturer, CENTRIM, University of Brighton

Pacey C. Foster Associate Professor, College of Management, University of

Massachusetts, Boston

Lucy L. Gilson Professor, University of Connecticut

Daniel A. Gruber Assistant Professor, Medill School of Journalism, Media,

Integrated Marketing Communications, Northwestern University

Elizabeth Gulledge Research Fellow, School of Management, University of St

Andrews

Allègre L. Hadida University Senior Lecturer in Strategy, University of Cambridge

Judge Business School, and Fellow of Magdalene College

Paul M. Hirsch James L. Allen Professor of Strategy & Organization, Kellogg

School of Management, Northwestern University

Candace Jones Associate Professor, Carroll School of Management, Boston

College

James C. Kaufman Professor of Educational Psychology, Neag School of

Psychology, University of Connecticut

Sean Keddy Research Assistant, School of Planning, University of Waterloo

Mukti Khaire Associate Professor of Business Administration, Harvard Business

School

Martin Kretschmer Professor of Intellectual Property Law, School of Law,

University of Glasgow, and Director of CREATe

Mark Lorenzen Professor, Copenhagen Business School

Fiona Macmillan Corporation of London Professor of Law, School of Law,

Birkbeck, University of London

Juan Mateos-Garcia Research Fellow in Economics, Creative Economy Policy and

Research, Nesta

Charlotta Mellander Professor in Economics, Jönköping International Business

School, Jönköping University, and Martin Prosperity Institute, University of
Toronto

Pierre-Michel Menger Professor, College de France and Directeur d'études, Ecole

des Hautes Etudes en Sciences Sociales, Paris

Richard E. Ocejo Assistant Professor, Department of Sociology, John Jay College

of Criminal Justice, City University of New York (CUNY)

Jason Potts Professor, School of Economics, Finance and Marketing, RMIT

University

Andy C. Pratt Professor of Cultural Economy, Department of Culture and Creative

Industries, City University London

Francesco Rullani Assistant Professor in Entrepreneurship and Management of

Innovation, LUISS Guido Carli, Department of Business and Management and
Visiting Associate Professor, Department of Innovation and Organizational
Economics, Copenhagen Business School

Jonathan Sapsed Principal Research Fellow, CENTRIM, University of Brighton

Elke Schüßler Assistant Professor of Organization Theory, School of Business &

Economics, Freie Universität Berlin

Barbara Slavich Associate Professor, IÉSEG School of Management (LEM-CNRS)

Robert J. Sternberg Professor of Human Development, College of Human

Ecology, Cornell University

Silviya Svejenova Professor with Special Responsibilities, Department of

Organization, Copenhagen Business School

Jörg Sydow Professor of Management, School of Business and Economics, Freie

Universität Berlin

Barbara Townley Professor of Management, School of Management, University of

St Andrews and Director, Institute for Capitalising on Creativity (ICC)

Tara Vinodrai Associate Professor, Department of Geography and Environmental

Management and School of Environment, Enterprise and Development, University
of Waterloo

Georgina Voss Visiting Fellow, University of Brighton and University of Sussex

 PART 1

INTRODUCTION
 CHAPTER 1

CREATIVE INDUSTRIES
A Typology of Change

CANDACE JONES, MARK LORENZEN, AND JONATHAN SAPSED

INTRODUCTION
EVEN if there are elements of creativity in most human endeavour, not all industries
are organized principally to take advantage of and capture the market value of
human creativity. Creativity is a process of generating something new by combining
elements that already exist (Boden, 1990; Romer, 1990; Runco and Pritzker, 1999;
Sternberg, 1999) and hinges upon individuals’ and organizations’ capability and
willingness to engage in non-routine, experimental, and often uncertain activities.
Creativity is enacted in the individual (Kaufman and Sternberg, 2015), within teams
(Gilson, 2015), and within networks (Cattani, Ferriani, and Colucci, 2015). Such
individuals, teams, and networks, as well as the business firms that profit from them,
are typically attracted to those geographic locations that offer the best milieus for
them to coexist and interact, and as a result, particular cities tend to be more
characterized by human creativity than others (Lorenzen and Andersen, 2009;
Florida, Mellander, and Adler, 2015). Thus, creative industries engage not only
individuals, firms, and cities, but also national and international governmental
policies to support and protect national cultures and economic sectors (Bakhshi,
Cunningham, and Mateos-Garcia, 2015).
To craft and capture value, creative entrepreneurs and organizations may
generate new business models (Svejenova, Slavich, and AbdelGawad, 2015) and
also translate various forms of capitals such as symbolic and economic (Townley
and Gulledge, 2015). They also organize creative products, performances, and
services around projects, and develop roles and routines that enable them to
successfully complete their products and enhance learning (DeFillippi, 2015),
particularly since creative industries are permeated by paradoxes and managerial
challenges that can undermine value creation and value capture (DeFillippi,
Grabher, and Jones, 2007). The desire to capture value from creative individuals
and products generates dynamics of stardom for individuals (Currid-Halkett, 2015),
labour market inequalities for most talent (Menger, 2015), sunk costs for firms
(Bakker, 2015), and laws and international agreements such as those surrounding
copyright (Kretschmer, 2015; Macmillan, 2015). There is a significant effort
expended on defining and measuring performance in creative industries, including
artistic, commercial, managerial, and social (Hadida, 2015).
The creation and pursuit of value alters cultural landscapes and generates
economic development. Creative industries transform cultural landscapes when
creatives play with semiotic codes—the structure and relations among symbolic
elements—to infuse new ideas and meanings into creative products (Barthes, 1977,
1990). For example, bebop jazz in the 1940s, miniskirts in the 1960s, or the waves
of Modernist architecture throughout the twentieth century not only changed how
creative artefacts were produced and consumed but also, importantly, cultural
meaning. Jazz was no longer only music to dance to, but was to be listened to and
taken seriously, miniskirts symbolized the new freedoms of the sixties, while
Modernist buildings celebrated technical scale and challenged implicitly the
primacy of the Church. These symbolic values were recognized and converted to
economic values. As engines of economic development, creative industries have
remarkable growth in terms of product offerings and turnover, and new business
models (see, e.g., DCMS, 2007, 2014; European Commission, 2001; HM Treasury,
2005; OECD, 2006; UNESCO, 2006), which vary dramatically depending on
national context (Christopherson, 2004, 2008; Hesmondhalgh and Pratt, 2005; Ye,
2008; Economist, 2013a). Although definitions differ, it is clear that the economics
of creative industries generate spillover effects across the wider economy
(Cunningham and Potts, 2015). The combination of changes in semiotic code and
material usage reflect and drive cultural change and economic value, encompassing
both the tangible and the intangible. Thus, creative industries are cultures of
development, playing a significant role in how both the social and economic life of
nation states develop and change (Pratt, 2015).
It is evident that while some degree of change is inherent to all creative industries,
they change at different paces, ranging from minor ripples to a ‘gale of creative
destruction’ (Schumpeter, 1942). Understanding the nature of change of creative
industries is central to understanding (and propagating) their potential for
development and transformation. In the following, we provide a framework for
such understanding. In order to do so, we first define creative industries by focusing
on creative products (Hirsch, 2000). By ‘products’ we mean the artefacts and
offerings of creative industries including physical items, performances, services,
and deliverables to clients (we use the term ‘product’ to denote all these). We
identify two key dimensions of creative products that may undergo change: semiotic
codes and the material base. Next, we identify four primary drivers of change:
demand, public policy, technology, and globalization. Finally, we identify four
primary types of change in the creative industries—Preserve, Ideate, Transform, and
Recreate—as particular combinations of change in semiotic codes and the material
base. Throughout the chapter, we provide examples of how particular creative
products and industries are characterized by these different change types, and how
this has differential effects on business models, industry organization, and
ultimately cultural transformation and economic growth.

