Charles Gottleib Raue.

Special pathology and diagnostics : with therapeutic hints online

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In its clonic form it causes the most awkward appearance of the
face ; whilst one side looks perfectly quiet and natural, the affected
side is continually in motion, cutting all sorts of capers and jerks.
The will has not the slightest influence over these distortions. They
come on unprovoked, and may last a shorter or longer time. In some
cases they are brought on by a usual effort to talk, chew, &c., disturb-
ing these natural muscular actions greatly.

The tonic spasm is different. The face appears as though, during a
•distortion, it had suddenly become rigid, stiffened, so that it does not
partake of the motions of the sound side, which manifests itself espe-
cially in laughing or whistling. This rigidity might give occasion to
confound it with paralysis of the face. However, chin, lips and nose
are drawn towards the affected side ; the corner of the mouth of the
affected side is drawn downwards, whilst the eyebrow is drawn up-
wards. The eyelids of the affected side cannot be perfectly closed,
and the mouth not perfectly opened, thus interfering with talking and
chewing. The muscles of the affected side are hard to the touch,
and the patient has a feeling as if thej'- were stretched.

As the most frequent cause of this complaint, may be mentioned :
suddenly taking cold by exposure to a sharp, piercing wind, rain or
snow driven into the face. Likewise external injuries, especially
bruises of the bones of the face and skull, decayed teeth, &c. Vio-
lent mental emotions, like anger or terror and hysteric conditions,
have also been observed as causes of this complaint.

Therapeutic Mints,

When caused by exposure to cold, compare Bell., Hyosc, Merc.

When caused by external injuries, Arn., Hypericum.

When caused by diseases of the bones, decayed teeth, Hepar,
Merc, Silic.

When caused by anger, N"ux vom.

When caused by fright and terror, Hyosc, Ign., Opium.

Constant winking of the eyelids, Anac, Bell., Stram.

Risus sardonicus, compare Aeon., Anac, Alum., Asa, Bell., Bo-
vista, Calc c, Cicuta, Con., Croc, Cupr., Hyosc, Natr. mur., Nux
mosch., Phos., Plat., Ran. seel., Sepia., Stram., Yeratr., Zinc.



504 MOTOEY NERVES.

2. Mogigraphia, Writing- Spasm.

It commences first as a mere tired feeling of the hand, after long-
continued writing. Bj-and-bj this feeling increases, and the writer
has to make pauses frequently in order to rest the hand ; lastly, it is
quite impossible to hold the pen and to write, because, 1st, either a
spasm of the extensors draws the fingers asunder, or, 2d, a spasm of
the flexors of the first three fingers, or only one of them, makes it
impossible to hold the pen. Such spasms may be clonic or tonic.
Sometimes the thumb and fingers are only slightly drawn together,
and writing might be possible, if it were not for the strong trembling
which attacks the hand and the whole arm up to the shoulder, as soon
as writing is attempted.

If writing be attempted with the other hand, it is not long before
the same spasms attack it also.

It is quite remarkable that all other motions and performances
with the hand can be easily executed, although in some cases similar
spasms and tremor have been observed to attend other performances.

Similar spasmodic actions have also been observed in other habit-
ual muscular actions; for example, shoemaking, milking, playing
different musical instruments, setting types, sewing, &c. Its causes
seem to be over- exertion in writing, or a peculiar irritability of the
muscular fibres as a predisposition. It is increased by anxiety, and
constant thinking of it.

The most important remedies are, Stannum, Secale, Nux v. Light
and large penholders ought to be used.

Chorea, St. Vitus' Dance,

This affection consists in a spasmodic involuntary agitation of
sino-le or several groups of muscles, hindering and interfering with
the performance of regular voluntary movements. Exertions of the
will, to prevent these involuntary motions, only increase their vio-
lence ; but thfey usually abate during sleep.

Symptoms.

1. Involuntary motions sometimes extend to all the muscles which
obey the will; sometimes they are confined to certain groups of
them ; oftenest to the upper half of the body ; sometimes only one
side is agitated, and in exceptional cases we find a crosswise agita-
tion—an arm of the one, and the leg of the other side. Again, in-



CHOEEA. 505

voluntary motions sometimes commence in a few muscles only,
gradually extending over the whole side, and finally to the muscles
of the whole body. We then find the whole body in constant agita-
tion ; jerking, twisting, swinging, a ludicrous and sometimes pitiful
sight. There is no interruption of these irregular motions, except
during sleep, which is generally restless and unrefreshing ; and even
then they recur, although in a less degree, when the patient dreams.
Waking up and returning consciousness restores them to full power
again.

