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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    gating the effect of stretching the spinal accessory nerve. If the brain be removed and the two nerves dissected out in the neck, a comparatively slight pull upon the spinal accessory produces a very obvious movement of the part which has been divided in the skull, as we should be led to expect from the shortness of the jugular foramen; but pull as hard as you please, even to tearing the nerve across, not the slightest move- ment is obsexwed in the cut end of the facial. In cases, then, like these under discussion, the nerve is stretched tightly over the comparatively sharp edge of the hook, and is thus more or less disorganised or broken, but with the certainty that restoration or union will take place; thus we generally find a complete paralysis as the primary result, lasting for a variable time, often for three months; after its disappearance the twitching has sometimes recommenced immediately, but oftener a respite for some time has been observed, and then either with or without some obvious exciting cause, it has again set in and has gradually regained, in part or altogether, its former intensity. We must, therefore, it seems to me, give up the idea of the profound effect upon the nerve centres (or at least allow that if such do occur it is only of a temporary nature), and recognise that the modus operandi is simply that of breaking a bad habit, which must be taken for what it is worth. In discussing the question of recommending the operation to a patient, we must not forget that the risk, with due cure is almost nil; that a certain immunity from the trouble may be safely promised for a time, and that this period may be very considerably prolonged, and while Southam’s remarkable case remains completely well, there is always the hope that the relief may be permanent. Were it not for this, however, I am afraid the general verdict would be that the time had come when this small chapter of surgical therapeutics, in the writing of which several of us have taken part, and which opened with a good deal of enthusiasm, must be closed. In conclusion, I beg to thank those gentlemen, at home and abroad, who have most kindly afforded me by letter particulars of their cases, and allowed me to place these in the table, which adds so materially to the value of the record of this case. And I would especially refer to the very interesting papers on this question by Dr. Bernhardt in the Zeitsehrift fur Minische Medicin (Frerichs and Leyden), Band iii, 1881, Seite 9G, and in the Deutsche Medicinisclxe Wochenschrift, No. 9, 1882, and No. 29, 1882.