DEFINING CREATIVE INDUSTRIES AND FOCUSING ON

CREATIVE PRODUCTS
There are numerous studies that attempt to define which industries should be seen as
principally creative, varying in whether they include fine arts, cultural heritage, and
information technology as part of creative industries. There has been significant
debate about the shift in language from cultural to creative industries (e.g.,
Garnham, 2005; Galloway and Dunlop, 2007). We suggest that research on the arts
(Frey, 2000; Ginsburgh and Throsby, 2006) and the cultural industries (Horkheimer
and Adorno, 1944; Hirsch, 2000; Throsby, 2001; Hesmondhalgh, 2013) can be seen
as subsets of creative industries because they depend on creativity and derive value
from this creativity. The best-known lists are UNESCO (1986), DCMS (2001,
updated 2013, 2014), WIPO (2003), Americans for the Arts (2005), KEA European
Affairs (2007), and UNCTAD (2008). From these lists, it is not easy to identify the
underlying dimensions for what is included or not as a creative industry. We
provide an overview of these in Appendix 1.1. Our goal is to provide simple yet
comprehensive dimensions for identifying and classifying creative products and
industries. This enables scholars and policy-makers to make much-needed
differentiation.
Measuring the exact size of the creative industries has proven to be a point of
contention (for discussions, see Howkins, 2001 and Throsby, 2001). Most scholars
focus on creative products, which enable scholars and policy-makers to trace
creative processes (Hirsch, 1972). It is the product by which artists generate new
meanings and experiences and are judged as creative; it is the product that peers,
critics, and consumers experience. In short, products link artists to audiences. Thus,
we focus on creative products in our discussion on creative industries.
 CREATIVE PRODUCTS: SEMIOTIC CODES AND THE
MATERIAL BASE
We highlight two key dimensions of creative products—semiotic codes and the
material base—that underpin art worlds and define institutions (Becker, 1982;
Friedland and Alford, 1991); the symbolic and material shape our aesthetic
experiences, enable us to categorize creative products, and generate market niches.
Importantly, these two dimensions can accommodate and capture diverse creative
products.
The first dimension, semiotic codes, highlights the primacy of a creative
product’s symbolic nature and by such codes artists give meaning to their work and
shape how audiences interpret it (Barthes, 1977, 1990; Caves, 2000; Granham, 2005;
Hirsch, 1972, 2000; Lampel, Lant, and Shamsie, 2000). The pattern among symbolic
elements comprises a semiotic code that is called a style in the visual arts or genre
in music and literary art worlds; these patterns are the basis for classifying creative
products (DiMaggio, 1987; Lena and Peterson, 2008). Semiotic codes vary in their
stability and change: in some creative products there are established conventions
that are refined, such as classical music, whereas in other creative products semiotic
codes experience dynamic change, such as in fashion. When semiotic codes change,
this creates high uncertainty about which products will be selected and their success
(Caves, 2000). Artists mitigate this uncertainty by working within a genre or style:
categories for which there is an established community, audience, or market niche
(Hsu, Hannan, and Koçak, 2009). When artists or firms marry or move across many
genres, they may attract multiple audiences but they also risk confusing these
audiences and lowering the perceived integrity of their creative product (Hsu, 2006).
By working within a genre, the artist or producer is selecting tried and tested
concepts and constraints from the infinite variety available. Semiotic codes and the
degree of change in their symbols and structural patterns are at the heart of how we
classify creative products.
The second dimension, the material base, includes not only materials that give
form to creative products, but also technologies and socio-technical systems that
enable the production and consumption of creative products (Douglas and
Isherwood, 1979; Bijker, Hughes, and Pinch, 1984; Pinch, 2008; Miller, 2010). The
material base in creative products is quite diverse, ranging from the body in dance
and music, to mediums such as molten glass and paint, to tools such as musical
instruments or paint brushes, to technologies such as computers, synthesizers,
cameras, and sound systems, and increasingly important: the digital format. The
material base of creative products entails distinct ecosystems of knowledge that are
reflected in patent categories, as well as types of suppliers, artists, and consumers.
The degree of change in the material base of creative products varies dramatically
from refining existing materials with an emphasis on quality, such as in museums
and classical music, to disruptive innovation that substitutes materials, such as the
shift from analogue materials and printed paper hardcopy to digital softcopy in
film, music, and publishing that has dramatically changed products, business
models, and industry structures. When radical innovation in the material base of
creative industries occurs, it engenders disruption because former suppliers and
distributors based on those material systems are rendered obsolete and new firms,
organizational forms, and industry structures arise to replace them (Schumpeter,
1942). The material base of creative products is central to cost structures,
knowledge reflected in patent rights, competitive dynamics such as substitution
(Anderson and Tushman, 1990; Barney, 1991), and organizational structures such as
vertical integration versus networks (Jones, Hesterly, and Borgatti, 1997; Djelic and
Ainamo, 1999). Thus, the material base and changes in the material base shape the
dynamics of creative industries.
The combination of semiotic code and the material base elicits aesthetic
responses from audiences (e.g., peers, gatekeepers, and consumers) that drive
choices about what creative products to purchase or showcase and how much to
value them (Charters, 2006; Hagtvedt and Patrick, 2008; Hoyer and Stokburger-
Sauer, 2012). These judgements can be quite contested and fraught with competing
demands such as to screen for ‘excellence’ or facilitate access (Garnham, 2005).
Semiotic codes and the material base are used to classify creative products that
populate creative industries, creating distinct niches, which vary on their conformity
to conventions and their degree of protection from market forces (Anand and
Croidieu, 2015). By understanding semiotic codes and the material base, we can
better categorize creative products and better discern appropriate business models,
supplier networks and industry structures. By understanding the changes in semiotic
codes and the material base, we can understand the different types of change in the
creative industries. But before we can do that, we need to consider the different
drivers of such change.

