Tremor

“ A familiar type is the tremor and unsteadiness of the legs which occur as a consequence of the dread of heights when a person unused to such situation attempts to walk across a narrow path a great distance above the ground.
Senile Tremor.—The most common of the involuntary tremors is that associated with old age. It develops in practically all very old people, but it comes to some who are comparatively young. Its occurrence at the age of fifty-five usually gives the sufferer a severe shock which is emphasized by the attitude of mind of friends toward the affection. ”

“ But that any one could have slept on undisturbed by those piercing screams and by our own comings and goings seemed unbelievable. Perhaps there were separate quarters in the grounds somewhere—
And then, without conscious will of my own, I felt my body stiffen and my fingers grip my pipe convulsively. A slow tremor seemed to start from the end of my spine, travel up it, and pass off across my scalp. There was someone in the room behind me; someone with gleaming eyes fixed upon me; and I sat there rigidly, straining my ears, expecting I knew not what—a blow upon the head, a cord about the neck. ”

“ The branch trembles when a hand approaches it to pluck a flower, and seems to both withdraw and to offer itself at one and the same time. The human body has something of this tremor when the instant arrives in which the mysterious fingers of Death are about to pluck the soul. ”

“ I was roused from this reverie by the sudden opening of the door. Some person, whom the uncertain light prevented me from distinguishing, walked across the room, with a slow and solemn pace, and, after taking several turns backwards and forwards, reclined on the sopha, remaining for some time perfectly still. A tremor shook my nerves—unable either to speak, or to move, I continued silent and trembling—my heart felt oppressed, almost to suffocation—at length, a deep, convulsive sigh, forced its way. ”

“ As a matter of fact, when unassociated with gross pathological lesions, the senile tremor has no such significance. When associated with definite lesions it is the prognosis of the special condition and not any supposed significance of this particular symptom of tremor that expresses the genuine outlook in the case. Many people who live to a very old age develop tremor before they are threescore. Most of those who live to be eighty or more have some tremor that develops about or just after the age of seventy. ”

“ I still felt under the influence of the sorcery that had been practiced upon me. Nevertheless, my blood, so long frozen in my veins, began to circulate more and more freely. A slight tremor occasionally went through my limbs. ”

“ She lay so still that, but for the labouring of her bosom and a tremor which now and again shook her limbs, the watchers would have thought her dead. She made no struggle of resistance; she lay quiet and still. ”

“ There is a progressive form of invasion when the tremor is not the first symptom. The patient has neuralgic or rheumatic pains in the limbs, which are afterward affected with tremor. Sometimes there is some mechanical injury of the limb, which subsequently is the seat of pain and tremor. The general health of the patient is at the same time more or less impaired. There is a sense of general weakness and lassitude; the temper is irritable, and there may be some vertigo. ”

“ Two types of tremors come to us for treatment: those that are quite involuntary and occur when muscles are at rest, and those that are associated with voluntary movements. The most common type of involuntary tremor is that seen in paralysis agitans to which a special chapter is devoted. After this, though coming for treatment much less frequently, is senile tremor which may, however, also be increased by voluntary movement. ”

“ The tremor felt in leaning against the walls in the upper apartments, when it blows fresh, or when the house is struck by a sea, or by a boat coming suddenly against it, may be compared to that which is perceptible in a common house, upon the slamming of particular doors, or when a carriage makes a rattling noise in passing along the streets ”

“ There are no pathological data for explaining what portions of the nervous system are the seat of disease in simple tremor. In experiments upon the lower animals it has been found that trembling occurs in muscles which have been separated from the nerve-centres by division of the nerve. So too in man: when there has been a wound or section of a nerve accidentally, there is likely to be tremor in the muscles which it supplies. ”

“ Tremor may be compared with incapability of fixing the attention, and this involuntary state of muscles ordinarily subjected to the will, also finds a parallel where the mind loses its influence in the train of thought, and becomes subject to spontaneous intrusions; as may be exemplified in reveries, dreaming, and some species of madness. ”