Intercurrent diseases have, in a few instances, cured the com-
plaint ; but very frequently are followed by no good effect. Fever
almost always increases the trouble.

2. The regular voluntary movements of the body are thus much
interfered with, and at last cannot be executed at all. Dressing,
writing, and playing instruments become impossible, talking difficult,
and exertions to overcome the difficulty have always had the con-
trary effect — increase of spasmodic action.

3. The refiex motions, however, are not disturbed. If the patient
itches somewhere, he can scratch himself without any trouble ; so
can he sneeze, cough, and evacuate bladder and bowels, &c.

4. All other involuntary motions of the body are perfectly free in
their action ; there is no interference in breathing, in the pulsations
of the heart, nor in the act of swallowing ; and the peristaltic mo-
tions of the intestines are normal.

5. The sensibility is in most cases normal.

6. The mental functions, however, suffer considerably from a long
duration of the disease. The patient at length shows a loss of
memory, weakness of mental capacity, and in some severe cases even
imbecility of mind; the disposition becomes fretful, irritable and
peevish.

Its predisposing cause seems to be the age between the time of
second dentition and puberty.

As exciting causes are mentioned: mental emotions, like fright, fear,
&c.; debilitated states of the system after diseases; growing too
rapidly ; suppression of cutaneous eruptions. A specific cause is
not known.

Therapeutic Sints.

Agaricus, the spasmodic motions range from simple involuntary
motions and jerks of different muscles to a dancing-like turning of
the whole body ; frequent nictitation of the eyelids ; redness of the-



506 MOTORY NERVES.

inner canthus of the eyes; flow of tears from tlie eyes; sensitiveness
of the lumbar vertebrae ; worse during the approach of a thunder-
storm.

Bellad., throwing the body forward and backward in lying, a kind
of constant changing from emprosthotonus to opisthotonus; boring
the head into the cushion; grating of the teeth; sore throat; numb-
ness in the fingers ; soreness of the last lumbar and the iirst dorsal
vertebris ; after mental excitement.

Calc. c, sometimes only one-sided involuntary motions ; sometimes
amounting to falling down ; period of second teething ; worm
symptoms; scrofulous habit; onanism.

Caulophyllum, in young girls with menstrual irregularities.

Caust., distortion, twisting and jerking of the limbs, even in the
night, preventing sleep; paralysis of the tongue and the right side
of the body.

Gross mentions a peculiar case of a young girl, who had the fol-
lowing paroxysms: the child laid down on her stomach, when one
of her knees was firmly inserted into the hollow of the other knee, and
her feet drawn upwards upon the buttocks. In this position her
body commenced jerking forward and backward, simulating the
movements which are exercised during coition ; at the same time the
muscles of her face became contorted, similar to risus sardonicus.
After the attack the child would be exhausted ; but during the in-
tervals she showed no particular symptoms; the spells were worst in
the morning. Cured by Causticum.

Cimicifuga, chiefly on the left side only; worse during the menstrual
period ; from rheumatic irritation.

Cina, the distortions often commence with a shriek, extend to the
tongue, oesophagus and larynx, and continue even through the night;
they are attended with frontal headache; enlarged pupils; dark rings
around the eyes; itching of the nose; pale, yellowish, earthy face;
ravenous appetite; pain around the umbilicus; hard stools; turbid
urine ; emaciation ; all pointing to irritation of the intestines by
worms.

Cocculus, involuntary motions with the right arm and right leg;
they cease during sleep; face puffed, somewhat bluish; hands look as
if frozen ; paralytic symptoms.

Crocus, jerking in the muscles ; spasmodic contractions of single
sets of muscles ; jumping, dancing, laughing, whistling; wants to kiss
everybody ; congestion of the head with bleeding of the nose ; sup-
pressed menses.



CHOREA. 507

Cuprum, commences in one arm and spreads over the whole body,
causing the most terrible contortions and awkward movements ; in-
ability to speak, or only imperfectly ; after fright.

Hyosc, throwing about of the arms; misses what he reaches for;
constant falling of the head from side to side; tottering gait; very
talkative, or loss of speech ; laughs at every thing that is told him ;
smiling, silly expression of countenance; after typhus.

Ignatia, especially when caused by fright or other mental excite-
ment ; worse after eating ; better when lying on the back.

Laurocerasus, she tears her clothing; strikes at every thing;
spasmodic deglutition ; indistinct articulation ; she gets angry be-
cause she cannot be understood ; idiotic expression of the face ; cold,
clammy feet up to the knees; she can neither stand nor sit, nor lie
down, on account of the incessant motion ; wasting away ; after fright.

