Clinical notes / by Alexander James.

  • James, Alexander, 1850-1932.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: Clinical notes / by Alexander James. 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.

    3/18
    In the performance of my duties as clinical medicine tutor for the Ordinary Physicians of the Eoyal Infirmary, I have opportunities of studying disease in almost all its forms, and through the kind- ness of those gentlemen I have been enabled from time to time to make a special study of cases of unusual interest. As some of the results of this, I beg to lay before you the following paper:—' I. Tendon Eeflex and Clonus Phenomena. The first case is that of a patient, Kellie, set. 30, in Dr Balfour's wards. He has the well-marked symptoms of lateral sclerosis, i.e., loss of voluntary power over the muscles of the legs, which are, however, very well nourished, and when he attempts to perform any movement with them he fails almost entirely, owing to the spasms which occur. There is, in addition, some loss of the cutaneous sensibility about the feet and ankles, and this, along with the lightning pains which he complains of, leads us to believe that other parts of the cord are involved. As a rule : the cutaneous reflexes are diminished and the deep increased. It is the latter and the clonus which I now wish to discuss. The ankle clonus is well-marked in both legs (especially the . left), either on sudden passive tension or on tapping the muscle I or tea don after gradual passive tension. In the left leg the ' front tap contraction can usually be easily induced. By means < of tambours, one placed in connexion with the foot and the other ' with a revolving cylinder, I have obtained tracings of the clonus, ; and by the chronograpli I find the contractions to occur at the I rate of about 68 per second. The movement is, as usual, per- I fectly uniform. By grasping the foot and suddenly pressing it i inwards or outwards a lateral clonus, due to clonic spasm of the 1 peronei or tibialis posticus can be induced. The toe clonus I have not been able to excite. On getting the patient to stand erect, it is found that in a (certain position of the leg as regards tlie trunk (the significance * It was intended that these notes should be read before the Medico- ( Chirurgical Society of Edinburgh previous to publication. .Want of time 1 prevented this being done.