Lectures on diseases of the nervous system

Preface To Second Edition

In offering to the profession a new edition of my lectures it may he necessary to state that the work has been much enlarged, both by a fuller description of some forms of disease and by a more copious illustration of cases. During the last few years considerable attention has been given to the study of some special kinds of nervous affection, such as hemi-anaesthesia and its treatment, by the French school. A fresh interest has thus been necessarily created in this and kindred subjects, and has obliged me more fully to discuss them in reference to recent theories, to many of which, however, I cannot assent. Again, the classification of spinal diseases by Erb and other German authors has been so closely followed by English writers that I have felt compelled to rearrange my own section on this subject in deference to the general adhesion to German nomenclature. It will be seen, however, that this change has reference rather to pathological considerations than to any greatly advanced clinical knowledge ; for example, under the new designation of lateral sclerosis and its varieties will be found cases which appeared formerly under meningitis and other headings. The alteration, therefore, observable in this section is not so great as it might appear.

I have always advocated the opinion that the nomenclature of disease should be founded on clinical facts rather than on pathological considerations. Names were originally given to various groups of symptoms which were easily recognisable by all, the nature or cause of these symptoms being left for further investigation. No theories can overthrow any terms of this kind used merely as tokens whose value all understand. There may often be no disagreement about the case which two practitioners are treating, although they may dissent widely about its pathology. I am speaking more especially of diseases of the nervous system, but I believe my opinion is strictly applicable to disease of all kinds, even should the terms in use clearly and admittedly designate an organic lesion in expressions such as phthisis or morbus Brightii. For should it be agreed that certain morbid changes are uniformly found in fatal

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PREFACE cases, such conditions can only be safely foretold in very marked and protracted instances. In recent affections, where we foresee a tendency to terminate in an organic lesion, Ave are not justified in the adoption of an expression Avhose very terms almost preclude hope of recovery. Moreover, it is undoubtedly true that there is not a single organic disease of the nervous system which may not be simulated by a functional and curable one. The evil attendant upon all such expressions as indicate serious organic pathological change is intensified by such a rash term as girogressive, which is perfectly useless if it merely implies that all disease has a tendency to advance, and is actually mischievous if it means that that particular disease to which “ progressive ” is applied is exceptionally hopeless and incurable. I have therefore endeavoured, in order to avoid such objectionable terms, to use clinical rather than pathological designations.

I must remind the reader that the fii’st edition of this work was a reproduction of lectures given several years before. Many terms, therefore, exjmessive of time, persons, and events, have reference to the very earliest period of delivery.

To Dr Horatio Donkin I scarcely know how to express my indebtedness for the invaluable services which he has rendered me. After I had sought for time at the instigation of my publisher during the last three years, in order to issue a new edition, Dr Donkin kindly came to my assistance, and taking all the fresh notes which had accumulated in the interval, arranged them in order, materially assisting thus in the development of the present work. He has, moreover, further lightened my labours, although adding to his own, by revising these new sheets as they passed through the press.

SAMUEL WILKS.

Grosvenor Street; May, 1883.

Preface To First Edition

In presenting this work to my readers, I may fairly be expected to preface it with a few words of explanation. In the year 1868 a part of my course on “Medicine” delivered at Guy’s Hospital relating to nervous diseases was published in a periodical form. Ever since that time the lectures have been frequently perused by my pupils, who have constantly demanded of me their reprint in a separate form. To this appeal, so often made, I now respond in the present volume. It contains my original lectures with the additional matter which ten subsequent years have enabled me to accumulate. Much of this has already appeared in the ‘ Guy’s Hospital Reports,’ but its repetition in this volume was inevitable, since it is evident that the cases which have been thought of sufficient importance to publish separately would necessarily be the most valuable ones with which to illustrate my lectures.

The order of the subjects which I have found useful for lecture cannot be justified on scientific grounds, but I may console myself with the conviction that with our present existing nomenclatux-e it is impossible to frame a systematic view of nervous diseases on any rational basis whatever, be it anatomical, pathological, or clinical. I have therefore endeavoured to make the best of a heterogeneous system.

Had I in other circumstances believed that there was room for such a work as this, I should have prepared to sit down and write a systematic treatise, which would thus have enabled me to omit many of the explanations now offered expressly for the instruction of students, and to add more precise scientific material than the present occasion demands. I might then also perhaps have attempted in my descriptions of disease to approach nearer to a scientific method. Time might then have permitted me to make appropriate references to the various authors whose works would have surrounded me, and to mention more emphatically the original observers in this department of medicine. The form of a lecture, however, does not admit of a reference to the source of information from which the instructor draws. He offers what he has in his possession, but how much of his wealth has been acquired by his own

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PREFACE digging, how much delivered over to him by his predecessors, and how much he has been unconsciously acquiring from his contemporaries, is unknown eveii to himself. From whatever sources my own knowledge has been obtained, I have endeavoured thoroughly to assimilate it before adapting it to the use of others ; at the same time I have always endeavoured to remember the name of any observer who has added a new fact to the general stock. In saying this I cannot but feel how indebted we all are to such men as Hughlings Jackson, who are always pouring out their best thoughts before the profession, and who therefore assist us in a greater measure than we ourselves are aware of in forming our opinions.

As regards myself I have offered my contributions to the profession from time to time, and were I asked what amount of originality may have been displayed in the lectures when published ten years ago I should point to the general view I took of cerebral physiology and pathology, the truth of which all observations and experiments have since tended to confirm. Indeed, from my earliest days as a teacher, and whilst controversies were still warm as to the interpretaton of a double brain, and the textbooks of physiology were throwing no light upon it, I taught that the two hemispheres were necessary complements to the separate ganglia with which they were associated, and that the distinction of the latter was a necessary accompaniment of the independent action of the limbs. The pathological facts of hemiplegia, of hemispasm, as well as physiological considerations, all combined to prove the correctness of this position.

