Cerebral and mental symptoms in relation to somatic disease, anæsthetics and toxic agents, traumata and surgical procedures : with a review of the treatment of some cerebral and mental symptoms by operation / by James Christian Simpson.

  • Simpson, James Christian.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Cerebral and mental symptoms in relation to somatic disease, anæsthetics and toxic agents, traumata and surgical procedures : with a review of the treatment of some cerebral and mental symptoms by operation / by James Christian Simpson. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    case of Ord's who was 5 years of age, apathetic and ex^ hibiting other signs of increasing intra-cranial pressure, including double optic neuritis. The conditions of the pulse and respirations are not fully noted in this case, though they were quoted from his second operation. The occiput was trephined in the region of the cerebellar fossa, and a small quantity of fluid escaped; a tube was left in, fragments of bone replaced and the wound closed. The child did well, though at one time the wound seemed to be infected with tubercle. In this case if the coma had been ventricular, this simple operation would probably not have relieved the symptoms unless there was no blocking of the foramen of Majendie, which would be improbable. Mr. Walsham, in a similar case, operated through one of the cervical vertebrae, a position which he considers presents several advantages over the occipital bone. This child died, and though there was no tubercular inflammation, there was increased intra-cranial pressure. A routine lumbar drainage must be attended by some failures, for it is evident that it can only help those cases in which the increased pressure is intra-cranial but extra-cerebral, unless the intra- cerebral pressure be accompanied by a patent foramen of Majendie, which, as before remarked, is improbable in cases of inflammatory origin. Thus the earlier a case is seen, if it be a simple or tubercular meningitis, the greater the probabihty that the symptoms are the result of basal irritation and pressure, but later, when coma becomes more marked, and monoplegia, or hemiplegia, or paresis occurs, as contrasted to some extent with the temporary paresis or paralysis mostly confined to cranial nerves in the earlier stages, then the probability is that there is ventricular distension from one cause or another, and hence the high operation is the most likely to be beneficial. We now come to consider the second group of acute cases, namely, those who are already the subjects of hydro- cephalus chronicus, but who are suffering from more or less acute or subacute inflammatory action with corresponding pressure symptoms. These cases must be to some extent differentiated from the purely chronic hydrocephalic cases, which are more or less stationary, for some time at least' and many of whom have been treated by tapping, as already alluded to. Broca reports the following case whose ven- tricles he drained with some amelioration of the symptoms and complete success so far as the operation was concerned' The child was a boy 3 years of age, who had first shown