Tremor.
In an analysis of the pathogenesis of tremor based upon a study of the ture of the subject and clinical tion, Adamkiewicz (Berl. klin. Woch., Oct. 3, 'AS) reached the conclusion that tremor arose from disturbances in the equilibrium of the two spinal innervat ing stimuli. Two currents pass along the spinal cord to the ganglion-cells of the anterior horns from which the nerves for the muscles arise. One of these cur rents passes along the posterior columns, the other along the pyramidal tracts. The former arises in the cerebellum and keeps the muscles in a state of tension; the other originates in the cerebral tex and conveys voluntary impulses to the muscles. When both currents are properly balanced, they act upon the muscles as a stimulus and as a check like whip and rein. If the excitation along the posterior columns is insufficient the muscles deprived of their check become unruly and produce ataxia. When, on the other hand, the muscles are trolled by the current along the pos terior columns and the regulating action of the pyramidal tracts is absent, as, for example, in lateral sclerosis, the muscles of the lower extremities are in a state of excessive tension; so that the joints be come immovable and the gait stiff, labored, and dragging. If the patient attempts to move, the hypertensioned muscles develop a state of tremor. In the beginning this tremor is slight, but in proportion as the tension of the mus cles increases it becomes augmented, until finally a tremor-paroxysm develops. Various toxics,—lead, tobacco, opium, coffee, tea, cocaine, hasheesh, arsenic, etc.,—hysteria, and old age are the main etiological factors in tremor. Dana has observed a family in which it was dis tinctly hereditary.
Conclusions based upon 1000 observa tions of tremor on more than 100 differ ent persons: L All muscular movements are made up of a series of elementary contractions and relaxations in alterna tion, which may be appreciable as tremor in conditions of both health and disease.
2. The differences between different tremors are of degree rather than of kind: i.e., no one form of tremor is dis tinctive of any one disease or group of diseases. 3. No definite relation exists between one form of tremor and any other. 4. The frequency of movement is in inverse ratio to the amplitude, and rice rerso. 5. Habitual movements are performed with greater freedom from tremor than unusual movements. 6. There is no material difference between the movements of the two sides of the body, except as related to proposition No. 5. A. A. Eshner (Jour. of Exper. Med., May, '07).
Toxic TREMOR.—This is a form of trembling due to the toxic influence of mercury. lead, copper, and arsenic, that induced by the latter drug being espe cially tenacious. Tobacco often induces tremor in elderly men.
Treatment. — In tremors due to the first three metals Liegeois recommends potassium bromide, 150 grains daily, during one month. It forms with the metal a soluble bromide which is easily voided by the urine. In arsenical tremor frictions and baths are alone effective.
ALcouoLic TREMOR. — The inability of the hands to hold anything, the pare sis of the legs, with a dragging gait, the arrest of the tendinous reflexes, and the trembling which are seen in alcoholics, should be classed, according to Liegeois, with the trembling of paralysis.
Treatment.—Strychnine alone is not so efficacious as when it is associated with picrotoxin and with veratrine. Ten galvanic or electric baths give successful results in tremor potatorum. For this acute stage of chronic alcoholism, which is called delirium tremens, alcohol in doses of from 2 to 3 ounces is an excel lent remedy. It induces sleep immedi ately and the patient awakens cured. (See ALCOHOLISM, volume i.)