I might also express a belief that my lecture on migraine or sick headache gave at that time an impulse to the further study of that malady ; at all events I was prompted to give the lecture by failing to find any description of this complaint in the bestknown works on medicine.

Nor am I aware that any account had previously been written of alcoholic paraplegia, or the effects of alcohol in producing a myelitis or meningitis. Some other minor matters relating to nerve pathology in which I have been interested I need not mention.

Finally, I must express my fear that the somewhat disorderlv arrangement of notes for lectures has caused the description of cases to be a little more informal than I should have desired.

SAMUEL WILKS.

Grosvenor Street ; January, 1878.

Part I— Brain Page

Anatomy and Physiology of the Brain — Vascular Supply — Minute

Anatomy — Morbid Anatomy — Symptomatology . . .15

Hemiplegia — Paralysis of Motion and Sensation of one half of the Body — From Spinal Disease — From Inflammation of one Hemisphere of the Brain — Paralysis from Lesion of the Convolutions, or Cortical Paralysis — Old Atrophic Paralysis — From Effusion of Blood external to Dura Mater — Hysterical Hemiplegia — Ordinary Hemiplegia— Arising from Lesions lower down the Motor Tract, and implicating Special Cranial Nerves . . . .35

Aphasia — Simple Dumbness or Mutism in Children . . .70

Apoplexy — Heat Apoplexy or Sunstroke — Lightning Shock . . 96

Inflammation of the Brain — Cerebritis and Softening — Chronic Cerebritis or Sclerosis, General and in Patches — Extension of Disease from Ganglia to Surface of Brain — Other Forms of Degeneration — Meningitis — Simple Hydrocephalus — Simple Arachnitis or Pachymeningitis — Meningitis from Special Causes — Results of Inflammation — Chronic Hydrocephalus — Arachnoid and Blood-cysts, or Hsematoma of Dura — Syphilitic Meningitis and Arteritis 132

Thrombosis of the Cerebral Sinuses .... 187

•Abscess of the Brain ....... 182

Tumours of the Brain ....... 186

Aneurysm of the Brain ...... 195

Chronic Meningo-cerebritis and General Atrophy . . 197

General Paralysis of the Insane — Other Forms of General Paralysis 198 Delirium Tremens ........ 211

PART II— THE SPINAL CORD Morbid Anatomy ........ 239

Inflammation of the Spinal Cord and its Membranes — Myelitis —

Acute Myelitis — Chronic Myelitis — Secondary Degenerations — Syphilitic Disease of the Spinal Cord — Hydro-myelus — Spinal Meningitis — Acute Meningitis — Chronic Meningitis — Cerebro-spinal Meningitis — Epidemic Cerebro-spinal Meningitis, or Cerebro-spinal Fever ....... 240

* This subject and the three which follow have been erroneously placed under subordinate (black letter) titles in the body of the work.

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CONTENTS

*; , ' PAGE

Sanguineous Apoplexy of tiie Spinal Cord .... 260

Paraplegia — Drunkards’ or Alcoholic Paraplegia — Acute Ascending Paralysis— Reflex Paralysis — Diphtheritic Paralysis — Choreal Paralysis —Peripheral Paralysis — Transient Temporary Paralysis — Hysterical Paraplegia ....... 266

Concussion, Railway Spine, &c. . . . . • 287

Paralysis Combined with Atrophy — Progressive Muscular Atrophy — Glosso-labio-laryngeal Paralysis or Bulbar Paralysis — Atrophic Infantile Paralysis — Atrophic Spinal Paralysis of Adults — Pseudo-hypertrophic Muscular Paralysis — Lead Paralysis . . 296

Sclerosis of Cord Combined with Progressive Muscular Atrophy 345 Paralysis Agitans . . . . . . . . 348

Rhythmical Paralysis or Insular Sclerosis of the Cord and the

Locomotor Ataxy or Disease of the Posterior Columns — Theory

of Muscular Sense ....... 356

PAET III— GENERAL AND FUNCTIONAL DISEASES

Epilepsy — Unconsciousness and Semi-consciousness without Falling — Unilateral and Syphilitic Epilepsy — Syphilitic Mania or Insanity — Epileptiform Attacks due to other Organic Causes, such as Injury to Head — Epilepsy Originating from an Injury in a Remote Part of the Body — Aural or Labyrinthine Vertigo, Meniere’s Disease . 376

Intermittent Tetany or Tetanilla ..... 438

Hysteria — Spasm and Hystero-epilepsy — Hysteria in Men — Catalepsy and Somnambulism — Trance — Ecstasy — Hysterical Anorexia — Nervous and Hysterical Conditions in Boys ..... 445

On the Connection Between the Cerebro-spinal System and the

Sympathetic ....... 491

Hypochondriasis — Sleep and Insomnia — Melancholia and Sympathetic

Mania — Mania after Acute Disease .... 504

PART IV— NERVES The Effects of Injury and Inflammation .... 529

Neuralgia — Neuralgia of the Fifth Nerve — Internal and Visceral Neuralgias— Cephalalgia, or Headache — Hemicrania (Migraine) or Sick Headache ....... 546

Local Paralysis — Local Paralysis of the Legs .... 556

Contractions and Spasmodic Affections of Muscles — Local Spasms

— Writers’ Cramp, or Scriveners’ Palsy — Rhythmical Spasms . 578

General Remarks on Remedies — Electricity .... 587

LECTURES

ON

DISEASES OF THE NERVOUS SYSTEM