A clinical lecture on remissions and relapses in insular sclerosis / by Thomas Buzzard.

  • Buzzard, Thomas, 1831-1919.
Date:
[1904]
Catalogue details

Licence: In copyright

Credit: A clinical lecture on remissions and relapses in insular sclerosis / by Thomas Buzzard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    7/16
    condition at that time. There was a little “intention”' tremor in the arms, especially on the right side, and he was clumsy in both hands in picking up a pin. The right leg was weaker than the left, especially in dorsiflexion of the foot, and there was some rigidity on both sides, with incoordination of the right foot. His gait, too, was unsteady and of the spastic-ataxic type. The wrist and knee jerks were in excess, but there was no ankle clonus. The plantar reflexes were brisk, with extensor (Babinski) response. Patches of anaesthesia were found about his trunk and legs. This patient steadily improved in hospital at first, and the anassthesia' practically dis- appeared. After being discharged he again had a relapse and was unable to walk. There were marked increase in the spasticity of his legs and some return of anaes- thesia. After keeping in bed for a short time he improved, but still showed an ataxic gait with some spasticity. He was discharged in May, 1901. At the present time he is under treatment in another hospital. On inquiry I have ascertained that he cannot stand without support or guide his hands. Work has been impracticable for four years past. (By the courtesy of hospital colleagues other cases illustrating the subject were shown.) It is evident that the extreme irregularity which charac- terises the distribution of the patches of sclerosis in different examples of the disease under consideration makes it quite unreasonable to expect the same degree of uniformity in the symptoms that we are accustomed to find when sclerosis is of the “system” type, as, e.g., in tabes. It is by com- parison of numerous examples, some of them verified by post-mortem examination, as well as by consideration of the effect which a sclerotic patch will be liable to produce when occupying any particular locality, that the ability to classify such cases as these under the name “insular sclerosis” is attained. The “symptom-complex”—to employ the rather unwieldy expression borrowed from the German—or “syn- drome,” to use the term employed by the French—the peculiar aggregation, that is, of the symptoms, points, I think, conclusively to this explanation of the cases. In the course of private practice I have met with many examples—some of which have been already published1— i Simulation of Hysteria by Organic Disease of the Nervous System. Churchill, 1891. Clinical Lecture on Insular Sclerosis and Hysteria. The Lancet, Jan. 2nd, 1897, p. 1.