on 11/1/99 4:27 PM, J. R. Bruman at [log in to unmask] wrote:
> After an unconscionable delay, the 17th (1999) edition of the Merck
> Manual finally reached the shelves of Crown Books, and I brought one
> home today. They usually revise every 5 years or so, but the 16th
> came out in 1992. Haven't had time to examine the new book, but without
> looking I can recommend it as the most complete and authoritative
> reference for just about any medical condition. And only about $30 at
> Crown. As an added touch honoring the centennial of the Merck Manual,
> the box contains a reproduction of the slim little first (1899) edition.
> Cheers,
the manual is on the web:
http://www.merck.com/pubs/
i looked for Parkinson's Disease. found in Section 14 chapter 179:
Symptoms and Signs
In 50 to 80% of patients, the disease begins
insidiously with a resting 4- to 8-Hz pill-rolling tremor of
one hand. The tremor is maximal at rest, diminishes during movement, and is
absent during sleep; it is enhanced by emotional tension or fatigue.
Usually, the hands, arms, and legs are most affected, in that order. Jaw,
tongue, forehead, and eyelids may also be affected, but the voice escapes
the tremor. In many patients, only rigidity occurs; tremor is absent.
Rigidity progresses, and movement becomes slow (bradycardia), decreased
(hypokinesia), and difficult to initiate (akinesia). Rigidity and
hypokinesia may contribute to muscular aches and sensations of fatigue. The
face becomes masklike, with mouth open and diminished blinking, which may be
confused with depression. The posture becomes stooped. Patients find it
difficult to start walking; the gait becomes shuffling with short steps, and
the arms are held flexed to the waist and do not swing with the stride.
Steps may inadvertently quicken, and the patient may break into a run to
keep from falling (festination). The tendency to fall forward (propulsion)
or backward (retropulsion) when the center of gravity is displaced results
from loss of postural reflexes. Speech becomes hypophonic, with a
characteristic monotonous, stuttering dysarthria. Hypokinesia and impaired
control of distal musculature results in micrographia and increasing
difficulty with activities of daily living. Dementia affects about 50% of
patients, and depression is common.
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about one third of the way down this paragraph, it seems to have an error.
the word "bradycardia" is used for slow movement. but, bradycardia is slow
pulse i believe.
if you have the interest, look in the paper edition, please.
Ron Vetter 1936, '84 PD dz
mailto:[log in to unmask]
http://www.ridgecrest.ca.us/~rfvetter
