Clinical notes on nerve disorders in surgical practice / by George Wherry.

  • Wherry, George, 1852-1928.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Clinical notes on nerve disorders in surgical practice / by George Wherry. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    third week spasmodic cramps occurred in the legs and thighs. ' The tetanic contractions followed therefore the same course as is witnessed in rigor mortis, beginning in the jaws, then the • neck, then the belly and trunk, the arms, and lastly the legs. With regard to the contraction of masticatory and facial muscles, it was always to be observed, even during sleep, , though aggravated at times. On two occasions he bit his ' tongue badly. The general spasms were often made worse by ■ sympathy, attempts to talk, efforts to make water, or to relieve ' the bowels. The digits were not affected. I The treatment pursued may be summed up as follows: ; Extraction of the teeth to remove a possible source of nerve- * irritation or of overcrowding, with rest and quiet in bed. Hydrate of chloral internally, to relieve the attacks of spasm, and ex • tract of belladonna ajjplied hot externally to the jaws and ' cheeks. Always the most important part of the treatment of these cases is the feeding, and milk, beef-tea, raw beef juice, j and cream, beat-up eggs and the like, were administered con- ! stantly at suitable intervals. Tetanus must be looked ujjon as i an exhausting malady which runs its course, and if the patient | can be kept alive during ten or twelve days it is rarely fatal. i In all cases of trismus dependent upon the eruption of j wisdom teeth, the patient is able to swallow food if soft and \ convenient, so that the first indication of the more alarming j malady was the inability to swallow solid food ; not even gruel r could be taken unless it was as thin as milk. The tetanic ■? smile which distorted the face was nearly contemporary with the dysphagia, and then followed the violent attacks with ? opisthotonos which are so painful and so dangerous. The only case in my experience which resembles this is that ? of a young man who cracked and ate a hundred walnuts for a . wao-er. No definite lesion in his mouth was discovered, when ^ some time after winning his wager he developed tetanus, which ' ran much the same course as in the above related case and terminated in recovery. The following case, which I have called hysterical dysphagia, is interesting in connexion with cases of vomiting due to spasm of the oesophagus—and it seemed that this patient, as in a case