anomalies and curiosities of medicine-第214部分

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nsion　of　the　middle　and　distal　phalanges。　The　athetoid　movements　of　the　toes　correspond　to　those　of　the　fingers　in　point　of　action。　In　a　great　majority　of　cases　the　disease　is　confined　to　one　side　（hemiathetosis）；　and　is　a　sequel　of　hemiplegia。　The　differential　diagnosis　of　athetosis　is　generally　easily　made。　The　only　nervous　affections　with　which　it　could　possibly　be　confounded　are　chorea　and　paralysis　agitans。　Attention　to　the　twitching；　spasmodic；　fibrillary　movements；　having　a　quick　beginning　and　a　quick　ending；　which　is　characteristic　in　Sydenham's　chorea；　would　at　once　exclude　that　disease。　These　jerky　movements　peculiar　to　St。　Vitus's　dance　may　be　easily　detected　in　a　few　or　many　muscles；　if　moderate　care　and　patience　be　exercised　on　the　part　of　the　examiner。　This　form　of　chorea　is　almost　always　a　disease　of　childhood。　So…called　post…hemiplegic　chorea　is；　in　the　opinion　of　both　Hammond　and　Gray；　simply　athetosis。　The　silly；　dancing；　posturing；　wiry　movements；　and　the　facial　distortion　observed　in　Huntington's　chorea　would　hardly　be　mistaken　by　a　careful　observer　for　athetosis。　The　two　diseases；　however；　are　somewhat　alike。　Paralysis　agitans　（shaking　palsy）；　with　its　coarse　tremor；　peculiar　facies；　immobility；　shuffling　gait；　the　'bread…crumbling'　attitude　of　the　fingers；　and　deliberate　speech；　would　be　readily　eliminated　even　by　a　novice。　It　is；　too；　a　disease　of　advanced　life；　usually。　Charcot；　Gray；　Ringer；　Bernhardt；　Shaw；　Eulenberg；　Grassel；　Kinnicutt；　Sinkler；　and　others　have　written　on　this　affection。〃

The　following　is　the　report　of　a　case　by　Drewry；　of　double　（or；　more　strictly　speaking；　quadruple）　athetosis；　associated　with　epilepsy　and　insanity：　〃The　patient　was　a　negro　woman；　twenty…six　years　old　when　she　was　admitted　into　this；　the　Central　State　（Va。）　Hospital；　in　April；　1886。　She　had　had　epilepsy　of　the　grand　mal　type　for　a　number　of　years；　was　the　mother　of　one　child；　and　earned　her　living　as　a　domestic。　A　careful　physical　examination　revealed　nothing　of　importance　as　an　etiologic　factor。　Following　in　the　footsteps　of　many　of　those　unfortunates　afflicted　with　epilepsy；　she　degenerated　into　a　state　of　almost　absolute　imbecility。