Natr. mur., chronic cases after fright or suppression of eruptions on
the face; worse during full moon; paroxysms of jumping high up
without taking notice of the things around him, thus hurting some-
times himself considerably; or mere jerkings of the right side and
of the head.

Nux vom,, when attended with a feeling of numbness in the affected
parts ; also after much drugging.

Phosph., he walks like one paralytic, without noticing it himself;
twitching of the limbs ; great exhaustion ; after Calc. c. ; during
second dentition ; in general, daring that period in which the body
is growing.

Secale, the morbid contractions usually commence in some muscles
of the face and spread thence over the whole body, and increase even
to dancing and jumping motions.

Sepia, convulsive motions of the head and limbs; when talking,
(which is only a stammering,) jerking of the muscles of the face;
general muscular agitation ; desire to constantly change position and
place ; ringworm-like eruptions on the skin every spring.

Sticta, she cannot keep her feet to the ground; they jump and
dance around in spite of her, unless held fast ; when lying down, her
limbs feel as though they were floating in the air as light as feathers.

Stramon., the convulsive motions are often crosswise, or violent all
over ; preceded by formication in the limbs and a melancholy mood ;
worse during the equinoxes ; inclination to pray ; loss of memory ;
stammering; loss of speech ; putting the hands to the genitals.

Sulphur, in chronic cases; after suppressed eruptions.

Veratrum viride, most violent distortions of the body, universal, un-



508 MOTORT NERVES.

affected by sleep ; lips embossed with foam ; waked up by a con-
tinual champing of the teeth ; inability to swallow ; intense sexual
excitement.

Zincum, especially in those cases in which the general health suffers
much from the disease, with great depression of spirits.

Trismus and Tetanus

Are characterized as tonic contractions of the voluntary muscular
fibres, alternating with convulsive concussions of these muscles. It is
seldom that the disease is at once fully developed. Several days
before its outbreak, chilly sensations are occasionally felt, and even
shaking chills ; and a kind of aura-like pains from an injured or
affected part of the body. There are at first drawing pains in the neck
and stiffness in the nape of the neck, with some difiiculty of swallow-
ing. These symptoms increase ; the head becomes immovable and
drawn backwards ; the masseter muscles become rigid ; the lower jaw
becomes set, and swallowing still more difficult, and even impossible.

This state of things is called trismus or loch-jaw ; if it end here sa
much the better ; but frequently this tonic spasm extends further,
even over all the dorsal muscles, down to the os sacrum, and over the
muscles of the chest and abdomen ; so that the whole body becomes
as hard and rigid as a piece of wood. Not quite so severely affected
are the muscles of the extremities, and sometimes not all. The muscles
of the face are likewise less severely handled ; but still they partici-
pate more or less. There is a peculiar tension and painful expression
in them. The eyeballs are rigidly drawn towards the inner canthus,
and during the convulsive exacerbations the forehead becomes corru-
gated ; the eyebrows frown, the eyes stare, the lips are drawn asunder,
showing the teeth ; the tongue is thrust between the teeth, and fre-
quently severely bitten. There is often risus sardonic us. This is
tetanus.

This general tonic spasm of the voluntary muscles, however, has its
remissions ; that is, the rigidity of the muscles yields occasionally to
a more relaxed state, until either without any external cause, or by
some external influence under a sudden general convulsive concussion,
the highest degree of rigidity again sets in. Sometimes these recur-
ring concussive jerks are so violent that the patient is thrown back-
wards and forwards ; whilst in other cases they resemble only electric
shocks. In this way the disease progresses, alternating with rigidity,
partial relaxation, and convulsive concussions. The contractions are



TETANUS. 509

SO yiolent that in most of the cases single bundles of muscular fibres
are torn and extravasation of blood takes place. The following forms
of these spasms have been recognized : Opisthotonus^ a bending of the
body backwards, even to such a degree that the patient lies upon his
heels and the back of his head; JEm237'osthotonus, a bending of the
body forwards ; Pleurothotonus, a bending of the body sideways ; and
Orthotonus, a being stretched out straight. The most frequent form
is opisthotonus ; which has its cause, no doubt, in the predominating
affection of the dorsal muscles. All other forms are quite excep-
tional.

