« PreviousContinue »
spasmodic contractions of the lower extremities, which often became so violent, that both knees were thereby forcibly drawn up towards the epigastrium, when the patient's legs would be again suddenly extended to their full length; and although the sufferer appeared perfectly cognizant of their occurrence, and often felt acute pain at the time, he was nevertheless quite unable to control any of these vehement involuntary movements of the extremities.
It should likewise be mentioned as a peculiar feature of the disease at this particular period, that often when talking to another person, Mr. G. was unable to finish the sentence he had just commenced, in consequence of an involuntary propensity, which he could not restrain, of repeating many times over some principal word in the phrase he wished to express; or the same difficulty would occur from making use of a word quite different from the one he really wished to employ; and this confusion in the use of words actually happened, without the patient being able to correct himself, although perfectly aware at the moment that he was speaking erroneously. At this period of the disease the pulse felt also very languid, but the circulation was never so slow as it had been during the previous attacks in January.
Subsequently, that is in the summer of 1840, Mr. G. complained of considerable weakness in his back and loins, accompanied with pains of the head, and in the nape of the neck. He soon afterwards
became unable to walk steadily without support: and, to use the patient's own words," he felt as if his body were cut in two, and the lower half falling away from the upper.” Both hands and arms now became very weak, and were soon nearly powerless ; and he also complained of considerable pain about the fourth cervical vertebra, increased in severity on merely bending his head backwards ; but this sensation felt however less painful when rotatory motion of the neck was only attempted.
About the end of autumn in 1840, as most of the symptoms had gradually undergone material alleviation, compared with their former severity, the patient seemed now greatly recovered in strength and could walk out occasionally, with only the aid of a staff. Indeed, towards the end of that year, the progress made was so far satisfactory, and the general health apparently so much restored, that Mr. G. was even able to visit his friends and join a little in society. During this temporary amendment, having dined at Kensington, on Christmas day, he was afterwards, in consequence of not meeting with a conveyance, unfortunately obliged to attempt walking to town, during a very cold and frosty night, when the streets were covered with snow. From the great exertions Mr. G. made on this occasion, he soon got so fatigued, that being totally unable to proceed the whole way on foot, he was taken home in a carriage, chilled and completely exhausted.
After this misadventure, all the symptoms from
which Mr. G. had previously suffered for a long time so peculiarly, again became as marked and severe as before, until the ability of moving any of his limbs got at last so very feeble, that eventually he was entirely deprived of the use of both legs and arms. Ultimately, the muscles of the abdomen and chest were similarly affected, whereby respiration could then be only carried on by the diaphragm ; when the patient likewise lost the power of coughing, and was scarcely able to expectorate. The bowels now became even more constipated than before, and in order to act upon them sufficiently, it was necessary to employ very active purgatives, assisted by strong enemata ; whilst the bladder required to be frequently emptied by the catheter, during many months consecutively. Notwithstanding the total loss of power over all the muscles situated lower than the neck, the sense of touch still continued as acute as ever throughout the entire frame; indeed, the cuticular surface appeared occasionally to be even more sensible to external impressions than in the patient's previous good health ; since he could, for instance, feel most acutely the slightest change in the temperature of the surrounding atmosphere, especially when a current of air passed over any part of his person.
Although the patient appeared, at a subsequent period of his disease, to have acquired a slight degree of control over some of the muscles connected with the shoulder, so as to be then able to move partially that part of his body, such temporary
power was again soon lost; and ultimately the privation of voluntary motion remained as marked as before, excepting in the head, the features, and the tongue; or in the muscles of deglutition, which were never affected. At the same time that these symptoms prevailed, all the senses continued perfectly normal, the memory appeared unimpaired, the patient had no headache, and his intellectual faculties were as perfect as they had ever been at any former period, although once or twice he seemed to be a little confused or slightly delirious ; but this symptom was of such partial duration, that it scarcely deserves observation.
Besides the symptoms already detailed, Mr. G. frequently complained of feeling intense heat over all the body, whilst the surface actually felt cold to a bystander; and at other times he experienced alternations of heat and cold, although his skin appeared to others of the natural temperature, Again, if a foot or even a toe were touched, spasmodic twitchings of the limb, accompanied with pain, were always produced; the patient's sense of feeling being, at the same time, so accurate, that he could distinctly tell the particular point of his body to which the attendant's finger was applied. The circulation still continued languid, and sometimes the pulse was intermitting ; whilst the cuticle remained devoid of perspiration, being perfectly dry, and exhibiting quite an opposite condition to that noticed during the patient's previous robust health.
In the latter months of his illness, Mr. G. often complained of excessive coldness in the epigastrium and stomach, along with considerable distension of the abdomen from flatus, although the trunk of the body and the extremities frequently felt burning hot to the patient at the same moment. At this stage of the disease, the spasmodic twitchings of the legs were not only more frequent than previously, but they sometimes even became so violent as almost to throw the patient off his couch, being also attended with great additional suffering.
Besides these symptoms, it ought to be mentioned that the urine, which at first was very little altered from its healthy condition, now deposited a considerable quantity of a thick ropy sediment, and although this secretion had long been drawn off by the catheter, it now passed involuntarily, and almost in drops; whilst the fæces likewise came away in a similar manner, the-evacuations being of a watery consistence, and latterly very offensive.
The appetite and digestion, always much impaired, entirely failed towards the termination of this painful and protracted malady; when frequent nausea, vomiting, singultus and apthæ supervened. Finally, notwithstanding the efforts made to alleviate the afflicted patient's sufferings, all the symptoms continued, with unmitigated severity till the 22nd of July last, when Mr. G. died, quite exhausted ; retaining however his intellectual faculties perfect to the last moment of existence.
Treatment. -Respecting the means pursued in