Fatal Haematemesis, From Oesophageal Varices, in Presence of Large Portal-Caval Anastomosis
Authors: T. S. L. Beswick, H. Butler
Journal: BMJ (1951)

everywhere normal except definitely impaired over the thumb.Power and position sense normal except that she could not flex her elbow against gravity.Hot and cold could not be distinguished.After a long walk angina was felt in the upper arm.Later it was felt in the chest and then in the elbow.It did not spread to the wrist, as was usual.Re-testing: Slight flinching with muscle pressure and finger bending, but much less than normal.Pin-prick was painful in patches in the upper arm and fourth and fifth fingers.Cotton-wool, power, and temperature unchanged.Cotnmenit: Patchy analgesia, power impaired; arm pain less widespread.Case 6.-An honest garrulous man aged 42, not very sensitive to pain or good at analysing symptoms.Ischaemic contractions, 100.After injection ischaemic contractions 110, almost paralysed but some deep aching.No pain with muscle squeezing.Pin-prick abolished except possibly for some sensibility in the hand.Cotton-wool always felt, but less than normal.Power and use of hand not affected.After strenuous walking angina was felt in the chest and arm as far as the elbow.The arm pain had the usual distri- bution and time relationship to the chest pain.Though quite definite, it was not as severe as he would have expected.Re-testing: Felt pin-prick " right at the end " all over the arm.Muscle and finger squeezing were just painful at the height of the stimulus.Ischaemic contractions stopped at 100 by pain.Other functions unchanged.Comment: Incomplete analgesia; arm pain less severe.Case, 7.-A decorator aged 51 was a good intelligent witness, hyperaesthetic.Ischaemic contractions, 55.After injection ischaemic contractions not tested.Completely analgesic to pin-prick and nmuscle and finger squeezing.Hot and cold not distinguished.Cotton-wool normal except for loss of tickle, especially along the ulnar border.Position sense not affected.Slight general weakness of hand.Did not swing his arm while walking.With walking the chest pain came at the normal point.At the same time there was a detectable pain in the usual distribution of the arm, but it was much weaker than that in the chest, instead of being stronger, as was usual.Re-testinig: Cotton-wool normal.Temperature nearly normal.Power still impaired.. Ischaemic contractions stopped at 110 by severe pain.Muscle and finger squeezing were just painful, though much less than normal.Conmment: Moderate analgesia, power impaired; arm pain definitely less.Case 8.-A man aged 46; a very analytical observer of his symptoms.He got pain in both arms equally.Ischaemic contractions, 70.Tested in the recovery phase after fairly complete paralysis.Pin-prick absent except over the central palm.No pain with muscle and finger squeezing.Ischaemic contractions stopped at 100 with paralysis and some tingling pain.Cotton-wool appreciated everywhere, but diminished.Some general muscular weakness.Fairly good distinction of temperature.With hard stepping exercise the pain appeared as usual in the chest and right arm.There was no pain at all in the injected arm.Re-testing: No pain with muscle and finger squeezing or pin-prick.Ischaemic contractions stopped at 70 by pain.Otherwise unchanged.