As long as the spasm prevails, the will has not the slightest influ-
ence over the muscles. On the contrary, any effort of the will only
increases the rigidity of the muscles ; and likewise do all reflex irri-
tations ; so that, as is well known, even the slightest touch, movement
of the bed, or even draught of air, is sufficient instantly to cause the
inost violent convulsive concussions.

The respiratory action is, of course, greatly interfered with, inas-
much as all the thoracic muscles are involved in the affection ; and
the breathing, it seems, goes on chiefly by means of the diaphragm.
Where the remissions are of only short duration, we find dyspnoea;
the skin becomes livid and covered with sweat ; sometimes even
resulting in entire cessation of breathing, and death.

Tetanus is always attended with a great deal of pain ; not only in
those convulsed and contracted portions of the body, but also in the
pit of the stomach.

Much less affected are the circulating and digestive apparatus.
The pulse is, in some cases, even normal ; in most cases, however, it
is frequent.

Vomiting and singultus mayor may not be present; while con-
stipation and retention of urine are frequent attendants upon these
spasms.

The skin is generally hot and covered with perspiration, as in
violent muscular exertions, and is followed by a miliary eruption.

The functions of the brain seem entirely unmolested ; the patient
has to suffer all these tortures in full consciousness.

Sleep is entirely absent, and if the patient loses himself for a
moment in consequence of exhaustion, he is at once aroused again by
violent concussions. This is the character of all kinds of tetanus.

Trismus or Tetanus neonatorum presents, on the whole, the
same features; commencing at first with stiffness of the jaws and
difiiculty of deglutition, so that the child becomes incapable of taking



510 MOTOEY NERVES.

fhe brenst, gradually extending over all the muscles of tlie body,
making them rigid and hard.

Trismus and tetanus frequently terminate fatally, and may last from
twenty-four hours to several weeks. If recovery takes place, it goes
on very slowly, and may take a good while. Death ensues in conse-
quence of suffocation — all the respiratory muscles ceasing to act — or
in consequence of exhaustion.

Causes.

1. External injuries of periplieric nerves of the extremities, face,
and genitals ; likewise parturition and abortus.

In new-born children, inflammation of the navel.

2. Rheumatism in consequence of severe cold. Taking cold, next to
external injuries, seems the most frequent cause.

3. Lesions of inner organs: injuries of the uterus, pleuritis, and
hepatization of the lung.

4. Central irritations, concussions of the spine; hj^persemia of the
cord and its membranes; extravasations within the spinal canal and
the skull.

5. Poisoning hy strychnine or brucine.

Therapeutic Hints,

Aconit., trismus and tetanus; contorted eyes; face changing color,
now red, now pale again.

Angust., opisthotonus from external injury.

Bell., at the commencement, when there is: restlessness; sudden
jerks and shrieks during sleep ; twitching of the muscles of the face
and limbs ; squinting ; inability to swallow ; later : convulsive mo-
tions ; spasmodic respiration ; dilated pupils ; staring, open eyes ; in-
voluntary discharges from the bowels and bladder.

Camphora, antidote to strychnine.

Cicuta, becoming suddenly stiff" and immovable; tetanic stiffness of
the whole body ; opisthotonus ; face puffed and bluish ; eyes fixed,
staring at one point ; foam before the mouth ; spasm of the chest,
afterwards trembling ; cannot recollect ; the spasms are renewed from
slightest touch, even from opening the door, and from loud talking.

Lycop., drawing of the head towards the right side, with stiff'ness
of the neck, face and jaw ; dizziness ; heaviness in the head ; weak
eyes ; dry and stuffed-up nose ; dry, difficult stool ; restless sleep ;
full of anxious dreams ; much depressed in spirits.

Moschus, stiffness of the body, with full consciousness ; spasms in
the abdominal muscles.



CATALEPSY. 511

Nux vom., intermitting fits of spasm ; disturbed respiration ; con-
sciousness not disturbed; renewal of spasms from slightest reflex-
irritation.

Phytolacca Inas caused the following symptoms: extremities stiff;
hands firmly shut ; feet extended and toes flexed ; eyes bleared and
dancing; papils contracted; teeth clenched; lips everted and firm;
general muscular rigidity; opisthotonus; respiration difficult and
oppressed ; convulsive action of the muscles of the face and neck,
followed by partial relaxation, which again was succeeded by the
same tetanic condition.

Platina, opisthotonus changing with spasms^ with full consciousness;
profuse menses ; overbearing, proud disposition,

Rhus t., in consequence of taking cold by getting wet.

Secale, after abortus, spasms with full consciousness, afterwards
■great exhaustion ; heaviness in the head and tingling in the legs.

