Clinical notes on nerve disorders in surgical practice / by George Wherry.

  • Wherry, George, 1852-1928.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Clinical notes on nerve disorders in surgical practice / by George Wherry. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    large quautity of pale urine while the attack was urgent. He was entirely restored by a seaside holiday. These alarming symptoms sefem to point to a lesion of some of the nuclei of the third nerve in the aqueduct of Sylvius. The re- covery after a course of iodide of potassium suggests that a syphi- litic gumma may have been the cause of the ocular disoi'ders. The lesion, if present in such a region, must be very small not to do more damage than just to affect that part of nerve which deals with the internal recti associated in con- vergence, leaving the lateral and other movements of the eyeball possible, without involving the levatores palpebrarum ; and at the same time dilating the pupils, without evidence of affection of the accommodation. With no experience of the curious disturb- ance of taste which the patient described to me, I should like to know whether it is found in hysteria and functional disorders, as this fact might cast a doubt on the syphilitic origin of the other symptoms. It differed quite from the unilateral hot pain in the tongue found sometimes in Bell’s palsy of the facial, due to affection of the chorda tympani. This pain does not, so far as I know, come on in eating and drinking. It was not a hyper- ajsthesia, but a painful perversion of taste. The patient himself thought his symptoms were due to a cerebral hmmorrhage during coitus. The next was a curious case in which one eye only was affected, all the external muscles Avere paralysed except the levator palpebrm, the ciliary muscle and pupillary sphincter not being affected. There had not been any pain or tenderness or anything to suggest inflammation about the orbit. If this was a deep nerve-lesion at all it did not seem likely to be mischief about the nerve-cords in the cavernous sinus— otherwise it would be difficult to conceive the escape of the levator palpebrse and the ciliary muscle. Further back among the nuclei of origin, or further forward where the nerves divide in the orbit, is a more probable seat of the lesion. On the whole it seems that the nuclei Avere affected rather tlian nerve-fibres selected so partially as to involve the entire fourth and sixth nerve, Avith that part only of the third Avhich supplies the internal, superior, and inferior rectus. In connexion Avith the