Myasthenia gravis / by Charles S. Myers.

  • Charles Samuel Myers
Date:
1902?]
Catalogue details

Licence: In copyright

Credit: Myasthenia gravis / by Charles S. Myers. Source: Wellcome Collection.

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    microscopic examination. Serial sections were made of the pons, medulla, and upper part of the cord, and were stained with various staining reagents, most of them after Weigert’s method. No changes, either in the ganglion cells, or in the nerve fibres, or in the neuroglia cells were found. In a few specimens the walls of the blood vessels appeared thickened, and showed slight cellular infiltration in the perivascular spaces, but no haemorrhages; no degeneration of nerve fibres or atrophy of the ganglion cells could he seen. The nuclei of the cranial nerves showed the ganglion cells in all their integrity, with processes, and in some places the network of fibres. Some of the cranial and spinal nerves were examined both fresh and hardened, and showed nothing abnormal. Of the motor cortex, and of some parts of the basal ganglion, sections were made and stained, and on examination gave equally negative results as to any pathological changes. Case 8 (described by Goldflam) (22, 22^<)._A man-servant, set. 25, came under treatment on December 22, 1891. His illness began seven weeks pr^ viously with cervical numbness, limitation of cranial movements, headache, and giddiness during stooping. A week later the speech and swallowing were affected, then movements of the arms, quickly followed by those of the legs. Latterly he had had tearing pains in the shoulders and sacral^ region. In the course of two weeks the limbs became so weak that the patient was hroug t bedridden to an infirmary. Two weeks later (six weeks from the onset) he was sufficiently improved to leave the infirmary. His previous history had been in all respects satisfactory. Condition on Admission to the Polyclinic.—Patient was a well-developed man, with heart, lungs, and other viscera healthy. His speech was nasal, especially after he had conversed for some time. The soft palate was very slightly movable. The pharyngeal and laryngeal reflexes were markedly diminished. The lower jaw moved feebly. Movements of mastication and deglutition quickly induced fatigue. Bilateral lagophthalmos, diminishe conjunctival and corneal reflexes, Graefe’s and Stelwag’s signs present, weakness of the neck and of all limbs, especially of their more proximal muscles; the head fell forwards. Thyroid gland normal. The knee_ jerks were active. There were no sensory disturbances, no atrophy, no fibrillar tremors. Ihe electric reactions of the muscles and nerves were normal. Urine was normal. Eespiratory movements superficial. Lingual and facial movements ^^rma . Eyes moved and reacted naturally. No exophthalmos. December 28, 1891. Improvement in the limbs, but the movements of deglutition were worse. January 9, 1892.—Knee jerks weak and easily fatigued. January 16,1892. No cervical pain; general improvement. February 1, 1892. A relapse. February 8, 1892.—Palatal reflex better. Laryngeal reflex normal. Graefe s si^n very slight. Slight double ptosis. February 10, 1892.—Palatal and pharyngeal reflexes normal. Patigue of one limb induced fatigue of the other. February 22, 1892.—Variations in the progress of the disease from day to day. AuWZ 11, 1892.—Continuous improvement. Patellar reflex still feeble. Heel reflex and arm reflexes normal. Patient was discharged, but was unfit for work and tired readily after a long walk. February 4, 1893.—Improvement maintained. Treatment had consisted in almost daily transverse galvanisation of the spinal cord, and in the administration of iodine, iron, and arsenic. December 7, 1897.—A relapse, in which a new phenomenon developed, namely, a limitation in downward movement of the lower jaw. The legs tired, but not so easily as before. The knee jerks could not be exhausted. There was no myasthenic reaction. January 4, 1898.—General advance of the diseas^ ihe deltoid and cervical muscles were markedly affected. The patient became dyspnoeic when walking. Diminution of excitability of the deltoid and biceps brachii by repeated electrical stimulation. February 3, 1898. Patient had to cease from hard work. February 9, 1898.—The left lid drooped more than the right, and its movements were more limited. July 15, 1898. Genera
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