Cases of stretching of the facial nerve for tic convulsif ; Cases of intussusception treated by operation ; Case of rare fracture of the radius / by Rickman J. Godlee.

  • Godlee, Rickman John, Sir, 1849-1925.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Cases of stretching of the facial nerve for tic convulsif ; Cases of intussusception treated by operation ; Case of rare fracture of the radius / by Rickman J. Godlee. 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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    angles of tlie mouth drawn downwards and outwards, and the whole head bent forwards. At times by a strong effort of will he was able to stop the spasms temporarily, and the same effect could be produced by exerting pressure behind the condyles of the jaw, but the result was always to cause a more severe attack directly afterwards. The history and the symptoms of the case are thus seen to be very like those of most others which have already been reported, with the exception that an affection of both sides appears to be rare. But even here, although the double affection led us to suspect a more extensive lesion than usual, the facials only appeared to suffer, which I suppose may be taken to support the view put forward in the paper by Dr. Sturge and myself, that the mischief, whatever it is, lies somewhere in the region of the medulla oblongata. For any other centres for the facial nerve of which we have any cognizance are either upon the surface of the brain, round the upper end of the fissure of Rolando, or possibly in the region of the corpora striata. Now, it is difficult to conceive of any affection which could exert an influence on both centres, either on the surface of the brain or in the great central ganglia, being so circumscribed and so symmetrical as to affect both sides so nearly equally and yet leave parts belonging to the same physiological system untouched. On the other hand, it is quite comprehensible that a comparatively small lesion in the medulla might exert an influence on both nerves almost or quite equally. I am afraid that little or nothing is accurately known about the pathology of the affection, except in those cases where a very definite lesion, such as an aneurysm of the vertebral artery* or other severe intracranial mischief, has been found post mortem; these facts are therefore only brought forward as tending to support the views indicated by Dr. Sturge in our paper. I was loth, however, to operate in this case, thinking that the double affection implied, at all events, a more profound lesion than in the last; he was therefore kept under observa- tion for some time. He was admitted into University College Hospital, and whilst there, as he was kept perfectly quiet, he apparently improved, and in fact said that he was better than he had been for long. It was ascertained that he was not suffering from any other serious complaint, and that his secre- tions were normal. He was then sent to Walton for a time. But after watching him from July 24 till the early part of * Sehultze, Virchoio’s Archiv, Bd. 65, S. 385.