Organic and functional nervous diseases : a text-book of neurology / by M. Allen Starr.

  • Moses Allen Starr
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Organic and functional nervous diseases : a text-book of neurology / by M. Allen Starr. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    1013/1038 (page 951)
    of the face^ are very markedly enlarged. It is evident from Baum- garten's study that the term leontiasis ossea must be limited to the cases in which the hyperostosis of bone has affected the bones of the cranium only, or these, together with the bones of the face. He con- siders that the pathological changes present are either a thickening of the surface of the bone alone, or a change both in the surface and the diploe ; the latter being in some cases transformed into a spongy tissue ; in others, into a hard tissue like ivory. He admits that the literature does not contain any description of this disease observed during life, and he does not think that cases have been observed. It is my opinion that the case here described is this disease, and that we can affirm that in these cases there is not only a hypertrophy of the bony tissue, but also of the soft parts about it. It is probable that the diffuse thickening of the bones of the head and neck causes some pres- sure upon the contents of the skull and upon the nerves at their exits between the vertebrae. This might explain the symptoms which are present in our patient — especially the complaints of numbness and the difficulty in her gait. Various forms of treatment have been pursued in the case under consideration. A thorough trial of thyroid extract failed to affect the condition in any way, and did not cause any variation in temperature from normal. The use of arsenic and strychnine, given in moderate doses, appears to have had some tonic effect, and these, together with the moderate use of corrosive sublimate internally, are the remedies relied upon. I have ventured to give the condition the name megalo-cephalie, because, as already shown, the term leontiasis has been applied to three entirely distinct conditions, and therefore leads to confusion. Since this case was described by me in 1894 several similar cases have been put on record. They all illustrate the condition of a localized hypertrophy of the bones of the head. Ulcerations of Neurotic Origin.—The most important trophic disturbances are those which consist of an actual disintegration of tissue. These are very numerous. Herpes zoster, certain forms of eczema and pemphigus, lepra ansesthetica, scleroderma, acute ulceration of the fingers, perforating ulcer of the foot, acute bed-sores, keratitis with anaesthesia of the cornea, sympathetic ophthalmia, and various forms of joint disease, are examples of such trophic diseases. For the discussion of the skin and eye diseases mentioned, the reader is referred to special articles on those subjects. Herpes zoster has been discussed in the chapter upon Neuralgia, page 731. In regard to lepra anaesthetica, reference may be made to page 243. I have reported a case of acute ulceration of the ends of the fingers and toes occurring in an anaemic girl aged twelve, and persisting for more than a year, associated with cyanosis of the hands and feet, and with a tendency to ra))id ulceration of any part of the body which happened to be exposed to pressure. The hair of the eyebrows, eye- lids, and to a less extent that of the seal]), fell out during the disease.