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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    Gl commissure are not uncommon evidences of tlie violence of tlie diseiise. Piitclies of false membrune which contain in tlieir mesiics these granular bodies are scattered over the convexity and base, and render the removal of the brain or its membranes separately a som(!Vvliat difficult nuitter. The hui<?s, or other organs, may also present indications of tuberculous matter. Rendu' affirms that whenever there is paralysis of jjermancnt form there must be some arterial obliteration from fibrinous exudation and consequent softening, and he does not believe that scattered granulations or ventricu- lar etl'usion are alone sufficient lor its causation. It is rarely possible to very closely localize limited deposit before death, but occasionally this may be done. A very interesting case is reported by Raymond Avhich presented seve- ral suggestive points. One was that the motor centre of the right arm was the seat of granular lesion, and that there was paralysis of that mem- ber. This, then, is an exception to the rule to which I have just re- ferred. The patient, a man twenty-two years of age, was admitted into the hospital in the early part of the month of January last, and then presented obvious symptoms of pulmonary tuberculosis, not, however, very pro- nounced. The affisction, indeed, seemed so be progressing slowly. He was thin, pale, coughed a good deal, and was a little feverish. On January 28 he began to complain of violent pain in the right hy- pochondi-ium, and two days later vomiting came on. This recurred fre- quently, the ejected matter having a greenish color. At the same time he suffisred from severe headache, -which affected chiefly the left side of the head. Fever then showed itself, the temperature rising to 140° ; the pulmonary lesions developed more rapidly, and the general condition be- came much worse. On March 24 he complained of great pain in his right arm, which seemed to be very heavy ; at times he had great difficulty in moving it. On March 25 there were fresh pains in the arm, and motor paralysis was complete, sensibility being retained. In the evening, with a great effort, he succeeded in raising his arm to his head. The paralysis of the arm, up to the time of his death, presented the character of inter- mittence. There never existed any trace of paralysis in the right leg nor in the left arm or leg. Perhaps there was a slight degree of loss of power in the bucco-labial muscle of the right side, and a sliglit deviation of the tongue to the left, but these symptoms were a little doubtful. In the whole case, there was nothing else comparable with the paralysis of the arm, which was indisputable. The patient died on April 4. At the necropsy, far advanced tubercular lesions w-ere revealed in the right lung, and the membranes of the brain were found to be the seat of tubercular granulations. These were found in the pia mater over the right lo])e, and there they were disseminated along flie parietal branch of the Sylvian fissure. On the left side, in addition to the tubercular granu- lations, there existed some meningitis with purulent deposits. The men- ingitis was, if it may be so said, circumscribed and localized on two con- volutions, the anterior and posterior marginal near tiie paracentral lobe. ' Review in Gaz. dcs HGpitaux, Jan. 15, 1873.