Medical diagnosis : with special reference to practical medicine: a guide to the knowledge and discrimination of disease / by J.M. Da Costa.

  • Da Costa, J. M. (Jacob Mendes), 1833-1900.
Date:
1881, ©1880
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Licence: Public Domain Mark

Credit: Medical diagnosis : with special reference to practical medicine: a guide to the knowledge and discrimination of disease / by J.M. Da Costa. 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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    limbs, but the more incomplete the palsy; and the farther the disease extends toward the corpus striatum, the more thorough does the paralysis of motion become. We may further distinguish the palsy which ensues from that caused by an affection lower down, as of the pons Varolii, by observing that, besides the pe- culiar crossed paralysis of the face and limbs which so often hap- pens in this, and which has been above described, we find extreme coldness of that side of the body which is to become paralyzed after a time; also giddiness and a tendency to vomit; proneness to cry or laugh without sufficient cause; jerkings of the muscles of the face on the side opposite to the injury; sensations of tick- lings in the face; and one-sided facial anaesthesia, with a loss of sense of taste on the corresponding side, though with unimpaired motion of the tongue. Should we encounter paralysis of sensi- bility and motion on one side of the body, and both sides of the face be palsied as to motion and sensation, should the recti muscles of the eye be paralyzed, and taste be lost over the anterior part of the tongue, we may infer that the injury is seated rather above the lower portions of the pons, and affects the spot where the facial nerve and part of the trigeminal cross.* In lesions involving the central parts of the pons, paralysis, mostly unequal, of both sides of the body, with impaired sensa- tion, irregular facial palsy, difficulty in deglutition and articula- tion, is the rule. Lesions of the lower and inner part of the crus Hermann Weber has taught us to recognize by an alternate pa- ralysis, in which the third nerve is palsied on the side of the brain affected, showing us want of action of the muscles of the eyeball, except the external rectus and superior oblique, with a dilated pupil, a tongue deviating to the paralyzed side, some difficulty in articulation, the body-palsy marked in the arm and leg, and coex- isting with local temperature higher by several degrees, and very defective sensation. The facts that have been thus far mentioned are such as have been on the whole well attested by clinical experience. But since the brilliant researches of Hitzig and of Ferrier on the localiza- tion of cerebral functions, renewed eagerness has been displayed in tracing special symptoms to lesions of particular portions of * Brown-Sequard, Dublin Quart. Journ., May, 18G5.