Case of remarkable hyper-excitability of all the muscles and tendons of the body to direct mechanical percussion, with clonus of various regions, including the lower jaw : recovery / by A. Hughes Bennett.

  • Alexander Hughes Bennett
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Case of remarkable hyper-excitability of all the muscles and tendons of the body to direct mechanical percussion, with clonus of various regions, including the lower jaw : recovery / by A. Hughes Bennett. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tion lively, but not excessively exaggerated. Sensibility is everywhere natural. Tliere are no trophic changes, and the electrical reactions of the nerves and muscles are normal. The patient was kept for a few days without treatment while the foregoing observations were being made. She was then directed to lie in bed, and ordered chloral hydrate, gr. XX.; pot. bromid. gr. xxx., every six hours. Fourteen days afterwards all the symptoms were notably diminished in degree, but still preserved the same characters as before. About this time she was seized with a mild attack of pleurisy of the left side. The draught prescribed above was discon- tinued, and poultices were applied to the chest. In one week she was convalescent from the pleurisy, and in two had quite recovered. It was then found that all her nervous symptoms had disappeared. On getting out of bed she felt weak, but after a few days expressed herself quite well. There was no trace of spontaneous spasm. The gait was normal, and the patient moved about the ward all day without fatigue. No clonus could be elicited either of eyelids, jaw, throat, upper or lower extremities. Everywhere percussion of the tendons produced natural responses, except at the knees, where they were somewhat lively, but not excessively so. The patient, when seen a month after discharge from the hospital, was found to have retained her improved condition. Commentary.-—This woman, as far as could be ascertained, was healthy in every respect except in the particulars just described, namely an abnormal readiness of all the muscles of her body to contract on the application of local percussion to their substance, and especially to their tendons; and also for this contraction to be succeeded by a rhythmical clonus, sometimes located in the individual muscle, and sometimes spreading to the entire limb or throughout the whole body. The nature of the morbid process which led to the produc- tion of these symptoms is very obscure. That it was not the result of serious gross organic disease is proved by the fact that, although of two years' standing, the affection completely recovered in a few weeks. In the absence of a positive anatomical demonstration we are reduced to speculation, and may theoretically assume the position to be most plausibly explained by a condition of extreme functional over-activity of the ganglion cells of the anterior cornua of the cord and medulla, causing hyper-tonicity of the entire muscular system and its consequent tendency to t^mic and clonic spasm. Even granting this to be the proximate cause of the physical phenomena, we have in this case no means of knowing whether it was primary
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