A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system — John Shaqi
A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Science
A system of practical medicine. By American authors. Vol. 5 : $b Diseases of the nervous system
Medicine -- Practice
(_g_) Visceral anæsthesia shows itself in the ordinary way by loss of
that feeble degree of common sensibility which the internal organs
possess, and also by impairment of their special functions, giving
rise to anorexia, hydroadipsia, retention of feces and urine, loss of
sexual feeling (without progenital anæsthesia). Of course, these
symptoms may be due to other conditions, and each case must be
carefully studied. In the insane, visceral anæsthesia gives rise to
delusions of emptiness, destruction of organs, and even, if coinciding
with general cutaneous anæsthesia, to the notion that the body is dead
or absent.
A singular phenomenon often witnessed is retardation in the
transmission of an impression (usually a painful one). Thus, in
testing the sensibility of the skin of the legs in tabetic patients,
it is observed that instead of the normal, almost instantaneous,
appreciation of the impression made by a needle-point, there is a
lapse of two, five, ten, or even sixty seconds between the pricking
and the signal of sensation by the patient. It should always be
determined in such cases whether the retardation is peripheral and
actual, or central and due to psychic conditions (dementia, absorption
in a delusional state). Thus, in a case of profound melancholia we may
observe extreme slowness and dulness of sensory impressions or
complete anæsthesia; but the symptoms would have a very different
significance, diagnostic and prognostic, from the same noted in a
mentally clear patient.
An important result of impairment of sensibility is a reduction or
loss of reflex movements originating from the area or organ which is
anæsthetic. This is shown in anæsthesia of the distribution of the
trigeminus {37} when the reflex protecting movements of the eyelids no
longer take place, in atrophy of the optic nerve when the pupillary
reflex actions are lost. In posterior spinal sclerosis we see several
illustrations of this law: progressive degeneration of nerve-fibres in
the posterior root-zones of the spinal cord, causing loss of patellar
reflex, of vesical, rectal, and sexual reflexes, and in most cases of
cilio-spinal reflexes and of muscular tonus. In these and analogous
conditions one arc of the reflex mechanism is deranged, centripetal
conduction is interfered with, and the reflex motor discharge can no
longer be evoked.
That a similar pathological condition occurs in the cerebral
mechanism, and may serve to explain many psychic symptoms, is very
probable.
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