Diseases of the nervous system / edited by Archibald Church.

Date:
1908
Catalogue details

Licence: In copyright

Credit: Diseases of the nervous system / edited by Archibald Church. Source: Wellcome Collection.

    1188/1256 (page 1146)
    in' the extremities, in 3 in the genitalia, in 3 in the back of the neck, and in one behind the ear. There seems to be no preference for the projecting parts of the body, and the edema is rarely symmetrical. The area in which the edema first appears often becomes less resistant to later attacks. These cases with definite localization do not warrant the construction of special pathological forms. Transitory edema of the eyelid is undoubtedly a variety of this affection. • Edema may also attack the mucous membranes, and most frequently that of the mouth, pharynx and larynx. Edema of the larynx produces very marked, and sometimes alarming symptoms, such as difficulty in deglutition and dyspnea. In such cases scarification may become necessary; according to recent reports there is no doubt that edema of the larynx so produced may he the immediate cause of death (cases of Collins, Mendel and Sträussler). Fortunately, these are great exceptions. Even edema of the lung was once regarded as a partial phenomenon of acute circumscribed edema (Quincke and Gross). Of other mucous membranes which are attacked I must mention the con- junctiva and the mucous membrane of the nose (nervous coryza), etc. Cer- tain intermittent gastrointestinal symptoms the genesis of which is not quite clear are important; for instance, pain, persistent vomiting, meteorism, con- stipation, exhaustive diarrhea, extreme and burning thirst. The gastric symptoms may be so severe as to closely simulate the picture of a gastric crisis. Schlesinger observed paroxysmally a swelling of the tendon sheaths. I saw several times, particularly in one case, peculiar painful contractions of certain muscles, among others the biceps; the muscles were very sensitive to pressure, but this condition lasted only a few hours. From the entire course of the case I concluded that the condition was analogous to edema (edematous infiltration of the muscles). Another localization is important, particularly because it forms a new disease: Intermittent articular dropsy {hydrops articulorum intermittens). This is a very rare symptom-complex, but is usually seen in nervous individuals. The chief symptom is swelling of one or several joints, almost invariably of one or both knee-joints. The swelling is often painful; there is no fever; the symptoms yield after a short time, but reappear at regular or irregular intervals. Schlesinger first called attention to the fact that this intermittent articular dropsy is merely a variety of hydrops hypostrophus, as is proven by the transitory swellings of the skin in this affection, and by the fact that there is articular swelling in ordinary circumscribed edema. Certain cerebral symptoms must be regarded as indicating the special localization of transitory edema. Lassitude, somnolence, headache, even serious symptoms of cranial pressure, loss of consciousness, slow pulse, and general convulsions have all been observed under these circumstances, and the symptoms were consequently referred to effusions in the meninges which were analogous to cutaneous edema. In some cases polyuria and transitory albuminuria have been observed and, exceptionally, paroxysmal hemoglobinu- ria. I have reason to believe that the latter occurred in one of my cases. Sometimes the attacks begin with general symptoms'. Lassitude, malaise, loss of appetite, slight fever (in one case I found 100.8° F.).