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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    000 syphilis, to cause acute symptoms which' subside, but not perfectly ■ and the residua] disturbance of function may persist, and even increase in the course of years, in consequence of the influence of the previous syphilis in rendering the nerve-elements prone to degenerate. Again, it has been pointed out that the gouty diathesis is an unquestionable cause of myelitis, and often of the grave relapsing and spreading dis- seminated variety. A concussion of the cord, which causes only slight symptoms, may excite the occurrence of this form of myelitis in persons thus predisposed; the symptoms of the later inflammation may come on months after the injury (the effects of which have generally not quite passed away), and are sometimes excited by some over-exertion, or slight fresh concussion which would have had no effect on a healthy individual . I have known the symptoms of insular sclerosis, cerebral and spinal, to quickly follow traumatic paraplegia. One other symptom remains to be considered, which is common to all forms of traumatic lesion of the cord, and is often severe and per- sistent when other symptoms are slight—spinal pain. It may con- tinue for years after other symptoms have ceased, and probably depends on a neuralgic state of the nerves of the membranes or of those of the vertebral column; often, probably, the pain depends on the nerves of the joints and ligaments of the spine. It is essentially a traumatic spinal neuralgia. The pain may be felt at one or more spots ; when severe, it often extends through a considerable length of the spine, and sometimes passes up to the occiput. It is occasionally referred to the sacrum, and may there have the character of a sense of weight or more vague discomfort. The pain is associated with tenderness of the spine, usually deep-seated, chiefly developed at the injured part, but sometimes present also at other spots. It may gradually assume the features of a true neuralgia, may occur in paroxysms, and be induced by mental and other influences which do not act directly on the spine, as well as by exertion, posture, and other agencies that may immediately influence the affected structures. This condition is often called spinal irritation. The cause of traumatic lesions of the cord often acts also on the brain. A cerebral lesion may occur from the violence which affects the cord; the cerebral symptoms then co-exist with those of the spinal lesion, and may mask the latter during the early stage. More common, however, is functional disturbance of the brain, the result, partly, perhaps, of the physical concussion, but chiefly of the mental shock which a serious accident necessarily causes. The resulting condition is favorable to the development and persistence of subjective sensory symptoms. Attention, maintained by concern, has a powerful in- tensifying influence on all forms of nerve-pain, and certainly aids in keeping up the pain in the back, and even the tenderness which follows injuries to the spine. So marked is the influence of nervous- ness on the subjective symptoms, that it has been even maintained that in a large number of cases of concussion of the spine the