Clinical lectures on neurasthenia.

  • Savill, Thomas Dixon, 1856-1910.
Date:
1902
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Licence: In copyright

Credit: Clinical lectures on neurasthenia. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    and the like; though even in these instances we must remember a large number of other diseases are attended by clonic spasms or convulsions. Comparatively few cases of nerve disease, however, do conform to a type. Moreover, we always have to make out two things concerning every case—the locality, and the nature of the lesion. I believe, therefore, that the best way, both for purposes of diagnosis and for purposes of research, is to take the locality and the nature of the lesion separately, (a) For the diagnosis of the locality we should take the patient's leading symptom, and see what position best explains this and the other symptoms, discussing the several positions which might account for all the symptoms. A knowledge of anatomy and physiology is necessary for this, and it is therefore to be regretted that neurology is generally relegated by the medical student to his post-graduate studies. However, the task is not such a formidable one as might be thought, for the prominent symptoms are usually few, and their expla- nation simple, (b) As regards the nature of the lesion, this is generally a simpler matter, for you may group all lesions into destructive or irritative, and organic or functional, either of which latter may be destructive or irritative. There are four features which will help us to come to a conclusion on this point. First, the position of the lesion having been decided is some guide, as in cases of hemiplegia, for instance, we know that only a few lesions affect the internal capsule. Secondly, the mode of onset of the case is important, cir- culatory lesions coming on suddenly, degenerative lesions slowly. Thirdly, the character of the symptoms affords important information, since destructive lesions of the motor tract, for instance, produce paralysis, whereas irritative ones produce convulsions and rigidity of the same parts. Fourthly, the age of the patient is perhaps as important a matter as