Case of epilepsy, occasioned by irritation in the socket of a tooth : with remarks / by William Baly.

  • Baly, William, 1814-1861.
Date:
[1851]
Catalogue details

Licence: Public Domain Mark

Credit: Case of epilepsy, occasioned by irritation in the socket of a tooth : with remarks / by William Baly. 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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    loss of consciousness, and were sue ceeded by a state of stupor more or less profound; and nearly all the severe attacks which the patient suffered after his return to London occurred, as is so often the case with idiopathic epilepsy, during sleep, when the excitability of the spinal cord is being restored, and when it is no longer subject to the con- trolling influence of the mind. Seve- ral questions of great interest are sug- gested by such a case as this. Has, for example, the fact yet been well ex- plained, that irritation of a centripetal nerve will excite, in one case, pain in the part supplied by it; in another case, the intense pain of “ tic” in a more distaut part; and, in a third case, no painful sensation, but only muscular movements? And again, what is the true explanation of the occurrence of coma in epilepsy as a consequence of the irritation of a sensitive nerve-fila- ment ? Does Dr. Marshall Hall’s theory satisfactorily solve this diffi- culty ? These questions, however, can- not be discussed here. The feature of the case to which I would more especially direct attention is the complete accordance of the phe- nomena of reflex movement presented in it with those observed in experiments on decapitated animals, or in paralysed parts of the human body. When, in a decapitated frog or tortoise, a point in the skin of one limb is gently irritated, reflex movements are produced in that limb only—that is to say, in muscles supplied by motor nerves connected with the same part of the spinal cord to which the sensitive or centripetal nerve conveys the impression from the irritated skin. In proportion as the part is irritated more strongly, the movements extend to other limbs, and at length to the whole body of the animal. In cases of paraplegia in the human subject, too, tickling or other- wise slightly irritating the skin of one foot causes a slight movement of that foot, perhaps only of the toes: if the irritation be stronger, the whole limb is retracted ; and, if the irritability of the spinal cord at the same time.be great, both limbs will be forcibly drawn up : so, in this case of epilepsy, the first effects of the irritation in the alveolus was spasmodic movement of the muscles of the cheek of the affected side, then of tho tongue and jaw; nnd increase ol the influence on the nervous centre was manifested, not merely by the loss of consciousness, but also' by extension of the convulsions, first over the side of the head and face, and thence to the whole body; it being still observed, however, that the movements were stronger on the side of the irritation than on the opposite side. In other recorded cases, where the effects of irritation of a dental filament of the fifth nerve have been more limited, they have been distinctly localised in the muscles of the face and jaw on the same side with the irritating cause, or, beginning in these parts, have extended only to the muscles of the neck and shoulder of the same side, which receive their motor nerves from the nearest part of the spinal cord. Thus, in the fourth volume of the Me- dico-Chirurgical Transactions, there is a case related by Mr. John Mitchell, of Kington, Herefordshire, in which spas- modic twitches, commencing iu the left side of the face and tongue, extended, in the more severe paroxysms, to the entire left side of the head and neck, to the left shoulder and arm, and left side of the thorax, and were ultimately re- lieved by the extraction of several de- cayed teeth from the left side of the upper jaw. And in the following case, communicated to me by my friend Dr. Kirkes, the only muscles excited to spas- modic action by irritation of a dental nervous filament were those closing the jaws. “ A healthy elderly lady went to liave one of her back teeth stopped. The tooth was perfectly comfortable the same afternoon and evening ; but in the night the lady awoke with a sensa- tion of difficulty in opening her mouth. This continued; and, in the morning, she was almost unable to separate the jaws so as to take any breakfast. The jaws became more and more fixed dur- ing the day, and continued so all the night, rendering the introduction of food almost impossible. She naturally attributed this singular condition to the stopped tooth, though there was not the least pain or sense of discomfort in this or any of the teeth. She proceeded early the second morning to her den- tist, who had great difficulty in opening her jaws sufficiently to enable him to get at the tooth, which he then re- moved, when, almost instantaneously, the rigidity of the jaws ceased, and never returned. It was not ascertained whether the rigid stato of the jaws was