The surgical treatment of idiocy / by G.E. Shuttleworth.

  • Shuttleworth, G. E. (George Edward), 1842-1928.
Date:
[1896]
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of idiocy / by G.E. Shuttleworth. 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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    that the designation of microceplialus is properly limited , to a very striking and quite characteristic type of idiocy. Whilst denoting smallness of head, it is not only in size, but also in form, that it is typical. Microcephalic cases have always a narrow receding forehead, a vertex tapering towards a point, and a flattened occiput. I do not limit the term uiicrocephalus to a cranial circumference not exceeding 17 inches (as has been done by some), but when the measure- ment considerably exceeds this, and the form of the head is quite other than I have described, it is not right to designate the case as one of microcephalus. Trephining is no doubt often useful in relieving pressure resulting from inflamma- tory products within the cranium, but it seems to me im- proper to describe a case of this sort under the heading of “ Microcephalus treated by linear Craniectomy.” The group, first adverted to, of cases of hemiplegia, with or without athetosis, is probably one promising better results from craniectomy than do those of pure microcephalus. Re- sulting as they frequently do in children from haemorrhage during the process of parturition, compressing the motor ( centres, interfering not only with movement but with speech, and so giving rise to the semblance of idiocy (though the intelligence may in truth not be much impaired), there is no • doubt that the early removal of a clot, or of adventitious i tissue resulting therefrom, may relieve pressure symptoms j and so produce a permanent amelioration, both physical and. mental. In another Section, two cases of this kind under the care of Dr. Beevor and Mr. Horsley, in which the results- were satisfactory, are to be described. Similarly in cases- of traumatic or localised epilepsy there is undoubtedly encouragement to trephine, supposing that the underlying:! organic cortical changes have not proceeded too far. But in | giving a prognosis the risk of subsequent irritation by cica- tricial tissue must be borne in mind. In hydrocephalus producing imbecility there is also a lair: prospect of relief to pressure, and consequent improvement, by means of Keen’s method of trephining followed by drainage. The following case, chronicled by Broca, iu the: Revue de Ghirurgie for January, 1891, may be taken as; typical. “ A boy, four years of age, had suffered from hydro- cephalus and was imbecile, and had contraction of the right arm following a series of convulsions. The trephining was3 done at the point indicated by Keen, three centimetres above and three centimetres behind the left auditory meatus. It J