Diseases of the nervous system : for the general practitioner and student

Front matter

ft.TLS,

Reference library

DISEASES

Preface To The Second Edition

In presenting trie second edition of this work I had again in view principally the general practitioner. The new facts which have been developed since the first edition I have endeavored to describe in a concise but at the same time complete manner. Each chapter almost without exception has been enlarged and among a number of additions the following important articles may be mentioned: (i) Fracture of the Skull; (2) Concussion of the Brain; (3) Lumbar Puncture; (4) Cerebro-spinal Fluid; (5) Wasserman Reaction; (6) Radiculitis; (7) Psychoanalysis.

Treatment has received special attention in accordance with the new data accumulated, such as administration of antimeningo coccus serum, of salvarsan, surgical procedures, etc.

Alfred Gordon.

1812 Spruce St., Philadelphia.

Open Knowledge Commons

Preface To The First Edition

In preparing this book for the medical public I had in view chiefly the general practitioner and the student. To both Neurology lias always appeared to be a difficult and an insurmountable subject and many a student hesitates to take up its study in earnest. The fault lies partly in the text-books and treatises in which neurological subjects are discussed from the standpoint of the expert neurologist. In my daily association with students and general practitioners I have invariably heard this continuous complaint, viz., that they cannot get hold of a book on Neurology which could give them a plain and practical account of diseases of the nervous system. It is the want of such a work that I have endeavored to meet in the modest volume I am offering.

The modern physician is not satisfied with a mere enumeration of facts. In reading a description- of any malady he wishes also to know the reason of the disturbed functions and the anatomical substratum of the morbid phenomena. Otherwise speaking he feels that he must know the relation of a certain manifestation to the normal and morbid physiology of an affected tissue or organ. The knowledge of pathology is therefore a sine qua non to every thinking man. This chapter must therefore precede any other in giving an account of a certain disease.

As I am aiming almost exclusively to present Nervous Diseases from a practical standpoint, I naturally avoided too technical and debatable points of pathology, but on the contrary endeavored to present the most essential changes necessary for a thorough understanding of various clinical manifestations.

In discussing the symptomatology I point out, whenever it is possible, the direct relation between certain phenomena and the pathological changes so as to give the reader an intelligent idea of the morbid symptoms.

Each form of functional or organic nervous disease is also discussed from the standpoint of differential diagnosis. All possible affections which may simulate a given disease have been taken up seriatim and differences emphasized.

The course of the diseases, their mode of termination, their prognosis and the etiology have been given full consideration. In describing the latter, the most well known and well established factors have been pointed out first. The reader may be surprised to find Etiology placed in some chapters before Symptomatology and in others immediately before Treat-

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Vlll PREFACE

ment. This was arranged according to the importance Etiology plays in certain diseases or according to the amount of knowledge we possess of the causative factors in various diseases.

Considerable space has been devoted to Treatment. Only the most useful and the best known devices, appliances, operations and drugs are described. Medications that are uncertain as to their therapeutic value are omitted or else only mentioned.

True to my original aim I have endeavored to present to the reader only the most essential points, whether it was in Pathology, Symptomatology, Pathogenesis, Etiology or Treatment. The latest views, ideas and thoughts have been presented as far as it was possible. Intentionally I avoided details on disputable questions and omitted them altogether whenever I could without sacrificing the clearness of the subject.

A Chapter on the Method for examination of patients precedes the description of diseases of then ervous system. In it are indicated what phenomena are considered normal or abnormal. I have described here the motor, sensory and trophic phenomena, also the reflexes, the state of sphincters and electrical contractility of muscles or nerves.

Finally a chapter on the Normal Anatomy of Brain and Cord, also Malformations of the Nervous System, has been added. Detailed descriptions have been omitted whenever it was possible and instead clear illustrations are given.

On the whole I feel that I am presenting a practical book to the average physician, but if also the neurologist, the teacher, the advanced student may find in it some ready references which they may peruse in their scientific studies, my labors will be more than compensated.

A word of thanks is due to the publishers. They have facilitated my task by allowing a large number of illustrations, without which no modern scientific work can be satisfactory.

Alfred Gordon.

1430 Pine St., Philadelphia,

CHAPTER I Anatomy and Physiology of the Central Nervous System

Page

Spinal Cord i

Meninges or the Cord 9

Blood Supply of the Cord n

Rhombencephalon "

Medulla oblongata "

