Volume 1

Textbook of nervous diseases for physicians and students / Translated by Alexander Bruce.

  • Oppenheim, Hermann.
Date:
1911
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Textbook of nervous diseases for physicians and students / Translated by Alexander Bruce. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    34/644 (page 5)
    signs of neuropathic and psychopathic diatheses. Too much weight should not, however, be laid upon these, as almost any one of them may occasionally occur in otherwise thoroughly healthy individuals. Percussion of the skull may give important indications in local disease of the brain and its membranes. Neither should auscultation be neglected, since vascular murmurs are more frequent in brain diseases than is generally recognised. The use of Rontgen rays may be of value in examination of the skull, but hitherto it has given positive results only in a few diseases (see specially the section on cerebral tumour and acromegaly). Condition of the Muscles. Examination of Motility A pronounced increase or decrease in the size of the muscles when confined to one side of the body, to one extremity or segment of a limb, is recognised at the first glance, but the conclusion formed from comparison of the corresponding muscles and muscular groups of the two sides may be extremely difficult when the differences are but slight. In making this examination care should be taken that the two extremities are in exactly the same position and that the muscles are equally contracted or relaxed. It should also be remembered that slight differences in the size of the muscles of the two sides of the bod}', especially an excess in those of the limbs of the right side of about 1 cm. (J in.), occur even under normal conditions. In order to determine the degree of atrophy, careful measurements with a tape are necessary. The position of the limbs must, of course, be similar. In the forearm and leg the thickest part of the limb should be selected. In the upper arm the middle part should be chosen ; in the thigh one should start from a fixed point and determine the size at about 12 to 15 cm. (or 5 to 6 in.) above the patella. Measurements are best made when the extremities are extended, but they should be held out, as differences may be marked by unequal pressure when they are sup- ported. Even measurement is no exact evidence. Small faults creep in which may even amount to \ to 1 cm. Metal tapes should be preferred. Muscular atrophy is also revealed by the formation of grooves, hollows, cavities at places which were formerly filled by muscular tissue, whilst hypertrophy is sometimes characterised by an equal increase of the circumference of the whole muscle, sometimes b}' the formation of swelling in certain segments. It should always be remembered that changes in the size of the muscle by no means reveal ever}' condition of degenera- tion, and that a muscle which has a normal appearance may be as severely affected as a hypertrophied muscle. Palpation does not furnish certain evidence with regard to the con- ditions of the muscular substance. The degenerated muscle is felt to be soft and even pulpy, but when the change is a fibrous one, it appears to the palpating finger to be hard and firm. If the muscle is much over- grown by fat or wholly changed into fatty tissue, it is felt to be doughy. But much experience is necessary to enable one to discern such anomalies by palpation. On the other hand, one is liable to many mistakes in this examination. Excision of small particles of muscle cannot be employed in practice for diagnostic purposes, and even as regards scientific in- vestigation this method has somewhat gone out of vogue, since it has