“ The wounds which seem like real wounds, the color of the skin, the contraction of the face, the attitude, the expression,—each thing is terribly real. If you touched the body, you would expect to feel the tremor of the limbs and the warmth of the blood. ”

“ Lord Angus, thou has't lied!"
Sir Walter Scott.
TREMOR QUALITY. The Tremor Quality is used in expressing pity, grief, joy, mirth, etc., and its characteristic is a frequent rise and fall of the voice, and a more delicate exercise of that particular vibration in the throat, known as "gurgling." It is apparent in extreme feebleness, in age, exhaustion, sickness, fatigue, grief, and even joy, and other feelings in which ardour or extreme tenderness predominate.
1.
Pity the sorrows of a poor old man
Whose trembling limbs have borne him to your door ”

“ One foot is drawn back behind the other, so that the body seems shrinking from the danger, and putting itself in a posture for flight. The heart beats violently; the breath is fetched quick and short; the whole body is thrown into a general tremor. The voice is weak and trembling; the sentences are short, and the meaning confused and incoherent. Imminent danger, real or fancied, produces in timorous persons, as women and children, violent shrieks, without any articulate sound of words; and sometimes irrecoverably confounds the understanding ”

“ The convulsive movements generally cease during sleep. The tremors are accompanied by interference with the functions of other organs: the respiration is weakened and difficult; dyspnœa, or an asthmatic condition, results; the pulse is small and slow; paresis, deepening into paralysis of the extremities, or of a group of muscles, follows; and, lastly, if the condition is not alleviated, the patient becomes much emaciated and sinks from exhaustion. Pregnant women are liable to abortion, and the living infants of women suffering from tremor have also exhibited tremor of the limbs. ”

“ Ataxic tremor is distinguished from common or spasmodic tremor by the fact that it is developed during the performance of a volitional act in parts which are quiet when not used. Thus, tremor appears in speaking, putting out the fingers, using the hands, etc. in the muscles actively employed, and occasionally also in others at the same time. This form of tremor is well seen in dementia paralytica, where in certain cases the patient's muscles are still until we induce him to make voluntary movements or provoke expression movements. ”

“ Sensation is usually impaired; especially is this true of sensibility to pain.
Tremor, although occasionally slight, may be said to be never wholly absent. Sometimes it affects the muscles of all parts of the body; more commonly it is limited to the hands, arms, tongue, and lips; less frequently it manifests itself in the lower extremities. Slight tremor may be increased by causing the patient to hold his hands extended with the [p. 629] fingers separated. The movements of the hands consist of rapid rhythmical oscillations of nearly equal extent and duration. ”

“ A typical and familiar case is the tremor that occurs upon the first appearance before large audiences of orators or actors or clergymen. Owing to excitement, they are unable to make flexor and extensor muscles exactly balance each other and the consequence is a tremulous movement that may be complicated by some swaying. ”

“ If the tremor of the legs got more energetic, the patient would get up and take a few steps. Any movement, such as laying hold of an object, carrying a spoon or a glass to the mouth, led to an exaggeration of the tremors in such wise that the tremor of multiple sclerosis in its most extreme form was recalled. It was very hard for the man to eat. If the eyes were closed, the tremors grew more marked. The emotion caused by sudden noise or sharp command or memory of his trench life caused motor crises, with coarse, generalized movements, and even loss of balance. ”

“ Tea, alcohol, coffee, and many stimulating medicines cause a very visible tremor. In convulsive laughter, pleasure, intoxication, voluptuous enjoyment, anger, when the necessity for heating the blood is certainly not apparent, one trembles also, the voice vibrates and the legs shake. All this makes it probable that Darwin is right, and more decidedly do I incline to his side when I think of the disastrous effects which trembling produces during fear. ”

“ To produce a straight line or to draw a circle becomes impossible. Involuntary tremor is predominant, a tremor, the rhythmical regularity of which becomes fully manifested in senile degeneration, and which is also observed, though without its rhythmical regularity, on the very eve of mental life, in infancy. ”

