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
(_a_) In the range of sensory disturbances this question rarely
presents itself for solution. Localized anæsthesia and pain of spinal
origin (except the fulgurating pains of tabes) are rare, and we do not
know the relation of cutaneous areas with the spinal segments as well
as we know the motor innervations. It should be stated here, however,
that the location of a fixed pain and of a zone of anæsthesia is often
of great value in determining what spinal nerve is affected, just
outside of the cord itself, by such directly-acting lesions as
vertebral caries, spinal pachymeningitis, tumors upon the spinal cord,
etc. Among the various symptoms of Pott's disease of the spine, fixed
pains in one side of the trunk, in one thigh, or in the upper
occipital region, etc. is a sign against which the physician should
always be on his guard, as it is a very early and valuable indication
of the existence of an affection which requires special treatment as
soon as a diagnosis can be made.
(_b_) Localized motor symptoms of spinal origin calling for a
diagnosis of the focal lesions causing them are frequent, and are
mostly met with in two affections—viz. progressive muscular atrophy
and poliomyelitis. The problem is now capable in many cases of an
approximately exact solution by the deductive application of our
knowledge of the intimate connection between certain muscles and
muscular groups and limited portions or segments of the spinal cord
(anterior gray horns more especially). This knowledge has been
accumulated and organized from ordinary anatomy, physiological
experiments, and more especially from carefully-made autopsies with
microscopic examination of the cord. We cannot present this subject
better than by reproducing a tabular statement of these results
prepared by M. Allen Starr.[5] Future autopsies may correct this
table, and in making use of it the occurrence of anomalous
nerve-distribution should be remembered:
LOCALIZATION OF FUNCTIONS IN THE VARIOUS SEGMENTS OF THE SPINAL CORD.
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