Case of Epilepsy of Six Years' Duration. Complete Recovery after Surgical Operation on the Skull and Brain

A. H. Bennett, A. P. Gould
1887 BMJ (Clinical Research Edition)  
and probably all cases included under that name were examples of alcoholic paralysis. Periplheral neuritis was not a distinct disease, but a substratum underlying the symptoms of several very different affections. Professor BLovN. SIiQUARD considered that the effect of vaso-motor influences in producing tissue-change was unduly exaggerated. He pointed out the necessity of remembering all the causes which operated in this direction: (1) changes in the chemical constitution of the part; (2) the
more » ... the part; (2) the blood-attracting inlluence of local tissue-change (3) the temporary suspension of the ordinary relations between the blood and the tissues. Under some circumstances of injury, etc., the blood in the veins came to resembla that in the arteries. All these conditions were produced through the influence of the nervous system. Dr. HYLA GREVES described the pathological changes found in two cases of alcoholic paraplegia occurring in the Liverpool Royal Infirmary, under the care of Dr. Glynn. In the first case, a woman aged 48, who had drunk largely of brandy for some time, had suffered from delirium trci nes. When admitted, she was greatly emaciated, and had a large bed-sore over the sacrum. The nervous symptoms were paresis ot the lower extremities, loss of knee-jerk, pain on pressure of muscles, cutaneous anesthesia and analgesia, burning pains in the soles of the feet. She dlied from septiciemia following septic absorption from the bed-sore. On post mortem examination of the nervous system, the followinig changes were found. In the spinal cord, there was distiniet ascending degeneratioln in the cervical region. The cord otherwise appeared normal. The peripheral nerves of the extremities were more or less affected, especially the cutaneous branches, the mixed nerves being affected in less extent. There was complete atrophy of a certain number of nerve-tubes in others and degeneration of the white substance of Schwann, which was split up into masses of myclin. There was also granular degeneration of the axis-cylinders. The ganglia in the posterior roots of the spinal nerves were also altered. Some of these cells were much degenerated, and the surroundin connectivo tissue was markedly increased ; it was possible that this had something to do with the pro luction of ascending degeneration in the cord. Similar changes were found in the second case. Dr. WHITTLE said that the speculative problems ot the subject were beyond the province ot the general practitioner, but he proposed to deal with it in its clinical aspects. He had seen a case of subcoracoid dislocation which remained unreduced for about six hours, during which the patient travelled a distance of ten miles. After reduction, all went well for a day or two, when pain came on, starting in the shoulder, and radiating round the back of the arm in the course of the musculo-spiral nerve, which was distinctly tender. At the
doi:10.1136/bmj.1.1357.12 fatcat:dztrjzlrtrawvegpqhxhpez2l4