Page:The American Cyclopædia (1879) Volume III.djvu/209

BRAIN (DISEASES) 203 marked influence on the causation. It very rarely occurs in persons under 50 years of age. Muscular tremor, beginning slightly in a few muscles and gradually increasing and extend- ing, is one of the most characteristic of the symptoms. After a time the limbs and some- times the head are involved in the tremor, which at first can be arrested by volitional efforts, and exists only in the waking hours, but at length continues in spite of the will and during sleep. Paralysis greater or less in de- gree follows the tremor. The name paralysis "jitans, or shaking palsy, has been applied to these cases. Prior to and with these symp- toms lancinating pains in the head are com- mon. Distortion of the limbs may occur from the paralysis affecting certain muscles (gene- rally the flexors) more than others. Certain cases present remarkable peculiarities in the mode of progression. Thus some patients are able to run forward rapidly when they cannot walk, and are obliged to support themselves by clinging to some solid body in order to prevent themselves from falling when they stop. In other cases patients are able to walk backward, but not forward. The course of this affection is usually slowly progressive ; yet in some cases it remains stationary. Existing in a marked degree, it may not prevent long life. A cure is not to be expected ; but improve- ment is sometimes effected by the chloride of barium, the phosphide of zinc, strychnia, and electricity. The tolerance and duration of life are promoted by measures which tend to im- prove the general health, and maintain it at the highest possible point. Multiple sclerosis of the brain is not infrequently associated with a similar affection of the spinal cord. Tumors within the cranium have the different anatomical characters which belong to tumors in other situations. The most frequent are those distinguished as cancerous, tuberculous, and syphilitic. Others which are compara- tively rare are aneurismal, fibro-plastic, and parasitic, the latter consisting of the cysti- cercus or hydatids. There are still others which are occasionally found. The different tumors vary in number, size, and situation. There may be but one tumor, of the number may be great ; in the latter case, they are nsually small. They may bo very small, not exceed- ing the size of a pin's head, or they may be as large as an orange, or even larger. They may be seated in different portions of the cerebral substance, or they may have their point of departure from the membranes, and sometimes from the bony structure. They produce morbid effects, or symptoms, by pressure on the cere- bral structure together with the nerves within the skull, and by giving rise frequently to circumscribed inflammation, which may lead to either induration or softening. The more grave of these morbid effects are paralysis affecting different parts, and more or less im- pairment of the intellectual faculties. Con- vulsions belong among their effects. They are generally accompanied with pain localized within a circumscribed space, and vertigo is not uncommon. The system suffers in propor- tion to the amount of the injury which the brain receives, and frequently also from the general condition with which the local affection is associated. The latter applies especially to cancerous and tubercular tumors. Sooner or later, as a rule, they destroy life. The local symptoms which denote especially tumor within the skull are a localized persistent pain, and the occurrence of paralysis affecting dif- ferent parts successively, after intervals of varying duration. Frequently, but not always, these points suffice for a positive diagnosis of tumor of some kind. The associated circum- stances, such as tuberculous or cancerous dis- ease elsewhere, or the fact of syphilis having existed, enable the physician to decide with considerable confidence on the nature of the tumor. Moreover, its situation may frequently be inferred from the parts which are paralyzed, together with the amount and kind of mental disturbance. With our present knowledge, curative treatment is limited exclusively to syphilitic tumors. The effect of anti-syphilitic medication, where the symptoms denote the existence of tumor of this kind, is sometimes remarkable. It is, therefore, highly important that the physician should know the grounds for supposing the tumor to be syphilitic in char- acter. Mercury and the iodide of potassium are the remedies indicated if the tumor be syphilitic. A curious morbid condition, incident to dif- ferent structural lesions, and sometimes occur- ring as a functional affection, may be noticed in this connection. Reference is had to the condition now generally known as aphasia. This term signifies loss of speech, not from any affection of the organs concerned in phonation, but from either an inability to remember words, or a want of power to coordinate the move- ments involved in speech. As thus defined, aphasia is to be distinguished from aphonia, the latter term denoting loss of voice from an affection of the vocal apparatus, or from a paralysis affecting the muscles concerned in phonation. In aphasia the vocal organs are unaffected, and the patient has voluntary con- trol over the muscles of the larynx and mouth. Nor is aphasia to be confounded with loss of speech in consequence of dementia or mental imbecility. Patients affected with aphasia un- derstand what is said to them, and they are able to read ; but the ability to express their ideas in language is lost or more or less im- paired. A marked difference exists among different cases of aphasia. In some, while the patient is unable to speak, there is the ability to communicate their ideas by writing; in other cases, the patient can neither speak nor write. Hence, according to this difference, aphasia is of two kinds, namely, amnesic and ataxic. In amnesic aphasia both speaking and writing are lost or impaired ; in ataxic aphasia speech is lost, but the ability to write remains.