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

Date:
1911
Catalogue details

Licence: In copyright

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

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

    1450/1480 (page 1398)
    partial or total. In a few cases the paralysis is not preceded by spasm. Spasm, e.g. of the orbicularis, and paresis of the other facial muscles, may be present at the same time (observation of Solmsen). Charante describes the opposite condition. There may be no facial paralysis (Branner, Neumann, Brunn^). In a few cases the paralysis involves the ocular muscles of the same side. If the wound is in the middle line of the face, the symptoms of spasm and paralysis maybe bilateral (Brunner). Eacial diplegia was present in the cases of Bourgeois and Crouzon, and Lloyd ^ describes a similar case. There is also usually an increase of the reflex excitability of the pharynx, for which reason an attempt to swallow food brings on a spasm of deglutition. This symptom has led to the adoption of the term hydrophobic tetanus. Dysphagia, which may develop into aphagia, has been mentioned (H. Neumann). Holub and Neumann have seen involvement of the hypoglossal muscle. There may also be spasm of the respiratory muscles. Salivation occasionally occurs. In a few cases slight hypcesthesia and even hyperaesthesia have been found in the face, but the sensibility is usually intact. Electrical excitability is either normal or shghtly increased. The muscular rigidity may extend still further in a descending direction, or it may be Hmited to the area just described. An observation by Friedlander and Meyer shows that in exceptional cases the rigidity of the neck may be absent. In every other respect the symptoms are the same as those of tetanus, but when the course is acute, fever and accelera- tion of the pulse are not unusual (Brunner). The prognosis is grave, btat less so than in general tetanus. The longer the interval between the injury and the onset of the disease, the more hope is there of recovery. The iUness usually terminates fatally ; out of fifty-nine cases, only twenty-four recovered. Pneumonia, erysipelas, meningitis, and nephritis are the most common complications. Nerhch found vacuolisation of the ganglion cells in the motor fifth nucleus, and in the facial and hypoglossal nuclei, and he regards these as the pathological cause of the disease. Similar changes have been described by Preobrajenski, Bourgeois, Joukowsky, Schupfer, and Kron,^ but these consisted partly in chromatolysis of the ganglion cells, which is of very doubtful pathological importance. In other cases also, investiga- tion gave negative results. No changes have been found in the facial nerve. Treatment is identical with that of tetanus, and tetanus antitoxin is said to have effected a cure in several cases (Trapp, Czyhlarz, Kocher, Helferich, Holub, Guinard.* 1 B. k. W., 1904. 2 Journ. Amer. Med. Assoc., 1905. 3 Korsakoff's Journ., 1906. ^ Societe de Ghirurgie, Paris, 1907 ; D. m. W., 1907.