Diphtherial nerve-affections / by Edward Headlam Greenhow.

  • Edward Headlam Greenhow
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: Diphtherial nerve-affections / by Edward Headlam Greenhow. 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.

    10/20 (page 8)
    thesia venders the sense of touch so imperfect, tliat, both in endea- vouring to walk and to use the hands, the patient is compelled to direct his movements by the eye. The sense of numbness is pretty constantly present in these cases, but the formication is chiefly, perhaps only, felt when efforts are made to move the affected limbs. If the paralysis continue for any length of time, the muscles concerned become flabby and sometimes very much emaciated, and their strength becomes so much impaired that patients Avho can move the affected limbs freely in bed often walk with much difficulty, or are- even unable to stand, their limbs bending under them in the effort, so that, unless sup])orted, they fall to the ground. Very often this loss of power and numbness are accompanied by increased sensibility of particular parts of the affected limbs. There is tenderness of the soles of the feet, of the calves of the legs, or of the fleshy parts of the arms ; besides this general tenderness, pressure of the instep between the finger and thumb often causes acute pain, with convulsive starting of the leg and foot; and pressure along the large nerves of the arm and thigh, especially the sciatic and median nerves, is attended by pain or acute tenderness, as shown in Case 3 (Davis). In Case 4 (Wise- man), there was very considerable pain on percussion over the dorsal and lumbar vertebras, and also tenderness on pressm-e by the sides of the vertebras, from the lower dorsal region doAvnwards. In the severest cases of diphtherial paralysis and auEesthesia, a sense of tightness is often experienced as if the parts were firmly bandaged. Tiiis does not usually occur till the patient is begin- ning to mend, and is then often very troublesome, affecting some- times only one set of limbs, but extending in other cases to the arms, legs, and abdomen, as will be seen by reference to Cases 3, 4, and 5. Patients occasionally speak of their limbs as swollen, but this is an error arising from the sense of constriction above described, as is proved by the fact that the feeling of swelling is often worst where the limbs, in consequence of emaciation, are much smaller than in health. The paralysis in some cases assumes a more or less hemiplegie character, as in Case 5 (Hawker), but I have seen no instance in which one side being paralyzed the other remained entirely unaffected. Nerve-affections of a graver character than any of those exem- plified in the present group of cases, sometimes, though not fre- quently, follow diphtheria, and several even fatal cases have fallen under my notice in private practice. In three of these latter, death was caused by failure of the action of the heart; in one of them it was sudden, apparently from syncope; in the others, more gradual, the pulse becoming slower and slower, until, in one instance, it fell below thirty beats in the minute. I have also seen one case m which, when the patient appeared to be convalescent, vomiting supervened, and proved fatal in a few days from exhaustion. For- tunately, however, such cases arc rare, and the great majority of