Case 418. (Cargill, February, 1916.)
Project Gutenberg EPUB3 edition
Southard, Elmer Ernest
A Naval Service man, 20, was thought to have peripheral neuritis. A long history of pain and numbness in arms and legs, a well-marked analgesia and anesthesia over the anterior aspects of forearms and legs, and an anesthetic band across the front of the chest, seemed consistent with the diagnosis. The calf muscles tightly squeezed yielded no pain. Pins could be thrust without pain into the anesthetic areas. When told to say yes when the pin was felt, and no when it was not felt, the man persistently said no when the areas noted above were touched. The deep reflexes were normal. Faradism by wire brush at two sittings yielded a complete cure. It seems that once this man, after seeing his sister fall in a fit on returning from a funeral, retired to the garden and had a similar fit himself.
Cargill found in 1052 sailors fifteen cases of total absence of one or both ankle-jerks; seven of the fifteen were probably cases of tabes.
Re peripheral neuritis and hysteria (see under Case 387).
Re differential diagnosis between peripheral neuritis and reflex (physiopathic) paralysis, Babinski and Froment offer the following table:
Peripheral Neuritis.
Reflex Paralysis and Contracture.
1. Motor disorder, degenerative amyotrophy, and sensory disorder corresponding topographically to anatomical distribution of nerve (neuritic) topography.
1. More or less segmentary topography.
2. Amyotrophy very pronounced, regardless of localization.
2. Amyotrophy variable; ordinarily well-marked but not so severe as that of neuritis.
3. Reaction of degeneration, especially weakening or abolition of faradic excitability of muscles.
3. Reaction of degeneration absent, never marked weakening of faradic excitability, which is often normal and may even be exaggerated.
4. Tendon reflexes, corresponding to the muscular territory of the nerve, weakened or abolished.
4. If reflexes are altered, they are as a rule exaggerated and never abolished.