A treatise on common forms of functional nervous diseases / by L. Putzel.

  • Putzel, L. (Leopold), 1855-1942.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on common forms of functional nervous diseases / by L. Putzel. Source: Wellcome Collection.

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

    14/272 (page 2)
    0, nomena. If tlio chest is hared, it will be found that inspiration is frequently interrupted, before the act is complete, by a sudden expira- tory movement. The speech of the jiatient is often interrupted, owimr to the irregularity in the respiratory rhythm. This disturbance is som<> times so marked that the patients must take a deep inspiration between the utterance of individual words, and become greatly fatigued after speaking a few sentences. According to Ziemssen,’ an affection of the laryngeal muscles usually accompanies severe cases of chorea. By means of the laryngoscope, Ziemssen was able to detect the irregular contractions of the different muscles which are engaged in varying the tension of the vocal cords. In some cases, this is shown by the low pitch and monotony of the voice; as improvement progresses, these phenomena gradually dis- appear. In many instances the hands are chiefly affected. Even when the child is perfectly quiescent and without any voluntary effort on his part, the hands will suddenly become forcibly flexed or extended, the fin- gers will be separated from one another, and the hand will be drawn away from the body, or vice versa. If the patient attempts to drink a glass of water, he experiences great difficulty in grasping the glass, and is unable to carry it directly to his mouth. A considerable portion of its contents is spilled in the endeavor to drink, and the patient may strike the vessel against his cheek or nose. The legs are also usually affected, though not, as a rule, to such an extreme degree as the hands. In walking, the knees frequently bend under, the patient trips and stum- bles on account of the ill-timed contractions of the extensors or flexors of the foot, and the legs often become entangled in one another; sometimes, however, a shuffling gait is the only evidence of the affection of the legs. In severe forms of the disease, the patient is in a truly deplorable condi- tion. The movements of the hands may be so intense that he is unable to feed himself, and when the muscles of mastication and deglutition are implicated to an extreme degree, the sufferer must be fed through the stomach-tube or by means of nutritive enernata. Sometimes the patient is unable to maintain his seat, but is continually jumping up and down or falling- from his chair. Even in cases of moderate severity, locomotion is often rendered difficult, if not impossible, by the irregular contractions occurring in the legs. As a rule, the movements cease almost entirely during sleep (although rest is often disturbed by frequent fits and starts); but, in cases of extreme severity, sleep is rendered impossible by the vio- lence of the movements, and the latter continue even Avhen the patient does finally fall into a light slumber. Ulcerations of the prominent por- tions of the body, from the continued friction against surrounding objects, supervene in these cases, and inanition and exhaustion rapidly develop from the lack of nutrition consequent on the inability to eat, from the continuous violence of the choreiform movements, and from the loss of sleep. In light cases, the choreic contractions usually occur when the patient endeavors to perform a voluntary act, and the bizarre movements are then due to associated contractions of antagonistic muscles. In the more severe forms, the movements develop irrespective of any voluntary effort on the part of the patient, and, as we have previously mentioned, may even continue uninterruptedly during sleep. But these statements will not hold good in all cases and under all circumstances. Gowers * * ' Handb. d. spec. Path. u. Therap. Bd. XII. p. 415.