A manual of diseases of the nervous system / by Sir W.R. Gowers ; edited by Sir W.R. Gowers and James Taylor.

  • William Richard Gowers
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A manual of diseases of the nervous system / by Sir W.R. Gowers ; edited by Sir W.R. Gowers and James Taylor. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    SYMPTOMS. that acute disturbance of nutrition is the result of irritative changes in the nutrition of the nerves, and is in proportion to the intensity of that irritation. If a thread i« passed through each sciatic nerve, and one is also irritated by the a] >] ilication, from 1 ime to time, of irritanl liquids, trophic changes occur in that limb with greater rapidity and far greater intensity than in the other (Lewaschew). The same fact is frequently indicated by the extreme readiness with which trophic lesions of the skin, and even cellular tissue, occur in certain forms of inflammation of the spinal cord, especially in those that have a strong tendency to spread in the cord, and to the nerves, if they reach the centres of them. The only apparent explanation of the various facts is that the nerve-endings are related, to the tissues in such a way that the nutrition of the molecules of the tissues is determined in its character by that of the nerves. The process of irritation descends the nerves ; it passes from them to the tissues, and extends to all that are in continvrity. Thus we can understand equally the acute changes in the muscles, which will be described as resulting from disease of the motor nerves, and also those in the skin and other tissues that are under the influence of the sensory fibres. Nutritive changes in the skin are easily recognised, but they differ much in their character according to their acuteness. When they are rapid, and due to very acute irritation of the nerves or the spinal cord, such as those just mentioned, the temperature of the limb is raised, the vessels readily dilate, and remain dilated for a long time, bidlse form, containing a dark-coloured liquid, and slight pressure occasions a slough. These changes sometimes seem to occur spontaneously, but are more often excited by some cutaneous irritation, and very slight irri- tation of the skin will suffice to produce them. Trifling pressure will set up a slough, and extensive vesication may result from the applica- tion of a hot-water bottle that is not more than pleasantly warm to a healthy hand. When the nerve irritation is intense, effusion may occur into the joints. In the case of the fifth nerve, acute trophic changes occur in the eyeball, chiefly when the disease involves the Gasserian ganglion, or the nerve in front of it. To produce the same effect, a lesion behind the ganglion has to be more irritating than one in front of it, and a similar relation obtains in the case of the spinal nerves and the spinal ganglia. The cells of the ganglia govern the nutrition of their processes in each direction, i. e. of the whole neuron, and we can understand that they have some power of hindering the propagation of irritative changes, while, if these invade the ganglion, they pass thence with special energy. Very intense changes in nutrition may thus pass to the skin in acute inflammation of the spinal cord. The alterations in nutrition in chronic lesions (which have been carefully studied by Paget and Weir Mitchell) differ considerably from 1 hose that result from acute irrital ion. There is a slow change in the nutrition of thesMn, which becomes red, thin, and shiny—the glossy