Mental diseases: a public health problemMay, James Vance
Science
Mental diseases: a public health problem
May, James Vance
Mental health services; Psychology, Pathological
Functions of the successive segments: In case of paresis or paralysis
define the limits of the condition and indicate the results of the
following tests: For loss of power: for the coordination of movement
(writing, buttoning coat); for muscular sense (discriminating
difference in weight; with eyes shut tell the position of the limbs
and show with one side the position of the other). Balancing power:
(walking along a straight line, stand upright with heels and toes
together and eyes closed).
Never forget the test of equality of grip, flexor and extensor strength
of elbow, knees and toes. For test of weakness of one lower extremity
have both lower extremities raised and hold to fatigue limit. The
weaker limb will sink a certain number of seconds before the other.
9. _Reflexes_:
1. Deep reflexes.
Masseteric: elbow, wrist, knee-jerk with or without Jendrassic, with
clonus, or contralateral adductor reflex, knee-cap reflex; ankle
clonus and Achilles tendon reflex.
2. Superficial reflexes:
Plantar (with full description as to the Babinski reflex), gluteal,
cremasteric, abdominal, epigastric, scapular, corneal, palmar,
sneezing.
10. _Condition of the Paralyzed Muscles_:
Firm and of good tone, or flaccid or deficient in tone. Rigid and
contracted. Note attitude of limb and the limitation of the motion,
active and passive. Atrophy, hypertrophy, electric reaction of nerve
and muscle (galvanic and faradic irritability when required).
11. _Fibrillary Twitching_:
Its distribution.
12. _Tremor_:
Of what parts; rhythm, intensity, rapidity. Condition at rest during
sleep; when first observed. Condition during motion, how influenced by
will.
13. _Organic Reflexes and Their Control_:
Bladder; delay of micturition. Dribbling from empty bladder, from
distended bladder. Peculiar sensations on micturition.
Sexual reflexes: Frequent involuntary contraction and evacuation.
Defecation: Is the patient conscious of evacuation?
14. _Convulsions_:
Distribution: Extending over head, trunk, extremities, one side, one
member.
Character: Which parts first and most attacked, and how do the waves of
the tonic and clonic spasm spread; what movements predominate?
Average duration, frequency, occurring night or day, or early in the
morning.
Breathing; pupils; vasomotor condition; froth and bites.
Sphincters: Consciousness totally or partially lost.
Aura.
Equivalents: with or without what automatic movements.
Physical and nervous symptoms before and after attack.
Hysterical attacks.
III. _THORACIC ORGANS_:
Respiratory organs: Is there any difficulty of breathing, permanent or
in attacks? Sleep with mouth open? Any pain on deep inspiration? Any
cough or expectoration (where from). Nose and larynx. Shape of chest.
Frequency of respiration. Respiratory movements. (Compare both sides
in deep inspiration and expiration).
Lungs: Percussion. Auscultation. Expansion.
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