An atlas of the differential diagnosis of the diseases of the nervous system : analytical and semeiological neurological charts.

  • Hun, Henry, 1854-1924.
Date:
1914
Catalogue details

Licence: Public Domain Mark

Credit: An atlas of the differential diagnosis of the diseases of the nervous system : analytical and semeiological neurological charts. 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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    INSPECTION Methods of Testing 20 The expression of the patient's face indicates, in most cases, the degree of his Facial expres- intelligence and his emotional state (sad or gay or anxious), and also may sion and gen- suggest the presence of certain diseases and conditions; such as myxedema eral appear- and cretinism (1163-4), acromegaly (1183), scleroderma (1165), exophthalmic ance and goitre (1193), paralysis agitans (677), myasthenia (553), nasal obstruction, behavior. atheroma of temporal arteries, notched teeth, hazy cornea, and the saddle- (Charts XVI back nose of syphilis, etc. His general appearance and behavior often indi- & XVII) cate his power of self restraint (inhibitory power, breeding), or the existence of hallucinations (213) of sight, hearing, touch, or of compulsory acts (218). 21 The walk of the patient may suggest the presenoe of hemiplegia (254), para- Walk, plegia (257), local paralysis (259), ataxia (motor or cerebellar) (248), spasm (Chart XIII) (242), atony (252), paralysis agitans (677) and other tremors (250), pseudo- hypertrophic paralysis (500), hysterical paralysis (527), foot drop, (bilateral in multiple neuritis and lead palsy, unilateral in acute anterior poliomyelitis), weakness, exhaustion, etc. 22 The skull should be observed as to type (brachy- or dolicho-cephalic, round or Skull. long heads), size (microcephalic — small, macrocephalic — large), rickets (box (Chart XVI) shaped), general or local hydrocephalus (bulging—posterior or anterior), fontanelles and sutures, asymmetry, tumors, etc. 23 The spinal column should be observed as to curvature (angular or lateral),scoliosis, Vertebral col- kyphosis, spina bifida (occulta), deformity (dislocation), Pott's disease, tumor umn. tenderness (by palpation), etc. (Chart X) 24 Note the existence of arcus senilis, the condition of pupils (unequal, anisocoria Eye. (341), myosis (340), mydriasis (339), and irregularity), the presence of keratitis (Charts V, VI or iritis, prominence of eyeballs, nystagmus, squint, ptosis, paralysis, etc. &XIV) 25 Note whether each pupil, the other eye being covered, dilates and contracts as Pupillary reflex the eye is alternately shaded by the hand and exposed to light, or an electric to light. light is flashed into it; vision being constantly fixed upon some distant object. (Charts V & When a pupil contracts to light (direct reflex) the pupil of the other eye also XIV) contracts (consensual reflex). 26 Hemiopic re- flex. (Charts V & XIV 27 Pupillary reflex to accommo- dation. (Charts V & XIV) 28 Double vision, diplopia. (Charts VI & XIV) 29 Secondary deviation of the sound eye, (Chart XIV) 30 Nystagmus. (Charts IV & XII) Note whether the pupil contracts as light is flashed on each half of the retina alternately. A ray of light collected by a lens should be used in this test. This reflex is difficult to obtain, and not entirely reliable. Note whether the pupil dilates when the patient looks at a distant object and contracts when he looks at one so near his face as to require convergence of the eyes. This test can be made on a blind man by having patient first con- verge his eyes and then make the axes of his eyes parallel, by imagining that he is looking at a near and then at a distant object. Note which eye deviates, however slightly, from the direct axis of vision and which eye lags more or less on movement of eyeballs in following the moving finger. Place a colored glass before the affected eye, move a bright object (candle) throughout the field of vision and have the patient note the relative position of the two images. The colored image will of course be the one seen by the affected eye. Hold a card close in front of the sound eye. Have the patient look at an object so held that the weakened muscle must be brought into action. The sound eye covered by the card will be observed to move too far and when the card is removed the sound eye will quickly move back into proper position. The oscillation of the eyeball which constitutes nystagmus is often plainly to be seen. Extreme deviation of the eyeballs in one direction or the other makes it more evident, and at times demonstrates a nystagmus not otherwise appar- ent. If present, nystagmus is usually recognized while making the two tests 28 and 29. It should not be confounded with the irregular jerky motion of a weakened ocular muscle attempting to move the eyeball.