On peripheral neuritis : a treatise / by James Ross and Judson S. Bury.

  • Ross, James, 1837-1892.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: On peripheral neuritis : a treatise / by James Ross and Judson S. Bury. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    limbs, which extended over the whole of the leg and foot in the lower, but was limited to the hands in the upper extremities. The patient became progressively worse, and died four and a half months from the commencement. Autopsy.—The muscles were found atrophied, pale, and small; but on microscopical examination the transverse striation was well marked, and the fibres had not undergone fatty degeneration. The small nerves of the hands and feet (median and plantar nerves) were found to have only a small number of primitive bundles, and the nerves showed an excess of connective tissue, and a large number of fat cells. In individual fibres there was a want of continuity in the myelin sheath, which, when present, manifested a marked degree of granular degenera- tion. The brain and spinal coi'd were found quite healthy. In commenting upon this case the author remarks : I ought not to omit to point out the resemblance in essential particulars between this form of paralysis and that which Duchenne has described under the name of i^aralysie generale spinale. In the one as in the other the disease begins in the extremities, which it attacks €7i masse. The muscles undergo a uniform wasting, and the electric contractility is abolished in muscles which have conserved their structure. In 1866, Dumenil,* in a second communication on peripheric paralysis, reported another case of this disease with autopsy. Although this case is not such a typical example of the affection as his first, it deserves to be quoted in abstract here because it foreshadows Avhat will be abundantly proved in the sequel, that in the diseases grouped together under the name of peripheral neuritis, the grey matter of the spinal cord is not always free from morbid changes, although the ^weight of the disease falls upon the nerves themselves. M. J., aged 36 years, an ironer, was of good constitution, and free from hysteria or other nervous affection. One year before she came under I observation, and after she had taken a journey of four hours in a badly 0 constructed vehicle, in which she was squeezed so that she could only sit on the right buttock, she felt a feeling of numbness in the right gluteal region, which soon extended over the whole of the back of the limb. She suffered from continuous pains in this region, but these were interrupted by neuralgic paroxysms of great severity, during which the pains radiated to the heel, which became so sensitive that the patient was unable to place it on the ground. After a time the numbness extended over the whole of the foot, and soon afterwards the patient was unable to move the toes, and a little later the power of movement at the ankle disappeared. The muscles were flaccid and offered no resistance to passive movements. The sole of each foot, the toes, and the outer aspect * Dumenil (L ). Contributions pom- servir k I'histoiie des paralysies periph^riques, et specialement de la nevrite.—Qazette Hebdomadaire de Med. et de Chir.—Tome III., 1866, p. 52.