358 DISEASES OF THE PERIPHERAL NERVES. 



and after it, must be regarded as of this character. The affection 

 is most common during childhood, especially the primitive form in- 

 duced by cold. The statement of Vatteix, that the disease is so rare, 

 that few physicians ever see it, strikes me as strange, as not only have 

 I myself observed a great number of such cases, but I well remember 

 that Krukeriberg used to describe it as a by no means uncommon 

 form of rheumatism among children. 



SYMPTOMS AND COURSE. Sometimes the disease is preceded by 

 a feeling of illness, languor, and depression of several days' duration. 

 The actual commencement of the disease is marked by pain, which 

 apparently shoots along the courses of the nerves, sometimes involving 

 the upper and lower extremities simultaneously, sometimes only the 

 hands and forearms, sometimes the feet and legs. In addition to this, 

 there is a sense of formication, and of stiffness and sluggishness in the 

 suffering members. These symptoms having lasted for a variable 

 period of time, fugitive cramps, in the calves of the legs and other 

 muscles, set in, which soon are converted into continued tonic contrac- 

 tions. The upper extremities are usually brought into a state of per- 

 manent flexion, the lower into permanent extension. If we are unac- 

 quainted with the malady, and see a child thus affected for the first 

 time, we shall be deeply impressed by the aspect of the rigid immov- 

 able limbs, the extended knees, the heels drawn up, the thumbs forced 

 into the palms of the hands, and shall be inclined to ascribe it to some 

 serious lesion of a central organ. The attempt to extend the upper 

 extremity or to flex the lower is extremely painful to the patient. 

 The contracted muscles are hard and prominent. Generally the joints 

 seem somewhat swollen by a slight oedema of the skin. Sometimes - 

 the tonic contractions extend to the muscles of the back and belly, 

 and even to those of mastication and to those of the face. The affec- 

 tion is either entirely free from fever or else the fever is of but little 

 intensity. In some patients the commencement of the contraction is 

 accompanied by a sensation of oppression and of rush of blood to the 

 head. In many instances the course of the disease is brief; the con- 

 tractions ceasing after a lapse of a few days, and free mobility becom- 

 ing reestablished. In other instances it is more protracted. Some- 

 times, too, relapses occur after some days or even some weeks have 

 passed. Certain observers, as Delpeche and Hasse, state that the dis- 

 ease consists of a series of spasmodic attacks, that these paroxysms last 

 for some minutes, some hours, or a day or more, and that in the inter- 

 vening period there is merely a certain degree of stiffness and swelling 

 of the limbs, accompanied, perhaps, by anaesthesia of the skin and mus- 

 cles. In the cases which I have had opportunity to observe, no such 

 paroxysms and intervals were discoverable. 



