A manual of clinical medicine and physical diagnosis / by Thomas Hawkes Tanner.

  • Tanner, Thomas Hawkes, 1824-1871.
Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: A manual of clinical medicine and physical diagnosis / by Thomas Hawkes Tanner. Source: Wellcome Collection.

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

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    his own case what others similarly circumstanced have felt. “ It is very easy for a person to complain of shattered nerves, inability to sleep, deep-seated pains, defective memory, weakness of sight, and various anomalous sensa- tions, and very difficult for the practitioner to judge whether they exist except in the patient’s imagination. A great deal can be done by careful inquiry and observation, and it is not safe to base an opinion upon assertions which have not been confirmed by investigation of this kind. Where there are objective symptoms—where, that is to say, something or other can be perceived for himself by the practitioner, whether it be the occurrence of convul- sions, local paralysis, alteration of the frequency of the pulse or the natural temperature of the body as indicated by the thermometer, or alteration of size of limbs as shown by the measuring tape, or changes in the retina as seen by the ophthalmoscope—the diagnosis is comparatively easy. Still in such cases there is one point which must be borne in mind. Constitutional syphilis will simulate many of the symptoms supposed to be due to violence; and it is very often a matter of extreme perplexity to decide how much may be due to either of these causes. Careful inquiry should always be instituted upon this point, and the opinion should be very guarded where, without any sign of blow upon the head, such symptoms as paralysis of one or other of the cranial nerves is evident. There is no doubt that a great many kinds of disease of the nervous system may be due to violence. I have myself seen, in hospital practice, numerous cases of epilepsy, some of general tremor, progressive muscular atrophy, general spinal paralysis, and a few of progressive locomotor ataxy which seemed clearly referable to such a cause. But, at the same time, it is to be noted and remembered as a very important fact, that but few cases exhibiting the anomalous nervous symptoms so often described in courts of law are to be found amongst hospital patients who have received violence closely resembling that resulting from railway collisions. My experience would lead me to be- lieve that, as a general rule, the nervous shock (where it is not complicated by objective phenomena) thus occasioned is a remediable evil—that after a few months, especially when litigation has ceased, repair takes place and the patient eventually is little or nothing the worse for his injury. On the whole the prognosis (and this is the