Paralyses : cerebral, bulbar and spinal : a manual of diagnosis for students and practitioners / by H. Charlton Bastian.

Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Paralyses : cerebral, bulbar and spinal : a manual of diagnosis for students and practitioners / by H. Charlton Bastian. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    Meanwliile, a most typical sign soon stows itself in the paretic or ■semi-paralysed limbs, in the form of a marked trembling or shaking of those muscles or parts of a limb which are called into voluntary action with any intensity, although these ]3henomena immediately sub- side when the voluntary exertion ceases. The involuntary movements consist either of extremely well-marked tremors, like those met with in some cases of paralysis agitans, or else of movements of greater range, more resembling those of chorea. Later, some paresis of the trunk-muscles may occur, as well as of those of the neck ; and this may be followed by a similar affection of the tongue, lips, and facial muscles—possibly, also, of those of the palate, pharynx, and larynx. When a patient affected in this manner, who has been previously lying perfectly still in bed, is told to endeavour to sit up, shakings and tremors begin in almost all parts of the body, and the scene is strangely changed until all voluntary efforts cease, and the recumbent position is again assumed. The same kind of thing is seen when movements of particular parts of the body are attempted : thus wlien, in the sitting posture, the patient attempts to hold up one leg,'tremors of it immediately begin ; ask him to take hold of some- thing or to squeeze a dynamometer, and the upper extremity called into action at once begins to shake ; request him to put out his tongue, and immediately irregular protrusions of the organ occur, associated with twitchings about the angles of the mouth and even in other parts of the body. The act of walking may cause, in more or less advanced cases, tremors of the legs, arms, trunk, head and neck —all at the same time. Movements of slight intensity occasion either no shakings or merely tremors of a very fine kind. The latter are seen in the early stages of the disease, when writing is attempted. Almost each letter registers a number of fine tremors, mixed here and there with greater irregularities. In more advanced cases, however, the movements are so disorderly that writing becomes either impossible or wholly illegible. Just as there is no loss of ordinary sensibility, so we find that patients generally remain fully conscious as to the positions and move- ments of their limbs, and that closure of the eyes occasions no increased uncertainty of their movements ; nor, when in the standing position, are they rendered more giddy or more unsteady by such a proceeding. All these signs may, however, be different in those cases in which the posterior as well as the lateral columns of the cord are distinctly -affected. Such cases are met with not unfrequently.