Text-book of nervous diseases for physicians and students / by Professor H. Oppenheim.

  • Oppenheim, Hermann, 1858-1919.
Date:
1911
Catalogue details

Licence: In copyright

Credit: Text-book of nervous diseases for physicians and students / by Professor H. Oppenheim. Source: Wellcome Collection.

    618/640 (page 586)
    In one of onr cases of this kind the intractable pain disappeared after a fit of weeping. From a diagnostic point of view we must refer also to intermittent claudication. The condition was first observed in horses (Boulay). Charcot1 then described it in man. It consists in a sensation of numb- ness, fatigue, and pain, which in walking comes on in one or both legs and increases with exhaustion, so that walking is at first difficult and then— often after a quarter of an hour or even a few minutes—quite impossible. The symptoms disappear during rest, and the patient can walk again after an interval. It is only in the later stages that an attack of pain may come on even during rest, or that the pain may be persistent. The sensation is sometimes felt in the whole leg, sometimes only in single segments, such as the calf, the thigh, less frequently along some particular nerve. One of my patients repeatedly stated that the symptoms came on offiy when walking outside, and not in the house (see below). Vaso- motor symptoms, cj^anosis, pallor, feeling of cold, are almost always present. They tend to come on chiefly in walking. I recommend the patient to walk for a time and then to look quickly at the sole of his foot ; it is found as a rule to be waxy-white on the affected side. I have only once seen oedema as an accessory symptom. The local blood- lessness produced by pressure of the finger disappears with unusual slowness (Zoege-Manteuffel). Slight hypsesthesia is sometimes found on the toes or the sole of the foot. The tendon reflexes are as a rule quite normal, but the knee-jerk may be exaggerated, whilst the Achilles jerk is sometimes absent, as in three of my patients. There is usually either arteriosclerosis, calcification of the arteries (Saenger, Holzknecht2), or obliterating endarteritis, and the weakness or absence of pulsation at the arteries of the affected extremities is verj^ striking (Charcot, Bieganski). Whilst these authors laid most stress upon the absence of pulsation at the great arteries, Erb has shown by careful investigations that one of the most important and constant symptoms is absence of 'pulsation in the arteries of the foot, viz., in the dorsalis pedis and posterior tibial arteries. In healthy individuals the pulse can almost always be felt in these vessels, although some skill and care may be required to detect it. I would advise that it should always first be localised by sight, as I have often found it easier to recognise the pulse in this way than by touch. Erb regards chill (forced cold-water treatment by Kneipp’s method), syphilis, chronic nicotine poisoning, alcoholism, and gout as the chief causes of the condition. His patients have almost exclusively been men, but I have treated women also for it. According to Erb's latest statistics, 120 of his patients were men and only seven women. The neuropathic diathesis has already been considered by Erb and Brissaud, and I have also been able to show the pre-eminent part played by this factor in the etiology. I have found the disease very frequently combined with neuroses or psychopathic conditions, and occuring in persons in whom the stigmata of degeneration, e.g. medullated nerve fibres in the discs, 1 Comptes rendns et Mem. de la Soc. de Biol., 1858 ; Gaz. mid. de Paris, 1859 ; also Prog, mid., 1887. Further literature : Erb, Z. f. N., xiii. ; Goldflam, D. m. W., 1895, N. C., 1901 and 1903 ; Oppenheim, Z. /. N., xvii. ; Erb, Verhandl. d. Kongr., f. inn. Med., 1904 ; ibid., M. m. 11., 1904, Z. f. N., xxix. and xxx., Mitt. aus. den Grenzg., iv., D. m. W., 06; Higier, Z. f. N., xix. ; Hagel- stam, Z. f. N., xx.; Saenger, N. C., 1901 ; Idelsohn, Z. f. N., xxiv. and xxxii. ; Zoege-Man- teuffel, Mitt. aus. Grenzg., x. 2 W. kl. R., 1903.