Lectures on diseases of the nervous system : delivered at Guy's Hospital / by Samuel Wilks.

  • Wilks, Samuel, Sir, 1824-1911.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on diseases of the nervous system : delivered at Guy's Hospital / by Samuel Wilks. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    reached the conditiou as seen on admission. The arm was flexed tightly iicross the chest and the fingers clenched. The leg was drawn up to the abdomen and not stretched out straight as usually seen in this class of case; when the limbs were forcibly straightened great pain was experienced, and they immediately returned to their original flexed position. There was no wasting, good reflex action with hj'persethesia over the left side of the body as well as tenderness over the left inguinal region. There was always a bad odour emanating from the arm, the cleric said, like old boots. She subsequently complained of dimness of vision of one eye. She was ordered galvanism and faradisation, and told to move her limbs as much as she could. She was soon able to get up and walk about, and left well in four months. Ordinary Hemiplegia.—The commonest form of hemiplegia is that which arises from disease of the corpus striatum, due generally to sanguineous effusion or softening. It is characterised by paralysis of the arm and leg, of the face in part and of the tongue ; that is, the lower part of the seventh nerve is affected and the ninth. The trunk and other parts of the body are not involved in the paralysis. These facts have opened up a subject of great interest both to writers on physiology and pathology. For since it is seen that in hemiplegia the will can still operate efficiently on all other parts but the limbs and a small portion of the face, it might be con- jectured either that there was some special channel of communica- tion between the nerves which supply these other parts and the cerebrum proper; or that, the centres of these nerves lying, not apart, as those which rule over the extremities, but in juxtaposition, can still be stimulated by their neighbours. Be this as it may, we shall find that if special nerves, or any other than those which supply the extremities, are paralysed in hemiplegia, we shall be able to conclude that disease exists at their roots or at the very centre whence they spring, and thus we shall have a means whereby we can detect the exact seat of the mischief. Owing to the intermixture of fibres, we find that a small sj)ot of disease in either of the central motor ganglia will produce paralysis of the limbs on the other side; a slight lesion, partial paralysis ; and a severe lesion, complete paralysis, and not, as might have been expected, had there been no blending of fibres in these ganglia or in the plexuses of nerves, a paralysis of particular muscles, according to the exact site of the lesion. When, then, disease of the corpus striatum exists, we have hemiplegia; any disease will produce it, as it is a necessary result of the lesion. You must not, therefore, say, as I heard one of you the other day conclude, that a patient necessarily had apoplexy because he was seized with hemiplegia. The fact of hemiplegia occurring so often in brain disease is owing to these central ganglia being so frequently attacked, and this arises, I