Jacksonian epilepsy, trephining, removal of small tumor and excision of cortex / by Charles K. Mills and W.W. Keen.

  • Charles Karsner Mills
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Jacksonian epilepsy, trephining, removal of small tumor and excision of cortex / by Charles K. Mills and W.W. Keen. 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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    Medical History After the Operation, and Certain Special Features of the Case, by Dr. Mills. History of loss and recovery of power in the left limbs after the operation; sensory investigation. When the patient came to from the effects of the ether, she had a feeling of numbness and heaviness in the left arm and hand, and also at times in the back of the left shoulder—what she de- scribed as a battery sensation, or a feeling of prickling. Five hours after the completion of the operation she was cautiously tested for motion and sensation. The tests were not elaborate, for fear of disturbing her too much. The left shoulder movements were paralyzed, but all the forearm, hand, and finger movements were retained, but weak. The power of flexion at the elbow was very feeble, probably abolished ; ex- tension was present, but much diminished. So far as could be deter- mined, sensations of touch, pain, and temperature were preserved. December 11 (first day after operation). The loss of power in the left arm and leg were about the same as noted the day before. Dynamom- eter : Right hand, 50; left hand, 26. Sensation was carefully tested for and found to be normal. \2th (second day after operation). The paralysis of the shoulder per- sisted, that of the upper arm was increased, and the loss below the elbow and in the hand and fingers was more marked. The left leg was growing much weaker; the loss of power was most decided below the knee. IWi (third day after operation). The foot movements were almost entirely abolished, but some power of flexion and extension of the thigh remained. The left upper extremity was completely paralyzed. No loss of sensation could be made out in the shoulder or anywhere in the upper or lower extremities. From December 13th to 20th (third to tenth day after operation) the paralyzed left extremities remained the same—paralysis was total in the arm and almost so in the leg, the only power retained in the latter being that of pushing the leg downward after it had been thrust upward and held by the examiner. On December 20th (the tenth day after operation) the patient had slight power of extension and flexion of the thigh, and marked increase of power of extending or thrusting the limb downward against resistance. Gradually power returned in the lower extremity, as nearly as could be made out in the following order : Thigh extension, thigh flexion, abduction, adduction. Until January 3d (the twenty-fourth day after operation) no foot movements below the knee returned. At this date signs of flexion and extension at the ankle ap- peared. January 2d, she could flex the leg over the thigh, and cross the left leg over the right, and could perform, but in a feeble manner, all movements of the foot and leg. No change was observed in the paralysis of the arm until December 29th (nineteenth day after operation) when, if the forearm was slightly flexed, she could extend it; at this time, as above noticed, she had re- gained considerable power in the lower extremity. January 1, 1891 (twenty-second day after operation) she began to flex the distal and second phalanges, but had no power of phalangeal extension, and no wrist movements. On January 3d (twenty-fourth day after operation) she could flex, extend and separate the fingers and hand, but had no elbow or shoulder movements. On January 6th (the twenty-seventh day
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