Text-book of nervous diseases : being a compendium for the use of students and practitioners of medicine / by Charles L. Dana.

  • Dana, Charles L. (Charles Loomis), 1852-1935.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Text-book of nervous diseases : being a compendium for the use of students and practitioners of medicine / by Charles L. Dana. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    pronators, the flexors and extensors of trie fingers, and the hand muscles are involved. The arm can be raised and the forearm flexed and supinated, but the hand is useless and the extension of the forearm is impossible. The lesion here involves chiefly the nerves from the seventh and eighth cervical and first dorsal roots (Fig. 75). If the lesion is in the nerve there will be atrophy, changes in electrical reaction, sensory disturbances, and often, if there is neu- ritis, pain over the nerves. The reflexes will be lessened or absent. If the lesion is in the spinal cord, symptoms in other parts of the body will be present, or, if not, there will be no sensory disturbance, as in an arm palsy from anterior poliomyelitis. In rare cases arm palsies may be caused by spinal tumors or a local meningitis, in which case diagnosis is difficult. The upper-arm type and lower-arm typje palsies are caused by much the same factors as the combined palsies; their symptoms have been indicated above. The upper-arm type is especially fre- quent in infants and constitutes one of the obstetrical paralyses. It may in some cases be due to injury or hemorrhage in the ;cord. The prognosis is usually good. Nearly all these cases get well, the duration of the incapacity being from two or three months to a year. Even in the severest cases recovery is possible after one or two years. If, however, the nerves are torn across and the ends widely separated, recovery is do'ubtful unless an operation is promptly done. The treatment consists in electrical applications, mechanical sup- port, with potassium iodide internally and abstinence from alcohol. Local inactions of nitrate of strychnine are useful, and massage should be used if it can be applied carefully. In brachial palsies due to severe injuries, dislocations, frac- tures, etc., in which there is evidence, from the extreme atrophy and absence of electrical reaction, that the nerve is entirely cut across and that the ends are not in apposition, a surgical operation is stringently needed. The nerves should be exposed and the ends brought as near together as possible. Decalcified-bone tubes or sterilized macaroni may be used to give a passage for the central end to grow into the peripheral. In these cases, however, it must be remembered that the two ends do not unite; but the central end grows down in the tract of the old degenerated peripheral stem. 1 A peculiar form of combined nerve palsy sometimes occurs, due apparently to a primary brachial neuritis. It begins in the plexus and involves first the nerves of the upper cervical roots. It may ■extend down and involve the ulnar, median, or musculo-spiral.