Nervous diseases : their description and treatment / by Allan McLane Hamilton.

  • Allan McLane Hamilton
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Nervous diseases : their description and treatment / by Allan McLane Hamilton. Source: Wellcome Collection.

    47/540 (page 47)
    organic nervous trouble Avhutever. Ten years ago, Avliilc working ujjon a fire-eseape, lie fell to the ground, two stories below, striking upon his head and shoulder, lie was taken up uneonseious, and remained so for four- teen hours. The only injuries he received were two severe scalp-wounds, one of wiiieh from its slowness in liealing must have been attended by some bone injury, for he was unable to resume work until three months later. He says that purulent accumulations took i)lace, and that the doctor luneed them. Two cicatrices are now visible, one of which is about an inch and a half long, and is situated on the left side of the head and covers a depression about three-iiuarters of an inch in diameter and one-quarter of an inch in depth, the centre of which is about one and one- luilf inches below the median line, five inches above the left ear, and four and three-quarters inches above the centre of the left supra-orbital arch. , This is the only depression visible, and the injury on the right side was apparently very superficial. lie gives no history of serious head symptoms, and when he resumed work was in good condition, there being no paralysis. About three months later he noticed a tremulousness of the fingers of the right hand, and afterwards of the arm of the same side. There was no pain nor loss of power, but simply a marked tremor Avhenever he attempted to do any- thing. This difficulty increased to such an extent that lie Avas obliged to resign his position as first-class workman, and become a helper, using his other arm to work the bellows. About six months after this the tremor afiected the right leg, and he was obliged to leave his work. Present Condition—The patient does not complain of head symptoms, except a slight hyperajsthesiix of the right side of the face, of short dura- tion. Vision normal; fundus of either eye presents no abnormal appear- ances ; pupils respond well to light, and iire of equal size. Hearing unatFected. No tremor of face or tongue, speech unembarrassed, memory trood, and no intellectual trouble Avhatever. He has never had headache. Upper Extremities—Left side unafl^ected. The right hand and arm are perfectl)' quiet during inaction, but when the most simple voluntary act is attempted they become agitated by a fine rhythmical tremor, which becomes more marked as the accomplishment of the act requires greater nicety of coordination. When he is asked to carry a glass of water to his mouth, he spasmodically grasps the vessel and carries it upward, tlie elbow iKjing raised, the tremor meanwliile increasing until the mouth is reached, wlien the movements become so violent that he is unable to place the rim of the glass between his lips. Certiiin motions are almost entirely unat- tended by tremor. He can extend the arm and hand, or can hold them rigidly upright, and is aVjle to pronate the hand, but movements of flexion are attended by increased violence of the tremor. Tactile sensation is somewhat impaired, but susceptibility to painful impressions is not dimin- ished. There is al)solutely no loss of muscular power, no atroj)hy of the hand or arm, the thenar eminences being covered by firm cushions, and the interosseous spaces being well filled. i ^ Lower Extremities—The left leg, like the arm, is in no Avay affected. The right leg, liowever, is agitated by muscular tremor when he attenipis to use it, or aj)proxirnates it with its fellow, as in standing erect. There is no loss of muscular power, but some an;esthesia, the ])atient beino- unable at any place to distinguish two points of the lesthesiometer, iniless they are separated at least eight centimetres. AVhen he stands with his eyes closed he is grf)ggy, but does not fall.