Clinical surgical diagnosis for students and practitioners / by F. de Quervain ; translated from the 4th ed. by J. Snowman.

  • Quervain, F. de (Fritz), 1868-1940.
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Clinical surgical diagnosis for students and practitioners / by F. de Quervain ; translated from the 4th ed. by J. Snowman. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    and painful scars over bones, or those involving nerve-trunks have long been credited with this evil. Even foreign bodies in the nose or ear may cause epilepsy. Demme reports a case wherein a rectal polypus acted in this way. When I was a student I saw a case of Kocher's, in which typical Jacksonian epilepsy appeared to start from a scar in the hand. The excision of the scar proved useless. It was then decided to trephine, but he escaped from this project by dying suddenly. The autopsy revealed a well-circumscribed tumour in the situation selected for the operation. Although too much has perhaps been attributed to reflex epilepsy, w^e must not neglect its consideration when examining the patient. Our conjecture will become a certainty if the patient experiences any abnormal sensations in the suspected scar before the attack, or if we are able to directly excite an attack by pressing on the scar. A boy, aged 3, who had never been epileptic, was brought into hospital with definite attacks, a few days after a fall on his forehead. Examination showed an abrasion of the forehead, from which ery- sipelas was spreading, and a subjacent abscess. This was opened ; there was no fracture of the skull. The fits ceased immediately, and the case, therefore, was either a toxic or reflex epilepsy. The actual observation of the fit is an important part of the clinical history. If it resembles an ordinary attack, beginning with general convulsions, and not regularly affecting any particular region of the body, either by a preceding aura or subsequent effects, we can draw no conclusion regarding its etiology. General convulsions usually signify so-called true epilepsy, i.e., epilepsy with an unknown anatomical basis, but they also occur in other forms of epilepsy, which are caused by certain gross anatomical changes. It is quite different when the aura, or the post-epileptic paralytic phenomena, either persistent or transitory, indicate a definite area of the cortex as the seat of origin of the attacks. Two varieties may be distinguished in this connection. In one, the convulsions are limited to a circumscribed motor area, and we are therefore confronted with typical Jacksonian cortical epilepsy. In the other, the attack similarly begins in one definite area, but it marches, in anatomical pro- cession, along into other areas, and thus the fit becomes generalized. Temporary paralysis in the area corresponding to the seat of origin, may follow the attack. The relatives can often furnish useful information on these points, but it is always advisable to personally confirm their statements, or to obtain their confirmation from a hospital trained attendant, because our treatment must frequently be dictated by this information. Finally, a careful investigation of the condition of the patient between the attacks must be undertaken. Scars on the scalp.