A system of medicine / by many writers.

Date:: 1911

Credit: A system of medicine / by many writers. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

51/944 page 27

$\ harmony with what we know of other diseases than to believe, as Dejerine and Sottas apparently do, that the abnormal contraction of the muscle leads to its abnormal growth. All who have written on the subject agree that it is a disease solely of the muscular system {vide also p. 57). In any discussion on the pathology of the disease, it must always be borne in mind that the peculiar contractions are exactly the same as those which may be induced in animals which have been poisoned by veratria ; as may be readily seen by comparing the curves I obtained with those in a textbook of physiology. Drs. Ringer and Sainsbury found that if phosphate of sodium be given to an animal and the sciatic nerve then stimulated, contractions like those of Thomsen's disease are pro- duced ; and this even if curare had been previously injected. Hence it appears that the Thomsen-like contractions are due to the action of phosphate of sodium on the muscular fibres themselves, and this experi- ment and that of giving veratria strongly support the view that Thomsen's disease is a malady of the contractile tissue of muscle. Symptoms.—Peculiarity of Movement.—This only occurs in voluntary movements, and consists in the fact that the contraction of the muscle which the patient wills to move is slower than normal, and that, because it relaxes gradually and very slowly, it remains for some seconds more or less contracted ; this contraction is so strong that the antagonistic muscles cannot overcome it. If a certain voluntary movement is repeated several times the patient begins to execute each movement before the preceding contraction had completely relaxed, and his difficulty as regards the stiffness gradually becomes less and less in each movement. Walking is very commonly affected ; for example, if the patient is standing still and sets out to walk, he puts forward one leg rather slowly, it then remains stiff for a few seconds; the next time it is moved the stiffness is of shorter duration, and he soon walks quite comfortably even for miles; but if he trip against a stone, and thus brings into play some new muscular combination, the nuiscles newly engaged become stiff, and he may fall down. Flexion of the fingers usually illustrates the peculiarity of the disease very well; it is obvious that the flexor muscles contract more slowly than normal; they appear to remain completely contracted for from one to three seconds, and then they are not at once completely relaxed, for if the patient is told to unclose the hand as quickly as possible it is often between seven and ten seconds before the extensors completely overcome the flexors ; as they do so, first the metacarpo-phalangeal joints become slowly extended, then the middle phalangeal, and finally the terminal phalangeal joints. If flexion be repeated as rapidly as possible the second contraction obviously occurs more ra])idly than the first, the third more rapidly than the second ; and after about half a dozen contractions the action appears quite normal; yet even then myographic tracings shew that many contractions take place before they become quite regular. The difficulty is the same whatever muscles are affected, and different patients find different movements particularly difficult. Thus the patient, from whom I took tracings, being a carpenter, finds it$

A system of medicine / by many writers.

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