Pons 15

Fourth ventricle 19

Mesencephalon (Middle Brain) 20

Area of Crura and Corpora quadrigemina 20

Diencephalon (Interbrain) 24

Area of Optic Thalami and Third ventricle 24

Cerebral Hemispheres. Telencephalon 26

Gray substance 27

White substance 31

Tracts 32

Cerebellum 4°

Meninges of the Brain 43

Blood Supply of the Brain 46

Histological Elements of the Central Nervous System 49

Neurone Doctrine and Secondary Degeneration 5°

Malformations of the Central Nervous System 52

CHAPTER II Method of Examination for Diagnosis of Nervous Diseases

I. Motor Phenomena 59

II. State of Nutrition of Muscles 62

III. Electrical Contractility 63

IV. Sensory Phenomena 68

V. Special Senses • • 7°

VI. Cranial Nerves 7*

VII. Speech and Writing 71

VIII. Reflexes 71

IX. Sphincters 74

X. Vasomotor and Trophic Disturbances 74

CHAPTER XVIII Diseases of the Medulla, Pons and Fourth Ventricle

A. Acute Superior Polioencephalitis 223

B. Chronic Superior Polioencephalitis 224

C Acute Inferior Polioencephalitis 226

D. Chronic Inferior Polioencephalitis 226

E. PSEUDO-BULBAR PALSY 229

F. Myasthenia Gravis 231

G. Hemorrhage and Softening of the Medulla 234

H. Occlusion of Posterior Inferior Cerebellar Artery 235

I. Compression of the Medulla 235

Diseases of the Pons 236

Hemorrhage. Softening. Tumors 237

Crossed Paralysis 239

Peduncular Syndrome 241

CHAPTER XIX Diseases of the Spinal Cord

A. Systemic Diseases of the Cord 242

I. Tabes 242

II. Spastic Paraplegia 256

Family Spastic Paraplegia 257

Paraplegia of the aged 258

III. x\taxic Paraplegia 259

IV. Friedreich's Ataxia 261

V. Acute Anterior Poliomyelitis 264

VI. Chronic Anterior Poliomyelitis 272

VII. Amyotrophic Lateral Sclerosis 272

B Non-systemic Diseases of the Cord 272

I. Myelitis 272

II. Hematomyelia 279

III. Divers' Paralysis 284

IV. Syringomyelia 286

V. Diseases of Conus Medullaris and Cauda Equina 291

VI. Disseminated Sclerosis 295

XU CONTENTS

Page

Secondary Affections of the Spinal Cord 302

I. Traumatic Lesions of the Cord 302

Concussion. Contusion 302

Sudden Compression. Laceration 303

II. Slow Compression. Tumors. Pott's Disease 306

Chapter XX

I. Progressive Muscular Atrophy of Spinal Origin 314

Progressive muscular atrophy of infants 318

Amyotrophic Lateral Sclerosis 319

II. Myopathy 321

III. Primary Neurotic Atrophy 325

IV. Arthritic Muscular Atrophy 327

Amyotonia Congenita 327

Myotonia Atrophica 329

Diseases of Spinal Meninges 329

Intermittent Claudication of the Spinal Cord 334

CHAPTER XXIV Diseases of the Peripheral Nervous System

Neuroma 384

A. Alcoholic Multiple Neuritis 387

B. Lead Multiple Neuritis 389

C. Arsenical Multiple Neuritis 390

D. Diphtheritic Multiple Neuritis 390

E. Carbonic Gas Multiple Neuritis 391

F. Mercurial Multiple Neuritis 392

G. Puerperal Multiple Neuritis 392

H. Beriberi Multiple Neuritis 392

I. Lepra Multiple Neuritis 393

K. Senile Neuritis 394

Acute Ascending Paralysis 396

Periodic Paralysis 398

Diseases of Individual Nerves 399

I. Paralysis of Cranial Nerves 399

II. Paralysis of Spinal Nerves 415

A. Upper Cervical Nerves 415

B. Lower Cervical Nerves (Brachial Plexus) 416

C. Lumbo-sacral Nerves 425

CONTENTS Xlll

Page

Radiculitis 429

Neuralgia in General | 430

Neuralgia of Individual Nerves 435

Neralgia Paraesthetica and Intermittent Claudication 445

CHAPTER XXV Functional Nervous Diseases psychasthenia 456

Anxiety Neurosis 464

Dystonia Musculorum Deformans 505

Tic 507

Facial Spasm 514

Myospasm from Intense Heat 524

Myotonia Congenita (Thomsen's Disease) 525

Occupation Neuroses - 527

Akinesia Algera 533

Chapter XXVI

Traumatic Neuroses and Psychoses. Medico-legal Considerations 548

CHAPTER XXVII Diseases of the Sympathetic System

Trophoneuroses. Angioneuroses

Gigantism 575

Achondroplasia 576

Adiposis Dolorosa 577

Scleroderma 579

Facial Hemiatrophy 581

Facial Hemihypertrophy 583

Acroparesthesia 583

Angioneurotic (Edema 584

Hereditary (Edema of the Legs 585

Erythromelalgia 585

XIV CONTENTS

Page CHAPTER XXVIII

A Metallic Poisons 591

I. Lead Intoxication 591

II. Arsenical Intoxication 592

III. Mercurial Intoxication 593

IV. Carbon Monoxide Intoxication 593

V. Manganese Intoxication 594

B. Organic Poisons 595

I. Alcoholism '. 595

II. Morphinism 599

III. Cocainism 601

CHAPTER XXIX Nervous Symptoms Caused by Some Special Infections 602

Tetanus 602

Pellagra 608

Index 609

Diseases of the Nervous System