Diseases of the nervous system : a text-book of neurology and psychiatry / by Smith Ely Jellife and William A. White.

  • Jelliffe, Smith Ely, 1866-1945.
Date:
1929
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the nervous system : a text-book of neurology and psychiatry / by Smith Ely Jellife and William A. White. Source: Wellcome Collection.

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    incubation averaging about ten or twelve days by hypersensitization to adrenalin, etc., of the pupil-dilator mechanism of the contralateral eye. After similar lesions of the brachial plexus the period of the incu¬ bation was shorter (about eight days) and the paradoxical effects occurred in the homolateral eye. It was found finally that lesions of any of the cranial or spinal sensory nerves induced paradoxical sensi¬ tization in the related pupil. After section of one sciatic nerve paradoxical effects appeared in the contralateral eye about the twelfth day regardless of whether the divided nerve ends had been sutured together or not. It was found, however, that after the paradoxical period had passed off which, in the absence of infection, usually occurred from the fifteenth to the thirtieth day it could readily be reinduced by injury of the proximal segment of the divided nerve. An intimate functional relationship exists between the efferent portion of the pupil dilator mechanism and every portion of the peri¬ phery through the medium of the sensory nerves. This relationship has important clinical significance since unilateral lesions of the sensory nerves are attended by well marked pupil inequality which in general follows the rule found for paradoxical dilatation. Because of this rela¬ tionship great care must be taken to give due consideration to lesions of the sensory nerves in interpreting the significance of pupil inequality in surgical and medical conditions. Compare the Klumpke-Dejerine sign. Psychical dilatation or contraction of the pupils may follow upon the idea of looking at an object at a distance or close to. Pilcz reaction: tight compression of lids causes mydriasis. Non¬ operative with Argyll-Robertson pupil. The Fifth (Trigeminus) Nerve—The motor functions of the fifth nerve are most readily tested by having the patient move his jaw to the right and left. The examiner’s hand, exerting contrary pressure, can determine differences in innervation (external pterygoid, tem¬ porals). The finger, wrapped in a towel, can be used to bite upon to determine variations in bite (masseter, temporal). Wooden tongue depressors are also serviceable, one on each side. By pulling weakness may be demonstrated. The state of hardness of the temporals and masseter muscles can be directly palpated. The jaw should be protruded (internal pterygoid). The use of a tuning-fork of low pitch is useful in determining varia¬ tions of function of the tensor tympani muscle. In one-sided somatic paralysis of the fifth nerve, the opened jaw deviates to the paralyzed side by the action of the sound external pterygoid. The patient chews on the sound side. It may or may not be accompanied by sensory changes. Elevation of the eyelid on strong biting is a frequent associated movement. The jaw reflex may be tested at the same time. With the mouth partly open a pencil or flat object is placed upon the teeth and lightly tapped with the hammer. There is a quick contraction of the mas-