Remarks on a case of alternate partial anaesthesia / by Sir George Paget.

  • Paget, George Edward, 1809-1892.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on a case of alternate partial anaesthesia / by Sir George Paget. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    phlegm collecting on the left side of his throat. His tongue was furred, and he had hiccough ; his pulse was 84, not full; and the impulse and sounds of his heart were feeble. Twenty-one leeches were applied to his temples, and calomel and active purgatives were administered in repeated doses; but these acted only once scantily, and in the afternoon his right arm was observed to be paretic and somewhat ataxic, though less paralysed than the left; and the pulse rising much in force and frequency, and a drowsiness and lethargy coming on, fifteen ounces of blood were abstracted from the arm. Two hours after this the bowels were freely evacuated, and some amendment was manifested. The stools were unhealthy. In the night he again suffered from’ severe pain in the left side of his head, but next morning it had ceased; the vertigo was diminished, the mouth was less drawn, the hiccough less frequent, and the vision was only sometimes double. From this time the urgency of most of the symptoms gradually abated. The distortion of the face first disappeared, and the eye- lid drooped less. The double vision and hiccough did not con- tinue much beyond eight or nine days. He had more and longer trouble with his throat. He complained of difficulty of swallow- ing, which he referred chiefly to the left side of the throat, and said that phlegm collected there and could not be raised without repeated efforts. Frequently, also, he had a sudden attack of dyspnoea, with a feeling of suffocation, which made him start up suddenly from his sleep, and was not relieved until some phlegm had been dislodged. This at first occurred several times every night, but gradually became less frequent, and in little more than a fort- night both dyspnoea and dysphagia ceased to give him much trouble, though they recurred now and then in a slighter degree for three months. For a week or two his voice was hoarse. On the third day after the attack it was observed that the left conjunctiva was inflamed, and the left nostril obstructed with mucus. These symptoms subsided in the course of a few days, but subsequently the left eye on several occasions became con- gested on the recurrence of pain in the left brow, and for many weeks its vessels appeared fuller than those of the right eye, and a like difference was observable for many months between the two cheeks, the left being persistently fuller of blood and warmer than the right. The sense of numbness which he had experienced in the whole left side was no longer felt in the trunk and limbs after a few days, but the paralytic weakness was more lasting, the grasp of the hand remaining feeble, and the faculty of directing it con- tinuing impaired for nearly three months. In his right hand he sooner recovered strength and directing power, so that after five weeks he was able to write with neatness and precision, but for many months was liable to a temporary enfee- blement of the right limbs accompanying attacks of pain about the left brow; and at these times the right limbs, which had been but little paralysed at first, became temporarily weaker than the left limbs. He was able to draw up his legs in bed, but at first was in- capable of standing. This inability was due partly to intense giddiness. When the giddiness had abated he became able—;-at the end of three weeks—to walk with support. He walked with tottering steps, looking down at his feet, but not dragging them. The legs were carried awkwardly, but not stiffly; both of them were weak, the left being commonly the weaker. It has already been mentioned that for twelve months he had been subject to vertigo whenever he lay on his left side. This