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.

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    second sound was heard at the second interspace, diminishing toward the apex, with a murmur much harsher than before and of greater intensity. The most careful examination with stethoscope and phonen- doscope fails to reveal any increase in the area covered by the heart dulness. The pulse is somewhat weak and small, from 80 to 90 during an attack ; sometimes, with about the same speed, its tension is increased and its character distinctly dicrotic, as shown in sphygmographic tracings made repeatedly during the attacks. The heart examinations were made over and over again. I made not less than a hundred careful examinations of the heart in the attacks, and as he was an object of interest to the other members of the hospital staff, the examinations were made many times over by them, and the general opinion confirmed the above statements, which indicate rather a relaxed condition of the heart muscle, as well as of the whole arterial system, than an acute cardiac dilatation. In this belief I am supported by the high authority of Professor. J. M. Da Costa, who studied the heart during an attack. The reflexes in the more severe paroxysms are totally lost except the reaction of the pupil. No contraction can be observed in the pectoral muscles on striking them; the abdominal recti do not contract to ordi- nary stimuli, the cremasteric reflex is abolished, there are no knee-jerks, and although the patient resents the attempt to secure the plantar reflex by irritation of the sole of the foot, no muscular contraction takes place. Sensation is perfect. The electrical examinaton was many times repeated during the attacks and in the intervals. In the typical attack there was practically total abolition of reaction to any form of electrical stimu- lation. In milder attacks some variations upon these general symptoms were noted. Muscle-jerks were sometimes present, the knee-jerks were occa- sionally found present by reinforcement, the cremasteric reflex was at times not altogether absent, though usually Aveakened. In the same way the degree of muscular enfeeblemeut varied a little. In the early part of even severe attacks, during the morning hours, the patient would be able to move his hands, perhaps his forearms, or even his toes. As the day went on the paralysis would become deeper and all movement would be abolished. Return of normal conditions followed much the same order that characterzied the onset. The knee-jerks improved a little, other reflexes reappeared, slight contractility in the muscles was discoverable, and in the course of an hour or so from the beginning of betterment the patient was almost perfectly well. Several times periods of apparent partial recovery were followed by relapses into total par- alysis. Usually progress was steady and rapid, and several times we have seen a man who at six o'clock was, so far as power to move or to respond to electrical stimulation could tell, as dead as a twelve-hours'