FOUR DRIVERS OF CHANGE IN CREATIVE PRODUCTS AND

CREATIVE INDUSTRIES
Inherent to creative products and industries, change is often initiated by one or
several of four primary drivers: demand, technology, policy, and globalization.
Demand exerts an exogenous pull for change when consumers have purchasing
power and organizations’ markets expand, ramping up production and consumption
(de Vany, 2004; Lampel, Lant, and Shamsie, 2000). Exogenous demand, or audience
expectations, either constrains or propels change in semiotic codes. Demand
constrains change when audiences and critics reward established genres such as in
film (Hsu, 2006; Hsu, Hannan, and Kocak, 2009). In music, creative products
‘usually have their distinguished genres purposely obscured or muted in the interest
of gaining wider appeal’ (Lena and Peterson, 2008, p. 699). In contrast, audiences
for haute couture and haute cuisine expect novelty in creative products (Aspers and
Godart, 2013; Svejenova, Mazza, and Planellas, 2007), which drives fads and
fashions (Simmel, 1957). Endogenous demand occurs when artists seek novel forms
of expression; they are ‘mavericks’ that reside at the periphery of the creative
industry (Becker, 1982), such as in music (Lena and Peterson, 2008) and painting
(Crane, 1987). Their changes in semiotic codes depend on network structures of
brokers connected to the periphery and core who translate new expressions into the
mainstream (Cattani, Ferriani, and Colucci, 2015; Sapsed, Grantham, and
DeFillippi, 2007). Endogenous demand is the basis for long-term predictable
change (Martindale, 1990). Fads and fashions in clothing and fabrics may appear
spontaneous, but are planned typically two seasons in advance. When exogenous and
endogenous demand combine, it alters industry structures such as the rise of art
dealers in impressionism to connect new consumers who desired new kinds of
paintings with painters who sought to alter existing semiotic codes of representation
and form (White and White, 1965/1997). This meeting of consumer and producer
interest is critical in many industries that depend on continuous feedback and design
and is increasingly seen in creative industries accelerated by developments in
technology (Di Maria, Finotto, and Rullani, 2015; Flowers and Voss, 2015).
Technology transforms the material base of creative products, altering processes
of production and consumption. Technological change may be driven by the
internal dynamics of creative industries or trends in the wider economy. Internal
change is seen in architecture with the rise of skyscrapers, whose development
required new materials (e.g., steel, reinforced concrete) and knowledge (e.g.,
statics), altering our experience of cities and living patterns across the globe (Jones,
Maoret, Massa, and Svejenova, 2012). Internal technological change may arise from
user innovations that drive advances in music production by lowering costs and
creating value through enhanced technological products; users are both distributed
and focused around particular communities where firms coordinate input to create
new products (Di Maria, Finotto, and Rullani, 2015; Flowers and Voss, 2015).
Technological change may be driven by change in adjacent domains such as
semiconductors and computer science, which enabled creative content to be stored
on chips and transferred via electronic signals on the worldwide web, bypassing
brokers who controlled the industry. Creative industries involve extensive
production networks (Coe, 2015); thus, the substitution or alteration of a node of the
network may disrupt production relations and the network. When technological
changes prompt substitution such as digital softcopy for analogue hardcopy, then we
see industry disruption and the rise of alternative organizations and ecosystems to
support the new material base (Schumpeter, 1942). These changes in the material
base vastly expanded who has access to music and film products, connecting
producers and consumers in new ways and altering industry economics and
structures (Hirsch and Gruber, 2015). For example, films are increasingly
distributed and produced by Netflix rather than movie studios and music is
distributed through Apple’s iTunes rather than record labels. Technological changes
have disrupted industry business models and industry structures by altering cost
structures, accessibility, reproducibility, and scalability. In contrast, when the
material base and knowledge that underpins an industry are not easily substitutable,
it creates a form of uniqueness that protects these products from market forces,
creating competitive advantage (Barney, 1991). Under these conditions, technology
more likely supports and extends current practices, companies, and strategies
(Christensen, 1997).
Public policy, such as copyright law and public subsidy, shifts over time and
drives change. The international copyright system, designed to value creative
products, influences the different creative industries in dissimilar ways, as it allows
for collection of revenues but also potentially marginalizes individual creativity
(Macmillan, 2015) and influences the pattern of creative production, such as the role
of sampling in hip hop music following case law that found sampled recordings to
be infringements (Kretschmer, 2015). Digitization in creative production and
consumption has diffused so widely that the enforcement of the extant copyright
system seems infeasible, yet industry and government interests have been intimately
linked in supporting it (Blanc and Huault, 2014; Dobusch and Schuessler, 2014;
Mangematin, Sapsed, and Schuessler, 2014). Public policy affects the rate of change
in creative products such as classical music, ballet, and opera, which rely on
established conventions that convey membership and status; as such, there is great
focus on processes that preserve and refine semiotic codes. Many Western
economies have a tradition for providing public support for creative industries with
low scale markets, and many depend on such subsidies for survival. The rationale
for such government support includes market failure and the idea of cultural and
creative products as ‘merit goods’. Objectives of policy have shifted from
traditional goals like exports and job growth to knowledge exchange and the
spillovers from creative industries to the wider economy (Bakhshi, Cunningham,
and Mateos-Garcia, 2015; Cunningham and Potts, 2015). The impact of institutional
reform to this system is likely to be differentiated across the creative industries, but
there has been a general agenda to promote collaboration and networking among
institutions.
 Globalization is the liberalization of trade and investment that moves money,
people, products, technologies, and ideas across regions (IMF, 2000), creating new
market opportunities, but also intensifying competition, for the creative industries.
For example, the last three decades’ migration from India to Western countries has
created export markets for Indian culture, while changes in Indian trade policies
during the same period has enabled hybridization of semiotic codes—a blending of
modern Western and traditional Indian themes. This has paved the way for an
international discourse and demand for Modern Indian Art (Khaire and Wadhwani,
2010) as well as a Bollywood export boom (Lorenzen and Mudambi, 2013). The
combination of global exposure and export revenues from the Indian creative
industries stimulates the creation of new institutional infrastructures and ecosystems
at home, such as fashion and film schools, fashion shows and film festivals, critics
and review systems, and retail outlets and multiplex cinemas. At the same time,
falling trade barriers and the opportunity for cross-border investments have also
resulted in the reorganization of Indian creative industries, for example the
displacement of traditional Indian clothes tailors by modern fashion companies
(Khaire, 2013) and the corporatization of Bollywood production and distribution
companies (Lorenzen and Taübe, 2008).
Next, we use the relations between changes in semiotic codes and the material
base to develop a typology of change in the creative products and industries.

