Lectures of the diagnosis of diseases of the brain / by W. R. Gowers.

  • Gowers, W. R. (William Richard), 1845-1915.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Lectures of the diagnosis of diseases of the brain / by W. R. Gowers. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    to the whole class of movements—unwisely, because they have nothing to do with chorea, and, moreover, resemble chorea only in rare cases. Generally, the movements are far slower than are seen in true chorea. If not constant, they are readily evoked by an attempt at voluntary movement, or even by attention, and by these they are always increased. Inco- ordination of movement results, peculiar in character—slow, irregular, spreading movements of the fingers, that have been compared, not inaptly, to the movements of the arms of a cuttlefish. Mobile spasm, it may be conveniently termed. With this there is often some more constant and unchanging spasm, especially in the flexors of the wrist. The arm is always involved in greater degree than the leg. In the latter the effect of the spasm is chiefly to cause inversion of the foot and over-extension of the great toe; spontaneous movements are rare. The arm is usually adducted at the shoulder-joint; the elbow is sometimes flexed, sometimes strongly extended. Often the arm, straightened out, is carried behind the body. Tlie wrist is frequently flexed; the fingers are usually flexed at the metacarpo-phalangeal joints, extended, and even over- extended at the others, the spasm preponderating in the inter- osseal muscles. There may be a subluxation of the extended finger-joints, the heads of the phalanges projecting on the palmar aspect. Thus there is a remarkable contrast between this spasm and ordinary late rigidity. In the latter the spasm chiefly affects the long flexors of the fingers; the digits are bent at all joints, a form of flexion that is employed in coarse movements of the limb. In the mobile spasm there is the interosseal flexion just described, the flexion that is em- ployed in many delicate operations, such as the act of wi-iting. The continuous action of the muscles often leads to theii^ overgroAvth, and the limb may be actually larger in cu'cmn- f erence than that of the opposite side, when it is less in length. This condition sometimes developes mthout preceding hemi- plegia ; and to such a case, in which there was no fixed spasm, but only the slowly-changing irregular movements, Hammond (of New York) gave the name of athetosis (=without fixed position). In the vast majority of cases the condition is a