The principal symptom of which Marshall complained was headache chiefly felt in the region of the osteitis. There was marked sensitiveness to percussion in this area. It is of course difficult to decide whether the headache was entirely due to the gummatous lesions or whether the trauma had caused contusions of the brain as well. It is also possible that the dura underlying this area was involved.
OCCUPATION-NEUROSIS in a granite-cutter: SYPHILITIC NEURITIS?
Case 94. David Fitzpatrick was a case referred to the Psychopathic Hospital by the Industrial Accident Board. He was a granite-cutter of 52 years of age, and had begun to complain of pain in the forearm, extending back from the elbow, about six months before admission. It seems that the patient had been growing progressively worse and had thought he would have to quit work because of difficulty in grasping the hammer. A physician had told him that he must stop his work at granite-cutting or else he would entirely lose the use of his arm. He was in point of fact laid off because of slackness of work and had been unable to get work again. The pain in the arm, however, had continued and at times was very severe. Sometimes the pain and the worry led to insomnia. Fitzpatrick wanted the insurance company to pay certain accumulated bills, and maintained that he would be able to do work at $15 a week if work could be found for him. The general situation in this case can be gathered from the following abstract from the report to the Industrial Accident Board.
“Secretary Industrial Accident Board,
“Dear Sir:
“In re David Fitzpatrick
referred to us with a copy of an impartial report filed by the Massachusetts General Hospital,—we concur with said impartial report that there is now no evidence of paralysis of the arm. We do not find that the positive Wassermann reaction, although it indicates a history of syphilis, has affected the patient other than possibly to have reduced his general mental capacity. Our special tests yielded a percentage of 62% of what a patient of his age and station should possess. There seems, however, to be no connection between this reduction of mental capacity and the difficulty with the arm. We cannot connect the history of alcoholism with the arm trouble.
“There is some evidence that other stone workers have at times shown such effects.
“The patient’s fairly circumstantial account of his difficulty seems to point to a degree of myalgia or muscular pain in the region of the forearm when held in a certain position and a feeling of numbness in the third and fourth fingers. Whether these phenomena are due to local pressure upon nerves in the upper part of the forearm due to neuritis, or whether we are dealing with a functional neuralgic phenomenon is a question.
“We have applied some special tests for faradic sensibility to all the fingers of both hands and have found that the fingers of the right hand are still less sensitive than those of the left, particularly the thumb and the little finger. This test has not yet been applied in a sufficiently large number of cases to prove any difficult point, nevertheless the findings are in line with the patient’s own circumstantial account of former feelings of numbness in the third and fourth fingers of the right hand.