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.

    7/10 page 5
    lasting for one week, characterized by unconsciousness for three or more days, a high temperature,—reaching once 107° F., and result- ing in right hemiplegia, contracture of the flexor muscles of the right hand and of the calf muscles, which latter condition persisted until after a severe scald of the same side, when it nearly disappeared, although detectable when admitted upon even a superficial examination. Con- vulsive attacks occurred almost daily, affecting principally the right side, commencing in the hand, then involving the tongue, and finally the whole right side. While generally involving only the right side and unattended by loss of consciousness, the convulsions were some- times generalized and consciousness was lost. March 7, 1894, I exposed the centre for the right hand and located it by the battery, but the brain being decidedly depressed rather than elevated, and nothing abnormal being detected beyond some congestion of the pia mater and a doubtful induration of the brain, I declined to proceed further, the exploration having been undertaken at the urgent solici- tation of a colleague, it being my original belief that very much the condition found at operation existed,—viz., some destruction of brain tissue had resulted from an apoplectic effusion, and that neither cyst nor any condition remediable by operation existed. Instead of daily paroxysms she now had intervals of days between the fits, some- times a week elapsing. She returned home improved, the attacks finally ceasing for several months, when, after a slight relapse, the extraction of some troublesome teeth again seemed to give her com- plete immunity. The interesting part of the case is, however, that the contracture of the hand entirely disappeared and the muscles of both upper and lower extremities regained their lost bulk and power, leaving only a little acquired pes equinus, which my assistant corrected by tenotomy and apparatus, so that the child at the last report was free from her fits and recovered from her paralysis. Whether this has proved a permanent or only a temporary recovery I am not in a position to say, as the patient lives in another State. To what were the good results due in this case ? Were they more than a mere coincidence ? I am convinced that they were. Did the results follow merely from the profound effects of the mechanical injury to the central nervous system inflicted during the operation, such an effect as is often produced by other oper- ations, even those involving only peripheral nerves, as the extrac- tion of a vesical calculus? I think not, because the results were not noticed at first, but the recovery was gradual, and pari passu with the improved function of the damaged centres and dis-
    digitised image 1
    digitised image 2
    digitised image 3