Two cases of nervous disease / by Walter K. Hunter, M.D., B.Sc., Assistant Physician, Royal Infirmary.

  • Hunter, Walter King.
Date:
[1901]
Catalogue details

Licence: In copyright

Credit: Two cases of nervous disease / by Walter K. Hunter, M.D., B.Sc., Assistant Physician, Royal Infirmary. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    Microscopic examination of the muscles of the pharynx and tongue showed them to be quite normal. Viewing this case, then, in the light of the post-mortem examination, it seems, with little doubt, to be one oi peri- pheral neuritis, probably of diphtheritic origin. The micro- scopic appearances explain the clinical signs and symptoms, except that it is difficult to understand the absence of degeneration in both hypoglossal nerves. The presence of at least a certain amount of paresis in the tongue seemed undoubted during life; but, on the other hand, it is to be noted that careful microscopic examination of that muscle showed no corresponding degeneration in its fibres, such as one would look for in a case of peripheral neuritis. Possibly, as is so often the case in diphtheritic paralysis, only some of the fibres in the nerve were affected, and these towards their distal terminations, where degeneration most often shows itself. It is, therefore, much to be regretted that both hypoglossals were not examined through a greater extent of their distribution, and stained also by Marchi’s method. It is quite certain, however, that in the portions of the nerves examined there was no increase of the internodal nuclei, and that the axis cylinders were quite intact. These points were well shown in the sections stained with methylene blue and Congo red. If this case, then, is one of peripheral neuritis, its special interest would seem to lie in the fact that, with histological changes confined to the peripheral nerves, we have a grouping of symptoms almost identical with those found in bulbar paralysis. As in that disease, the onset was gradual. The lips, tongue, soft palate, pharynx, and larynx were all involved. It is true that the lips and tongue were affected late in the disease, and that there was no atrophy of the tongue. But it sometimes also happens this way in bulbar paralysis. In bulbar paralysis, too, we sometimes have the muscles of the upper part of the face and of the jaw affected just as in this case. The symptoms, therefore, closely resemble those found in bulbar paralysis; and the above record may be of value in that it might suggest an explanation of these rather obscure cases of “ chronic bulbar paralysis without anatomical lesion.”