GEN. III. SPEC. III. Shaking stage. mode of exercise to which the patient is in general very partial. Of this temporary mitigation of suffering, how- Synclonus ever, he is now deprived. When he attempts to advance Ballismus. he is thrown on the toes and fore part of his feet, and im- palsy. pelled unwillingly to adopt a running pace, in danger of falling on his face at every step. In the more advanced Advanced stage of the disease the tremulous motions of the limbs occur during sleep, and augment in violence till they awaken the patient in much agitation and alarm. The power of conveying the food to the mouth is impeded, so that he must submit to be fed by others. The torpid bowels require stimulating medicines to excite them into action. Mechanical aid is often necessary to remove the feces from the rectum. The trunk is permanently bowed; muscular power diminished; mastication and deglutition difficult; and the saliva constantly dribbles from the mouth. The agitation now becomes more vehement and constant; and when exhausted nature seizes a small portion of sleep, its violence is such as to shake the whole room. The chin is almost immoveably bent down upon the sternum; the power of articulation is lost; the urine Fatal close. and feces are discharged involuntarily, and coma with slight delirium closes the scene." causes. The remote cause is involved in some obscurity. Long Remote exposure to damp vapour, by lying from night to night on the bare earth, in a close unventilated prison, seems to have produced it; and possibly other causes of chronic rheumatism: and hence it has frequently supervened on chronic rheumatism itself. Long indulgence in spiritous potation has often given rise to it; and probably any thing that debilitates the nervous power. And on this account miners, and others exposed to the daily exhalation of metallic vapours, and especially those of mercury, are frequent and severe sufferers; of which Hornung has adduced many interesting examples from the quarrymen in Carniola *. It has also followed upon • Cista, p. 280. GEN. III. SPEC. III. Synclonus Ballismus. Shaking palsy. Seat of the troverted. Cerebrum as regarded by Bonet. Cervical part of the spinal marrow, as regarded by Parkinson. Question examined. worms in the intestines*; and in this case, has sometimes assumed a periodical type+. The part of the nervous organ more immediately affected has, also, afforded some ground for controversy. Bonet ascribes it to a diseased state of some portion of disease con- the cerebrum, and has given examples of its being found, on dissection, to contain, in various quarters, proofs of serum, sanies, and other morbid secretions. But the misfortune is here, as we have already observed in similar appearances after mania, that it is impossible for us to determine whether these diseased fluids give rise to the disease or the disease to them. And hence Mr. Parkinson seems to pay no attention to them, at least as a cause, and fixes the seat of the affection in the cervical part of the spinal marrow, from which he supposes it to shoot up by degrees to the medulla oblongata. We have already shown sufficiently in the Physiological Proem to the present Class, that the nervous fibres which ramify over the extremities, whether sensific or motific, originate from the chain of the spinal marrow; and we have also shown, in discussing the diseases of trismus, tetanus, and lyssa, how acutely one extremity of a chain of any kind, and particularly of a continuous fibrous chain, sympathizes with another and there can be no difficulty, therefore, in conceiving that wherever the cutaneous ends of the nerves of motion are torpified, or otherwise affected by any of the causes just adverted to, the vertebral column must itself very seriously participate in the mischief, and consequently the upper or cervical part of this column: and that from this point the disease must ramify to the brain before the general functions of the system become affected, as in its latter stages. Vertebral column must participate in the disease. Remedial process. Vesicatories. The remedial process is not very plainly indicated. Vesicatories, and other stimulants applied to the neck or even the dorsal vertebræ, have appeared useful. A • Commerc. Liter. Nor. 1743. p. 55. SPEC. III. seton or caustic, and especially the actual cautery, as GEN. III. practised so generally in France, might possibly be of Synclonus more avail applied to different parts of the spine. Beyond Ballismus. Shakingthis an active purgative system, as strongly recommended palsy. by Riedlin, has certainly been found efficacious*; and Actual the solution of arsenic bids as fair for a favourable result cautery. gatives. here as in the preceding species. Stark tried musk, and Active purcarried it to very large doses frequently repeated every Solution of day but it does not seem to have produced any deci- arsenic. sive success. Musk. mulants. Friction of the affected extremities resolutely persever- Local stied in by a skilful rubber, with stimulant embrocations of camphor or ammonia, should also be tried in an early stage of the disease, and be alternated with the use of the voltaic trough. Here, too, we may expect