〃Some　degree　of　mental　deficiency　seems　usually　to　accompany　athetosis；　even　when　uncomplicated　by　any　other　degenerating　neurosis。　Athetoid　symptoms　of　an　aggravated　character；　involving　both　upper　and　both　lower　extremities；　had　developed　previous　to　her　admission　into　this　hospital；　but　it　was　impossible　to　find　out　when　and　how　they　began。　She　had　never　had；　to　the　knowledge　of　her　friends；　an　attack　of　'apoplexy；'　nor　of　paralysis。　The　head　was　symmetric；　and　without　scars　thereon。　The　pedal　extremities　involuntarily　assumed　various　distorted　positions　and　were　constantly　in　motion。　The　toes　were　usually　in　a　state　of　tonic　spasm；contracted；　and　drawn　downward　or　extended；　pointing　upward；　and　slightly　separated。　Irregular　alternate　extension　and　flexion　of　the　toes　were　marked。　The　feet　were　moved　upon　the　ankles　in　a　stiff　and　awkward　manner。　During　these　'complex　involuntary　movements；'　the　muscles　of　the　calf　became　hard　and　rigid。　The　act　of　walking　was　accomplished　with　considerable　difficulty；　on　account　of　contractures；　and　because　the　feet　were　not　exactly　under　the　control　of　the　will。　The　unnatural　movements　of　the　hands　corresponded　to　those　of　the　lower　extremities；　though　they　were　more　constant　and　active。　The　fingers；　including　the　thumbs；　were　usually　widely　separated　and　extended；　though　they　were　sometimes　slightly　flexed。　The　hands　were　continually　in　slow；　methodic；　quasi…rhythmic　motion；　never　remaining　long　in　the　same　attitude。　In　grasping　an　object　the　palm　of　the　hand　was　used；　it　being　difficult　to　approximate　the　digits。　The　wrist…joints　were　also　implicated；　there　being　alternate　flexion　and　extension。　In　fact　these　odd　contortions　affected　the　entire　limb　from　the　shoulder　to　the　digital　extremities。　When　standing　or　walking　the　arms　were　held　out　horizontally；　as　if　to　maintain　the　equilibrium　of　the　body。　The　patient's　general　physical　health　was　fairly　good。　She　frequently　complained　of　headache；　and　when　she　was　exceedingly　irritable　and　violent　all　the　athetoid　movements　would　be　intensified。　Speech　was　jerky　and　disordered；　which　gave　it　a　distinctive　character。　The　special　senses　seemed　to　be　unimpaired；　and　the　pupils　were　normal；　except　when　an　epileptic　attack　came　on。　Death　occurred　in　January；　1895；　after　an　obstinate　attack　of　status　epilepticus。〃　Paramyoclonus　multiplex　is　a　condition　of　chronic　muscular　spasm　affecting　the　trunk；　occasionally　the　muscles　of　the　face；　abdomen；　or　diaphragm。　The　muscles　affected　are　usually　in　the　trunk　and　in　the　limbs；　and　not　in　the　toes　and　hand；　occasionally　the　movements　are　tonic　as　well　as　clonic；　the　degree　of　spasm　varies　greatly；　and　according　to　Gray　may　sometimes　be　so　violent　as　to　throw　the　patient　down　or　out　of　the　chair。

Saltatoric　spasm　is　an　extremely　rare　condition；　first　observed　by　Bamberger　in　1859。　The　calf；　hip；　knee；　and　back…muscles　are　affected　by　clonic　spasm；　causing　springing　or　jumping　movements　when　the　patient　attempts　to　stand。　The　disease　is　transient；　and　there　are　no　mental　symptoms。

Progressive　muscular　atrophy　has　been　observed　as　far　back　as　Hippocrates；　but　it　is　only　in　recent　times　that　we　have　had　any　definite　knowledge　of　the　subject。　It　is　divided　into　four　types；　the　hand　type　（causing　the　griffin…or　claw…hand；　or　the　ape…hand）；　the　juvenile　type　（generally　in　the　muscles　of　the　shoulder　and　arm）；　the　facial　type；　and　the　peroneal　type。　Generalized　progressive　atrophy　leads　to　a　condition　that　simulates　the　appearance　of　a　〃living　skeleton。〃

Facial　hemiatrophy　is　an　incurable　disease；　as　yet　of　unknown　pathology。　It　consists　of　wasting　of　the　bones；　subcutaneous　tissues；　and　muscles　of　one…half　of　the　face　or　head；　the　muscles　suffering　but　slightly。　The　accompanying　illustration　shows　a　case　in　which　there　was　osseous　depression　of　the　cranium　and　a　localized　alopecia。　The　disease　is　very　rare；　only　about　100　cases　having　been　reported。　Of　five　cases　seen　by　Dana；　three　were　in　females　and　two　in　males；　in　all　the　cases　that　could　be　found　the　origin　was　between　the　tenth　and　twentieth　years。　It　is　a　chronic　affection；　usually　beginning　in　early　life；　increasing　slowly　for　years；　and　then　becoming　stationary。　It　is　distinguished　from　one…sided　muscular　atrophy　by　the　electric　reaction；　which　is　not　lost　in　the　facial　muscles　in　facial　hemiatrophy；　and　there　is　no　atrophy　of　other　muscles　of　the　body。

