Volume 1

A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper.

Date:
1893-1894
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper. Source: Wellcome Collection.

    877/962 (page 857)
    is put forward slowly, and for perhaps a second or two is stift'and can scarcely be moved. Gradually this rigidity wears off', the legs become limber, and the patient can walk for hours without fatigue. After a period of I'est the same initial difficulty is experienced. Tiie muscles of the arms and legs are those implicated. Motion and cold aggravate the condition. Sensation and the reflexes are normal. In soma instances there have been mental changes, such as hypochondria. The patients are well nourisiied and appear muscular. In .some instances there has been great increase in the muscular strength ; in others the strength is scarcely in ])ropoi'tion to the size of the muscles. The muscles are voy sensitive to mechanical stimuli, and pressure upon tliem may be followed by a tonic contraction lasting many seconds. Erlj has described a characteristic reaction of the nerve and muscle to the electrical currents, the .so-called myotonic reaction, the chief feature of which is that the conti'actions caused by either current attain tlieir maximum slowly and relax slowly, and that vermicular wave-like contractions pass from the cathode to the anode. The condition persists throughout life. In a few instances it has been arrested temporai ily, and there have been changes and variations in the intensity of the manifestations. No post-mortem has yet been made upon the disease. Many examinations have been made of excised portions of muscle, and in all instances the fibres Iiave been found to be greatly increased in size, and in some in.stances accom- panied with ail increase in the nuclei of the sarcolemma and of the interstitial tissue. The true nature ol the disease is unknown, but it is usually ]>laced among affecticjus of the muscles. No treatment for the disease has yet been f )und. Afi'ectifjns which may be regarded as varieties of Thomsen's disease are on record ; thus, Eulenberg reported a series of cases, the history of which could be traced through six generations, in which there were tonic spasms of variable duration, affecting chiefly the muscles of the face and less often those of the extremities. The contractions are followed by weakness. As it appeared in some members of the family shortly after birth, he termed it congenital jiara- myotone. In other instances, as in a case described by Gowers, the tonic spasm was associated with distinct ataxia. Paramyoclonus Multiplex. This is an affection first described by Friedreich, characterized by clonic contraction, chiefly of the muscles of the extremities, occurring usually in paroxysms. A majoritv of the cases have been in male adults. The disease has most frequently followed fright or violent emotion or an injury. The clonic spasms usuallv begin in the muscles of the legs, and may at first not be severe enough to prevent the patient from working, and they can be to a certain measure controlled. They are, as a rule, bilateral, and vary from fifty to a hundred and fifty in a minute. In the intervals between the attacks there may be tremors in the muscles. Sometimes the contra<'tit)ns are definitely rhythmical.