A case of intra-cranial injury with extensive destruction of brain substance about the rolandic area and loss of the so-called muscular sense / under care of J. Cooke ; report with observations and comments by G.L. Laycock.

  • Cooke, J.
Date:
[1893]
Catalogue details

Licence: Public Domain Mark

Credit: A case of intra-cranial injury with extensive destruction of brain substance about the rolandic area and loss of the so-called muscular sense / under care of J. Cooke ; report with observations and comments by G.L. Laycock. 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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    got to the fingers there was a tingling as if the hand had been numb with cold, and had been brought to a fire. The patient was able to follow the sensation downward with his linger. On the current being increased to 12 or 13 milliamperes, both sides were affected; the right, however, not so much as the left, the sensation downwards being of much greater rapidity. On the anode being placed on the upper part of the posterior margin—the centre for the trunk and thigh—there was a sensation just at the angle of the neck and shoulder. With the kathode the sensation was in the same region, but somewhat deeper from the surface. In none of these observations was any muscular action obtained. The sensations were not painful, being only of a tingling character, and it should be noted that the upward current gave far more definite results than the downward. As regards the subsequent history, the patient has improved steadily in the condition of his left arm and foot, and performs movements with them much more expertly. The right arm, however, is showing signs of weakness. When I last saw him, the crampy sensation in the flexoi'S of the hand and wrist was still there, and it was accompanied by a burning pain at the same region. There was no tenderness or swelling, and no headache of any kind. The pain was best relieved by simple rubbing. On reviewing the history, there are one or two points of interest. From the nature of the injury, a zone of brain substance just in front of the fissure of Rolando would bear the brunt of the blow, and its left half would, at least, be severely concussed. This left half would include Broca's convolution (the centre for speech), and the anterior end of the temporal lobe (one of the auditory centres). It will be remembered that it was noted that, for two or three days after the accident, the patient was very noisy, and if anyone were talking in his presence, he would catch up the last two or three words of the sentence and repeat them several times, he being unconscious at the time. This would signify that the auditory and speech centres were in a state of extreme excitability, and that the stimulation by the vibration of the sound of a word would set automatically into action the whole chain of centres, the result being the spoken words. The zone of brain substance would also include the centre for the right arm. During the first two or three days he threw about this arm a great deal, chiefly in