Nervous diseases : their description and treatment / by Allan McLane Hamilton.

Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Nervous diseases : their description and treatment / by Allan McLane Hamilton. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    I. TETANY. A liglit form of attack arising generally from diurrlioja, cold, and con- stipuHon, and sonuitinies milking its a|)i)eanuic(i during lactation. There is usually some I'ormieation of the palms or soles, and an.awkwardness in the movements of the hands and feet, which is afterwards followed by a firm tonic contraction of the muscles of either of tliese ])arts. The flexors are usually contracted, so that the hand is curved, or all the fingers closed. A more decided contraction may flex the forearm on tiie arm. Tlie foot may be also aftected, a condition of talipes resulting, or the back part of the leg may be brougiit in apposition to the thigh. In marked forms the upper and lower extremities are affected together, though tiicre is no rule governing this, and the spasm may be bilateral or unilateral. The attack rarely lasts beyond an hour or two, and in the majority of instances relaxa- tion may take place in from five to ten minutes. The spasms may come on from time to time, being separated by greater or less intervals. They are entirely uncontrolled by the will, and the patient cannot open his fin- gers wlien tliey are thus contracted. In more severe forms the muscles of the trunk or face become involved. Contraction of the ocular muscles, laryngeal spasm, trismus, or vesical spasm are examples of more violent action. The spasms seem to be produced when pressure is made upon a nerve-trunk or muscular belly, and there is loss of tactile sensibility asso- ciated with neuralgic pain in the main nerve-trunk of the convulsed limb. Tetany differs from true tetanus from the fact that the spasms affect the limbs, that they are intermittent in character, and that there are intervals of relaxation. Petit-mal sometimes resembles this condition, but there is always some loss of consciousness. II. FUNCTIONAL SPASM AVITH VOLUNTAHY MOVEMENTS. MitchelP reports some cases of functional spasm, which somewhat resem- bles the so-called tetany. The spasm appeared during the exercise of a voluntary act; they occur with the act of laughing, chewing, and talk- ing, and evidently depend upon functional derangement of muscles inner- vated by the first cervical and spinal accessory nerves. In one case the head was drawn back, and the spine bowed so that the patient was jerked into a squatting posture, the gastrocnemius being finally affected. In other cases the spasms occurred when the individual began to walk. In still other cases there was a rhythmical motion when the patient attempted any simple voluntary action. These Weir Mitchell called pendulum spasms, the number of twitches averaging IGO per minute, and recurring with great regularity. Bamberger''' reports a case which resembled spasm of another kind, of which I shall presently speak. Whenever the child was held in the stand- ' Am. Journ. Med. Sciences, Oct. 1876. « Quoted by Handfield Jones, Functional Nervous Disorders.