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.

    19/272 (page 7)
    ClIOllEA. quent calls to urinate disturb him. Ho improves under arsenic, quinine, or any general tonic or country air.” I have also observed a case of chorea in -which the patient, although previously able to retain his urine, was frequently seized with inconti- nence which came on suddenly, and which I could only explain on the hvpothe.sis that the symptom was duo to sudden, choreiform contractions of the detrusor urinm. After the chorea subsided, the patient was again able to retain his urine as usual. As a general rule, both pupils are considerably dilated in this disease, and do not respond readily to light. I have not observed any noteworthy difference in their condition in hemichorea. The appearance of tlie pupils is not, however, characteristic of this affection, and is frequently ob- served in children whose health is below par. Rosenthal reports one case in which, at the height of the paroxysm, he observed very marked dilata- tion of both pupils, which was not modified by exposure to a bright light or by introducing a small electrode between the sclerotic and conjunctiva. The pupillary dilatation disappeared spontaneously at the termination of the disease. Dr. H. R. Swanzy ‘ reports a case in which an ophthalmoscopic ex- amination in a choreic girl (whose choreiform movements developed simul- taneously with blindness of the left eye) showed the appearances indicative of embolism of the central artery of the retina. After the lapse of five weeks, the retinal circulation was restored, and the chorea likewise ceased about the same time. Three months later, this patient was suddenly seized with complete paralysis of the seventh nerve on the right side. Five days afterward, violent and persistent vomiting occurred, which continued all night and the following morning, and appeared to be of a cerebral character. The sense of taste on the right half of the tongue was some- what impaired. Three months after the beginning of the paralysis the child was growing stronger and the paralysis had improved considerably. Dr. Swanzy regarded the paralytic affection as indicative of an organic cerebral lesion. It is unfortunate that no note was made of the electrical i reactions of the affected nerve and muscles; but from the fact that the paralysis was said to be complete, and that the sense of taste was im- paired, we should regard the former as more probably peripheral in its origin. Some authors state that sensory disturbances are quite common in chorea, while others barely mention their occurrence. The French writers especially maintain that hemianjesthesia is a frequent concomitant of hemichorea, and that in some cases the special senses are affected. Although my attention has been directed to this point for several years, I have not been able to verify the observation. It is more than probable that many of the cases of chorea in which hemianmsthesia has been a prominent symptom, have been really examples of post-liemiplegic chorea, and there- fore^ belong to another category. At other times, general hyperms- thesia of the surface has been noticed, or vague, wandering pains in the muscles and joints. Especial importance has been attached to ten- derness upfiTi pressure over the spinal column, particularly in the cer- vical and upper dorsal regions. Stiebel. Rosenbach, and Seifert have laid great stress upon the value of this symptom from a j)athological and ' Ophthalm. IIosp. Ilep., Sept., 187ij.