A T YPOLOGY OF CHANGE IN THE CREATIVE INDUSTRIES

We argue that the two dimensions of creative products—semiotic codes and the
material base—are subject to different paces of and processes for change, ranging
from slow-paced change, dominated by artists and firms seeking to preserve
semiotic codes and the material base, to fast-paced change, where artists and firms
ideate semiotic codes and/or transform the material base. Figure 1.1 illustrates four
different stylized types of change in the creative industries, which, for the sake of
simplicity, we will refer to as Preserve (slow change in semiotic codes and the
material base), Ideate (fast change in semiotic codes but slow change in the material
base), Transform (fast change in the material base but slow change in semiotic
codes), and Recreate (fast change in semiotic codes and the material base). As paces
of change are, of course, continua rather than discrete clusters, in between our types
are a mix of continuity and change in either semiotic codes or the material base.
Figures 1.2 and 1.3 provide some examples of how our change typology may be
applied to prototypical creative products and industries. These are illustrative
examples, showing how different types of change occur even within the same
industry, for instance between mainstream and niche products, or at varying
historical points. We observe that a few drivers of change tend to be associated with
a type of change: State policy with Preserve, demand and globalization with Ideate,
technology with Transform, and a combination of globalization and technology with
Recreate. We discuss different drivers and types of change in the next four sections,
seeking to provide a more detailed account of such variations.
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number of cases; the only authority of weight who opposes this view
is Charcot, and his opposition is abundantly neutralized by a number
of carefully-studied American and European cases.
145 The coincidences among these three cases were remarkable. All three were
Germans, all three musicians, two had lost an only son. In all, the emotional
manifestations were pronounced from the initial to the advanced period of the
disease.

146 A Bohemian cigar-maker was startled by the sudden firing of a pistol-shot in a

dark hallway, and on arriving at the factory, and not fully recovered from the first fright,
he was again startled by the sudden descent of an elevator and the fall of a heavy
case from it close to where he stood. From the latter moment he trembled, and his
tremor continued increasing till the last stage of his illness was reached. This was my
shortest duration, four years, and of nuclear oblongata paralysis type.

Hysterical and other obscure neuroses have been claimed to act as

predisposing causes. But, inasmuch as it is well established that
sclerosis is not a legitimate sequel of even the most aggravated
forms of true hysteria,147 and, on the other hand, that disseminated
sclerosis, particularly in the early stages, may progress under the
mask of spinal irritative or other neuroses, it is reasonable to
suppose that cause and effect have been confounded by those who
advanced this view. According to Charcot, the female sex shows a
greater disposition to the disease than the male. Erb, who bases his
remarks on the surprisingly small number of nine cases, is inclined to
account for Charcot's statement on the ground that it was at a
hospital for females that Charcot made his observations. On
comparing the figures of numerous observers, it will be found that in
the experience of one the females, and of the other the males,
preponderate. In my own experience the males far exceed the
females both in private and in dispensary practice. Of 22 cases with
accessible records, only 7 were females.
147 Charcot's observation of lateral sclerosis in hysterical contracture, although made
so long ago, has not been confirmed, and the most careful examinations in equally
severe and protracted cases have proven altogether negative.
Syphilis has also been assigned as a cause. The connection is not
as clear as in tabes. In the few cases where there appears to be a
direct causal relation the lesion is not typical. There are sclerotic foci,
but in addition there is a general lesion, particularly of the posterior
columns of the cord, such as is found with paretic dementia. And it
has been noted that periendymal and subendymal sclerosis is more
frequent with the cases of alleged syphilitic origin than with those of
the typical form.

DIFFERENTIAL DIAGNOSIS.—In view of what has been already stated

regarding the numerous clinical types found in disseminated
sclerosis, it is easily understood why the diagnosis of this disease is
becoming more and more uncertain: every new set of researches
removes some one or several of the old and cherished landmarks;
and it may be safely asserted that only a minority of the cases show
that symptom-group which was formerly claimed as characteristic of
all. The discovery of a series of cases by Westphal,148 in which the
typical symptom-group of Charcot was present, but no sclerosis
deserving the name found after death, as well as the interesting
experience of Seguin, who found well-marked disseminated
sclerosis in a case regarded as hysterical intra vitam, illustrates the
increasing uncertainly of our advancing knowledge. It was believed
within a few years that the presence of cranial nerve-symptoms was
a positive factor in determining a given case to be one of
disseminated sclerosis, but in the very cases described by Westphal
such symptoms were present notwithstanding the lesion was absent.
Up to this time, however, no case has been discovered in which,
optic-nerve atrophy being present in addition to the so-called
characteristic symptoms of intention tremor, nystagmus, and
scanning in speech, disseminated foci of sclerosis were not found at
the autopsy. This sign may be therefore regarded as of the highest
determining value when present; but as it is absent in the majority of
cases, its absence cannot be regarded as decisive. The presence of
pupillary symptoms also increases the certainty of the diagnosis
when added to the ordinary and general symptoms of the disorder
related above.
 148 Archiv für Psychiatrie, xiv. p. 128.

Although the difference between the tremor of typical disseminated

sclerosis and that of paralysis agitans is pathognomonic, yet the
existence of a group of cases of disseminated sclerosis, as well as of
one of cases of paralysis agitans without tremor, renders an exact
discrimination in all cases impossible. It is a question, as yet,
whether the form of paralysis agitans without tremor described by
Charcot, and which is marked by pains in the extremities, rigidity,
clumsiness, and slowness of movement, general motor weakness, a
frozen countenance, impeded speech, and mental enfeeblement, is
not in reality a diffuse or disseminated sclerosis.

The diagnosis of this disease, while readily made in a large number

of cases on the strength of the characteristic symptoms detailed,
may be regarded as impossible in a minority which some good
authorities incline to regard as a large one.

