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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    i into the characters of the precursory : spasms. It lias already been noticed : as a striking feature of that caso, that i the convulsive movements, beginning in the muscles of the cheek, extended gradually to those of the tongue and jaw, and thence to the side of the head and face generally, before they affected the whole body. The same peculiarity was observed in the analogous case of convulsive movements arising from the same cause, which has been quoted from the Medico-Chirurgical Transac- tions ; aud, in a third case, related by Sir E. Home, in the Philosophical Transactions for 1801, where irritation or inflammation of the nerve of one thumb, originating in mechanical in- jury, gave rise to spasmodic paroxysms ending sometimes in coma, the muscu- lar spasms commencing in the thumb bad tbe same character of extending gradually up tbe limb to the trunk A little consideration, indeed, leads to the inference that local spasms ought gene- rally to possess more or less of this character when they result from an eccentric irritation acting on healthy nervous centres, and producing, in ac- cordance with physiological laws, reflex muscular movements in the parts with which the irritated nerve has normal relations. If such be the case—if spasms arising from irritation in or near tbe affected part commence con- stantly in the same muscle or limited group of muscles, and extend gradually to other muscles in the order of their contiguity, in consequence of' the excito- motory influence conveyed to the ner- vous centre extending progressively to the motor nerves arising from the next contiguous parts of the same lateral half of the spinal cord, this is a distinctive character; for local muscular spasms, which are the mere manifestation of the special excitability of the particular part of the brain or spinal cord presid- ing over the affected muscles, involve at once the whole group of muscles, or the muscles of an entire region, as the neck, or corresponding parts of the two sides of the body, and do not extend from a centre gradually to neighbouring parts. How far the distinctions here pointed out are applicable as a means of diag- nosis in epilepsy must be determined by future observation. But there cer- tainly appear to me grounds for believ- ing that, at least in some cases, both of local spasm and of epilepsy com- mencing with spasm, a closer attention to the mode of commencement and in- crease of the convulsive movements, as well as the consideration of the degree of liability of the particular part to spasm from internal causes, will aid in determining whether the cause is to be sought there, and relief attempted by the removal of a possible cause of irri- tation seated m or near the affected part. In most cases of epilepsy the history will much aid the diagnosis of the cause, connecting the disease, perhaps, in its origin and course, with a special irritation. The inquiry into the history of a case of epilepsy is, indeed, generally speaking, a far more important mode of investigation than is the observation of the precursory symptoms; for in every variety of the malady the history may throw light on its pathology; while the warning “ aura” and spasms are, in the majority of cases, not present, and may be absent even where the disease arises from an eccentric cause, if the brain and spinal cord are generally very sus- ceptible of the morbid influence. Nevertheless, in a disease usually so in- tractable, any occasional aid to be de- rived from these symptoms cannot wisely be neglected; and the principal object of the foregoing remarks has been, by directing attention to the dif- ferences which tbe spasms in different cases present, to render any informa- tion they are capable of affording more easily available. It is not improbable that the epileptic “ aura” likewise presents differences corresponding with the conditions on which it depends; but the investigation of its characters will always be more difficult, since they can be iearned only from the relation of the patient, while spasmodic movements may be observed by others, perhaps by the medical attendant himself, and may still for a time give valuable information after the patient has lost consciousness.