A study of a case of family periodic paralysis / John K. Mitchell.

  • Mitchell, John K. (John Kearsley), 1859-1917.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A study of a case of family periodic paralysis / John K. Mitchell. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    examinations of any toxic condition, intestinal antiseptics were stopped and an attempt was made by the use of full doses of strychnine to stimulate the spinal cord, upon the secondary assumption that this might be the source of the disturbance. Full doses of strychnine were given and rapidly increased, and if any change took place in the patient it wa-s that the attacks appeared at rather shorter intervals than before. Strychnine had a very decided effect upon him, and it was not long before it had to be stopped. For a time he was left without any treat- ' ment, with orders to the hospital people to occupy him as much as pos- sible and to let him go out every day for a walk. No decided difference in the frequency of paroxysms appeared under this regime, and for a time under no treatment at all the attacks, without evident cause, grew somewhat mure frequent and recurred several times with only three or four days' intermission Bromide was then given, and the first week of its administration in doses of twenty grains three times a day there was no spell, although just previously the intervals between the attacks had been, at the utmost, four days. He was rather long in the next seizure, which was a very complete one, and when he recovered from it he had a week during which the knee-jerks were irregular— sometimes absent, sometimes slightly present—and in this whole period the patient felt dull and not so strong as usual upon his feet. Little as we have discovered of any unusual condition of the blood, feces, or urine iu this case, it seems to me impossible to attribute the attacks to any other than a toxic cause, even in face of the negative results of the chemical studies. The analogy is sufficiently striking to some other autotoxic, or partially autotoxic, disorders, iu spite of the want of direct findings to support this view, and in spite of the fact that some aspects of the case are against it. In migraine, for example, we have an instance of a disease in which family tendency is strongly evinced, which usually begins at about the age of puberty and lessens or disappears in middle life, which occurs paroxysmally and often at fairly regular intervals. The manifesta- tions of migraine are largely cerebral, and those of the disorder we are considering appear in the spinal centres and peripheral nerves and muscles. As to other possibilities, it has been variously suggested that, as in the cases described by Higier, and lately in Philadelphia by Dr. J. W. McConnell, the attacks are the paralytic equivalents of epileptic fits. But in the instances where paralytic seizures have replaced epileptic paroxysms no alteration in electrical reactions have been found, so far as I know, nor any loss of reflex and direct muscular irritability, nor are heart-murmurs produced. The perfectly clear mind of the patient throughout the attack is also against this supposition, and so is the long duration of the palsy.