Burr　contributes　an　exhaustive　paper　on　hemiatrophy　of　the　tongue　with　report　of　a　case　as　follows：　〃L。　B。；　female；　mulatto；　thirty…one　years　old；　married；　came　to　the　Medico…Chirurgical　Hospital；　Philadelphia；　September　23；　1895；　complaining　that　her　'tongue　was　crooked。'　Save　that　she　had　had　syphilis；　her　personal　history　is　negative。　In　February；　1895；　she　began　to　suffer　from　headache；　usually　behind　the　left　ear；　and　often　preventing　sleep。　At　times　there　is　quite　severe　vertigo。　Several　weeks　after　the　onset；　headache　persisting；　she　awoke　in　the　night　and　found　the　left　side　of　the　tongue　swollen；　black；　and　painless。　For　some　hours　she　could　neither　speak　nor　chew；　but　breathing　was　not　interfered　with。　After　a　few　days　all　symptoms　passed　away　except　headache；　and　she　thought　no　more　of　the　matter　until　recently；　as　stated　above；　she　noticed　by　accident　that　her　tongue　was　deformed。　She　is　a　spare；　poorly…fed；　muddy…skinned　mulatto　girl。　The　left　half　of　the　tongue　is　only　about　one…half　as　large　as　the　right。　The　upper　surface　is　irregularly　depressed　and　elevated。　There　are　no　scars。　When　protruded　it　turns　sharply　to　the　left。　Fibrillary　twitching　is　not　present。　The　mucous　membrane　is　normal。　Common　sensation　and　taste　are　preserved。　The　pharyngeal　reflex　is　present。　The　palate　moves　well。　There　is　no　palsy　or　wasting　of　the　face。　The　pupils　are　of　normal　size　and　react　well　to　light　and　with　accommodation。　Station　and　gait　are　normal。　There　is　no　incoordination　of　movement　in　the　arms　or　legs。　The　knee…jerks　are　much　increased。　There　is　an　attempt　at；　but　no　true；　clonus；　that　is；　passive　flexion　of　the　foot　causes　two　or　three　jerky　movements。　There　is　no　glandular　swelling　or　tumor　about　the　jaw　or　in　the　neck。　Touch　and　pain…sense　are　normal　in　the　face　and　hands；　but　she　complains　of　numbness　in　the　hands　as　if　she　had　on　tight　gloves。　There　is　no　trouble　in　speaking；　chewing；　or　swallowing。　There　is　no　pain　or　rigidity　in　the　neck　muscles。　Examination　of　the　pharynx　reveals　no　disease　of　the　bones。　Under　specific　treatment　the　patient　improved。〃

Astasia…abasia　was　named　by　Blocq；　who　collected　11　cases。　According　to　Knapp；　four　cases　have　been　reported　in　America。　The　disease　consists　in　an　inability　to　stand　erect　or　walk　normally；　although　there　is　no　impairment　of　sensation；　of　muscular　strength；　or　of　the　coordination　of　other　muscles　in　walking　than　the　lower　extremities。　In　attempting　to　walk　the　legs　become　spasmodic；　there　are　rapid　flexions　and　extensions　of　the　legs　on　the　thighs；　and　of　the　thighs　on　the　pelvis。　The　steps　are　short；　and　the　feet　drag；　the　body　may　make　great　oscillations　if　the　patient　stands；　walks；　or　sits；　and　the　head　and　arms　make　rhythmical　movements；　walking　may　become　impossible；　the　patient　appearing　to　leap　up　on　one　foot　and　then　up　on　the　other；　the　body　and　head　oscillating　as　he　advances；　he　may　be　able　to　walk　cross…legged；　or　by　raising　the　legs　high；　or　to　walk　on　his　hands　and　feet；　he　may　be　able　to　walk　at　certain　times　and　not　at　others；　or　to　hop　with　both　feet　together；　he　may　succeed　with　great　strides　and　with　the　arms　extended；　or　finally　he　may　be　able　to　use　his　legs　perfectly　if　suspended　（Gray）。　There　are　various　types　which　have　been　called　the　paralytic；　the　choreic；　and　the　saltatory。　A　tendency　to　go　backward　or　retropulsion　has　been　observed；　according　to　Gray；　as　has　also　a　tendency　to　go　forward　or　propulsion。　A　curious　phenomenon　in　this　disease　is　that　the　patient　can　use　the　legs　perfectly　well　lying　in　bed。　The　prognosis　seems　to　be　favorable。

Meniere's　disease　is　a　disease　probably　of　the　semicircular　canals；　characterized　by　nausea；　vomiting；　vertigo；　deafness；