The operative treatment of Jacksonian and focal epilepsy / by Charles Beylard Nancrede.

  • Charles B. Nancrede
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The operative treatment of Jacksonian and focal epilepsy / by Charles Beylard Nancrede. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    C. L., aged twenty-seven years, with a family history containing no record of epilepsy or any chronic neurosis, was in perfect health until nine years of age, when he was struck upon the left parietal region by a piece of wood, the blow causing unconsciousness lasting for three hours. Immediate convulsions followed the return of con- sciousness, the seizures recurring thrice in rapid succession. He was positive that the paroxysms chiefly involved the right side and resem- oled those he had while under my care. For the three succeeding months he had a diurnal fit, followed by a fortnight’s intermission. Next the fits numbered from three to four daily for five weeks, when a two-weeks interval of complete immunity occurred. Between ten and fifteen years of age he averaged five seizures weekly, but during the next five years only about four occurred each week. From the age of twenty until May 7, 1888,—i. e., for about seven years,—the number of attacks increased, until latterly he always had at least one daily, even forty having been noted during one twenty-four hours. Treatment in various institutions failing to afford relief, he entered a Philadelphia hospital, where the seizures were observed by Dr. C. K. Mills to commence on the left side,—i.e., on that of injury, and consequently must have been of dural or, at least, fifth-pair origin. You will note that this differs from the patient’s account of his earlier attacks, but a man reduced to the condition he was in when I saw him was hardly competent to recall the facts as they had been eigh- ■ teen years before, especially as his present paroxysms were said by others to commence exactly like his first ones. A surgeon removed a one and a half inch button of bone by the trephine, the cut over- lapping the fissure of Rolando, a scar over the excised portion of bone being also removed, because pressure upon this cicatrix excited the paroxysms. The bone was replaced, but one convulsion occurred ten days after the operation, the wound healed, and he was free from seizures for probably about six weeks, when some return of the fits and a sinus at the site of the operation-wound led him to enter another hospital, where the partially necrosed bone button was re- moved from a bed of granulations. Prompt relief and healing occurred, but upon September 1 he entered the Jefferson Medical College Hospital under my care, suffering from his old ailment in an aggravated form. Avoiding all unnecessary discussion of details, a study of twenty-five of the convulsions showed that the discharging lesion was located in the centre governing the motions of the right thumb, the procession of symptoms progressing very slowly from the prodromal pains at the site of injury to the total loss of consciousness.
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