ALTERATIONS IN MUSCULAR MOVEMENT - Indications derived from the muscular system divide themselves into irregular or involuntary movements, and loss of power : spasms, convulsions, and palsy. Some of these conditions have been already enumerated, but they must be again cited, in order to contrast them with those which are essentially connected with disease of the brain : they belong to objective phenomena, and are symptoms which can hardly escape observation.
§ 1. Spasmodic slightest., but not the least import ant form of this affection is seen in the muscular twitchings of fever, as subsultus: it is at first only indicated by a tremulous movement in performing any voluntary act, caused by the irregu lar action of the muscles combined in its performance, and differ ing in some measure from the tremor of mere weakness by this irregularity : in a further stage of the fever it is more constant, and such movements of the muscles of the arm are almost always seen : at an advanced period it is combined with delirium, assum ing the character of " floccitatio," a picking at the bedcLathek_ performed in this tremulous and irregular manner. It does not fever poison, but only that the brain and nerves are especially acted upon by it. Tremor also characterizes the muscular movement in delirium tremens ; in this condition there is less irregularity of action, and every motion is performed in a hurried manner, with marked energy and activity, while in fever they are all essentially slow and apa thetic.
When the muscular twitchings are more spasmodic'or convul sive in character, and there is delirium or loss of consciousness, we have reason to suspect more serious mischief; they are in such circumstances often confined to one side of the body, or more marked on one than on the other; not unfrequently paralysis of one side is seen associated with spasmodic twitchings of the other. In such affections imperfect co-ordination of muscular movement is associated with some irritation of nerve-fibre which stimulates the muscles to action.
Loss of voluntary control is also a phenomenon of chorea, in the form of irregular jactitation of the whole body, of the vari ous limbs, or only of one of them ; the movements are more spasnlodic than convulsive ; the muscles act, not simultaneously, but severally, in opposition to, or uncontrolled by volition.
The absence of delirium or stupor in thisinstance, proves that no serious lesion of the brain exists, and leaves it undecided in what part of the nervous tracts the irritation is seated.
General convulsion is a more fearful form of spasm ; the mus cles of the whole body are thrown into violent and irresistible contraction, which produces contortions of the features and move ments of the limbs ; volition is lost, consciousness is suspended, contraction of one set of muscles is immediately followed by that of their antagonists, in consequence of which the body may be thrown by an almost superhuman strength from one side to ano ther; the feces, the urine, and the semen, are often involuntarily evacuated. General convulsions occur in various forms of brain disease, but attain their greatest severity in the distressing attacks of the regular epileptic ; the great distinction between epilepsy and convulsion will be found in the context of symptoms ; at its first incursion, the patient attacked with epilepsy seems to be in perfect health before hid seizure ; when it has passed, there is nothing beyond a feeling of languor for a day or two, or muscular soreness from violent action, to show that he has passed through the struggle ; he once more appears to be free from disease ; in its later stages the history of. recurring attacks leave,s no room for doubt. When dependent on other diseases, convulsions do not stand alone, but are found in connection with a febrile state, with delirium, or with stupor. (See Chap. XIII. § b.) Children are particularly liable to convulsions ; irritation of the nervous system is with them very apt to produce the affection, and teething, disordered digestion, or intestinal worms are ita common causes; but we must remember that it is not unfrequently the first symptom by which the attention of parents or nurses is drawn to the existence of insidious inflammation. In adults there is generally some previous history when convulsion is a symptom of disease of the brain; stilt it does occasionally occur as the first manifestation of fatal effusion of serum in the ventri cles, in consequence of the very same sort of inflammation as the hydrocephalus of childhood. Convulsion is also a very usual symptom of blood-poisoning, in e,ases of albuminuria.