Diffuse Sclerosis.

SYNONYMS.—Chronic myelitis, Diffuse myelitis, Simple or Diffuse

spinal sclerosis, Chronic transverse myelitis, Sclerosis stricte sic
dicta (Leyden, in part), Gray degeneration.

The various forms of sclerosis thus far considered were at one time
considered as varieties of chronic myelitis, and under different
names, founded on leading symptoms, were considered to be
merely local, and perhaps accidental, variations of one and the same
morbid process. More accurate clinical and pathological analysis has
separated from the general family of the scleroses one clearly
demarcated form after another. Tabes dorsalis, disseminated
sclerosis, amyotrophic lateral sclerosis, and the combined forms of
sclerosis have been successively isolated. Still, a large number of
cases are left which cannot be classified either with the regular
affections of the cord, limited to special systems of fibres, or with the
disseminated form last considered. They agree with the latter in that
they are not uniform; they differ from it in that they are not
multilocular. Not a few modern authors have neglected making any
provisions for these cases, while others treat of them in conjunction
with acute myelitis, of which disease it is sometimes regarded as a
sequel. The term diffuse sclerosis is here applied to those forms of
chronic myelitis which follow no special rule in their location, and to
such as are atypical and do not correspond in their symptomatology
or anatomy to the more regular forms of sclerosis. In regional
distribution the foci of diffuse sclerosis imitate those of acute myelitis:
they may be transverse, fascicular, or irregular.

MORBID ANATOMY.—In typical cases the lesion of diffuse sclerosis

constitutes a connecting-link between that of the disseminated form
and posterior sclerosis. Its naked-eye characters are the same.
There is usually more rapid destruction of the axis-cylinders, more
inflammatory vascularization, proliferation of the neuroglia-nuclei,
and pigmentary and hyaline degeneration of the nerve-cells, than in
the disseminated form.

Syphilitic inflammation of the cord extends along the lymphatic

channels, including the adventitial spaces, and leads to a diffuse
fibrous interstitial sclerosis. In one case in which I suspected syphilis,
though a fellow-observer failed to detect it after a rigid search, I
found a peculiar form of what would probably be best designated as
vesicular degeneration, according to Leyden, though associated with
a veritable sclerosis. The lymph-space in the posterior septum
showed ectasis; the blood-vessels were sclerotic, and each was the
centre of the mingled sclerotic and rarefying change. It appears that
while the interstitial tissue hypertrophied, the myelin of adjoining
nerve-tubes was pressed together till the intervening tissue
underwent pressure atrophy. The result was, the myelin-tubes
consolidated, some axis-cylinders perished, others atrophied, a few
remained, and, the myelin undergoing liquefaction, long tubular
cavities resulted, running parallel with the axis of the cord, and
exposed as round cavities on cross-section (Fig. 32). The changes in
the cells of the anterior horn in the same cord (Fig. 33) illustrate one
of the common forms of disease to which they are subjected in the
course of sclerotic disease.
FIG. 32.

FIG. 33.
The so-called myelitis without softening, or hyperplastic myelitis of
Dujardin-Beaumetz, which is ranked by Leyden and Erb among the
acute processes, properly belongs here. It is characterized by a
proliferation of the interstitial substance, both of its cellular and
fibrillar elements. The nerve-elements proper play no part, or at best
a very slight or secondary one. In the sense that this affection occurs
after acute diseases and develops in a brief period it may be called
an acute myelitis, but both in its histological products and its clinical
features it approximates the sclerotic or chronic inflammatory
affections of the cord. As far as the clinical features are concerned,
this is particularly well shown in the disseminated myelitis found by
Westphal after acute diseases, such as the exanthematous and
continued fevers.

CLINICAL HISTORY.—Impairment of motion is the most constant early

feature of chronic myelitis; in the transverse form it may be as
absolute as in the severest forms of acute myelitis; as a rule,
however, it is rather a paresis than a paralysis. The patient is usually
able to walk, manifesting the paraparetic gait: he moves along
slowly, does not lift his feet, drags them along, makes short steps; in
short, acts as if his limbs were heavily weighted. This difficulty of
locomotion is preceded and accompanied by a tired feeling before
other sensory symptoms are developed. Rigidity of the muscles, like
that found in disseminated sclerosis, is a common accompaniment,
and may even preponderate over the paresis to such an extent as to
modify the patient's walk, rendering it spastic in character. In such
cases the muscles feel hard to the touch, and the same exaggerated
reflex excitability may be present as was described to be
characteristic of spastic paralysis.

If, while the leg is slightly flexed on the thigh, the foot be extended,149
so as to render the Achilles tendon and the muscles connected with
it tense, and the hand while grasping the foot suddenly presses the
latter to still further extension, a quick contraction occurs, which, if
the pressure be renewed and kept up, recurs again and again, the
succession of the involuntary movements resembling a clonic
spasm. This action is termed the ankle-clonus or foot-phenomenon.
Gowers has amplified this test of exaggerated reflex excitability by
adding what he calls the front-tap contraction. The foot being held in
the same way as stated above, the examiner strikes the muscles on
the front of the leg; the calf-muscles contract and cause a brief
extension movement of the foot. It is believed that the foot-clonus
and the front-tap contraction are always pathological, but a few
observers, notably Gnauck, leave it an open question whether it may
not occur in neurotic subjects who have no organic disease. Gowers
considers the foot-clonus found in hysterical women as spurious,
and states that it differs from the true form in that it is not constant,
being broken by voluntary contractions, and does not begin as soon
as the observer applies pressure. But I have seen the form of clonus
which Gowers regards as hysterical in cases of diffuse sclerosis.
With regard to the front-tap contraction, its discoverer150 admits that
it may be obtained in persons in whom there is no reason to suspect
organic disease. It is significant only when unequal on the two sides.
149 By extension the approximation of the dorsal surface to the tibial aspect of the leg
—what some German writers call dorsal flexion—is meant.
 150 Gowers, The Diagnosis of the Diseases of the Spinal Cord, 3d ed., p. 33.

In severe cases contractures are developed in the affected muscular

groups, being, as a rule, preceded by the rigidity, increased reflex
excitability, and the thereon dependent phenomena above detailed.
These contractures may be like those of spastic paralysis, but
usually the adductors show the chief involvement, and sometimes
the leg becomes flexed on the thigh and the thigh on the abdomen in
such firm contraction that the patient, albeit his gross motor power is
not sufficiently impaired, is unable to move about, and is confined to
his bed, his heel firmly drawn up against his buttock. It is stated by
Leyden that the contracted muscles occasionally become
hypertrophied—an occurrence I have not been able to verify. As a
rule, some muscular groups are atrophied, though the limbs as a
whole, particularly in those patients who are able to walk about, are
fairly well nourished.

