The Neuroglia Elements in the Human Brain
Authors: W. L. Andriezen
Journal: BMJ (1893)

mEDICAL JOURNAL -severe and some slighter fits every twenty-four lhours till the operationi.I need only describe one, for Dr. Johll Smith, with whom I saw the case, the house physician, and clinical assistanlts at Guy's Hospital, and I myself agreed that the fits were all similar, except that they differed in degree.The patient knew when a fit was comiing on by a senisation of numbness and tingling in the right finigers anld thulb.Then in less than a minute there were a series of rapidly-repeated extensionstof the right wrist and metacalpo-phalangeal joints.At the same time there were a series of rapid abductioiis of the lhand to the ulnar side.The next stage consisted of rapid flexionis of the phalangeal and metacarpo- phalangeal jOinits, so that the fingers were dug into the palms of the hlands, causing considerable pain.Then followed a series of rapid flexions and extensions of the elbow, after which the fit was over.It usually, lasted, exclusive of the stage of numbness, about niinety seconds.The sliglhter fits were miluch shorter, and consisted only of a little move- ment of the fingers.In a few, after the flexions of the elbow, the shoulder was for a few seconds rapidly adducted and abducted, and the head was jerked to the left.It is said that she was unconscious after the first fit, but those observed by us were never followed by unconsciousness.In between the fits the right upper extremity was in all movements weaker thani the left.The hand lay pronated, and the supinators were unable to move it.On the right side she could onlly move the dynamo- meter to 50, but oni the left to 90.There was no paresis of the muscles of the lbead, face, eyes, tongue, trunk, or lower extrecmllities.Both knee- jerks anid both plantar refexes were presenlt, but were better marked on the right than the left.There was nio clonus of eitlher kniee or ankle.Both elbow-jerks were absent.Both wrist-jerks were present, that on the right being exaggerated.She was an intelligent wvoman.Sensibility to touch, pain, and temperature was quite normal over the whole body.In the right hanid she could easily tell the addition of 1 oz. to 20 oz.The fields of vision were norimal; she recognised colour aind form cor- rectly.The pupils were equal, anid reacted wvell.Tlhelre was no ocuilar par-alysis.There was early optic neuritis in the right eye, the left was iorimal.Smell, taste, and hearing were all normal.The diagnosis was made of a growth on the cortex of the left cerebrum implicatinlg the armii ar'ea, and secondary to the disease of the breast.The fits were so fre- quCIlt that the patient desired an operation, although she was told that it would not prevent othel secondary deposits.On January 5th Mr. Arbuthnot Lane exposed the middle of the fissure of Rolando.Over anl area wlhichl as iiearly as could be judged corre- sponded with the part of the arm area in the ascending paiietal coiivolu- tion, the cortex at one palrt was of a ratlher iimore brownisli-green tint than was lnormal.This part was cut away to suclh a depth that white mnatter was exposed.Wlien frozeni and cut, it clearly coiisisted of growtll.At the oper-ation it was not definiitely iiiarked off from healthy grey matter, whieh it resembled so closely that several considered it to be healthy.January 7th.There is paralysis of the whole of the right face, except the orbicularis palpebrarumu and the occipito-frontalis.No ocular sym- ptoins.The toiigue lies oni the floor of thie miioutlh quite motionless.The right upper and the right lower extreemities are completelyparalysed, but no sensory defect is noticeable.She is comipletely aphasic.Janiuary 8th.The condition is the samiie, except that the right pupil is larger than the left, and last night it was observed that the right side of the face was sweating, although the left was quite dry.Janiuary 11th.Her condition is unchanged, except that the tongue can be protruded a little; the facial paralysis is less marked anld the pupils are equal.Janiuary 14th.The movements of the facial and lingual muscles are still improving.She can sliglltly move the right toes, and can detect 1 oz.added to 20 oz. in the r-iglht palm.January 19th.She lhas still further regained the powver of movements of the face and tongue; the movement of the right foot lhas ceased to