A study of a case of family periodic paralysis / John K. Mitchell.

  • Mitchell, John K. (John Kearsley), 1859-1917.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: A study of a case of family periodic paralysis / John K. Mitchell. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    4/16 (page 4)
    well and awake ia the morning wholly paralyzed from the neck down. I say from the neck down, but the neck to a certain extent shares in the difficulty. He can, when lying still, turn the head from side to side, but he cannot raise it from the pillow, and if placed in an erect position the head falls forward on the chest, or backward almost between the shoulders, without the possibility of any control on the patient's part. Breathing in the attacks is somewhat shallow, and appears almost altogether diaphragmatic in character. If he is requested to cough he is unable to, or even to take a normally full inspiration. If the nares are irritated he cannot sneeze, though he feels the annoyance and has a desire to do so. He does not have much appetite, and says he perceives slight dift- culty in swallowing, but this is not evident to the observer. While the paralysis lasts he usually passes water only once or twice in the twenty- four hours and has no fecal movement. There is no disturbance of the mind ; speech is not affected, and he has no pain except the discomfort of lying absolutely in one position, which somewhat annoys him. So far for his own statement of his feelings and symptoms. Physical Examination During an Attack. The patient is notably paler in the attack than during healthy intervals. His lips are less well colored ; his tongue is somewhat coated and his breath has a heavy smell, but there is no change of expression and certainly no mental impairment. He answers readily to all questions and takes an interest in the examination of his symptoms. Upon study of the chest the breath sounds are found to show slight general lessening, due, probably, to imperfect dilatation of the chest. On being asked to take a long breath he makes an effort to do it, but has little control of the accessory muscles, and moves the cage of the ribs but slightly. The heart's action and pulse are decidedly changed from normal. The apex-beat is below the fifth rib, rather indistinct, two and a quarter inches from the mid-sternal line. The heart's action varies much in different attacks; it is sometimes a little irregular in time, though no distinct intermittency has been observed at any time. The heart conditions, however, were not always the same during the attacks. Examined several times during October and November in attacks, the heart presented usually a split second sound, very distinct in the pulmonary area, a systolic murmur well heard upon full expira- tion and limited to the same area, transmitted somewhat up and down the left side of the sternum, strong and decided, but not loud or harsh. In the latter part of November, examining him one day with Dr. Morris J. Lewis, we both agreed that there was a soft, low, systolic murmur, best heard at full expiration at the second right interspace and very faintly upon the left side. This was a condition which was never found again. Three days later, during an interval, the split