Pain in the back is a frequent accompaniment of diffuse sclerosis. It

is not pronounced, but constant.

The drift of opinion to-day is to regard pain in the spinal region as not
pathognomonic of organic spinal affections. It is true that pain is a
frequent concomitant of neuroses, and that it is more intense and
characteristic in vertebral and meningeal disease; but in denying a
significance to pain in the back as an evidence of diffuse disease of
the cord itself, I think many modern observers have gone to an
extreme. It is particularly in diffuse sclerosis that a dull heavy
sensation is experienced in the lumbo-sacral region; and in a
number of my cases of slowly ascending myelitis and of tabes
dorsalis the involvement of the arms was accompanied by an
extension of the same pain, in one case associated with intolerable
itching, to the interscapular region. It cannot be maintained that the
pain corresponds in situation to the sclerotic area. It is probably, like
the pain in the extremities, a symptom of irradiation, and
corresponds in distribution to that of the spinal rami of the nerves
arising in the affected level.
As the posterior columns are usually involved in transverse myelitis,
the same lancinating and terebrating pains may occur as in tabes
dorsalis. As a rule, they are not as severe, and a dull, heavy feeling,
comparable to a tired or a burning sensation, is more common. A
belt sensation, like that of tabes, and as in tabes corresponding to
the altitude of the lesion, is a much more constant symptom than
acute pains.

Cutaneous sensibility is not usually impaired to anything like the

extent found in advanced tabes. It is marked in proportion to the
severity of the motor paralysis; where mobility is greatly impaired,
profound anæsthesia and paræsthesia will be found; where it is not
much disturbed, subjective numbness, slight hyperæsthesia, or
tingling and formication may be the only symptoms indicating
sensory disturbance; and there are cases where even these may be
wanting.

The visceral functions are not usually disturbed. In intense

transverse sclerosis of the upper dorsal region I observed gastric
crises, and in a second, whose lesion is of slight intensity, but
probably diffused over a considerable length of the cerebro-spinal
axis, there is at present pathological glycosuria. The bladder
commonly shows slight impairment of expulsive as well as retaining
power, the patients micturating frequently and passing the last drops
of urine with difficulty. Constipation is the rule. The sexual powers
are usually diminished, though rarely abolished. As with sclerotic
processes generally, the sexual functions of the female, both
menstrual and reproductive, are rarely disturbed.

It is not necessary to recapitulate here the symptoms which mark

diffuse sclerosis at different altitudes of the cord. With this
modification, that they are less intense, not apt to be associated with
much atrophic degeneration, nor, as a rule, quite as abruptly
demarcated in regional distribution, what was said for acute myelitis
may be transferred to this form of chronic myelitis. The progress of
diffuse sclerosis is slow, its development insidious, and the history of
the case may extend over as long a period as that of diffuse
sclerosis. Sooner or later, higher levels of the cord are involved in
those cases where the primary focus was low down. In this way the
course of the disease may appear very rapid at one time, to become
almost stationary at others. Of three deaths which occurred from the
disease in my experience, one, in which there were distinct signs of
involvement of the oblongata,151 occurred from sudden paralysis of
respiration; a second from a cardiac complication, which, in view of
some recent revelations concerning the influence of the tabic
process on the organic condition of the valves of the heart, I should
be inclined to regard as not unconnected with the sclerosis; and in a
third, from bed-sores of the ordinary surgical variety. The malignant
bed-sore is not of frequent occurrence in this disease.
151 On one occasion the patient had momentary anarthria, followed a day later by two
successive periods of anarthria, lasting respectively about twenty seconds and one
minute, one of which was accompanied by diplopia of equally brief duration.

PROGNOSIS.—The disease may, as in the instances cited, lead to a

fatal termination, directly or indirectly, in from three to twenty years.
The average duration of life is from six to fifteen years, being greater
in cases where the sclerotic process is of slight intensity, even
though it be of considerable extent, than where it is of maximum or
destructive severity in one area, albeit limited. I am able to say, as in
the case of tabes dorsalis, that a fair number of patients suffering
from this disease whom I have observed for from two to six years
have not made any material progress in an unfavorable sense in that
time. One cure152 occurred in this series, of a patient manifesting
extreme contractures, atrophies, bladder trouble, and ataxiform
paresis, where the cause was plainly syphilis, and the histological
character of the lesion is somewhat a matter of conjecture in
consequence. Diffuse sclerosis of non-syphilitic origin—and this may
apply also to established sclerosis in syphilitic subjects—is probably
as unamenable to remedial treatment as any other sclerotic
affection.
152 The patient went, under direction of Leonard Weber and R. H. Saunders, to Aix-
la-Chapelle, where this happy result was obtained after mixed treatment had
 practically failed.

The same rules of DIAGNOSIS applicable to transverse myelitis of

acute onset apply, level for level, to the diagnosis of transverse
myelitis of insidious development, the history of the case often
furnishing the only distinguishing point between the acute and the
chronic form.

The main difference between the diffuse sclerosis and acute myelitis,
clinically considered, consists in the gradual development of
symptoms in the former as contrasted with their rapid development
in the latter disease. Acute myelitis is established within a few hours,
days, or at most, in the subacute forms, a few weeks; chronic
myelitis requires months and years to become a clearly-manifested
disorder. It is the essential correspondence of the symptoms of both
conditions, intrinsically considered, which renders it impossible to
distinguish clinically and in the absence of a history of the case
between some cases of acute myelitis in the secondary period and
the processes which are primarily of a sclerotic character.

It is unusual to find the degeneration reaction in myelitis of slow and

gradual development. Sometimes there is diminished reaction to
both the faradic and galvanic currents, or the so-called middle form
of degeneration reaction is obtained from atrophied muscles, the
nerve presenting normal or nearly normal irritability, and the muscle
increased galvanic irritability and inversion of the formula.

Among the less reliable or accessible points of differentiation

between the residua of acute myelitis and the chronic form is the
history of the onset and the age of the patient at the time of the
onset. Myelitis in young subjects is more likely to be of the acute
kind; in older persons it is more apt to be chronic.

