Excerpt from An Atlas of the Differential Diagnosis of the Diseases of the Nervous System: Analytical and Semeiological Neurological Charts

In spite of its apparent complexity, the diagnosis of nervous diseases lends itself better than that of the diseases of most of the other organs to exact path ological analysis. Just as a chemist in analyzing a substance of unknown com position by a series of appropriate tests eliminates from consideration one group of chemical bodies after another until he finally discovers its class and name, so the neurologist subjects a patient to one test after another in definite sequence. As the result of each test he throws out of consideration one or more groups of diseases and assures himself that he has to do with a disease belonging to another definite group. With each successive test the number of diseases constituting a group becomes less, until finally one definite individual disease stands revealed among the few most closely related to it by a comparison of the remaining symp toms characteristic of each. This analytical method is used, I think, by all great teachers of neurology in demonstrating cases of disease before their classes of students. It is the crystallization of this teaching into the tabular form which this book attempts to present.

In using this book for diagnostic purposes the student, having made a com plete investigation of the patient according to the scheme presented in chart I, should turn to chart X, or to some subsequent chart, according to the nature of the prominent symptom or symptoms present in the case. If motor paralysis (analysed in chart X) is present, the disease must be in the motor neurons and the student must decide from the history of the case whether it is a continuous or an intermittent paralysis, and if the former, he must learn from his physical examination whether the superficial and deep reflexes (of which the tendon reflexes are the best exponent) are present or absent within the paralysed area This test will make it certain whether the disease involves the central or the peripheral motor neurons. If the reflexes are absent the disease involves the peripheral motor neurons and the examiner must learn from his physical exam ination whether muscular atrophy is present or not, or whether there is a mixture of atrophy and apparent hypertrophy and further whether the initial symptom was the paralysis or the atrophy. From this test the student can determine whether he has to do (let) with a functional disease or (2nd) with one of the degenerative atrophies or (3rd) with one of the dystrophies. The diagnosis between the diseases constituting the degenerative atrophies can be made by the condition of the organic reflexes, showing whether or no the lumbar enlarge ment is involved and by the presence or absence of sensory disturbances, showing whether spinal nerve trunks, or cranial motor nerve trunks, or motor nuclei of nerves are involved. The ultimate diagnosis of the individual disease is to be made from the short abstract of the most important remaining symptoms characteristic of each disease.

About the Publisher

Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com

This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.