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.

    6/20 (page 4)
    A brief period of convalescence usually intervenes between the disappearance of the primary, and the appearance of these secondary, symptoms of diphtheria. If the case have been treated in aii hospital, the patient may even, during this intervening period, have been discharged as well; and several cases have fallen under my notice in private practice, in which patients who had apparently recovered, and had been sent from home for change of air, have subsequently fallen into a helpless condition from the accession of diphtherial paralysis. In Case 4 (Wiseman), the patient had returned to his work before the manifestation of the impairment of sight, which, as will be seen in the report of his case, was the beginning of his nervous disorders. The duration of this interven- ing period of apparent convalescence is uncertain; it does not generally exceed a few days, but it may occasionally, as in Case 5 (Hawker),. extend to several weeks. The fact of the frequent occurrence of this interval between the subsidence of the primary disease and the accession of the secondary nerve-affections is the more important, because it shows that the latter can by no means be entirely attributable to debility or antemia, seeing that patients have often during this interval begun in some degree to regain flesh and strength, and yet have not escaped the subsequent acces- sion of paralytic symptoms. Neither can these nerve-affections be considered as attributable to the albuminuria which so often accom- panies the acute stage of diphtheria, seeing that this symptom has also for the most part either disappeared, or at least greatly diminished, previous to their accession. Thus, in Case 1 (Mufford), there was a copious deposit of albumen in the urine during the last days of January, but it had nearly disappeared on the lltli of February, Avhen the patient's voice became of a nasal character, and a mere trace of it was found on 16th February, when the tip of the tongue and the fingers began to be paralyzed. In Case 3 (Davis), the urine contained much albumen at the time he first came under obser- vation, but the quantity had much diminished by 24th March, and it had entirely disappeared before 14th April, although the nervoiis symptoms, from which he suffered so severely, did not reach their greatest intensity till 12th May. In Case 2 (Bunkall), albuminuria was likewise found on the admission of the patient into the hospital, 17th December, and the presence of much albumen in the urine was noted on 28th December ; but it had diminished to a mere trace by the 10th January, and then disappeared, altliough the nervous disorder did not subside until nearly a month later. These nerve-affections do not at once attain their maximum of intensity, but are progressive, although their progress CA-cn in tlic same sets of muscles is seldom quite uniform. For exanii)lc, tlie grasping power of the hands will vary somewhat from day to day, as in Case 5 (Hawker), or the power of using the lower linibs will vary, so that a ])atient who could scarcely walk at a certain date nmv be much better able to do so a few days later, and yet retro-