In the diagnosis of diffuse sclerosis the question of differentiation

from neuroses not based on ascertainable structural disease, such
as are called functional, will be most frequently raised. In
differentiating between organic and functional spinal disorders all
known exact signs of organic disease must be excluded before the
case can be considered as appertaining to the latter group.
Symptoms of hysteria, nervous exhaustion, and spinal irritation
frequently coexist with diffuse sclerosis as well as with the
disseminated form; and this is not surprising, for, instead, as seemed
at one time to be believed, of the neurotic taint granting comparative
immunity against organic disease, it is the reverse, and it is not at all
uncommon to find a strongly-marked neurotic diathesis in the family
history of sufferers from diffuse sclerosis. That ordinary hysteria,
epilepsy, and what is vaguely called nervousness are common
features in the ancestral record of the hereditary forms of spinal
disease has already been stated in considering those affections.

One of the commoner forms of the grave phase of hysteria is

paraplegia.153 Often muscular atrophy—which ensues from disuse—
exaggeration of the deep reflexes, and retention of urine are added
to the paraplegia and heighten the resemblance to an organic
affection. Its development, though sometimes sudden, often
occupies weeks or months, and may be preceded, exactly as in
chronic myelitis, by weakness in the legs, and not infrequently by
combined ataxia and weakness. It is much more difficult to
discriminate here than is generally held or than is enunciated in
textbooks. The sufferer from hysterical paraplegia does not always
give other indications of the hysterical neurosis, and even if she did
show a globus and tenderness at certain points, it is a question
whether it could be called a scientific diagnosis which determined the
case to be one of functional trouble on these signs alone. More than
one error has been committed in this respect. In chronic myelitis
retention of urine is less common than incontinence, which is the
reverse of hysterical paraplegia. Pupillary symptoms do not occur
with the latter affection. If there be sensory anæsthesias, they are
bizarre in character or distribution, and do not usually harmonize with
the distribution of the paralysis. In most cases moral influences can
be exerted so as to increase the power of movement far beyond
what would be possible in an organic disease; and while an electrical
examination will not always yield positive results in chronic myelitis,
yet no case of chronic myelitis with complete or nearly complete
paraplegia but will show at least quantitative changes of such extent
as to prove beyond doubt that the case is of an organic character.
153 I have observed for two years a stationary brachial diplegia, of undoubted
hysterical origin, although the patient had never shown any ordinary hysterical
manifestations, and had had no other hysterical symptom than chromatopsia, and that
only for a short period. From its long duration, constancy, and the resulting atrophy of
disuse it had been regarded as a case of peculiarly limited chronic myelitis.

There is one point in which spinal and cerebral disease involving the
motor tract differs in the majority of cases, which may be utilized in
distinguishing obscure affections of the former from those of the
latter kind. In cerebral paralysis of any standing the superficial
reflexes, such as the cremaster and abdominal reflexes, are usually
diminished or abolished, while the deep or tendon reflexes are
exaggerated. In spastic conditions due to spinal disease—say
sclerosis of any kind affecting the lateral column and leaving the
motor nuclei of the anterior cornua unaffected—the deep reflexes
are similarly increased, but the cremaster reflex is increased also.154
This feature of the superficial reflexes is significant in the case of
cerebral disease only when unilateral.
154 Attention has been called, I believe, by Westphal, to the fact that the cremaster
reflex may not be demonstrable when reflex excitability is at its highest, because the
cremaster muscle is already in extreme spastic contraction.

The initial period of diffuse sclerosis is sometimes confounded with

rheumatism—an error less pardonable than in the case of tabes,
inasmuch as in diffuse sclerosis the pains are not usually
premonitory, but associated with motor paresis. It is erroneous to
regard a pain as rheumatic because it is aggravated or relieved by
changes in the weather. There are many subjects of myelitis who
regard themselves as veritable barometers, and with more justice
than most rheumatic patients.

In some cases of chronic alcoholism there are motor weakness and

a gait much like that of diffuse sclerosis.155 It is to be remembered
that the solar tickling reflex is very often abolished in alcoholic
subjects, and profound diminution of the normal cutaneous
sensibility of the leg and feet usually coexist. But unless there is
peripheral neuritis—which is an exceptional and, when present, well-
marked affection—the absence of profound nutritive changes of the
muscle, the presence of the alcoholic tremor, the absence of
sphincter and bladder trouble, and the great variation of the
symptoms from week to week, and even from day to day, serve to
distinguish the alcoholic spinal neurosis from myelitis.
155 Wilks' alcoholic paraplegia.

The Secondary Scleroses.

In studying the lesions underlying the symptoms of organic spinal

disease, the occurrence of fascicular scleroses, secondary to such
disease and due to the destructive involvement of nerve-tracts, was
repeatedly noted. Türck may be regarded as the discoverer of these
degenerations, and the reliability of this old observer may be inferred
from the fact that one bundle of fibres liable to individual
degeneration still goes by his name, and that, as far as he was able
to discriminate between the various paths which secondary
degenerations follow through the cerebro-spinal fibre-labyrinth, his
statements have not been materially modified by more recent
investigators, such as Bouchard, Vulpian, and Westphal.

The discovery by Meynert that the great cerebro-spinal tracts attain

the white color which they owe to the development of myelin around
their component axis-cylinders with advancing maturity, and that the
tracts of noblest, and therefore most intelligent, function were the last
to show this sign of maturity, was greatly extended by Flechsig, who
found that each tract receives its myelin at a definite period of intra-
uterine life, the lowest or the nerve-roots first; then the short or
intersegmental or—as the physiologist may call them—the automatic
tracts; then the long or controlling tracts; and last, the associating
tracts of the cerebral hemispheres which mediate the complex
relations underlying mental action. It was this discovery which gave a
new impulse to the study of the secondary affections of the cord and
brain. The accuracy with which secondary degeneration follows the
lines marked out by the normal course of the tract is as great,
diminishing when the tract diminishes, changing its position or
direction and decussating where the latter changes its direction or
position or decussates, that it constitutes not alone an interesting
subject for pathological study, but has become one of the most
reliable guides of the cerebral anatomist. It is of great importance to
the pathologist to be able to differentiate between the primary
disease and its secondary results, and, as the controversy
concerning the so-called system diseases shows, even the most
studious observers are uncertain in this direction in many cases.

