Systematic case-taking / by Henry Lawrence McKisack.

  • McKisack, Henry Lawrence.
Date:
1912
Catalogue details

Licence: In copyright

Credit: Systematic case-taking / by Henry Lawrence McKisack. Source: Wellcome Collection.

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

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    standing with closed eyes is known as Romberg's sign. Want of neatness and accuracy in the various movements is to be noted. This is best marked when the eyes are closed. Thus, he may be directed to touch the tip of his nose with his forefinger, or bring the forefinger of each hand together, the eyes being closed. The legs may be tested by requesting him to describe circles or other figures in the air, or on the floor, with his great- toe, to touch certain spots with his toe or heel, to walk along a board or follow a pattern in the carpet, etc. His mode of progression, or gait, is to be observed ; it may be stamping, reeling, or stumbling. Inco-ordination is found in (i) lesions of the posterior columns of the cord, of which locomotor ataxia is the commonest example; (2) lesions of the cerebellum ; (3) disease of the semicircular canals and vestibular nerves causes an ataxia similar to that of cerebellar disease [vertigo], and, when accompanied by vomiting, deafness, faintness, and other symptoms, is known as Meniere’s disease—irritation in the external or middle ear is a common cause of vertigo ; (4) other cerebral lesions, especially those of the parietal lobes, cause a form of ataxia ; (5) lastly, peripheral nerve lesions may produce a condition closely resembling inco-ordination. 2. Reflexes.—Certain muscular contractions occur inde- pendently of volition ; their normal occurrence depends on the integrity of a reflex arc, consisting of a sensory nerve, a motor centre (in the anterior cornua, medulla, pons, or crura), and an efferent nerve with its muscle. It is by a mechanism of this nature that the normal tone of muscles is maintained. It is found that the activity of the reflex acts is modified and controlled by nerve impulses descending to the reflex arc from higher cerebral centres. Owing to interruption in these con- 9