Stram., opisthotonus and trismus, with congestion to the head ; red
face ; heat of the body ; too profuse urine ; deep, snoring sleep.

Veratr. vir., opisthotonus.

Catalepsy

Is a sudden loss of all voluntary motory power, so quickly befalling
all muscles that the different parts of the body remain precisely in
the same position in which the attack finds them, thus making the
patient appear like a statue. At first the muscles are rather rigid;
but they gradually grow more pliant, assume a waxy flexibility, so
that the limbs may be brought into any position, in which they con-
tinue to remain. The sensibility and consciousness of the patient is
usually gone ; he perceives nothing and recollects nothing ; whilst in
other cases some sensibility seems to remain; and in still others, sen-
sibility and consciousness are entirely undisturbed. The patient sees,
hears and knows every thing that is going on around him, but is per-
fectly unable voluntarily to move a single muscle of his body ; the
link which makes the body an instrument of the soul seems broken.
Such fits end in simple forms of the disease often quite as sudden as
they come on. The patient draws a long breath, sighs, yawns, and
acts as though he was waking out of a deep sleep, and goes on with
his interrupted work without even suspecting that any thing has
happened to him. Such attacks sometimes follow others in short in-
tervals, and they may last only a few minutes at a time. Graver
attacks last hours and days. Skoda mentions one that lasted several
months.



512 MOTOET NERVES.

Cataleptic spells are frequently combined with hysteria, melancholy,
ecstasy, St. Vitus' dance, somnambulism, and other nervous derange-
ments. The disease is of rare occurrence, and its real exciting causes
seem to be mental agitation, anger, fright, sudden joy or fear, grief,
disappointment, vexation, ecstasy, or religious excitements, &c.

Catalepsy is, by itself, not fatal.

Therapeutic SJints,

If caused by anger and vexation, Cham., Bryon.

If caused by fright. Aeon., Bell., Ign., Gels., Op.

If caused by sudden joy, Coffea.

If caused by grief, Ignat., Phos. ac.

If caused by jealousy, Hyosc, Lach.

If caused by sexual erethism, Plat., Stram.

If caused by disappointed love, Ignat., Lach.

If caused by religious excitement, Stram., Sulph. and Yeratr.

Epilepsy, Morbus Sacer.

/Pj //~ ^^ g^'^® ^ definition of this affection, I might say : epilepsy is a

^^^"'^^^^^^'^'^^^ ahvoniQ, form of fits, which occur repeatedly, but without any typical

La>o^ regularity; and which are characterized by loss of sensibility and

consciousness, and are attended with clonic spasms. The intervals

between these fits are at first free from any morbid affections ; later,

however, they are more or less disturbed by different brain-symptoms.

Symptoms.

Single attacks are in some cases preceded by headache, dizziness,
sparks before the eyes, noises in the ears, bad smell in the nose,
trembling, nausea, urging to empty the bowels and the bladder,
chilliness, palpitation of the heart, dyspnoea, soreness in the hypo-
chondriac and epigastric regions.

The so- called aura, which means a sensation as though, imme-
diately before the attack breaks out, cool air were passing quickly
up the extremities towards the head, is either of quite rare occur-
rence, or passes off so quickly that the patient does not remember it
after the attack is over.

The jit itself, which, in most cases, sets in without any premonitory
signs, often commences with —

1. A shrill, piercing shriek; in children some have observed tears
instead of a shriek.



EPILEPSY. 513

2. At tlie same time the patient falls suddenly and violently to tlie
ground, deprived of all consciousness.

3. Gonvidsions, partially tonic, partially dome, sometimes alternating.
In rare cases these spasms are so violent that they cause fractures of
bones and luxations of joints. Oftener the teeth are broken by the
violent contraction, and the tongue becomes seriously bitten. Ecchy-
mosis, blood-extravasations in the skin, and especially in the con-
junctiva, are often found ; less frequently, however, extravasations of
blood within the brain and its membranes.

4. The respiration becomes disturbed, as, no doubt, the spasms ex-
tend over the respiratory muscles. In consequence of this we see
symptoms of asphyxia and cyanosis : namely, swelling of the veins of
the neck, protusion of the injected eyes, blueness and swelling of the
face, tongue, and extremities.

5. The pulse is at first small and hard, later it becomes more fre-
quent ; it is seldom irregular or slow, except in coexisting diseases
of the brain.

6. The alimentary canal exhibits the following symptoms: The



Online LibraryCharles Gottleib RaueSpecial pathology and diagnostics : with therapeutic hints → online text (page 51 of 65)