On February 26, 1862, a porter, aged forty-nine, was suddenly
seized with an "attack of the nerves," and at its close lost his
speech. When examined at the hospital two days later, he was found
to have full use of his limbs, understood perfectly all that was
said to him, and evinced great impatience at being unable to
respond except in writing or by gesture. He made signs to indicate
that his head was paining him, and that he had difficulty in
swallowing. In addition, abrupt, forcible, and rapid movements of
the facial muscles on the right side were taking place; the angle
of the mouth and the outer angle of the palpebral aperture were
being dragged on; the external ear was elevated, or moving to and
fro; the platysma was twitching visibly and the hyoid bone so acted
on as to pull up the larynx spasmodically. The exhibition was an
exact replica of the effect produced in animals by intracranial
galvanisation of the facial nerve. Moments of absolute repose
alternated with periods of spasm of a few seconds' duration, which
addressing or handling the patient seemed to aggravate. There was
synchronous spasm in the masseter muscles, resulting in elevation
of the inferior maxilla. No other region of the body was affected.
On the night of March 2 the attacks of spasm and of pain increased
in intensity and frequency, without any other change in their
nature. The patient's mind remained unclouded, and as he was still
deprived of the faculty of speech, he again indicated in writing
the severity of his sufferings. About eleven o'clock at night the
situation became more distressing; he began to be profoundly
agitated, then passed into a more or less maniacal state, in which
his limbs were involved in powerful muscular spasms, his eyes
rolled in their sockets, and his respiration commenced to be
stertorous, while the violence of his struggles necessitated the
intervention of two assistants to control him. An hour or two
later, during one of these attacks the end came.
At the autopsy, under the arachnoid and spreading over the left
hemisphere at the junction of its anterior and middle thirds, was a
large blood-clot, dark, coagulated, and free in the cerebral
substance, which it had penetrated for a depth of about one
centimetre. It appeared to be of about four or six days' formation,
and probably dated from the incipient "attack of the nerves."
Painstaking scrutiny of the cerebellum and cranial nerves failed to
reveal any further pathological condition.
To tell the truth, we are not averse to wagering that to-day the opinion
of the surgeon would be invited on a similar case, where the motor
reactions of the so-called tic are manifestly based on a Jacksonian
type.
Public-domain text, read in full here on John Shaqi.
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