LONDON HOSPITAL

Hughlings Jackson
1874 The Lancet  
622 was so much hyperaesthesia on the left side of the abdomen that he could not bear it to be touched, it required some amount of pressure before he felt anything on the right side. His face was drawn to the left side, and there was contraction of the right pupil. Towards evening he began to recover, so as to have some use of his right arm and leg, and he could speak, though indistinctly. On shaking hands, he brought up the affected arm with a sudden jerk, not having the complete power of
more » ... plete power of control over his muscles. He passed a good night, and the following morning was sufficiently well to be up and about, although the jerk was still perceptible in shaking hands. There was a slight impediment in his speech, and he was decidedly irritable. He passed water freely, and his bowels were open. On Sept. 9th (only two days after the first commencement of the attack) he had to all appearance completely reo covered. There was no perceptible difference in his mental condition after the seizure. The general symptoms of this case are similar to those which Dr. Hughlings Jackson classes as premonitory sym. ptoms of cerebral haemorrhage, but it would be interesting to know what the lesion was which produced such marked effects, and yet was so temporary. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum et dissectionum historias, turn aliorum, turn proprias collectas habere, et inter se comparare.-MORGAGNI De Sed. et Caus. Morb., lib. iv. Procemium. AFTER excluding from consideration cases where the defect of smell is owing to actual changes in the tissues of the nose itself, Dr. Hughlings Jackson remarked on pseudodefects of smell. When the muscles supplied by the portio dura nerve of one side are paralysed, the patient, on his power of smell being tested, may say that he smells less on the paralysed side. The reason is that he cannot 11 sniff up" so well on that side, and thus fewer of the volatile elements are brought in contact with the true olfactory region of the nose. Again, when the fifth nerve is paralysed the patient does not, he may say, smell so well on the side affected. The fact is that he cannot appreciate irritants on that side. He would appreciate the flavour of cinnamon or of oil of peppermint, but would not smell, or rather feel, ammonia. Of course uneducated patients do not distinguish between such irritants and scents. In cases of true loss of smell, the patient, when very confidently smelling at a bottle of ammonia, finds, to his astonishment, that he "can smell that." One of Dr. Hughlings Jackson's patients who had lost smell said the only thing he could smell was "the frying-pan": here, no doubt, the real action was that of irritant vapours which were produced by changes in fats by heat. But it must be remarked that palsy of the fifth nerve may, by permitting changes in the mucous membrane of the nose, lead in an indirect way to deterioration of smell proper, as it may do to deterioration of the sense of sight by causing or permitting changes in the tissues of the eyeball. But, with the rarest exceptions, palsy of the fifth nerve occurs on but one side; whereas, so far as Dr. Jackson can determine, true loss of smell is nearly always double. It is scarcely possible to speak of defects of smell, as, unless the patient be very intelligent, our investigations end in no trustworthy results. In speaking of smell proper, we must consider taste too. As just remarked, loss of smell very rarely occurs on one side, and now we have to add that loss of taste uncomplicated with other symptoms very rarely occurs on both sides. In fact, Dr. Hughlings Jackson has never discovered loss of taste even on but cne side, except in cases of paralysis of the fifth nerve, and then the side of the tongue is insensible not to sapid things only, but to impressions of all kinds. Of course when both fifth nerves are paralysed taste will be lost on both sides, but this double palsy is a thing of great rarity. In some cases of palsy of the portio dura we seem, on inquiry, to make out that taste is defective on the paralysed side, but it is rare that we can be certain that it is. It is obvious that in uneducated patients we run great risk of error in such investigations, especially if we are so unscientifically-minded as to ply them with leading questions. It is well known that smell and taste go together in their action. There are many things which we seem to taste which in reality we smell. We are now and then consulted by patients for what they call loss of taste, and we find that the olfactory is the only sense wanting. The distinction of duties between smell and taste is generally believed to be that the former serves for the appreciation of those volatiles which undergo oxidation in the nose, and taste for crystalloids which can act on the tongue locally. Hence we smell sulphuretted hydrogen, which is a gas easily oxidisable, and we do not smell carburetted hydrogen, which is a gas not acted on by oxygen. But there are exceptions; for example, carbonic acid, a fully oxidised body, has smell. Possibly such exceptions are apparent only-the action may be that of an irritant. Diluted carbonic acid has no smell. We taste crystalloids like sugar and quinine, but we only feel colloids like starch and gum. We do not taste but smell the bouquet of wines and the flavour of essential oils. If we put a little oil of peppermint on the tongue of a patient who has loss of smell, he may say he tastes it. So he does in a fashion; he can tell that it is hot, but he does not appreciate its flavour; and unless we get a patient to give us the name of the flavour we cannot be sure that his smell really enters into his appreciation of the substance he has in his mouth. It must be admitted that the investigation of the condition of the senses of smell and taste is one of very great difficulty. It is next to impossible in unintelligent patients to arrive at trustworthy conclusions.
doi:10.1016/s0140-6736(02)49037-x fatcat:joosrdsryzfynanxfd34wcsy4y