On diffuse encephalitis : with an account of a case in which the patient survived / by R. Lawford Knaggs and R. Conyngham Brown.

  • Knaggs, Robert Lawford.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: On diffuse encephalitis : with an account of a case in which the patient survived / by R. Lawford Knaggs and R. Conyngham Brown. 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.

    6/22 (page 216)
    was drawn to the left side, and a stiffening of the left arm and leg was succeeded by clonic spasms ; these, though most marked on the left side, were never entirely limited to it. A fit lasted about two minutes, and on recovering he became pale and faint for a few seconds and then said he felt well again. The convulsive movements did not begin in any particular muscle or group of muscles. At other times the left arm would be involuntarily jerked forward once. This was of frequent occur- rence and was unaccompanied by any other symptom. The tem- perature was normal, but when taken in the left axilla it usually registered nearly a degree lower (subnormal) than when taken in the right. The history, and the unilateral and progressive character of the paralysis and of the convulsions pointed to some lesion of a traumatic character implicating the R. motor area, and after con- sultation it was decided to explore over that part of the brain. Operation. On October 16 (the boy’s head having been pre- viously shaved and rendered aseptic), the situation of the fissure of Rolando was marked out on the right side of the scalp, a large semi-lunar flap reflected down, and two half-inch discs of bone removed above and below a point situated over the arm centre. The dura mater did not pulsate very evidently at this stage, and it did not bulge. A third disc in front of, and intermediate between the other two was removed, the intervening bone marked out by Key’s saw, and clipped away with bone forceps, and in this way a triangular aperture was made whose sides measured from 2 to 2i inches. The exposed dura concealed the lower J- of the fissure of Rolando, and the centres for the face and arm, and part of the leg centre. The dura did not bulge at all into the opening, and there was no pulsation, but the child’s condition had rapidly failed and the absence of pulsation was thought to be connected with that fact. The flap was re-adjusted and further exploration postponed. There had been a good deal of haemorrhage from the flap and the bone, but not to such an extent as to raise alarm. Before the operation i of a grain of morphia was to have been injected, but owing to a defective syringe less than that quantity was probably administered. At the beginning of the operation the child’s condition was good, but no chloroform was given after the removal of the second disc. When Hey’s saw was being used the anaesthetist found it necessary to inject ether, and though the operation was concluded