Medical evidence and the laws relating to compensation for injury / by R.J. Collie, M.D., J.P.

  • Collie, John, Sir, 1860-1935
Date:
1909
Catalogue details

Licence: In copyright

Credit: Medical evidence and the laws relating to compensation for injury / by R.J. Collie, M.D., J.P. Source: Wellcome Collection.

    18/44 (page 14)
    Nervous Diseases. In medico-legal matters I think most mistakes are made wit] nervous diseases. The difficulty in settling what is functional am what is organic seems to scare most men, and I do not wonder. Tin neuromimetic is a foeman worthy of your steel, and I wish you jo^ of him. When called upon in a medico-legal case to distinguish him fron a case of locomotor-ataxia, from the incipient stages of genera paralysis of the insane, or from a chronic alcoholic, you will he ii need of all the sympathy your friends can spare. Satisfy yourself by the ordinary means at your disposal whethe: actual objective signs do, or do not exist, and that no serious trophl changes, which cannot be accounted for by mere disuse of parU have taken place. Superficial and deep reflexes should be examined. Slight altera tions in these, however, are not of the importance generally attache* to them in the law courts. Remember, something which may easily be mistaken for Babinski’ sign is found in the neurotic. It is sometimes a little difficult t< elicit. Bear in mind that plantar reflexes are absent when the foot i very cold or moist. In the various palsies said to be the result o accidents, test for the reaction of degeneration. Take each case as i whole. The more you know of the nervous system and its diseases the less worrying do these cases become. For instance, fine fibrilla tremors are generally genuine, coarse trembling is almost alway assumed. The difference between functional and organic disease is ex ceedingly difficult to tell, and the difficulty, in view of the increasing volume of litigation and the stress of modern life, is likely to increase In your anxiety not to overlook anything, beware of exaggerating trifling abnormalities, which by no means necessarily mean disease. Knee Jerks. The man who walks into your consulting room whose knee jerk: are entirely absent has organic nerve disease, generally eithe: locomotor ataxia or neuritis ; but it is a very difficult thing to saj positively that knee jerk is absent: it is sometimes very difficult t( elicit. The patellar reflex can be said to be absent only when a lianc placed on the quadriceps extensor femoris fails to detect the slightes contraction of the muscular fibres. Do not forget the method o reinforcement. A patellar reflex, however feeble, if constant must no: be looked upon as pathological,