to derive Voltaic advantage from a free use of diaphoretic and alterant apozems, as the decoction of the woods, and especially where the disease is suspected to be of a rheumatic origin:-to which may be added a regular course of bathing Bath in the Bath springs. trough. waters. SPECIES IV. RAPHANIA. Raphania. SPASTIC CONTRACTION OF THE JOINTS; WITH TREM BLING AND PERIODICAL PAINS. Or this species we know little or nothing in our own country. It was first described by Linnéus, who called it Raphania, from his supposing it to be produced by eating the seeds of the raphania Raphanistrum, a wild raddish or sharlock that grows indigenously in our native * Lin. Med. 4695, p. 101. Klinische und Anatomische Bemerkungen. GEN. III. SPEC. IV. Origin of specific name, and disease as fixed by Linnéus. cause of the GEN. III. SPEC. IV. Raphania. Raphania. Other sources urged by other writers, but by all ascribed to the use of vitiated grain of some kind. Illustrated. corn-fields as well as in the corn-fields of most parts of Europe. By other writers, as Hermann and Camerarius, it has been ascribed to the use of darnel or rye* infested with the spur, or ergot, or some other parasitic plant, which, as we have already observed, is a frequent cause of other very severe complaints, as MILDEW MORTIFICATION (gangræna ustalaginea †) and ERYTHEMATOUS PLAGUE (pestis erythematica‡). All these diseases, however, are so distinct from each other, that though there can be little doubt of their being severally produced by some poisonous material contained in the patient's food, the poison must be of different kinds, and we do not seem to be acquainted with the cause of this difference; and hence the question has given rise to much controversy, and been discussed with some warmth on the Continent; for, while the greater number of writers refer the disease to the raphania, or spurred rye (secale cornutum), many deny that it is produced by either of these §, and Lentin ascribes it to the honey-dew of various plants ||, concerning which we shall have to speak in the fifth volume, under PARURIA mellita. That it is a vegetable poison, however, seems to be admitted by common consent, and it is possible that the poison is not confined to a single plant. That many poisonous plants have a direct tendency to affect the nervous system and excite entastic or clonic spasm, or a mixture of the two according to the peculiarity of the poison itself, or of the habit into which it is introduced we have frequently had occasion to notice already, and particularly under the head of ERUPTIVE SURFEIT (colica cibaria efflorescens). This is particularly the case with several of the deleterious agarics or funguses, some of which seem to operate chiefly on the * Abhandlung von der Kriebelkrankheit, &c. Cassell, 1775-8. De Lall. Lolio. temulento. Tubing. 1710. § Wichmann, Beyträg. zur Geschichte der Kriebelkrankheit. Leips 1771-8. Beobachtungen einiger Krankheiten, &c. ¶ Vol. 1. p. 213. GEN. III. SPEC. IV. sensific nerves, and produce a general stupor; and others on the motory, and produce palpitations, cramps, or con- Raphania. vulsions over the whole system*. It is very probable, Raphania, therefore, that the ordinary cause assigned for the present species of disease is the true one. tates Aca demicæ. There is an excellent paper upon this subject in the Rothman's Amoenitates Academicæ + furnished by Dr. Rothman, a in Amonidescription pupil of Linnéus, from which the disease seems to be not unfrequently epidemical, and always to commence in the autumn. It is found, however, only among the lower orders of people, and, in the epidemic referred to, is sufficiently traced to impure admixtures with their grain, and the employment of this vitiated grain in too new a state. Dr. Rothman delineates the disease from actual observation, and does not believe it to be a new malady, as generally supposed, but thinks he has traced it in the Supposed writings of various authors from the year 1596 to 1727; which would establish, moreover, that it has been common to other parts of Europe as well as to Sweden. And in confirmation of this we may observe, that Dr. Mercard‡ describes a disease very much resembling raphania that appeared at Stade in the winters of 1771, 1772, which was evidently epidemic, and accompanied with symptoms of fatuity, or that narcotic effect which many deleterious plants are sure to produce. to be of early date. Regarded by Cullen as a species Dr. Cullen who has generalized far too much his description of chorea, in his Practice of Physic, seems to have embodied this species as well as the preceding in of chorea. the common delineation, and hence, when he tells us that "there have been instances of this disease (chorea) appearing as an epidemic in a certain corner of the country"§, there can be little doubt that he alludes to the species before us originating from the cause now assigned, although, without some such interpretation as the present, the passage is not very intelligible. The disease commences with cold chills and lassitude, Origin and • See Heberden, Med. Trans. II. 218. Tom. vi. Art. cxxIII. 1763. Medicinische Versuche. Zweyter Theile, 8vo. Leipzig. progress of the disease. |