CEREBRAL SURGERY WITHOUT ANESTHETICS 563 



tacks already described. For three months early in the year 1903, 

 the headaches were particularly intense, and this period of intense 

 pain in the head ushered in a period of definite occular symptoms, 

 consisting of momentary attacks of blindness, followed by diplopia for 

 two or three days. The headaches suddenly disappeared, but there 

 was permanent loss of visual acuity, weakness of the left leg, and 

 general nervousness. 



At the time the patient entered the hospital, careful examination 

 of the nervous condition gave the following results : The optic nerves 

 seemed atrophied and there was some constriction of the visual fields. 

 There was distinct hemiplegic limp on the left side, a slight weakness 

 in the dorsal flexion of the left ankle, and possibly also in the flexion 

 of the knee and hip. The reflexes of the left leg were also somewhat 

 exaggerated. On the contrary, sensation seemed to be normal over 

 the arm and hand. The deep reflexes in the arms and right leg were 

 normal. The sensibility of the right leg and foot were without dis- 

 coverable abnormality. 



The conclusion of the diagnosis made at this time afiirms : " It 

 was evident that the patient was suffering from an organic lesion 

 situated in the upper part of the Eolandic region, involving the cor- 

 tex itself or lying just below it." 



Four different operations were performed for relief of this patient, 

 between the dates of November 22, 1906 and March 21, 1907. These 

 were all unsuccessful and did not even reveal the cause of the malady, 

 and this unfavorable result was chiefly due to the fact that the pa- 

 tient bore anesthetics — both chloroform and ether — so badly and the 

 cyanosis was so profound and threatening as to compel the surgeons 

 to abandon their attempts at further exploration of the brain, lest it 

 might lead to a fatal result. Moreover these operations served to 

 show that the exposed surface of the brain was entirely normal in ap- 

 pearance; and when this part of the cortex was faradized, there was 

 no abnormality of motor response. " Clean-cut movements were 

 elicited in the toes, lower leg and thigh." In the same way move- 

 ments were also obtained in the thoracic muscles, in the lateral ab- 

 dominal muscles and in the muscles of the shoulder; and from still 

 lower centers were obtained flexion of the elbow and flexion of the 

 wrist. Posterior to the central fissures no motor responses could be 

 elicited. 



Following the third operation, or on and after December 23, 1906, 

 the seizures increased in severity. Aggravated by the weakness fol- 

 lowing an attack of bronchial pneumonia in January, 1907, the 

 nervous sjinptoms increased to one or more daily, consisting of severe 

 epileptiform fits which involved the entire body, and always with loss 

 of consciousness. 