“ The tremor from alcohol or opium is most marked when the individual has been without the use of the stimulant for a short time, and the trembling may be temporarily checked by renewing the dose of alcohol or opium as the case may be.
The muscular trembling from plumbism and mercurial poisoning is more violent than the other forms of simple tremor, and often resembles the tremor of paralysis agitans. In toxic tremors there are often secondary paretic symptoms and indications of other disturbances of the brain and nervous system. ”

“ The symptom itself is annoying because of the notice that it attracts, but their dread that it may have some serious significance, indicating the development of a progressive lesion of the central nervous system, constitutes the worst part of their ailment. When the intentional tremor is intermittent and occurs only at times of excitement, or when the patients are under observation, they can be reassured that it is merely neurotic and that no ulterior development is to be anticipated. ”

“ It is probable that in simple tremor the lesion is situated in the spinal cord; for in this disease we seldom see any evidences of cerebral disturbance. There are no paralytic or psychical symptoms, and no vertigo. In toxic tremors the disease is no doubt located in the brain, for accompanying the trembling resulting from alcohol, opium, mercury, and other drugs are mental changes and more or less muscular enfeeblement. ”

“ Tremor of old age consists of a perpetual trembling of the hands, or of the head, or of other muscles, when they are exerted; and is erroneously called paralytic; and seems owing to the small quantity of animal power residing in the muscular fibres. ”

“ All such impressions, which act as auto-suggestions for the continuance of their tremor and lack of control, must be combated, otherwise there is very little hope of improvement. The preceding disease is not the direct cause, though the weakness consequent upon it may predispose to the tremor. Overhaste in attempting to resume their occupations before their strength has returned is often the real cause. It is the patient's mind more than his body that needs to be set in order, but this will not be possible unless the physical condition is normal and thorough reassurance can be given. ”

“ It is noteworthy that collapse with tremor seems to be especially characteristic of Man in whom all the different modes of reaction to danger found in the animal kingdom are present in some degree, but no one of them so specially developed as to form an immediate and invariable mode of behaviour in the presence of danger. ”

“ Hysterical tremor is of various forms and of frequent occurrence: a single limb, both upper or both lower extremities, or the entire body may be affected. In a case of hystero-epilepsy, which will be reported in the next article, the patient had a marked tremor of the left arm, forearm, and hand, which was constant, but worse before her attacks ”

“ Paralysis agitans is a neurosis, chronic in its forms and characterized by a tremor which gradually increases in extent and severity. The tremor is not increased by voluntary muscular movements. A peculiar manner of walking, known as festination, comes on later in the disease, and there are also alterations in the attitude of the head and trunk. ”

“ Tremors may occur in connection with almost any set of actions requiring special co-ordination of muscles, but they are especially likely to occur when a feeling of dread disturbs the control over muscles. A typical example of this is noted in shaving. There are many men who cannot shave without trembling so as to cut themselves. The feeling that they have a sharp instrument in their {582} hand with which they may cut themselves sets up the tremor. ”

“ Here the people were sometimes seized with general tremor, the pulse grew weaker, their breathing difficult, and, at long intervals, their hands and feet became cold, and finally they fell, and both pulse and breath, and all symptoms of life forsook them for nearly an hour, during which time they suffered no pain, and were perfectly conscious of their condition and knew what was passing around them. ”

“ Many of these people do not eat substantial breakfasts. Their tremor, too, is likely to be worse in the early morning than at any other time during the day, unless, of course, they have become overtired during the day, when the tremor will reassert itself with vigor. ”

“ Under this authority the term palpitation may be employed to mark those morbid motions which chiefly characterise this disease, notwithstanding that this term has been anticipated by Sauvages, as characteristic of another species of tremor [7] . The [23] separation of palpitation of the limbs (Palmos of Galen, Tremor Coactus of de la Boë) from tremor, is the more necessary to be insisted on, since the distinction may assist in leading to a knowledge of the seat of the disease. ”