MORBID ANATOMY.—Secondary degeneration manifests itself by a

discoloration of the affected nerve-tract, which accurately
corresponds in area to the normal area of that tract. The more recent
the degeneration the less pronounced is this change. In advanced
cases the color may be a dark gray, in moderately old ones a reddish
or yellowish gray, and in those of very recent origin no change may
be visible to the naked eye. It is claimed, however, that even here a
loss of translucency of the white substance, giving it a sort of
cheese-like opacity, may be detected. On hardening the specimen
containing the degenerated tract in Müller's fluid or a simple
bichromate salt solution, the affected area, instead of appearing dark
on section in contrast with the gray substance—which in such
preparations appears yellowish or a light brown—contrasts with the
former by its lighter tinge. This contrast is observable even in cases
where the naked eye was unable to detect the change in the fresh
specimen. It can be sometimes found as early as the tenth day after
the primary lesion, and is apparently simultaneously developed in
the whole length of the nerve-tract affected.

The minute changes characterizing secondary degeneration begin in

the essential conducting elements, the axis-cylinder, which exhibits a
finely granular or molecular disintegration, and disappear. According
to Homén, it shows an initial swelling and a failure to stain properly
before this. The myelin then follows suit: it becomes fragile, forms
variously-shaped globules, and also disappears, and together with
this a nuclear proliferation is noticed in the interstitial substance; fatty
granule-cells are observed in large numbers, and manifest a
tendency to accumulate in the perivascular districts. These cells are
not permanent; their gradual diminution is accompanied by a
proliferation of the interstitial tissue, which ultimately appears as a
pure connective substance composed of fine fibrillæ arranged in
undulating bundles. The entire process may be not inaptly compared
to an hypertrophy of the interstitial substance resulting from
overfeeding of its cellular elements by the morbid pabulum furnished
through the disintegration of the nervous substance proper.

The disappearance of the nerve-tubes, and the formation of a new

tissue in their place, which, like all tissues of the same character,
undergoes shrinkage, leads to considerable deformity in the shape
of the part which is the site of secondary degeneration. This is seen
in the accompanying figure, where in an old-standing secondary
degeneration of one interolivary layer the corresponding half of the
medulla is greatly reduced in diameter as compared with the other
side (Fig. 34), and the entire raphé is distorted. When one side of the
cord is the site of such a change a similar asymmetry results.

FIG. 34.
 Secondary Degeneration of Interolivary Layer: D Ds D, degenerated
area; r, the distorted raphé.

According as the original lesion is incompletely or completely

destructive, a larger or fewer number of axis-cylinders may be found
preserved in the sclerotic tissue. It is not yet determined whether in
some instances these fibres may not represent an admixture from
another source than are comprised in the mainly affected tract.

Secondary degenerations are classified as ascending and

descending. An ascending degeneration is one which is found
situated brainward of the primary lesion; a descending one is found
caudad of the lesion. It was once maintained that the direction of the
secondary degeneration was constant for each individual tract. This
seems to be true for a few. Some tracts, particularly in the brain,
degenerate on both sides of the lesion, as I showed with regard to
the interolivary layer.

The best studied form of secondary degeneration is that of the

voluntary motor conduit known as the pyramid tract. Beginning in the
so-called motor area of each cerebral hemisphere, the Rolandic loop
passes into the anterior part of the posterior half of the internal
capsule, to be thence continued through the crus, pons, and the
pyramids of the oblongata to the decussation or crossing-point of the
pyramids. Here the greater part of the tract crosses into the opposite
lateral column, occupying the position described in the section on
Spastic Paralysis. A smaller part remains on the same side of the
continuous interpyramidal and ventro-spinal fissure, constituting the
direct fasciculus of Türck.

The crossed-pyramid tract diminishes as it passes caudad in the

cord, giving off its fibres to the lateral reticular processes of the cord,
whence—whether interrupted by cells (Von Monakow) or not—they
probably reach the great cells in the gray substance from which the
anterior rootlets spring. The direct fasciculus probably terminates in
a similar way, and perhaps makes good, as it were, its failure to
participate in the gross decussation at the level of the foramen
magnum by decussating in detail along its entire length. It is usually
exhausted before the lumbar cord is reached, whereas the crossed
tract in the lateral column continues down as low as the origin of the
sacral nerves. A destructive lesion anywhere in the course of the
pyramid tract, whether it be in the motor area of the cortex, in the
loop of Rolando, in the internal capsule, the pons, or the cord itself,
will provoke descending degeneration; that is, sclerosis of so much
of the tract as lies below the lesion. Thus such degeneration is found
with porencephalic defect of the motor area. I found it in a paretic
dement who had extensive cortical destruction following a
submeningeal hemorrhage. It has been observed after focal lesion of
the pons (Homén, Schrader), and after transverse lesions of the
cord, either myelitic, traumatic, or as the result of compression by
vertebral disease. As a rule, the cells in the anterior horn are not
involved, and some observers question whether this ever occurs. I
have never found such involvement, although in its gross dimensions
the anterior horn as a whole appears atrophied. This atrophy I have
been able to account for satisfactorily by the disappearance of many
of the fibres which run into the gray substance from the reticular
processes.
While the distribution of degeneration in the cord is rather uniform,
varying only in harmony with the ascertained individual variations in
the relative preponderance of the crossed and uncrossed parts of
the pyramid tract, there is much more variation in the cerebral
distribution of the degeneration according to the extent of the original
lesion. Thus, if the entire capsule be destroyed, the greater part of
the crus is involved. If only the posterior division in its anterior part
be destroyed, the degeneration is in the crus, limited to that part
which runs a subpial course on the crural demi-cylinder, occupying
from a fifth to a third of its surface-area. Still more limited
degenerations are described, but as yet are too few in number to
base other than tentative conclusions on them. Among these is one
occupying a thin strip on the inner side of the crus, which
degenerates after lesions near the genu of the capsule, and probably
represents the tract which governs the cranial nerve-nuclei. An
excellent observation by Von Mannkopf shows that the course of the
motor fasciculus is subject to some individual variation even within
the capsule.

A number of forms of secondary degeneration are described,

involving intracerebral tracts, such as those connecting the cerebrum
and cerebellum. The degeneration of the visual tract, from the optic
nerve to the occipital lobe, observed by Richter and Von Monakow,
with some conflict of opinion between these observers, is often as
perfectly demonstrative of the course of the optic fasciculi as
degeneration of the pyramid tract is demonstrative of the course of
the voluntary innervation of the muscles moving the limbs.

The secondary degenerations following lesion of the pons varolii are

acquiring special interest in view of their relation to special nerve-
tracts of the spinal cord of hitherto unknown function. The purest
instance of an isolated degeneration of other than the pyramid tract
is the case illustrated in the accompanying diagrams. It involved the
interolivary layer, was both ascending and descending, being traced
above into the subthalamic region, and below decussating into the
opposite side of the oblongata, to terminate in the nuclei of the