Volume 1

Sajous's analytical cyclopædia of practical medicine / by Charles E. de M. Sajous and one hundred associate editors.

  • Charles E. de M. Sajous
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Sajous's analytical cyclopædia of practical medicine / by Charles E. de M. Sajous and one hundred associate editors. Source: Wellcome Collection.

    738/748 (page 700)
    CATALEPSY. TREATMENT. that the communication between the higher and lower nerve-centres is made difficult or entirely impossible, as wit¬ nessed in lesions in the upper portion of the cord and in the motor regions of the brain, the muscular tonus is not only increased, but the deep reflexes are also increased and the typical wax-like condi¬ tion of the muscles, as observed in cata¬ lepsy, is rarely seen. In catalepsy, on the other hand, while the muscular tonus is increased, the deep reflexes are dimin¬ ished. It is a curious fact that compara¬ tively mild passive motion will cause the limbs to mold themselves in various positions in catalepsy; yet a far greater stimulant to muscles, muscle-nerves, and cutaneous nerves—the strongest faradic or galvanic current—fails to accomplish the same result. [This does not seem to me so difficult of explanation as Eulenburg seems to infer. By passive motion the limbs are not made, even in catalepsy, to assume different positions on account of any stimulation, either direct or indirect, communicated to any reflex nervous ap¬ paratus, but the change in position of the limb is the result of mechanical force, applied usually to the best ad¬ vantage to accomplish the desired re¬ sult. On the other hand, when elec¬ tricity is applied to a group of muscles to cause flexion or extension of a limb, the power does not act to the same ad¬ vantage to cause the limb to assume different positions as is the case when passive motion is employed; besides in the use of strong currents of electricity diffusion of the currents to a greater or less extent takes place, and in con¬ sequence, indirect stimulation of the an¬ tagonistic group of muscles results. J. T. Eskridge.] Rosenthal thinks the waxy mobility is due to reflex contraction. Eulenburg, in commenting on this conclusion, states: “To the latter view we are at all events driven; but just the ‘how?* and the wherefore?’ of the form or reflex action is, alas! still unknown to us.” At the present day it is impossible to account for all the phenomena that oc¬ cur in catalepsy. That it is a symptom of a disordered condition of the highest nerve-centres, the cerebral cortex, seems to be a fact. That during the attacks, the nervous system, especially the spinal representatives of it, is in an excitable state, with a disarrangement of the nor¬ mally-adjusted influence of the higher nerve-centres over the lower appears to be equally true. When the pathology of hysteria is thoroughly understood then we shall be able to explain many, if not all, of the manifestations observed in catalepsy. Until then we may observe and gather facts to be utilized. [No one in discussing the theory of the mechanism of the phenomena that occur in catalepsy has apparently taken into account the possible influence of suggestion. J. T. Eskridge.] Treatment.—This should consist of measures for the relief of the paroxysm, and the employment between the attacks of those agents most likely to aid in toning up the nervous system, together with such changes in the daily life and surroundings of the patient as are best adapted to improve the mental state. Two cases showing the beneficial effects of thyroid medication after the complete failure of other methods of treatment. Conclusions: 1. That in conditions marked by inhibition of sensory, motor, and mental activity, without gross or¬ ganic lesion, such as are met with in catatonia and in certain types of stu¬ porous insanity and melancholia, we may expect benefit from thyroid medi¬ cation, judiciously used. 2. That the effects of thyroids in full dose bear a striking resemblance to many of the symptoms of Graves’s dis¬ ease, namely: orbicular weakness, con¬ secutively conjunctivitis, skin eruptions, and temporary bronzing, without icterus