On diseases of the spine and of the nerves / by Charles Bland Radcliffe, John Netten Radcliffe, J. Warburton Begbie, Francis Edmund Ainstie, and John Russell Reynolds.

Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: On diseases of the spine and of the nerves / by Charles Bland Radcliffe, John Netten Radcliffe, J. Warburton Begbie, Francis Edmund Ainstie, and John Russell Reynolds. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    of a person considerably older than himself. The pain went off' in a few minutes, and soon afterwards the stiffened muscles relaxed. The effort to move, one of the legs spontaneously gave rise to sharp pain in the thigh and loins, and the limb became somewhat stiffened in a semi-flexed position, and this state of things did not pass off' for several minutes; and passive movement produced the same result. There was no numbness: on the contrary, the condition of the skin as to sensation everywhere, as judged by pricking and pinching and by differences of temperature, was plainly that of slight over-sensitive- ness. Pressure along the spinal column failed to detect tenderness anywhere, and the result of applying a sponge wrung out of hot water was equally negative. In the course of the examination it was evident that any movement of the body, or neck, or legs, active or passive, gave rise to pain and stiffness in the muscles moved; and also that there was little or no pain or stiffness so long as the patient kept quite still. It was evi- dent, in fact, that the muscles were relaxed, except perhaps in the neck, in the intervals between the paroxysms. The poor sufferer was evidently in a great strait, dreading all movement, because he knew full well what the effect of movement would be, and at the same time continually prompted by an intolerable feeling of unrest and fidgeti- ness to wish to have his position changed in a way which he could not or dared not compass by his own efforts: and it is difficult to avoid the conclusion that the stiffness is, in the main, an instinctive act to prevent the movement which gives rise to the pain, rather than spasm like that which is met with in tetanus. The arms are affected as well as the legs, but not to the same degree. They are weak—so weak that it is not easy to find strength to carry the food to the mouth, the left arm being somewhat the weaker of the two. The left arm also cannot be moved, either actively or passively, without giving rise to pain and rigidity, to pain shooting up between the shoulders, to rigidity flexing the limb somewhat at the elbow, and bending the thumb slightly into the palm: not so the right arm. There is no numbness in either arm, and no very decided over-sensitiveness. Mastication is difficult, and deglutition still more so, apparently from the muscles set in movement becoming stiff in moving. The breathing is shallow and slow; the pulse quick (130) and very wanting in strength; the skin profusely perspiring after a paroxysm, and hot and moist at other times. Thirst is much complained of. The bladder is full, and it cannot now be emptied voluntarily. The urine is acid. The penis is flaccid, and has been so ever since the commencement of the illness. The bowels have not acted. The pupils are equal and natural, and there is no headache or other head symptom. BOth.—A tolerably good night has been passed, and this after- noon the patient thinks himself a little better. Slst.—There has been a bad night, and much ground has evi- dently been lost since the last visit. In a paroxysm which is just over, want of breath was experienced rather than pain. Sensation is still somewhat exaggerated everywhere. Urine cannot be passed without the catheter, but the bowels have responded to-day to a dose