Diseases of the spinal cord.

  • Bramwell, Byrom, Sir, 1847-1931.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the spinal cord. 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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    to side; in other cases again the feet seem to cling to the ground, and the spastic gait is conjoined with a rhythmical, shaking tremor of the whole body. A jerking movement of the eyeballs (nystagmus) occurs in many cases, and is a very characteristic symptom. The affected muscles are of normal bulk, and their electrical reactions are healthy. The reflexes are, as a rule, normal or exaggerated.1 The bowels are generally constipated, but the functions of the bladder are seldom interfered with, till a much later stage. The sensory functions are not much affected at this period of the case j as a rule, subjective de- rangements of sensation, such as ' pins and needles,' numb- ness, etc., are experienced by the patient, but distinct objective anaesthesia cannot be demonstrated. The general state of nutrition is well preserved, and complications on the part of the other systems and organs are rarely present. The symptoms gradually increase; but periods of temporary improvement, or even complete remission, are not uncommon, and may lead an inexperienced observer to expect a favourable termination of the case. After the condition has become well established, the facial expression becomes vacant, stolid, and stupid-looking; and a peculiar alteration in the voice is very generally observed, the speech is slow and drawling, every syllable being pronounced separately (scanning speech); the tone of voice, too, is singularly monotonous; towards the end of the case it may be weak and whispering. The cerebral symptoms become more prominent, the headache and vertigo may continue ; the mental faculties are decidedly blunted; in many cases the patient becomes irritable, and loses his self- control ; actual mental derangement is occasionally observed. Dimness of vision is very frequent; in some cases it is only apparent, depending upon nystagmus ; in others, it is real, and is associated with white atrophy of the optic discs or alteration of the central parts of the visual nerve apparatus. The pupils may be irregular, in some cases they are 'pin pointed,' but the Argyll Eobertson phenomenon (see p. 230) is probably rare. In a small proportion of cases, apoplecti- form attacks, characterised by complete insensibility, quick 1 Exceptions to all of these statements may occur, for the lesion may invade any part of the transverse section of any spinal segment.