Diphtherial nerve-affections / by Edward Headlam Greenhow.

  • Greenhow, Edward Headlam, 1814-1888.
Date:
[1863]
Catalogue details

Licence: Public Domain Mark

Credit: Diphtherial nerve-affections / by Edward Headlam Greenhow. Source: Wellcome Collection.

    17/24 (page 13)
    could walk round the table, though unsteadily, with the help of a stick in the other hand. llth. General aspect greatly improved; patient could now stand and walk across the ward with no support but a stick. Muscles of hands, arms, and legs had gained both in volume and power. Sensation of roughness in the fingers on touching anything still continued. Numbness of lower limbs had disappeared, but acute pain was felt on pressure over the sciatic nerves, and tenderness as before on pressure of the calves. 21st June Patient in almost all respects improved; the pain on pressure over the sciatic nerves alone rather increased than diminished. 26lh. Patient rapidly im- proving, though he still walked a little unsteadily. All sense of formication, numbness, and tightness in the extremities had ceased ; the tenderness in the calves was entirely gone, and the pain on pressure over the sciatic nerves very greatly diminished. The sensibility and motor power of the soft palate had been entirely regained, the sight had for some time been perfect, and the muscles of the limbs were gaining in bulk and firmness. Discharged to the Convalescent Asylum at Walton. Case 4.—Arthur Wiseman, aged 28, married, shoemaker, admitted under the care of Dr Stewart, 18th March 1862. Had been healthy previous to his present illness, which began on the 8th January, with catarrhal symptoms. On the following day his throat was sore, and he had much difficulty in swallowing. The first medical man who saw him called his complaint diphtheria, but a second who saw him a little later said it was ulcerated sore-throat. There can, however, be no doubt that the disease had been really diphtheria. In about a fortnight from the commencement of his illness, the throat began rapidly to amend, and in about a month the patient was able to return to work. He did not feel strong, but worked very well for two days, being able to see dis- tinctly both to work and read. On the third day his sight became indistinct, as though from a mist floating before his eyes, and he was unable to read. The impairment of sight lasted three weeks, during which time, however, he discovered that he could read with the help of spectacles. His power of vision returned almost as suddenly as it had departed. About the same time that his sight became impaired, the patient had felt numbness in the tip of the tongue, which also felt cold, and he was unable to move it freely in the mouth. Besides this numbness and coldness, there was a sense of scalding or tingling in the tongue, which gradually extended upwards from the tip towards the dorsum. This affection of the tongue was before long accompanied by a sensation of choking in the throat, and by difficulty of speech. The duration of these symptoms is uncertain, as the patient could supply no accurate data by which it could be estimated. Next commenced numbness and formication in the tips of the fingers, which gradually, but slowly, crept upwards to the shoulders, and was attended by almost complete loss of power in the arms. About the same time, or very shortly afterwards, numbness, but unattended with tingling, commenced in the toes, and gradually crept up to the hips and to the lower part of the abdomen, causing his gait to be feeble and unsteady. Throughout the course of his illness, previous to the day of his admission into the hospital, he had never been confined to bed, and on that day, the 18th March, he walked up stairs to the ward, though with difficulty. On admission, he was pale and somewhat emaciated; countenance anxious ; skin soft and warm ; tongue flabby, indented by the teeth, and covered on the dorsum with a thin white fur. Pulse from 68 to 80, very excitable, sometimes irregular, and frequently intermitting. Pupils of equal size, dilated and sluggish under the influence of light. Occasional tinnitus aurium, swallowing difficult, and attended with a choking sensation. There was a feeling of constriction around the lower part of the abdomen, and the cutaneous sensibility was much im- paired from the umbilicus downwards ; there was also pain on percussion over the spine, and tenderness on pressure by the sides of the vertebrae, from the lower dorsal region downwards. The velum pendulum palati and the adjoining parts of the fauces were insensible to touch, and the velum hung relaxed and almost motionless in respiration, and in the attempt to articulate the word.