Note of a new form of pseudo-paraplegia / by T. Grainger Stewart.

Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Note of a new form of pseudo-paraplegia / by T. Grainger Stewart. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    reason to Lope that the symptoms may be in great measure due to increased excitability of a functional nature. What is known as associated movement (Mitbewegung) appears to be the condition most closely allied to that which is found in our case. The essential characteristic of this abnormality is that when by voluntary effort one muscle is brought into play, contraction simultaneously occurs in others. Nothnagel speaks of this as a result of irradiation of the voluntary impulse ; and remarks that the more intense that impulse is, the wider is the irradiation. It occurs in health when a violent effort is made, but is a prominent feature of certain morbid conditions. Some- times the intended movement is feebly performed; the associated, vigorously,—so that the result is quite different from that which was aimed at. An arm may be flexed when the patient wishes to extend it, or an effort to thrust out the tongue may result in firm closure of the mouth. The longer the voluntary effort is continued the greater does the irradiation become, so that a patient effected in this way may be able to walk tolerably for a short time, but afterwards be quite unable to proceed. Care- ful observation of our patient shows that his symptoms are not referable to any of the described types of associated movement, although in some respects and in so far similar. It is quite possible that the irradiation observed in our case is directly due to sclerosis; and if so we may expect to find a further gradual extension of the disease, with increase and altera- tion of the symptoms, true paralysis becoming ultimately developed. Meanwhile it is clear that the object to be kept in view in treatment is the diminution of the excitability of the spinal cord. The application of icebags along the spine appears to be invariably followed by temporary improvement. When they have been applied for. some time, the patient bends his legs quite readily; but when he attempts to walk, little difference is noticed. Ergot of rye has failed to do good; conium has also failed ; chloral hydrate appeared to prove in some degree bene- ficial, but latterly has been found to be of little use.