Three successful cases of cerebral surgery : including (1) the removal of a large intracranial fibroma (2) exsection of damaged brain tissue, and (3) exsection of the cerebral centre for the left hand : with remarks on the general technique of such operations / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Three successful cases of cerebral surgery : including (1) the removal of a large intracranial fibroma (2) exsection of damaged brain tissue, and (3) exsection of the cerebral centre for the left hand : with remarks on the general technique of such operations / by 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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    affected; his judgment is not good ; memory fair; general mental powers slow ; at times peevish and fretful.” May SO, 1887. Present condition. Headaches moderately severe, gener- ally lasting from half an hour to several hours, and occurring from two or three in a week to one in several weeks. His speech is hesitating and slow and he has a feeling as of being dazed. He is very anxious to have an operation done if it holds out the slightest possible chance of relief. When he has spasms “ hot air seems to rise from the stomach to the nose;” the eyes become dim and twitch toward the right followed quickly by the head, which is turned in the same direction. During this time he is mostly conscious and feels as if smothered ; unconsciousness soon follows. As soon as the “ hot air ” is felt the right hand closes tightly, the forefinger first, then the thumb. He cannot tell whether the wrist, shoulder, and elbow are flexed in succession. The face also is affected (whether one side or both he does not know) and turns to the left, so that it seems “ as if he were going to be turned entirely round to the left.” These attacks last from five to ten minutes. Sometimes he has minor attacks with the same symptoms moderated without loss of consciousness. He has a good movement of the bowels every day; appetite ravenous; for four or five weeks has had night sweats almost every night, especially on the legs; has lost flesh since March 1st; his usual weight is 135 pounds, present weight 122 pounds The gait would not now show any paralysis; his hand-squeeze is about equal; the leg-thrust of equal force, as judged by resistance to my hand; the face is not paralyzed; the right ear shows a slight discharge, but is the better hearing ear of the two; his deafness for conversation, however, is only moderate; the right pupil is slightly larger than the left. The right eye deviates slightly upward and out- ward. An examination of the head shows a small scar a quarter of an inch long, three and three-quarters inches above the middle of the zygoma and one and five-eighths of an inch in front of the bi-auricular line. °The skull feels slightly irregular as if the bone had been injured ; no marked depression ; not now tender or painful, nor is there any sensation located at this point preceding the fits. The urine is rather highly colored and slightly clouded, the specific gravity 1023, no albumin, no sugar, a few crystals of uric acid ; normal mucus. June 7, 1887. While in the hospital he had six fits to-day. Dr. .oylan saw the fourth from the beginning. The eyes were starinf, with the whites turned up, the eyelids moved rapidly up and down; the right pupil was larger than the left; the head was turned far to the right and the mouth drawn in the same direction; the four limbs were hexed throughout. He was lying on the left side, with the feet turned to the left, and rigid. This condition soon passed into marked convul- sive efforts The attack lasted two minutes. The face was normal in *,at first but soon became very blue. There was no frothing at the sive A ?W dajS L?ter1Dl1' Charles A. Oliver saw him in the convul- de8CribCd 3 f0°'VS' t0geter *“> * “ At the request of Dr. Keen I examined T. D. and obtained thp fo]m„„g resultsThe pupil of the right eye was Cbytolri sue upon exposure to broad, diffuse daylight', whilst the pupil of the ieft nicatlon. ounectlon with other cases observed with Dr. Keen) for a separate comm,.