Volume 4

Studies in neurology / by Henry Head ; in conjunction with W.H.R. Rivers [and others].

  • Henry Head
Date:
1920
Catalogue details

Licence: Public Domain Mark

Credit: Studies in neurology / by Henry Head ; in conjunction with W.H.R. Rivers [and others]. Source: Wellcome Collection.

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    definitely cold. But it will not seem “ hotter ” on the affected side, until the temperature of the stimulus reaches about 45° C. or above. (d) Visceral Stimulation. Discomfort in its purest form is produced by stimulation of the viscera, and we therefore compared the condition of testicular sensibility on the two sides in patients who showed this over-response to painful stimuli. If care is taken not to pinch the scrotum, the characteristic testicular sensation, a sickening discomfort, can be evoked with no other accompaniment than a sensation of not unpleasant pressure. Many patients complained that the discomfort was more intense in the testicle of the affected side. Pressure, sufficient to produce “ a slight feeling ” only on the normal side, caused a widespread expression of discomfort and brisk cremasteric movements of the testicle on the affected half of the body. The glans penis is endowed with a peculiar form of sensibility which differs normally from that of the skin in the absence of the more discriminative faculties (Rivers and Head p. 274). Heat and cold can be distinguished, but the finer grades of temperature are not appreciated. A prick causes a more widely spread sensation and is more unpleasant than over the rest of the normal skin. In fact, the glans penis is an organ endowed chiefly with the more affective elements of cutaneous sensibility, and it is therefore a peculiarly appropriate field for examination in cases wrhich exhibit the over-reaction on the abnormal side. When the glans is pricked with such an instrument as the algesimeter, the same strength of stimulus may be necessary to evoke pain on the two halves of the organ; but the discomfort described by the patient and obvious from his expression is greater on the abnormal than on the normal portion. (e) Scraping, Roughness, Vibration. All the stimuli, considered so far, contain for the normal person some obvious element of pain or discomfort. But, in these cases of over-reaction on the affected side, scraping the palm or the sole of the foot, moving a rough object over the skin, or even rubbing the hairs, may evoke an unpleasant sensation, unlike that from the normal half of the body. The difference between the two sides is, as a rule, most evident when the observer gently scrapes with his. fingers the patient’s palm. Under normal conditions this is not unpleasant; but on the affected side the patient may cry out and attempt to withdraw his hand. His face is contorted with dis¬ comfort. One patient complained : “ It is a horrid sensation, as if my hand were covered with spikes and you were running them in; it is not painful but very unpleasant.” Frequently this sensation spreads widely, running up the arm or the leg, and is often started with peculiar ease from the sole of the foot (Roussy [100], Case 1). This excessive response to scraping is frequently a striking feature during