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
_α_. The Faradic Reactions diminish rapidly in degree in both nerve
and muscles from the third or fourth day, and in the nerve they are,
as a rule, completely lost at the end of from ten to fifteen days. In
the muscles complete loss of faradic reaction is noted only somewhat
later, and is absolute. A return of musculo-faradic contractility is a
most positive sign of recovery of the nerve.
_β_. The Galvanic Reactions.—In the nerve, distal of the lesion, the
result is similar to that stated above—viz. after a few days (from
five to fifteen) all reaction disappears. The anatomical cause of the
complete {67} loss of the faradic and galvanic reactions in the nerve
is its disintegration by the Wallerian degeneration. In the attached
muscles the phenomena are widely different, and present interesting
and complicated variations. In the first place, during a variable
number of days there is increased excitability—_i.e._ the paralyzed
muscles, deprived of innervation, contract to a much weaker current
then do the homologous normal muscles. This is best shown in cases of
peripheral facial paralysis (Bell's palsy) in the second and third
weeks, by placing the electrodes in the median line, one upon the
cervical vertebræ, the other (a small testing interrupting electrode)
on the chin; on closing a very weak current of from four to eight
elements it will be seen that the muscles on the paralyzed side of the
face (the lower muscles) contract distinctly, while those on the
normal side remain quiet. In the course of time, many weeks usually,
the excitability diminishes, and falls below the normal, and in some
cases ultimately disappears. These are known as the quantitative
changes in musculo-galvanic reactions. During the long period
preceding recovery, or without it, various qualitative changes are
also observed in the reaction. The normal general formula of
CaCC > AnCC (with rapid, jerking and full contractions of the muscle)
becomes CaCC = AnCC or CaCC < AnCC. Often, too, distinct opening
contractions occur, usually AnOC. The muscular contractions also tend
to the tonic type or tetanus, expressed as CaDT or AnDT, etc.
The form of the contractions obtained is much altered. Throughout a
practically endless period in some cases, or until regeneration of the
nerve takes place in others, it is observed that musculo-galvanic
contractions are delayed, are slower, less jerking, or assume an
undulating wave-like character, easily passing into tetanus. This
change from the rapid, jerky, and full normal muscular contraction to
one which is slow and wave-like we consider to be the most positive
and reliable evidence of neuro-muscular degeneration and of the
cutting off of the spinal-cord influence. Fig. 4 shows the characters
of a human degenerative myogram contrasted with a normal one, Fig. 3.
[Illustration: FIG. 3. Contraction of Normal Abductor Indicis, CaCC,
with strong current (Amidon[2]).]
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