On the pathology and treatment of convulsive diseases / [by R. B. Todd].

Robert Bentley Todd

Date:: 1849

Credit: On the pathology and treatment of convulsive diseases / [by R. B. Todd]. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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sary will show ; and when we remember how many of these cases are neglected, left solely to nature, receiving neither care nor medical assistance,—we are fully justified in laying it down as a feature of the disease, that its natural tendency is to get well. Whatever morbid disturbance may take place in any of the internal organs calculated to give rise to chorea, it may be presumed from the facts I have detailed that it is not such as does not admit of easy amendment ; and the few post mortem examinations on record of patients dead of this disease, show that it leaves beliind it no trace of any lesion in any organ of the body likely to produce it. In some of the cases no morbid lesion of any kind could be detected ; and it cannot for a moment be imagined that the slight opacities of the arachnoid, the effusion of liquid in the spinal canal, the marks of chronic ovarian disease, noticed in other cases, could at all have the relation of a cause to the phenomena of the disease. How many hundreds of spinal effusions, or opaque arachnoids, or irritated ovaries, have there been without the slightest indication of chorea! So far for such points in the clinical his- tory of chorea as may serve me as a basis for my argument respecting its pathology. I have already stated that movements analogous to those of chorea may occur in rheumatic or gouty states. I have known such affections of the upper, and more rarely of the lower, extremity. The affec- tion consists in a sort of fidgetty restlessness of the limb, and a difficulty, and sometimes an impossibility, of accomplishing certain actions with anything like accuracy or pre- cision. In the cases which have come under my own observation there has been a con- siderable development of the gouty constitu- tion. There is a curious affection, of which I have met with two examples in my own practice, and of which five or six have been recorded by Albers of Bremen : the pro- minent feature of it is the inability to hold a pen and to write for any time. The pa- tient begins to write—writes two or three words—when the hand forthwith is spasmo- dically extended, the fingers cease to be controllable, the pen falls away from them. If the patient attempt to control his pen hand with the other hand, or if any one else does it for him, the movements become worse, and he suffers excessive pain up the arm : yet all other actions are well done, and the power of the hand to grasp is good. One gentleman thus affected is a man of consi- derable mental endowments, and he has found it so impossible to overcome the irregular movements of his hand, that he has trained himself to write with his left hand, which he can now do with such facility that he can carry on an extensive correspondence. There can be no doubt that the impair- ment of speech, which is sometimes a fore- runner of cerebral mischief, and which ought always to be regarded as a warning of such an invasion, is of this character. Emotional excitement will cause hesitation of speech in many healthy persons : many can do cer- tain things very well if allowed to take their own time, but if hurried and flurried they are apt to bungle about them very seriously. In one instance I found well-marked choreic convulsions of the right arm, with disturbed intellect, and gangrene of the toes, associated with extensive colourless softening of the left cerebral hemisphere, involving the optic thalamus. Allied to the movements of chorea are the fidgets of children, and, perhaps, also those of grown persons. In some children these fidgetty movements are so excessive that the child becomes almost a nuisance in a room. All the muscles are affected ; the child incessantly makes grimaces of the most various kinds ; every minute he as- sumes a new attitude; if any thing comes in his way he must handle or touch it: and these irregularities are always the greater when there is derangement of general health. Children thus afi'ected might readily be thrown into the convulsions of chorea by a strong mental emotion. My second class of convulsive affections is typified by the well-known malady, Tetanus. The points to which I would beg your particular attention in the clinical history of this disease are these :— 1. Tlie little variation of the symptoms in different cases of tetanus as compared with each other. If you see one well- developed case of tetanus, you have seen all; the variations are only as to the degree of tetanic convulsion: in r 11 you have the tetanic face, the rigid limbs, the locked jaw, the opisthotonos. In the acute form of the disease, indeed, the malady runs its course with much greater, sometimes with extraordinary, rapidity ; while in the more chronic form it lasts a fortnight or three weeks, and in a few a much longer period. 2. The fact, now abundantly proved, that these symptoms occur without any lesion of the nervous system appreciable by aided or unaided vision ; and what is equally remarkable, the artificial tetanus (if I may so speak) caused by the administration of strychnine in large doses, occurs equally without the slightest lesion of any part of the cerebro-spinal axis. I have examined, with the most scrupulous care, the spinal cords of rabbits which died in strong tetanic convulsions, kept up for some time after

On the pathology and treatment of convulsive diseases / [by R. B. Todd].

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